|
HC PLATELETPHERESIS LR
|
Facility
|
IP
|
$2,969.18
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
1371004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2,226.89 |
| Max. Negotiated Rate |
$2,761.34 |
| Rate for Payer: Aetna Commercial |
$2,565.37
|
| Rate for Payer: Cash Price |
$1,781.51
|
| Rate for Payer: Cigna All Commercial |
$2,562.40
|
| Rate for Payer: CORVEL All Commercial |
$2,761.34
|
| Rate for Payer: Coventry All Commercial |
$2,612.88
|
| Rate for Payer: Encore All Commercial |
$2,733.13
|
| Rate for Payer: Frontpath All Commercial |
$2,731.65
|
| Rate for Payer: Humana ChoiceCare |
$2,564.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,672.26
|
| Rate for Payer: PHCS All Commercial |
$2,226.89
|
| Rate for Payer: PHP All Commercial |
$2,251.83
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.21
|
| Rate for Payer: Signature Care EPO |
$2,464.42
|
| Rate for Payer: Signature Care PPO |
$2,612.88
|
| Rate for Payer: United Healthcare Commercial |
$2,339.71
|
|
|
HC PLATELETPHERESIS LR IRRAD
|
Facility
|
IP
|
$2,723.49
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
1371010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2,042.62 |
| Max. Negotiated Rate |
$2,532.85 |
| Rate for Payer: Aetna Commercial |
$2,353.10
|
| Rate for Payer: Cash Price |
$1,634.09
|
| Rate for Payer: Cigna All Commercial |
$2,350.37
|
| Rate for Payer: CORVEL All Commercial |
$2,532.85
|
| Rate for Payer: Coventry All Commercial |
$2,396.67
|
| Rate for Payer: Encore All Commercial |
$2,506.97
|
| Rate for Payer: Frontpath All Commercial |
$2,505.61
|
| Rate for Payer: Humana ChoiceCare |
$2,352.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,451.14
|
| Rate for Payer: PHCS All Commercial |
$2,042.62
|
| Rate for Payer: PHP All Commercial |
$2,065.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,102.53
|
| Rate for Payer: Signature Care EPO |
$2,260.50
|
| Rate for Payer: Signature Care PPO |
$2,396.67
|
| Rate for Payer: United Healthcare Commercial |
$2,146.11
|
|
|
HC PLATELETPHERESIS LR IRRAD
|
Facility
|
OP
|
$2,723.49
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
1371010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$71.47 |
| Max. Negotiated Rate |
$2,532.85 |
| Rate for Payer: Aetna Commercial |
$2,298.63
|
| Rate for Payer: Aetna Medicare |
$871.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$71.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$844.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,564.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,702.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$71.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,002.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$958.67
|
| Rate for Payer: Cash Price |
$1,634.09
|
| Rate for Payer: Cash Price |
$1,634.09
|
| Rate for Payer: Centivo All Commercial |
$1,481.58
|
| Rate for Payer: Cigna All Commercial |
$2,350.37
|
| Rate for Payer: CORVEL All Commercial |
$2,532.85
|
| Rate for Payer: Coventry All Commercial |
$2,396.67
|
| Rate for Payer: Encore All Commercial |
$2,506.97
|
| Rate for Payer: Frontpath All Commercial |
$2,505.61
|
| Rate for Payer: Humana ChoiceCare |
$2,352.28
|
| Rate for Payer: Humana Medicare |
$871.52
|
| Rate for Payer: Lucent All Commercial |
$1,481.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,451.14
|
| Rate for Payer: Managed Health Services Medicaid |
$71.47
|
| Rate for Payer: MDWise Medicaid |
$71.47
|
| Rate for Payer: PHCS All Commercial |
$2,042.62
|
| Rate for Payer: PHP All Commercial |
$2,065.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,062.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2,102.53
|
| Rate for Payer: Signature Care EPO |
$2,260.50
|
| Rate for Payer: Signature Care PPO |
$2,396.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,314.97
|
