|
HC MYCOPLASMA IGG
|
Facility
IP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001963
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$297.79 |
| Max. Negotiated Rate |
$369.26 |
| Rate for Payer: Aetna Commercial |
$343.06
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.26
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.29
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: PHCS All Commercial |
$297.79
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
|
|
HC MYCOPLASMA IGM
|
Facility
OP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$369.26 |
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: Aetna Medicare |
$131.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.13
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Centivo All Commercial |
$202.50
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.26
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.29
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Humana Medicare |
$202.50
|
| Rate for Payer: Lucent All Commercial |
$202.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: MDWise Medicaid |
$13.24
|
| Rate for Payer: PHCS All Commercial |
$297.79
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$154.85
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$337.50
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
| Rate for Payer: United Healthcare Medicare |
$131.03
|
|
|
HC MYCOPLASMA IGM
|
Facility
IP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$297.79 |
| Max. Negotiated Rate |
$369.26 |
| Rate for Payer: Aetna Commercial |
$343.06
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.26
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.29
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: PHCS All Commercial |
$297.79
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
|
|
HC MYCOPLASMA PNEUMONIAE IGG
|
Facility
IP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$297.79 |
| Max. Negotiated Rate |
$369.26 |
| Rate for Payer: Aetna Commercial |
$343.06
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.26
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.29
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: PHCS All Commercial |
$297.79
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
|
|
HC MYCOPLASMA PNEUMONIAE IGG
|
Facility
OP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$369.26 |
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: Aetna Medicare |
$131.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.13
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Centivo All Commercial |
$202.50
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.26
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.29
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Humana Medicare |
$202.50
|
| Rate for Payer: Lucent All Commercial |
$202.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: MDWise Medicaid |
$13.24
|
| Rate for Payer: PHCS All Commercial |
$297.79
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$154.85
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$337.50
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
| Rate for Payer: United Healthcare Medicare |
$131.03
|
|
|
HC MYCOPLASMA PNEUMONIAE IGM
|
Facility
OP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001962
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$369.26 |
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: Aetna Medicare |
$131.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.13
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Centivo All Commercial |
$202.50
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.26
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.29
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Humana Medicare |
$202.50
|
| Rate for Payer: Lucent All Commercial |
$202.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: MDWise Medicaid |
$13.24
|
| Rate for Payer: PHCS All Commercial |
$297.79
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$154.85
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$337.50
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
| Rate for Payer: United Healthcare Medicare |
$131.03
|
|
|
HC MYCOPLASMA PNEUMONIAE IGM
|
Facility
IP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001962
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$297.79 |
| Max. Negotiated Rate |
$369.26 |
| Rate for Payer: Aetna Commercial |
$343.06
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.26
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.29
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: PHCS All Commercial |
$297.79
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
|
|
HC MYELOGRAPHY VIA LUMBAR INJ; LUMBOSACRAL
