|
HC PET IMAGE W/CT SKULL-THIGH IN
|
Facility
|
IP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 PI
|
| Hospital Charge Code |
1639005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$6,640.27 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,649.60
|
| Rate for Payer: Cash Price |
$5,312.22
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.40
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: PHCS All Commercial |
$6,640.27
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
|
|
HC PET IMAGE W/CT SKULL-THIGH ST
|
Facility
|
OP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 PS
|
| Hospital Charge Code |
1639002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$777.75 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,472.52
|
| Rate for Payer: Aetna Medicare |
$2,833.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$777.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,744.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,084.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,534.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$777.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,258.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,116.50
|
| Rate for Payer: Cash Price |
$5,312.22
|
| Rate for Payer: Cash Price |
$5,312.22
|
| Rate for Payer: Centivo All Commercial |
$4,816.41
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.40
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Humana Medicare |
$2,833.18
|
| Rate for Payer: Lucent All Commercial |
$4,816.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: Managed Health Services Medicaid |
$777.75
|
| Rate for Payer: MDWise Medicaid |
$777.75
|
| Rate for Payer: PHCS All Commercial |
$6,640.27
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,452.94
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,525.65
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
| Rate for Payer: United Healthcare Medicare |
$2,833.18
|
|
|
HC PET IMAGE W/CT SKULL-THIGH ST
|
Facility
|
IP
|
$8,853.70
|
|
|
Service Code
|
CPT 78815 PS
|
| Hospital Charge Code |
1639002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$6,640.27 |
| Max. Negotiated Rate |
$8,233.94 |
| Rate for Payer: Aetna Commercial |
$7,649.60
|
| Rate for Payer: Cash Price |
$5,312.22
|
| Rate for Payer: Cigna All Commercial |
$7,640.74
|
| Rate for Payer: CORVEL All Commercial |
$8,233.94
|
| Rate for Payer: Coventry All Commercial |
$7,791.26
|
| Rate for Payer: Encore All Commercial |
$8,149.83
|
| Rate for Payer: Frontpath All Commercial |
$8,145.40
|
| Rate for Payer: Humana ChoiceCare |
$7,646.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,968.33
|
| Rate for Payer: PHCS All Commercial |
$6,640.27
|
| Rate for Payer: PHP All Commercial |
$6,714.65
|
| Rate for Payer: Sagamore Health Network All Products |
$6,835.06
|
| Rate for Payer: Signature Care EPO |
$7,348.57
|
| Rate for Payer: Signature Care PPO |
$7,791.26
|
| Rate for Payer: United Healthcare Commercial |
$6,976.72
|
|
|
HC PFT SPIROMETRY
|
Facility
|
OP
|
$364.48
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
1706489
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$338.97 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$116.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$209.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$227.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$134.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$128.30
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Centivo All Commercial |
$198.28
|
| Rate for Payer: Cigna All Commercial |
$314.55
|
| Rate for Payer: CORVEL All Commercial |
$338.97
|
| Rate for Payer: Coventry All Commercial |
$320.74
|
| Rate for Payer: Encore All Commercial |
$335.50
|
| Rate for Payer: Frontpath All Commercial |
$335.32
|
| Rate for Payer: Humana ChoiceCare |
$314.80
|
| Rate for Payer: Humana Medicare |
$116.63
|
| Rate for Payer: Lucent All Commercial |
$198.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$328.03
|
| Rate for Payer: Managed Health Services Medicaid |
$36.37
|
| Rate for Payer: MDWise Medicaid |
$36.37
|
| Rate for Payer: PHCS All Commercial |
$273.36
|
| Rate for Payer: PHP All Commercial |
$276.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.15
|
| Rate for Payer: Sagamore Health Network All Products |
$281.38
|
| Rate for Payer: Signature Care EPO |
$302.52
|
| Rate for Payer: Signature Care PPO |
$320.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$309.81
|
| Rate for Payer: United Healthcare Commercial |
$287.21
|
| Rate for Payer: United Healthcare Medicare |
$116.63
|
|
|
HC PFT SPIROMETRY
|
Facility
|
IP
|
$364.48
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
1706489
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$273.36 |
| Max. Negotiated Rate |
$338.97 |
| Rate for Payer: Aetna Commercial |
$314.91