| Rate for Payer: United Healthcare Commercial |
$2,146.11
|
| Rate for Payer: United Healthcare Medicare |
$871.52
|
|
|
HC PLCMT BREAST DEV FIRST LES W/ MAMMO GUID
|
Facility
|
OP
|
$2,465.14
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1619281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$764.19 |
| Max. Negotiated Rate |
$2,292.58 |
| Rate for Payer: Aetna Commercial |
$2,080.58
|
| Rate for Payer: Aetna Medicare |
$788.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$764.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,415.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,540.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$907.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$867.73
|
| Rate for Payer: Cash Price |
$1,479.08
|
| Rate for Payer: Centivo All Commercial |
$1,341.04
|
| Rate for Payer: Cigna All Commercial |
$2,127.42
|
| Rate for Payer: CORVEL All Commercial |
$2,292.58
|
| Rate for Payer: Coventry All Commercial |
$2,169.32
|
| Rate for Payer: Encore All Commercial |
$2,269.16
|
| Rate for Payer: Frontpath All Commercial |
$2,267.93
|
| Rate for Payer: Humana ChoiceCare |
$2,129.14
|
| Rate for Payer: Humana Medicare |
$788.84
|
| Rate for Payer: Lucent All Commercial |
$1,341.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,218.63
|
| Rate for Payer: PHCS All Commercial |
$1,848.86
|
| Rate for Payer: PHP All Commercial |
$1,869.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$961.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,903.09
|
| Rate for Payer: Signature Care EPO |
$2,046.07
|
| Rate for Payer: Signature Care PPO |
$2,169.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,095.37
|
| Rate for Payer: United Healthcare Commercial |
$1,942.53
|
| Rate for Payer: United Healthcare Medicare |
$788.84
|
|
|
HC PLCMT BREAST DEV FIRST LES W/ MAMMO GUID
|
Facility
|
IP
|
$2,465.14
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1619281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,848.86 |
| Max. Negotiated Rate |
$2,292.58 |
| Rate for Payer: Aetna Commercial |
$2,129.88
|
| Rate for Payer: Cash Price |
$1,479.08
|
| Rate for Payer: Cigna All Commercial |
$2,127.42
|
| Rate for Payer: CORVEL All Commercial |
$2,292.58
|
| Rate for Payer: Coventry All Commercial |
$2,169.32
|
| Rate for Payer: Encore All Commercial |
$2,269.16
|
| Rate for Payer: Frontpath All Commercial |
$2,267.93
|
| Rate for Payer: Humana ChoiceCare |
$2,129.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,218.63
|
| Rate for Payer: PHCS All Commercial |
$1,848.86
|
| Rate for Payer: PHP All Commercial |
$1,869.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,903.09
|
| Rate for Payer: Signature Care EPO |
$2,046.07
|
| Rate for Payer: Signature Care PPO |
$2,169.32
|
| Rate for Payer: United Healthcare Commercial |
$1,942.53
|
|
|
HC PLMT BREAST DEV EA ADD LES W/ MAMMO GUID
|
Facility
|
IP
|
$993.99
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
1619282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.49 |
| Max. Negotiated Rate |
$924.41 |
| Rate for Payer: Aetna Commercial |
$858.81
|
| Rate for Payer: Cash Price |
$596.39
|
| Rate for Payer: Cigna All Commercial |
$857.81
|
| Rate for Payer: CORVEL All Commercial |
$924.41
|
| Rate for Payer: Coventry All Commercial |
$874.71
|
| Rate for Payer: Encore All Commercial |
$914.97
|
| Rate for Payer: Frontpath All Commercial |
$914.47
|
| Rate for Payer: Humana ChoiceCare |
$858.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.59
|
| Rate for Payer: PHCS All Commercial |
$745.49
|
| Rate for Payer: PHP All Commercial |
$753.84
|
| Rate for Payer: Sagamore Health Network All Products |
$767.36
|
| Rate for Payer: Signature Care EPO |
$825.01
|
| Rate for Payer: Signature Care PPO |
$874.71
|
| Rate for Payer: United Healthcare Commercial |
$783.26
|
|
|
HC PLMT BREAST DEV EA ADD LES W/ MAMMO GUID
|
