|
HC PRESUMPTIVE BACT ID
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
63001076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$115.32 |
| Rate for Payer: Aetna Commercial |
$104.66
|
| Rate for Payer: Aetna Medicare |
$39.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.65
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Centivo All Commercial |
$67.46
|
| Rate for Payer: Cigna All Commercial |
$107.01
|
| Rate for Payer: CORVEL All Commercial |
$115.32
|
| Rate for Payer: Coventry All Commercial |
$109.12
|
| Rate for Payer: Encore All Commercial |
$114.14
|
| Rate for Payer: Frontpath All Commercial |
$114.08
|
| Rate for Payer: Humana ChoiceCare |
$107.10
|
| Rate for Payer: Humana Medicare |
$39.68
|
| Rate for Payer: Lucent All Commercial |
$67.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.60
|
| Rate for Payer: Managed Health Services Medicaid |
$8.09
|
| Rate for Payer: MDWise Medicaid |
$8.09
|
| Rate for Payer: PHCS All Commercial |
$93.00
|
| Rate for Payer: PHP All Commercial |
$94.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.36
|
| Rate for Payer: Sagamore Health Network All Products |
$95.73
|
| Rate for Payer: Signature Care EPO |
$102.92
|
| Rate for Payer: Signature Care PPO |
$109.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.40
|
| Rate for Payer: United Healthcare Commercial |
$97.71
|
| Rate for Payer: United Healthcare Medicare |
$39.68
|
|
|
HC PRESUMPTIVE BACT ID
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
63001076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$115.32 |
| Rate for Payer: Aetna Commercial |
$107.14
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna All Commercial |
$107.01
|
| Rate for Payer: CORVEL All Commercial |
$115.32
|
| Rate for Payer: Coventry All Commercial |
$109.12
|
| Rate for Payer: Encore All Commercial |
$114.14
|
| Rate for Payer: Frontpath All Commercial |
$114.08
|
| Rate for Payer: Humana ChoiceCare |
$107.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.60
|
| Rate for Payer: PHCS All Commercial |
$93.00
|
| Rate for Payer: PHP All Commercial |
$94.04
|
| Rate for Payer: Sagamore Health Network All Products |
$95.73
|
| Rate for Payer: Signature Care EPO |
$102.92
|
| Rate for Payer: Signature Care PPO |
$109.12
|
| Rate for Payer: United Healthcare Commercial |
$97.71
|
|
|
HC PRIMIDONE/PHENO
|
Facility
|
IP
|
$126.70
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
63001196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$117.83 |
| Rate for Payer: Aetna Commercial |
$109.47
|
| Rate for Payer: Cash Price |
$76.02
|
| Rate for Payer: Cigna All Commercial |
$109.34
|
| Rate for Payer: CORVEL All Commercial |
$117.83
|
| Rate for Payer: Coventry All Commercial |
$111.50
|
| Rate for Payer: Encore All Commercial |
$116.63
|
| Rate for Payer: Frontpath All Commercial |
$116.56
|
| Rate for Payer: Humana ChoiceCare |
$109.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.03
|
| Rate for Payer: PHCS All Commercial |
$95.03
|
| Rate for Payer: PHP All Commercial |
$96.09
|
| Rate for Payer: Sagamore Health Network All Products |
$97.81
|
| Rate for Payer: Signature Care EPO |
$105.16
|
| Rate for Payer: Signature Care PPO |
$111.50
|
| Rate for Payer: United Healthcare Commercial |
$99.84
|
|
|
HC PRIMIDONE/PHENO
|
Facility
|
OP
|
$126.70
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
63001196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.59 |
| Max. Negotiated Rate |
$117.83 |
| Rate for Payer: Aetna Commercial |
$106.93
|
| Rate for Payer: Aetna Medicare |
$40.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.60
|
| Rate for Payer: Cash Price |
$76.02
|
| Rate for Payer: Cash Price |
$76.02
|
| Rate for Payer: Centivo All Commercial |
$68.92
|
| Rate for Payer: Cigna All Commercial |
$109.34
|
| Rate for Payer: CORVEL All Commercial |
$117.83
|
| Rate for Payer: Coventry All Commercial |
$111.50
|
| Rate for Payer: Encore All Commercial |
$116.63
|
| Rate for Payer: Frontpath All Commercial |
$116.56
|
| Rate for Payer: Humana ChoiceCare |
$109.43
|
| Rate for Payer: Humana Medicare |
$40.54
|
| Rate for Payer: Lucent All Commercial |
$68.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.03
|