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cigna All Commercial |
$314.55
|
| Rate for Payer: CORVEL All Commercial |
$338.97
|
| Rate for Payer: Coventry All Commercial |
$320.74
|
| Rate for Payer: Encore All Commercial |
$335.50
|
| Rate for Payer: Frontpath All Commercial |
$335.32
|
| Rate for Payer: Humana ChoiceCare |
$314.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$328.03
|
| Rate for Payer: PHCS All Commercial |
$273.36
|
| Rate for Payer: PHP All Commercial |
$276.42
|
| Rate for Payer: Sagamore Health Network All Products |
$281.38
|
| Rate for Payer: Signature Care EPO |
$302.52
|
| Rate for Payer: Signature Care PPO |
$320.74
|
| Rate for Payer: United Healthcare Commercial |
$287.21
|
|
|
HC P GUIDE WIRE KIT
|
Facility
|
OP
|
$2,225.00
|
|
| Hospital Charge Code |
41608183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$2,069.25 |
| Rate for Payer: Aetna Commercial |
$1,877.90
|
| Rate for Payer: Aetna Medicare |
$712.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$689.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,277.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,390.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$818.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$783.20
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Centivo All Commercial |
$1,210.40
|
| Rate for Payer: Cigna All Commercial |
$1,920.17
|
| Rate for Payer: CORVEL All Commercial |
$2,069.25
|
| Rate for Payer: Coventry All Commercial |
$1,958.00
|
| Rate for Payer: Encore All Commercial |
$2,048.11
|
| Rate for Payer: Frontpath All Commercial |
$2,047.00
|
| Rate for Payer: Humana ChoiceCare |
$1,921.73
|
| Rate for Payer: Humana Medicare |
$712.00
|
| Rate for Payer: Lucent All Commercial |
$1,210.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,002.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,668.75
|
| Rate for Payer: PHP All Commercial |
$1,687.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$867.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,717.70
|
| Rate for Payer: Signature Care EPO |
$1,846.75
|
| Rate for Payer: Signature Care PPO |
$1,958.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,891.25
|
| Rate for Payer: United Healthcare Commercial |
$1,753.30
|
| Rate for Payer: United Healthcare Medicare |
$712.00
|
|
|
HC P GUIDE WIRE KIT
|
Facility
|
IP
|
$2,225.00
|
|
| Hospital Charge Code |
41608183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$2,069.25 |
| Rate for Payer: Aetna Commercial |
$1,922.40
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna All Commercial |
$1,920.17
|
| Rate for Payer: CORVEL All Commercial |
$2,069.25
|
| Rate for Payer: Coventry All Commercial |
$1,958.00
|
| Rate for Payer: Encore All Commercial |
$2,048.11
|
| Rate for Payer: Frontpath All Commercial |
$2,047.00
|
| Rate for Payer: Humana ChoiceCare |
$1,921.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,002.50
|
| Rate for Payer: PHCS All Commercial |
$1,668.75
|
| Rate for Payer: PHP All Commercial |
$1,687.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,717.70
|
| Rate for Payer: Signature Care EPO |
$1,846.75
|
| Rate for Payer: Signature Care PPO |
$1,958.00
|
| Rate for Payer: United Healthcare Commercial |
$1,753.30
|
|
|
HC PH-BODY FLUID
|
Facility
|
IP
|
$72.79
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
63001292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.59 |
| Max. Negotiated Rate |
$67.69 |
| Rate for Payer: Aetna Commercial |
$62.89
|
| Rate for Payer: Cash Price |
$43.67
|
| Rate for Payer: Cigna All Commercial |
$62.82
|
| Rate for Payer: CORVEL All Commercial |
$67.69
|
| Rate for Payer: Coventry All Commercial |
$64.06
|
| Rate for Payer: Encore All Commercial |
$67.00
|
| Rate for Payer: Frontpath All Commercial |
$66.97
|
| Rate for Payer: Humana ChoiceCare |
$62.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.51
|
| Rate for Payer: PHCS All Commercial |
$54.59
|
| Rate for Payer: PHP All Commercial |
$55.20
|
| Rate for Payer: Sagamore Health Network All Products |
$56.19
|
| Rate for Payer: Signature Care EPO |
$60.42
|
| Rate for Payer: Signature Care PPO |
$64.06
|
| Rate for Payer: United Healthcare Commercial |
$57.36
|
|
|
HC PH-BODY FLUID
|
Facility
|
OP
|
$72.79
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
63001292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$67.69 |
| Rate for Payer: Aetna Commercial |
$61.43
|
| Rate for Payer: Aetna Medicare |
$23.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.62
|
| Rate for Payer: Cash Price |
$43.67
|
| Rate for Payer: Cash Price |
$43.67
|
| Rate for Payer: Centivo All Commercial |
$39.60
|
| Rate for Payer: Cigna All Commercial |
$62.82
|
| Rate for Payer: CORVEL All Commercial |
$67.69
|
| Rate for Payer: Coventry All Commercial |
$64.06
|
| Rate for Payer: Encore All Commercial |
$67.00
|
| Rate for Payer: Frontpath All Commercial |
$66.97
|
| Rate for Payer: Humana ChoiceCare |