Facility
|
OP
|
$993.99
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
1619282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.14 |
| Max. Negotiated Rate |
$924.41 |
| Rate for Payer: Aetna Commercial |
$838.93
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$308.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$570.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.88
|
| Rate for Payer: Cash Price |
$596.39
|
| Rate for Payer: Centivo All Commercial |
$540.73
|
| Rate for Payer: Cigna All Commercial |
$857.81
|
| Rate for Payer: CORVEL All Commercial |
$924.41
|
| Rate for Payer: Coventry All Commercial |
$874.71
|
| Rate for Payer: Encore All Commercial |
$914.97
|
| Rate for Payer: Frontpath All Commercial |
$914.47
|
| Rate for Payer: Humana ChoiceCare |
$858.51
|
| Rate for Payer: Humana Medicare |
$318.08
|
| Rate for Payer: Lucent All Commercial |
$540.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.59
|
| Rate for Payer: PHCS All Commercial |
$745.49
|
| Rate for Payer: PHP All Commercial |
$753.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.66
|
| Rate for Payer: Sagamore Health Network All Products |
$767.36
|
| Rate for Payer: Signature Care EPO |
$825.01
|
| Rate for Payer: Signature Care PPO |
$874.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.89
|
| Rate for Payer: United Healthcare Commercial |
$783.26
|
| Rate for Payer: United Healthcare Medicare |
$318.08
|
|
|
HC PNEUMONITIS ALLERGEN SPECIFIC IGG - EA
|
Facility
|
OP
|
$41.30
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
63001758
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$38.41 |
| Rate for Payer: Aetna Commercial |
$34.86
|
| Rate for Payer: Aetna Medicare |
$13.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$7.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.54
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Centivo All Commercial |
$22.47
|
| Rate for Payer: Cigna All Commercial |
$35.64
|
| Rate for Payer: CORVEL All Commercial |
$38.41
|
| Rate for Payer: Coventry All Commercial |
$36.34
|
| Rate for Payer: Encore All Commercial |
$38.02
|
| Rate for Payer: Frontpath All Commercial |
$38.00
|
| Rate for Payer: Humana ChoiceCare |
$35.67
|
| Rate for Payer: Humana Medicare |
$13.22
|
| Rate for Payer: Lucent All Commercial |
$22.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.17
|
| Rate for Payer: Managed Health Services Medicaid |
$7.82
|
| Rate for Payer: MDWise Medicaid |
$7.82
|
| Rate for Payer: PHCS All Commercial |
$30.98
|
| Rate for Payer: PHP All Commercial |
$31.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.11
|
| Rate for Payer: Sagamore Health Network All Products |
$31.88
|
| Rate for Payer: Signature Care EPO |
$34.28
|
| Rate for Payer: Signature Care PPO |
$36.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$32.54
|
| Rate for Payer: United Healthcare Medicare |
$13.22
|
|
|
HC PNEUMONITIS ALLERGEN SPECIFIC IGG - EA
|
Facility
|
IP
|
$41.30
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
63001758
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$38.41 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Cigna All Commercial |
$35.64
|
| Rate for Payer: CORVEL All Commercial |
$38.41
|
| Rate for Payer: Coventry All Commercial |
$36.34
|
| Rate for Payer: Encore All Commercial |
$38.02
|
| Rate for Payer: Frontpath All Commercial |
$38.00
|
| Rate for Payer: Humana ChoiceCare |
$35.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.17
|
| Rate for Payer: PHCS All Commercial |
$30.98
|
| Rate for Payer: PHP All Commercial |
$31.32
|
| Rate for Payer: Sagamore Health Network All Products |
$31.88
|
| Rate for Payer: Signature Care EPO |
$34.28
|
| Rate for Payer: Signature Care PPO |
$36.34
|
| Rate for Payer: United Healthcare Commercial |
$32.54
|
|
|
HC PNEUMONITIS ASPERGILLUS AB - EA
|
Facility
|
IP
|
$106.82