| Rate for Payer: Managed Health Services Medicaid |
$16.59
|
| Rate for Payer: MDWise Medicaid |
$16.59
|
| Rate for Payer: PHCS All Commercial |
$95.03
|
| Rate for Payer: PHP All Commercial |
$96.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.41
|
| Rate for Payer: Sagamore Health Network All Products |
$97.81
|
| Rate for Payer: Signature Care EPO |
$105.16
|
| Rate for Payer: Signature Care PPO |
$111.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$107.69
|
| Rate for Payer: United Healthcare Commercial |
$99.84
|
| Rate for Payer: United Healthcare Medicare |
$40.54
|
|
|
HC PROBE BLANKET HYPOTHERM DISP
|
Facility
|
IP
|
$41.72
|
|
| Hospital Charge Code |
41601011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Aetna Commercial |
$36.05
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cigna All Commercial |
$36.00
|
| Rate for Payer: CORVEL All Commercial |
$38.80
|
| Rate for Payer: Coventry All Commercial |
$36.71
|
| Rate for Payer: Encore All Commercial |
$38.40
|
| Rate for Payer: Frontpath All Commercial |
$38.38
|
| Rate for Payer: Humana ChoiceCare |
$36.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.55
|
| Rate for Payer: PHCS All Commercial |
$31.29
|
| Rate for Payer: PHP All Commercial |
$31.64
|
| Rate for Payer: Sagamore Health Network All Products |
$32.21
|
| Rate for Payer: Signature Care EPO |
$34.63
|
| Rate for Payer: Signature Care PPO |
$36.71
|
| Rate for Payer: United Healthcare Commercial |
$32.88
|
|
|
HC PROBE BLANKET HYPOTHERM DISP
|
Facility
|
OP
|
$41.72
|
|
| Hospital Charge Code |
41601011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Aetna Commercial |
$35.21
|
| Rate for Payer: Aetna Medicare |
$13.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.69
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Centivo All Commercial |
$22.70
|
| Rate for Payer: Cigna All Commercial |
$36.00
|
| Rate for Payer: CORVEL All Commercial |
$38.80
|
| Rate for Payer: Coventry All Commercial |
$36.71
|
| Rate for Payer: Encore All Commercial |
$38.40
|
| Rate for Payer: Frontpath All Commercial |
$38.38
|
| Rate for Payer: Humana ChoiceCare |
$36.03
|
| Rate for Payer: Humana Medicare |
$13.35
|
| Rate for Payer: Lucent All Commercial |
$22.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.55
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$31.29
|
| Rate for Payer: PHP All Commercial |
$31.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.27
|
| Rate for Payer: Sagamore Health Network All Products |
$32.21
|
| Rate for Payer: Signature Care EPO |
$34.63
|
| Rate for Payer: Signature Care PPO |
$36.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.46
|
| Rate for Payer: United Healthcare Commercial |
$32.88
|
| Rate for Payer: United Healthcare Medicare |
$13.35
|
|
|
HC PROBE TEMP 9F
|
Facility
|
OP
|
$10.36
|
|
| Hospital Charge Code |
41607463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Medicare |
$3.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.65
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Centivo All Commercial |
$5.64
|
| Rate for Payer: Cigna All Commercial |
$8.94
|
| Rate for Payer: CORVEL All Commercial |
$9.63
|
| Rate for Payer: Coventry All Commercial |
$9.12
|
| Rate for Payer: Encore All Commercial |
$9.54
|
| Rate for Payer: Frontpath All Commercial |
$9.53
|
| Rate for Payer: Humana ChoiceCare |
$8.95
|
| Rate for Payer: Humana Medicare |
$3.32
|
| Rate for Payer: Lucent All Commercial |
$5.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.32
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.77
|
| Rate for Payer: PHP All Commercial |
$7.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.04
|
| Rate for Payer: Sagamore Health Network All Products |
$8.00
|
| Rate for Payer: Signature Care EPO |
$8.60
|
| Rate for Payer: Signature Care PPO |
$9.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.81
|
| Rate for Payer: United Healthcare Commercial |
$8.16
|
| Rate for Payer: United Healthcare Medicare |
$3.32
|
|
|
HC PROBE TEMP 9F
|
Facility
|
IP
|
$10.36
|
|
| Hospital Charge Code |
41607463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cigna All Commercial |
$8.94
|
| Rate for Payer: CORVEL All Commercial |
$9.63
|