$62.87
|
| Rate for Payer: Humana Medicare |
$23.29
|
| Rate for Payer: Lucent All Commercial |
$39.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.51
|
| Rate for Payer: Managed Health Services Medicaid |
$3.58
|
| Rate for Payer: MDWise Medicaid |
$3.58
|
| Rate for Payer: PHCS All Commercial |
$54.59
|
| Rate for Payer: PHP All Commercial |
$55.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.39
|
| Rate for Payer: Sagamore Health Network All Products |
$56.19
|
| Rate for Payer: Signature Care EPO |
$60.42
|
| Rate for Payer: Signature Care PPO |
$64.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.87
|
| Rate for Payer: United Healthcare Commercial |
$57.36
|
| Rate for Payer: United Healthcare Medicare |
$23.29
|
|
|
HC PHENCYCLIDINE(PCP) MS
|
Facility
|
IP
|
$50.43
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
63001651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.82 |
| Max. Negotiated Rate |
$46.90 |
| Rate for Payer: Aetna Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cigna All Commercial |
$43.52
|
| Rate for Payer: CORVEL All Commercial |
$46.90
|
| Rate for Payer: Coventry All Commercial |
$44.38
|
| Rate for Payer: Encore All Commercial |
$46.42
|
| Rate for Payer: Frontpath All Commercial |
$46.40
|
| Rate for Payer: Humana ChoiceCare |
$43.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.39
|
| Rate for Payer: PHCS All Commercial |
$37.82
|
| Rate for Payer: PHP All Commercial |
$38.25
|
| Rate for Payer: Sagamore Health Network All Products |
$38.93
|
| Rate for Payer: Signature Care EPO |
$41.86
|
| Rate for Payer: Signature Care PPO |
$44.38
|
| Rate for Payer: United Healthcare Commercial |
$39.74
|
|
|
HC PHENCYCLIDINE(PCP) MS
|
Facility
|
OP
|
$50.43
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
63001651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$46.90 |
| Rate for Payer: Aetna Commercial |
$42.56
|
| Rate for Payer: Aetna Medicare |
$16.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$26.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.75
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Centivo All Commercial |
$27.43
|
| Rate for Payer: Cigna All Commercial |
$43.52
|
| Rate for Payer: CORVEL All Commercial |
$46.90
|
| Rate for Payer: Coventry All Commercial |
$44.38
|
| Rate for Payer: Encore All Commercial |
$46.42
|
| Rate for Payer: Frontpath All Commercial |
$46.40
|
| Rate for Payer: Humana ChoiceCare |
$43.56
|
| Rate for Payer: Humana Medicare |
$16.14
|
| Rate for Payer: Lucent All Commercial |
$27.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.39
|
| Rate for Payer: Managed Health Services Medicaid |
$26.00
|
| Rate for Payer: MDWise Medicaid |
$26.00
|
| Rate for Payer: PHCS All Commercial |
$37.82
|
| Rate for Payer: PHP All Commercial |
$38.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.67
|
| Rate for Payer: Sagamore Health Network All Products |
$38.93
|
| Rate for Payer: Signature Care EPO |
$41.86
|
| Rate for Payer: Signature Care PPO |
$44.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.87
|
| Rate for Payer: United Healthcare Commercial |
$39.74
|
| Rate for Payer: United Healthcare Medicare |
$16.14
|
|
|
HC PHENOBARBITAL
|
Facility
|
IP
|
$233.38
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
63001315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.03 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$201.64
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Cigna All Commercial |
$201.41
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.83
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$177.00
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.71
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
|
|
HC PHENOBARBITAL
|
Facility
|
OP
|
$233.38
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
63001315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$196.97
|
| Rate for Payer: Aetna Medicare |
$74.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.15
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Centivo All Commercial |
$126.96
|
| Rate for Payer: Cigna All Commercial |
$201.41
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.83
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Humana Medicare |
$74.68
|
| Rate for Payer: Lucent All Commercial |
$126.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: Managed Health Services Medicaid |
$15.30
|
| Rate for Payer: MDWise Medicaid |
$15.30
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$177.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.02
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.71
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
| Rate for Payer: United Healthcare Medicare |
$74.68
|
|
|
HC PHENYTOIN
|
Facility
|
OP
|
$231.09
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
63001316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$214.91 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna Medicare |