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
63001919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.11 |
| Max. Negotiated Rate |
$99.34 |
| Rate for Payer: Aetna Commercial |
$92.29
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cigna All Commercial |
$92.19
|
| Rate for Payer: CORVEL All Commercial |
$99.34
|
| Rate for Payer: Coventry All Commercial |
$94.00
|
| Rate for Payer: Encore All Commercial |
$98.33
|
| Rate for Payer: Frontpath All Commercial |
$98.27
|
| Rate for Payer: Humana ChoiceCare |
$92.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.14
|
| Rate for Payer: PHCS All Commercial |
$80.11
|
| Rate for Payer: PHP All Commercial |
$81.01
|
| Rate for Payer: Sagamore Health Network All Products |
$82.47
|
| Rate for Payer: Signature Care EPO |
$88.66
|
| Rate for Payer: Signature Care PPO |
$94.00
|
| Rate for Payer: United Healthcare Commercial |
$84.17
|
|
|
HC PNEUMONITIS ASPERGILLUS AB - EA
|
Facility
|
OP
|
$106.82
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
63001919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$99.34 |
| Rate for Payer: Aetna Commercial |
$90.16
|
| Rate for Payer: Aetna Medicare |
$34.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$49.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.60
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Centivo All Commercial |
$58.11
|
| Rate for Payer: Cigna All Commercial |
$92.19
|
| Rate for Payer: CORVEL All Commercial |
$99.34
|
| Rate for Payer: Coventry All Commercial |
$94.00
|
| Rate for Payer: Encore All Commercial |
$98.33
|
| Rate for Payer: Frontpath All Commercial |
$98.27
|
| Rate for Payer: Humana ChoiceCare |
$92.26
|
| Rate for Payer: Humana Medicare |
$34.18
|
| Rate for Payer: Lucent All Commercial |
$58.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.14
|
| Rate for Payer: Managed Health Services Medicaid |
$15.05
|
| Rate for Payer: MDWise Medicaid |
$15.05
|
| Rate for Payer: PHCS All Commercial |
$80.11
|
| Rate for Payer: PHP All Commercial |
$81.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.66
|
| Rate for Payer: Sagamore Health Network All Products |
$82.47
|
| Rate for Payer: Signature Care EPO |
$88.66
|
| Rate for Payer: Signature Care PPO |
$94.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.80
|
| Rate for Payer: United Healthcare Commercial |
$84.17
|
| Rate for Payer: United Healthcare Medicare |
$34.18
|
|
|
HC POLIOVIRUS ABS
|
Facility
|
OP
|
$207.77
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
63001936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$193.23 |
| Rate for Payer: Aetna Commercial |
$175.36
|
| Rate for Payer: Aetna Medicare |
$66.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$95.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.14
|
| Rate for Payer: Cash Price |
$124.66
|
| Rate for Payer: Cash Price |
$124.66
|
| Rate for Payer: Centivo All Commercial |
$113.03
|
| Rate for Payer: Cigna All Commercial |
$179.31
|
| Rate for Payer: CORVEL All Commercial |
$193.23
|
| Rate for Payer: Coventry All Commercial |
$182.84
|
| Rate for Payer: Encore All Commercial |
$191.25
|
| Rate for Payer: Frontpath All Commercial |
$191.15
|
| Rate for Payer: Humana ChoiceCare |
$179.45
|
| Rate for Payer: Humana Medicare |
$66.49
|
| Rate for Payer: Lucent All Commercial |
$113.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.99
|
| Rate for Payer: Managed Health Services Medicaid |
$13.03
|
| Rate for Payer: MDWise Medicaid |
$13.03
|
| Rate for Payer: PHCS All Commercial |
$155.83
|
| Rate for Payer: PHP All Commercial |
$157.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.03
|
| Rate for Payer: Sagamore Health Network All Products |
$160.40
|
| Rate for Payer: Signature Care EPO |
$172.45
|
| Rate for Payer: Signature Care PPO |
$182.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$176.60