| Rate for Payer: Coventry All Commercial |
$9.12
|
| Rate for Payer: Encore All Commercial |
$9.54
|
| Rate for Payer: Frontpath All Commercial |
$9.53
|
| Rate for Payer: Humana ChoiceCare |
$8.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.32
|
| Rate for Payer: PHCS All Commercial |
$7.77
|
| Rate for Payer: PHP All Commercial |
$7.86
|
| Rate for Payer: Sagamore Health Network All Products |
$8.00
|
| Rate for Payer: Signature Care EPO |
$8.60
|
| Rate for Payer: Signature Care PPO |
$9.12
|
| Rate for Payer: United Healthcare Commercial |
$8.16
|
|
|
HC PROCALCITONIN
|
Facility
|
OP
|
$466.46
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
63001663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$433.81 |
| Rate for Payer: Aetna Commercial |
$393.69
|
| Rate for Payer: Aetna Medicare |
$149.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$214.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$171.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$164.19
|
| Rate for Payer: Cash Price |
$279.88
|
| Rate for Payer: Cash Price |
$279.88
|
| Rate for Payer: Centivo All Commercial |
$253.75
|
| Rate for Payer: Cigna All Commercial |
$402.55
|
| Rate for Payer: CORVEL All Commercial |
$433.81
|
| Rate for Payer: Coventry All Commercial |
$410.48
|
| Rate for Payer: Encore All Commercial |
$429.38
|
| Rate for Payer: Frontpath All Commercial |
$429.14
|
| Rate for Payer: Humana ChoiceCare |
$402.88
|
| Rate for Payer: Humana Medicare |
$149.27
|
| Rate for Payer: Lucent All Commercial |
$253.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.81
|
| Rate for Payer: Managed Health Services Medicaid |
$27.22
|
| Rate for Payer: MDWise Medicaid |
$27.22
|
| Rate for Payer: PHCS All Commercial |
$349.85
|
| Rate for Payer: PHP All Commercial |
$353.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.92
|
| Rate for Payer: Sagamore Health Network All Products |
$360.11
|
| Rate for Payer: Signature Care EPO |
$387.16
|
| Rate for Payer: Signature Care PPO |
$410.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$396.49
|
| Rate for Payer: United Healthcare Commercial |
$367.57
|
| Rate for Payer: United Healthcare Medicare |
$149.27
|
|
|
HC PROCALCITONIN
|
Facility
|
IP
|
$466.46
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
63001663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$349.85 |
| Max. Negotiated Rate |
$433.81 |
| Rate for Payer: Aetna Commercial |
$403.02
|
| Rate for Payer: Cash Price |
$279.88
|
| Rate for Payer: Cigna All Commercial |
$402.55
|
| Rate for Payer: CORVEL All Commercial |
$433.81
|
| Rate for Payer: Coventry All Commercial |
$410.48
|
| Rate for Payer: Encore All Commercial |
$429.38
|
| Rate for Payer: Frontpath All Commercial |
$429.14
|
| Rate for Payer: Humana ChoiceCare |
$402.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.81
|
| Rate for Payer: PHCS All Commercial |
$349.85
|
| Rate for Payer: PHP All Commercial |
$353.76
|
| Rate for Payer: Sagamore Health Network All Products |
$360.11
|
| Rate for Payer: Signature Care EPO |
$387.16
|
| Rate for Payer: Signature Care PPO |
$410.48
|
| Rate for Payer: United Healthcare Commercial |
$367.57
|
|
|
HC PROGESTERONE
|
Facility
|
OP
|
$245.49
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
63001160
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$228.31 |
| Rate for Payer: Aetna Commercial |
$207.19
|
| Rate for Payer: Aetna Medicare |
$78.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$112.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.41
|
| Rate for Payer: Cash Price |
$147.29
|
| Rate for Payer: Cash Price |
$147.29
|
| Rate for Payer: Centivo All Commercial |
$133.55
|
| Rate for Payer: Cigna All Commercial |
$211.86
|
| Rate for Payer: CORVEL All Commercial |
$228.31
|
| Rate for Payer: Coventry All Commercial |
$216.03
|
| Rate for Payer: Encore All Commercial |
$225.97
|
| Rate for Payer: Frontpath All Commercial |
$225.85
|
| Rate for Payer: Humana ChoiceCare |
$212.03
|
| Rate for Payer: Humana Medicare |
$78.56
|
| Rate for Payer: Lucent All Commercial |
$133.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.94
|
| Rate for Payer: Managed Health Services Medicaid |
$20.86
|
| Rate for Payer: MDWise Medicaid |