$73.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$106.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.34
|
| Rate for Payer: Cash Price |
$138.65
|
| Rate for Payer: Cash Price |
$138.65
|
| Rate for Payer: Centivo All Commercial |
$125.71
|
| Rate for Payer: Cigna All Commercial |
$199.43
|
| Rate for Payer: CORVEL All Commercial |
$214.91
|
| Rate for Payer: Coventry All Commercial |
$203.36
|
| Rate for Payer: Encore All Commercial |
$212.72
|
| Rate for Payer: Frontpath All Commercial |
$212.60
|
| Rate for Payer: Humana ChoiceCare |
$199.59
|
| Rate for Payer: Humana Medicare |
$73.95
|
| Rate for Payer: Lucent All Commercial |
$125.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.98
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$173.32
|
| Rate for Payer: PHP All Commercial |
$175.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.13
|
| Rate for Payer: Sagamore Health Network All Products |
$178.40
|
| Rate for Payer: Signature Care EPO |
$191.80
|
| Rate for Payer: Signature Care PPO |
$203.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$196.43
|
| Rate for Payer: United Healthcare Commercial |
$182.10
|
| Rate for Payer: United Healthcare Medicare |
$73.95
|
|
|
HC PHENYTOIN
|
Facility
|
IP
|
$231.09
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
63001316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.32 |
| Max. Negotiated Rate |
$214.91 |
| Rate for Payer: Aetna Commercial |
$199.66
|
| Rate for Payer: Cash Price |
$138.65
|
| Rate for Payer: Cigna All Commercial |
$199.43
|
| Rate for Payer: CORVEL All Commercial |
$214.91
|
| Rate for Payer: Coventry All Commercial |
$203.36
|
| Rate for Payer: Encore All Commercial |
$212.72
|
| Rate for Payer: Frontpath All Commercial |
$212.60
|
| Rate for Payer: Humana ChoiceCare |
$199.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.98
|
| Rate for Payer: PHCS All Commercial |
$173.32
|
| Rate for Payer: PHP All Commercial |
$175.26
|
| Rate for Payer: Sagamore Health Network All Products |
$178.40
|
| Rate for Payer: Signature Care EPO |
$191.80
|
| Rate for Payer: Signature Care PPO |
$203.36
|
| Rate for Payer: United Healthcare Commercial |
$182.10
|
|
|
HC PHENYTOIN FREE
|
Facility
|
IP
|
$171.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
63001113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$159.65 |
| Rate for Payer: Aetna Commercial |
$148.32
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna All Commercial |
$148.15
|
| Rate for Payer: CORVEL All Commercial |
$159.65
|
| Rate for Payer: Coventry All Commercial |
$151.07
|
| Rate for Payer: Encore All Commercial |
$158.02
|
| Rate for Payer: Frontpath All Commercial |
$157.94
|
| Rate for Payer: Humana ChoiceCare |
$148.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.50
|
| Rate for Payer: PHCS All Commercial |
$128.75
|
| Rate for Payer: PHP All Commercial |
$130.19
|
| Rate for Payer: Sagamore Health Network All Products |
$132.53
|
| Rate for Payer: Signature Care EPO |
$142.49
|
| Rate for Payer: Signature Care PPO |
$151.07
|
| Rate for Payer: United Healthcare Commercial |
$135.28
|
|
|
HC PHENYTOIN FREE
|
Facility
|
OP
|
$171.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
63001113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$159.65 |
| Rate for Payer: Aetna Commercial |
$144.89
|
| Rate for Payer: Aetna Medicare |
$54.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.43
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Centivo All Commercial |
$93.39
|
| Rate for Payer: Cigna All Commercial |
$148.15
|
| Rate for Payer: CORVEL All Commercial |
$159.65
|
| Rate for Payer: Coventry All Commercial |
$151.07
|
| Rate for Payer: Encore All Commercial |
$158.02
|
| Rate for Payer: Frontpath All Commercial |
$157.94
|
| Rate for Payer: Humana ChoiceCare |
$148.27
|
| Rate for Payer: Humana Medicare |
$54.93
|
| Rate for Payer: Lucent All Commercial |
$93.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.50
|
| Rate for Payer: Managed Health Services Medicaid |
$13.76
|
| Rate for Payer: MDWise Medicaid |
$13.76
|
| Rate for Payer: PHCS All Commercial |
$128.75
|
| Rate for Payer: PHP All Commercial |
$130.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.95
|
| Rate for Payer: Sagamore Health Network All Products |
$132.53
|
| Rate for Payer: Signature Care EPO |
$142.49
|
| Rate for Payer: Signature Care PPO |
$151.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.92
|
| Rate for Payer: United Healthcare Commercial |
$135.28
|
| Rate for Payer: United Healthcare Medicare |
$54.93
|
|
|
HC PHOSPHATIDYLSERINE IGA
|
Facility
|
OP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$136.98
|
| Rate for Payer: Aetna Medicare |
$51.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.13
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Centivo All Commercial |