|
| Rate for Payer: United Healthcare Commercial |
$163.72
|
| Rate for Payer: United Healthcare Medicare |
$66.49
|
|
|
HC POLIOVIRUS ABS
|
Facility
|
IP
|
$207.77
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
63001936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.83 |
| Max. Negotiated Rate |
$193.23 |
| Rate for Payer: Aetna Commercial |
$179.51
|
| Rate for Payer: Cash Price |
$124.66
|
| Rate for Payer: Cigna All Commercial |
$179.31
|
| Rate for Payer: CORVEL All Commercial |
$193.23
|
| Rate for Payer: Coventry All Commercial |
$182.84
|
| Rate for Payer: Encore All Commercial |
$191.25
|
| Rate for Payer: Frontpath All Commercial |
$191.15
|
| Rate for Payer: Humana ChoiceCare |
$179.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.99
|
| Rate for Payer: PHCS All Commercial |
$155.83
|
| Rate for Payer: PHP All Commercial |
$157.57
|
| Rate for Payer: Sagamore Health Network All Products |
$160.40
|
| Rate for Payer: Signature Care EPO |
$172.45
|
| Rate for Payer: Signature Care PPO |
$182.84
|
| Rate for Payer: United Healthcare Commercial |
$163.72
|
|
|
HC PORPHYRINS 24H
|
Facility
|
OP
|
$132.93
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
63001042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$123.62 |
| Rate for Payer: Aetna Commercial |
$112.19
|
| Rate for Payer: Aetna Medicare |
$42.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$61.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.79
|
| Rate for Payer: Cash Price |
$79.76
|
| Rate for Payer: Cash Price |
$79.76
|
| Rate for Payer: Centivo All Commercial |
$72.31
|
| Rate for Payer: Cigna All Commercial |
$114.72
|
| Rate for Payer: CORVEL All Commercial |
$123.62
|
| Rate for Payer: Coventry All Commercial |
$116.98
|
| Rate for Payer: Encore All Commercial |
$122.36
|
| Rate for Payer: Frontpath All Commercial |
$122.30
|
| Rate for Payer: Humana ChoiceCare |
$114.81
|
| Rate for Payer: Humana Medicare |
$42.54
|
| Rate for Payer: Lucent All Commercial |
$72.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.64
|
| Rate for Payer: Managed Health Services Medicaid |
$14.71
|
| Rate for Payer: MDWise Medicaid |
$14.71
|
| Rate for Payer: PHCS All Commercial |
$99.70
|
| Rate for Payer: PHP All Commercial |
$100.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.84
|
| Rate for Payer: Sagamore Health Network All Products |
$102.62
|
| Rate for Payer: Signature Care EPO |
$110.33
|
| Rate for Payer: Signature Care PPO |
$116.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.99
|
| Rate for Payer: United Healthcare Commercial |
$104.75
|
| Rate for Payer: United Healthcare Medicare |
$42.54
|
|
|
HC PORPHYRINS 24H
|
Facility
|
IP
|
$132.93
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
63001042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.70 |
| Max. Negotiated Rate |
$123.62 |
| Rate for Payer: Aetna Commercial |
$114.85
|
| Rate for Payer: Cash Price |
$79.76
|
| Rate for Payer: Cigna All Commercial |
$114.72
|
| Rate for Payer: CORVEL All Commercial |
$123.62
|
| Rate for Payer: Coventry All Commercial |
$116.98
|
| Rate for Payer: Encore All Commercial |
$122.36
|
| Rate for Payer: Frontpath All Commercial |
$122.30
|
| Rate for Payer: Humana ChoiceCare |
$114.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.64
|
| Rate for Payer: PHCS All Commercial |
$99.70
|
| Rate for Payer: PHP All Commercial |
$100.81
|
| Rate for Payer: Sagamore Health Network All Products |
$102.62
|
| Rate for Payer: Signature Care EPO |
$110.33
|
| Rate for Payer: Signature Care PPO |
$116.98
|
| Rate for Payer: United Healthcare Commercial |
$104.75
|
|
|
HC PORPHYRINS, QUANTITATIVE, RANDOM URINE
|
Facility
|
OP
|
$94.49
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
63044076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna Commercial |
$79.75
|
| Rate for Payer: Aetna Medicare |