$20.86
|
| Rate for Payer: PHCS All Commercial |
$184.12
|
| Rate for Payer: PHP All Commercial |
$186.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.74
|
| Rate for Payer: Sagamore Health Network All Products |
$189.52
|
| Rate for Payer: Signature Care EPO |
$203.76
|
| Rate for Payer: Signature Care PPO |
$216.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.67
|
| Rate for Payer: United Healthcare Commercial |
$193.45
|
| Rate for Payer: United Healthcare Medicare |
$78.56
|
|
|
HC PROGESTERONE
|
Facility
|
IP
|
$245.49
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
63001160
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$184.12 |
| Max. Negotiated Rate |
$228.31 |
| Rate for Payer: Aetna Commercial |
$212.10
|
| Rate for Payer: Cash Price |
$147.29
|
| Rate for Payer: Cigna All Commercial |
$211.86
|
| Rate for Payer: CORVEL All Commercial |
$228.31
|
| Rate for Payer: Coventry All Commercial |
$216.03
|
| Rate for Payer: Encore All Commercial |
$225.97
|
| Rate for Payer: Frontpath All Commercial |
$225.85
|
| Rate for Payer: Humana ChoiceCare |
$212.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.94
|
| Rate for Payer: PHCS All Commercial |
$184.12
|
| Rate for Payer: PHP All Commercial |
$186.18
|
| Rate for Payer: Sagamore Health Network All Products |
$189.52
|
| Rate for Payer: Signature Care EPO |
$203.76
|
| Rate for Payer: Signature Care PPO |
$216.03
|
| Rate for Payer: United Healthcare Commercial |
$193.45
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
63001178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$53.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.24
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Centivo All Commercial |
$91.56
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$53.86
|
| Rate for Payer: Lucent All Commercial |
$91.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$19.38
|
| Rate for Payer: MDWise Medicaid |
$19.38
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$53.86
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
63001178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC PROPOXYPHENE MS
|
Facility
|
OP
|
$127.31
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna Commercial |
$107.45
|
| Rate for Payer: Aetna Medicare |
$40.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.81
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Centivo All Commercial |
$69.26
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.40
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.13
|
| Rate for Payer: Humana ChoiceCare |
$109.96
|
| Rate for Payer: Humana Medicare |
$40.74
|
| Rate for Payer: Lucent All Commercial |
$69.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.65
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.67
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.21
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
| Rate for Payer: United Healthcare Medicare |
$40.74
|
|
|
HC PROPOXYPHENE MS
|
Facility
|
IP
|
$127.31
|
|
|
Service Code
|
CPT 80367
|
| Hospital Charge Code |
63001428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna Commercial |
$110.00
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.40
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.13
|
| Rate for Payer: Humana ChoiceCare |
$109.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.67
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
|
|
HC PROPOXYPHENE MS
|
Facility
|
IP
|
$127.31
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna Commercial |
$110.00
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.40
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.13
|
| Rate for Payer: Humana ChoiceCare |
$109.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.67
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
|
|
HC PROPOXYPHENE MS
|
Facility
|
OP
|
$127.31
|
|
|
Service Code
|
CPT 80367
|
| Hospital Charge Code |
63001428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna Commercial |
$107.45
|
| Rate for Payer: Aetna Medicare |
$40.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.81
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Centivo All Commercial |
$69.26
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.40