$88.29
|
| Rate for Payer: Cigna All Commercial |
$140.06
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.82
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Humana Medicare |
$51.94
|
| Rate for Payer: Lucent All Commercial |
$88.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: Managed Health Services Medicaid |
$16.07
|
| Rate for Payer: MDWise Medicaid |
$16.07
|
| Rate for Payer: PHCS All Commercial |
$121.72
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.30
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.96
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$51.94
|
|
|
HC PHOSPHATIDYLSERINE IGA
|
Facility
|
IP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.72 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$140.23
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cigna All Commercial |
$140.06
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.82
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: PHCS All Commercial |
$121.72
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.82
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
|
|
HC PHOSPHATIDYLSERINE IGG
|
Facility
|
OP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$136.98
|
| Rate for Payer: Aetna Medicare |
$51.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.13
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Centivo All Commercial |
$88.29
|
| Rate for Payer: Cigna All Commercial |
$140.06
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.82
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Humana Medicare |
$51.94
|
| Rate for Payer: Lucent All Commercial |
$88.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: Managed Health Services Medicaid |
$16.07
|
| Rate for Payer: MDWise Medicaid |
$16.07
|
| Rate for Payer: PHCS All Commercial |
$121.72
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.30
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.96
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$51.94
|
|
|
HC PHOSPHATIDYLSERINE IGG
|
Facility
|
IP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.72 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$140.23
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cigna All Commercial |
$140.06
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.82
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: PHCS All Commercial |
$121.72
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.82
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
|
|
HC PHOSPHATIDYLSERINE IGM
|
Facility
|
IP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.72 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$140.23
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cigna All Commercial |
$140.06
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.82
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: PHCS All Commercial |
$121.72
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.82
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
|
|
HC PHOSPHATIDYLSERINE IGM
|
Facility
|
OP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$136.98
|
| Rate for Payer: Aetna Medicare |
$51.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.13
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Centivo All Commercial |
$88.29
|
| Rate for Payer: Cigna All Commercial |
$140.06
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.82
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Humana Medicare |
$51.94
|
| Rate for Payer: Lucent All Commercial |
$88.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: Managed Health Services Medicaid |
$16.07
|
| Rate for Payer: MDWise Medicaid |
$16.07
|
| Rate for Payer: PHCS All Commercial |
$121.72
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.30
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.96
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$51.94
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR AUTOANTIBODIES, IGG
|
Facility
|
OP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63044074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Medicare |
$41.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.06
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Centivo All Commercial |
$71.19
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$41.88
|
| Rate for Payer: Lucent All Commercial |
$71.19
|
| 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 |
$51.04
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
| Rate for Payer: United Healthcare Medicare |
$41.88
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR AUTOANTIBODIES, IGG
|
Facility
|
IP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63044074
|
|
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 |
$78.52
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| 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 |
$115.16
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
|