$30.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$43.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.26
|
| Rate for Payer: Cash Price |
$56.69
|
| Rate for Payer: Cash Price |
$56.69
|
| Rate for Payer: Centivo All Commercial |
$51.40
|
| Rate for Payer: Cigna All Commercial |
$81.54
|
| Rate for Payer: CORVEL All Commercial |
$87.88
|
| Rate for Payer: Coventry All Commercial |
$83.15
|
| Rate for Payer: Encore All Commercial |
$86.98
|
| Rate for Payer: Frontpath All Commercial |
$86.93
|
| Rate for Payer: Humana ChoiceCare |
$81.61
|
| Rate for Payer: Humana Medicare |
$30.24
|
| Rate for Payer: Lucent All Commercial |
$51.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.04
|
| Rate for Payer: Managed Health Services Medicaid |
$14.71
|
| Rate for Payer: MDWise Medicaid |
$14.71
|
| Rate for Payer: PHCS All Commercial |
$70.87
|
| Rate for Payer: PHP All Commercial |
$71.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.85
|
| Rate for Payer: Sagamore Health Network All Products |
$72.95
|
| Rate for Payer: Signature Care EPO |
$78.43
|
| Rate for Payer: Signature Care PPO |
$83.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.32
|
| Rate for Payer: United Healthcare Commercial |
$74.46
|
| Rate for Payer: United Healthcare Medicare |
$30.24
|
|
|
HC PORPHYRINS, QUANTITATIVE, RANDOM URINE
|
Facility
|
IP
|
$94.49
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
63044076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.87 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna Commercial |
$81.64
|
| Rate for Payer: Cash Price |
$56.69
|
| Rate for Payer: Cigna All Commercial |
$81.54
|
| Rate for Payer: CORVEL All Commercial |
$87.88
|
| Rate for Payer: Coventry All Commercial |
$83.15
|
| Rate for Payer: Encore All Commercial |
$86.98
|
| Rate for Payer: Frontpath All Commercial |
$86.93
|
| Rate for Payer: Humana ChoiceCare |
$81.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.04
|
| Rate for Payer: PHCS All Commercial |
$70.87
|
| Rate for Payer: PHP All Commercial |
$71.66
|
| Rate for Payer: Sagamore Health Network All Products |
$72.95
|
| Rate for Payer: Signature Care EPO |
$78.43
|
| Rate for Payer: Signature Care PPO |
$83.15
|
| Rate for Payer: United Healthcare Commercial |
$74.46
|
|
|
HC PORT FILM - ONE
|
Facility
|
OP
|
$318.24
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
1547417
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$295.96 |
| Rate for Payer: Aetna Commercial |
$268.59
|
| Rate for Payer: Aetna Medicare |
$101.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$26.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$182.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$198.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.02
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Centivo All Commercial |
$173.12
|
| Rate for Payer: Cigna All Commercial |
$274.64
|
| Rate for Payer: CORVEL All Commercial |
$295.96
|
| Rate for Payer: Coventry All Commercial |
$280.05
|
| Rate for Payer: Encore All Commercial |
$292.94
|
| Rate for Payer: Frontpath All Commercial |
$292.78
|
| Rate for Payer: Humana ChoiceCare |
$274.86
|
| Rate for Payer: Humana Medicare |
$101.84
|
| Rate for Payer: Lucent All Commercial |
$173.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$286.42
|
| Rate for Payer: Managed Health Services Medicaid |
$26.05
|
| Rate for Payer: MDWise Medicaid |
$26.05
|
| Rate for Payer: PHCS All Commercial |
$238.68
|
| Rate for Payer: PHP All Commercial |
$241.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.11
|
| Rate for Payer: Sagamore Health Network All Products |
$245.68
|
| Rate for Payer: Signature Care EPO |
$264.14
|
| Rate for Payer: Signature Care PPO |
$280.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$270.50
|
| Rate for Payer: United Healthcare Commercial |
$250.77
|