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.13
|
| Rate for Payer: Humana ChoiceCare |
$109.96
|
| Rate for Payer: Humana Medicare |
$40.74
|
| Rate for Payer: Lucent All Commercial |
$69.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.65
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.67
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.21
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
| Rate for Payer: United Healthcare Medicare |
$40.74
|
|
|
HC PROTECTOR HEEL W/WEDGE GREEN
|
Facility
|
IP
|
$266.77
|
|
|
Service Code
|
CPT E0191
|
| Hospital Charge Code |
41608187
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$200.08 |
| Max. Negotiated Rate |
$248.10 |
| Rate for Payer: Aetna Commercial |
$230.49
|
| Rate for Payer: Cash Price |
$160.06
|
| Rate for Payer: Cigna All Commercial |
$230.22
|
| Rate for Payer: CORVEL All Commercial |
$248.10
|
| Rate for Payer: Coventry All Commercial |
$234.76
|
| Rate for Payer: Encore All Commercial |
$245.56
|
| Rate for Payer: Frontpath All Commercial |
$245.43
|
| Rate for Payer: Humana ChoiceCare |
$230.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.09
|
| Rate for Payer: PHCS All Commercial |
$200.08
|
| Rate for Payer: PHP All Commercial |
$202.32
|
| Rate for Payer: Sagamore Health Network All Products |
$205.95
|
| Rate for Payer: Signature Care EPO |
$221.42
|
| Rate for Payer: Signature Care PPO |
$234.76
|
| Rate for Payer: United Healthcare Commercial |
$210.21
|
|
|
HC PROTECTOR HEEL W/WEDGE GREEN
|
Facility
|
OP
|
$266.77
|
|
|
Service Code
|
CPT E0191
|
| Hospital Charge Code |
41608187
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$248.10 |
| Rate for Payer: Aetna Commercial |
$225.15
|
| Rate for Payer: Aetna Medicare |
$85.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$153.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.90
|
| Rate for Payer: Cash Price |
$160.06
|
| Rate for Payer: Cash Price |
$160.06
|
| Rate for Payer: Centivo All Commercial |
$145.12
|
| Rate for Payer: Cigna All Commercial |
$230.22
|
| Rate for Payer: CORVEL All Commercial |
$248.10
|
| Rate for Payer: Coventry All Commercial |
$234.76
|
| Rate for Payer: Encore All Commercial |
$245.56
|
| Rate for Payer: Frontpath All Commercial |
$245.43
|
| Rate for Payer: Humana ChoiceCare |
$230.41
|
| Rate for Payer: Humana Medicare |
$85.37
|
| Rate for Payer: Lucent All Commercial |
$145.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.09
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$200.08
|
| Rate for Payer: PHP All Commercial |
$202.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.04
|
| Rate for Payer: Sagamore Health Network All Products |
$205.95
|
| Rate for Payer: Signature Care EPO |
$221.42
|
| Rate for Payer: Signature Care PPO |
$234.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$226.75
|
| Rate for Payer: United Healthcare Commercial |
$210.21
|
| Rate for Payer: United Healthcare Medicare |
$85.37
|
|
|
HC PROTECTORS PIN BLUE
|
Facility
|
IP
|
$37.13
|
|
| Hospital Charge Code |
41602391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$34.53 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cigna All Commercial |
$32.04
|
| Rate for Payer: CORVEL All Commercial |
$34.53
|
| Rate for Payer: Coventry All Commercial |
$32.67
|
| Rate for Payer: Encore All Commercial |
$34.18
|
| Rate for Payer: Frontpath All Commercial |
$34.16
|
| Rate for Payer: Humana ChoiceCare |
$32.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.42
|
| Rate for Payer: PHCS All Commercial |
$27.85
|
| Rate for Payer: PHP All Commercial |
$28.16
|
| Rate for Payer: Sagamore Health Network All Products |
$28.66
|
| Rate for Payer: Signature Care EPO |
$30.82
|
| Rate for Payer: Signature Care PPO |
$32.67
|
| Rate for Payer: United Healthcare Commercial |
$29.26
|
|
|
HC PROTECTORS PIN BLUE
|
Facility
|
OP
|
$37.13
|
|
| Hospital Charge Code |
41602391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$34.53 |
| Rate for Payer: Aetna Commercial |
$31.34
|
| Rate for Payer: Aetna Medicare |
$11.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.07
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Centivo All Commercial |
$20.20
|
| Rate for Payer: Cigna All Commercial |
$32.04
|
| Rate for Payer: CORVEL All Commercial |
$34.53
|
| Rate for Payer: Coventry All Commercial |
$32.67
|
| Rate for Payer: Encore All Commercial |
$34.18
|
| Rate for Payer: Frontpath All Commercial |
$34.16
|
| Rate for Payer: Humana ChoiceCare |
$32.07
|
| Rate for Payer: Humana Medicare |
$11.88
|
| Rate for Payer: Lucent All Commercial |
$20.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.42
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$27.85
|
| Rate for Payer: PHP All Commercial |
$28.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.48
|
| Rate for Payer: Sagamore Health Network All Products |
$28.66
|
| Rate for Payer: Signature Care EPO |
$30.82
|
| Rate for Payer: Signature Care PPO |
$32.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.56
|
| Rate for Payer: United Healthcare Commercial |
$29.26
|
| Rate for Payer: United Healthcare Medicare |
$11.88
|
|
|
HC PROTECTORS PIN PINK
|
Facility
|
OP
|
$20.18
|
|
| Hospital Charge Code |
41602392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.10
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Centivo All Commercial |
$10.98
|
| Rate for Payer: Cigna All Commercial |
$17.42
|
| Rate for Payer: CORVEL All Commercial |
$18.77
|
| Rate for Payer: Coventry All Commercial |
$17.76
|
| Rate for Payer: Encore All Commercial |
$18.58
|
| Rate for Payer: Frontpath All Commercial |
$18.57
|
| Rate for Payer: Humana ChoiceCare |
$17.43
|
| Rate for Payer: Humana Medicare |
$6.46
|
| Rate for Payer: Lucent All Commercial |
$10.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.16
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$15.13
|
| Rate for Payer: PHP All Commercial |
$15.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.87
|
| Rate for Payer: Sagamore Health Network All Products |
$15.58
|
| Rate for Payer: Signature Care EPO |
$16.75
|
| Rate for Payer: Signature Care PPO |
$17.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.15
|
| Rate for Payer: United Healthcare Commercial |
$15.90
|
| Rate for Payer: United Healthcare Medicare |
$6.46
|
|
|
HC PROTECTORS PIN PINK
|
Facility
|
IP
|
$20.18
|
|
| Hospital Charge Code |
41602392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna Commercial |
$17.44
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cigna All Commercial |
$17.42
|
| Rate for Payer: CORVEL All Commercial |
$18.77
|
| Rate for Payer: Coventry All Commercial |
$17.76
|
| Rate for Payer: Encore All Commercial |
$18.58
|
| Rate for Payer: Frontpath All Commercial |
$18.57
|
| Rate for Payer: Humana ChoiceCare |
$17.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.16
|
| Rate for Payer: PHCS All Commercial |
$15.13
|
| Rate for Payer: PHP All Commercial |
$15.30
|
| Rate for Payer: Sagamore Health Network All Products |
$15.58
|
| Rate for Payer: Signature Care EPO |
$16.75
|
| Rate for Payer: Signature Care PPO |
$17.76
|
| Rate for Payer: United Healthcare Commercial |
$15.90
|
|
|
HC PROTECTORS PIN WHITE
|
Facility
|
OP
|
$47.02
|
|
| Hospital Charge Code |
41602393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: Aetna Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.55
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Centivo All Commercial |
$25.58
|
| Rate for Payer: Cigna All Commercial |
$40.58
|
| Rate for Payer: CORVEL All Commercial |
$43.73
|
| Rate for Payer: Coventry All Commercial |
$41.38
|
| Rate for Payer: Encore All Commercial |
$43.28
|
| Rate for Payer: Frontpath All Commercial |
$43.26
|
| Rate for Payer: Humana ChoiceCare |
$40.61
|
| Rate for Payer: Humana Medicare |
$15.05
|
| Rate for Payer: Lucent All Commercial |
$25.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.32
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$35.27
|
| Rate for Payer: PHP All Commercial |
$35.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.34
|
| Rate for Payer: Sagamore Health Network All Products |
$36.30
|
| Rate for Payer: Signature Care EPO |
$39.03
|
| Rate for Payer: Signature Care PPO |
$41.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.97
|
| Rate for Payer: United Healthcare Commercial |
$37.05
|
| Rate for Payer: United Healthcare Medicare |
$15.05
|
|