| Rate for Payer: United Healthcare Medicare |
$101.84
|
|
|
HC PORT FILM - ONE
|
Facility
|
IP
|
$318.24
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
1547417
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$238.68 |
| Max. Negotiated Rate |
$295.96 |
| Rate for Payer: Aetna Commercial |
$274.96
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cigna All Commercial |
$274.64
|
| Rate for Payer: CORVEL All Commercial |
$295.96
|
| Rate for Payer: Coventry All Commercial |
$280.05
|
| Rate for Payer: Encore All Commercial |
$292.94
|
| Rate for Payer: Frontpath All Commercial |
$292.78
|
| Rate for Payer: Humana ChoiceCare |
$274.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$286.42
|
| Rate for Payer: PHCS All Commercial |
$238.68
|
| Rate for Payer: PHP All Commercial |
$241.35
|
| Rate for Payer: Sagamore Health Network All Products |
$245.68
|
| Rate for Payer: Signature Care EPO |
$264.14
|
| Rate for Payer: Signature Care PPO |
$280.05
|
| Rate for Payer: United Healthcare Commercial |
$250.77
|
|
|
HC PORT FILMS - EIGHT
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
1547424
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,912.50 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
|
|
HC PORT FILMS - EIGHT
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
1547424
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,152.20
|
| Rate for Payer: Aetna Medicare |
$816.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$26.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$790.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,464.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,594.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$938.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$897.60
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Centivo All Commercial |
$1,387.20
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.43
|
| Rate for Payer: Humana Medicare |
$816.00
|
| Rate for Payer: Lucent All Commercial |
$1,387.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: Managed Health Services Medicaid |
$26.05
|
| Rate for Payer: MDWise Medicaid |
$26.05
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$994.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,167.50
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
| Rate for Payer: United Healthcare Medicare |
$816.00
|
|
|
HC PORT FILMS - FIVE
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
1547421
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Aetna Commercial |
$1,291.32
|
| Rate for Payer: Aetna Medicare |
$489.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$26.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$474.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$878.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$956.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$563.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$538.56
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Centivo All Commercial |
$832.32
|
| Rate for Payer: Cigna All Commercial |
$1,320.39
|
| Rate for Payer: CORVEL All Commercial |
$1,422.90
|
| Rate for Payer: Coventry All Commercial |
$1,346.40
|
| Rate for Payer: Encore All Commercial |
$1,408.37
|
| Rate for Payer: Frontpath All Commercial |
$1,407.60
|
| Rate for Payer: Humana ChoiceCare |
$1,321.46
|
| Rate for Payer: Humana Medicare |
$489.60
|
| Rate for Payer: Lucent All Commercial |
$832.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,377.00
|
| Rate for Payer: Managed Health Services Medicaid |
$26.05
|
| Rate for Payer: MDWise Medicaid |
$26.05
|
| Rate for Payer: PHCS All Commercial |
$1,147.50
|
| Rate for Payer: PHP All Commercial |
$1,160.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$596.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,181.16
|
| Rate for Payer: Signature Care EPO |
$1,269.90
|
| Rate for Payer: Signature Care PPO |
$1,346.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare Commercial |
$1,205.64
|
| Rate for Payer: United Healthcare Medicare |
$489.60
|
|
|
HC PORT FILMS - FIVE
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
1547421
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,147.50 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Aetna Commercial |
$1,321.92
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna All Commercial |
$1,320.39
|
| Rate for Payer: CORVEL All Commercial |
$1,422.90
|
| Rate for Payer: Coventry All Commercial |
$1,346.40
|
| Rate for Payer: Encore All Commercial |
$1,408.37
|
| Rate for Payer: Frontpath All Commercial |
$1,407.60
|
| Rate for Payer: Humana ChoiceCare |
$1,321.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,377.00
|
| Rate for Payer: PHCS All Commercial |
$1,147.50
|
| Rate for Payer: PHP All Commercial |
$1,160.35
|
| Rate for Payer: Sagamore Health Network All Products |
$1,181.16
|
| Rate for Payer: Signature Care EPO |
$1,269.90
|
| Rate for Payer: Signature Care PPO |
$1,346.40
|
| Rate for Payer: United Healthcare Commercial |
$1,205.64
|
|
|
HC PORT FILMS - FOUR
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
1547420
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$1,138.32 |
| Rate for Payer: Aetna Commercial |
$1,057.54
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna All Commercial |
$1,056.31
|
| Rate for Payer: CORVEL All Commercial |
$1,138.32
|
| Rate for Payer: Coventry All Commercial |
$1,077.12
|
| Rate for Payer: Encore All Commercial |
$1,126.69
|
| Rate for Payer: Frontpath All Commercial |
$1,126.08
|
| Rate for Payer: Humana ChoiceCare |
$1,057.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,101.60
|
| Rate for Payer: PHCS All Commercial |
$918.00
|
| Rate for Payer: PHP All Commercial |
$928.28
|
| Rate for Payer: Sagamore Health Network All Products |
$944.93
|
| Rate for Payer: Signature Care EPO |
$1,015.92
|
| Rate for Payer: Signature Care PPO |
$1,077.12
|
| Rate for Payer: United Healthcare Commercial |
$964.51
|
|
|
HC PORT FILMS - FOUR
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
1547420
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$1,138.32 |
| Rate for Payer: Aetna Commercial |
$1,033.06
|
| Rate for Payer: Aetna Medicare |
$391.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$26.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$379.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$702.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$765.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$450.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$430.85
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Centivo All Commercial |
$665.86
|
| Rate for Payer: Cigna All Commercial |
$1,056.31
|
| Rate for Payer: CORVEL All Commercial |
$1,138.32
|
| Rate for Payer: Coventry All Commercial |
$1,077.12
|
| Rate for Payer: Encore All Commercial |
$1,126.69
|
| Rate for Payer: Frontpath All Commercial |
$1,126.08
|
| Rate for Payer: Humana ChoiceCare |
$1,057.17
|
| Rate for Payer: Humana Medicare |
$391.68
|
| Rate for Payer: Lucent All Commercial |
$665.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,101.60
|
| Rate for Payer: Managed Health Services Medicaid |
$26.05
|
| Rate for Payer: MDWise Medicaid |
$26.05
|
| Rate for Payer: PHCS All Commercial |
$918.00
|
| Rate for Payer: PHP All Commercial |
$928.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$477.36
|
| Rate for Payer: Sagamore Health Network All Products |
$944.93
|
| Rate for Payer: Signature Care EPO |
$1,015.92
|
| Rate for Payer: Signature Care PPO |
$1,077.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,040.40
|
| Rate for Payer: United Healthcare Commercial |
$964.51
|
| Rate for Payer: United Healthcare Medicare |
$391.68
|
|