|
Facility
OP
|
$3,313.14
|
|
| Hospital Charge Code |
01612304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,093.34 |
| Max. Negotiated Rate |
$3,081.22 |
| Rate for Payer: Aetna Commercial |
$2,796.29
|
| Rate for Payer: Aetna Medicare |
$1,093.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,093.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,071.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,257.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.67
|
| Rate for Payer: Cash Price |
$2,054.15
|
| Rate for Payer: Centivo All Commercial |
$1,689.70
|
| Rate for Payer: Cigna All Commercial |
$2,859.24
|
| Rate for Payer: CORVEL All Commercial |
$3,081.22
|
| Rate for Payer: Coventry All Commercial |
$2,915.57
|
| Rate for Payer: Encore All Commercial |
$3,049.75
|
| Rate for Payer: Frontpath All Commercial |
$3,048.09
|
| Rate for Payer: Humana ChoiceCare |
$2,861.56
|
| Rate for Payer: Humana Medicare |
$1,689.70
|
| Rate for Payer: Lucent All Commercial |
$1,689.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,981.83
|
| Rate for Payer: PHCS All Commercial |
$2,484.86
|
| Rate for Payer: PHP All Commercial |
$2,512.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,292.13
|
| Rate for Payer: Sagamore Health Network All Products |
$2,557.75
|
| Rate for Payer: Signature Care EPO |
$2,749.91
|
| Rate for Payer: Signature Care PPO |
$2,915.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,816.17
|
| Rate for Payer: United Healthcare Commercial |
$2,610.76
|
| Rate for Payer: United Healthcare Medicare |
$1,093.34
|
|
|
HC MYELOGRAPHY VIA LUMBAR INJ; LUMBOSACRAL
|
Facility
IP
|
$3,313.14
|
|
| Hospital Charge Code |
01612304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,484.86 |
| Max. Negotiated Rate |
$3,081.22 |
| Rate for Payer: Aetna Commercial |
$2,862.56
|
| Rate for Payer: Cash Price |
$2,054.15
|
| Rate for Payer: Cigna All Commercial |
$2,859.24
|
| Rate for Payer: CORVEL All Commercial |
$3,081.22
|
| Rate for Payer: Coventry All Commercial |
$2,915.57
|
| Rate for Payer: Encore All Commercial |
$3,049.75
|
| Rate for Payer: Frontpath All Commercial |
$3,048.09
|
| Rate for Payer: Humana ChoiceCare |
$2,861.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,981.83
|
| Rate for Payer: PHCS All Commercial |
$2,484.86
|
| Rate for Payer: PHP All Commercial |
$2,512.69
|
| Rate for Payer: Sagamore Health Network All Products |
$2,557.75
|
| Rate for Payer: Signature Care EPO |
$2,749.91
|
| Rate for Payer: Signature Care PPO |
$2,915.57
|
| Rate for Payer: United Healthcare Commercial |
$2,610.76
|
|
|
HC MYOCARDIAL PERFUSION MULTI PLANAR
|
Facility
IP
|
$3,131.64
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
01639012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$2,348.73 |
| Max. Negotiated Rate |
$2,912.43 |
| Rate for Payer: Aetna Commercial |
$2,705.74
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Cigna All Commercial |
$2,702.61
|
| Rate for Payer: CORVEL All Commercial |
$2,912.43
|
| Rate for Payer: Coventry All Commercial |
$2,755.85
|
| Rate for Payer: Encore All Commercial |
$2,882.68
|
| Rate for Payer: Frontpath All Commercial |
$2,881.11
|
| Rate for Payer: Humana ChoiceCare |
$2,704.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,818.48
|
| Rate for Payer: PHCS All Commercial |
$2,348.73
|
| Rate for Payer: PHP All Commercial |
$2,375.04
|
| Rate for Payer: Sagamore Health Network All Products |
$2,417.63
|
| Rate for Payer: Signature Care EPO |
$2,599.27
|
| Rate for Payer: Signature Care PPO |
$2,755.85
|
| Rate for Payer: United Healthcare Commercial |
$2,467.74
|
|
|
HC MYOCARDIAL PERFUSION MULTI PLANAR
|
Facility
OP
|
$3,131.64
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
01639012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,019.85 |
| Max. Negotiated Rate |
$2,912.43 |
| Rate for Payer: Aetna Commercial |
$2,643.11
|
| Rate for Payer: Aetna Medicare |
$1,033.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,033.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,798.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,957.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,019.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,188.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,136.79
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Centivo All Commercial |
$1,597.14
|
| Rate for Payer: Cigna All Commercial |
$2,702.61
|
| Rate for Payer: CORVEL All Commercial |
$2,912.43
|
| Rate for Payer: Coventry All Commercial |
$2,755.85
|
| Rate for Payer: Encore All Commercial |
$2,882.68
|
| Rate for Payer: Frontpath All Commercial |
$2,881.11
|
| Rate for Payer: Humana ChoiceCare |
$2,704.80
|
| Rate for Payer: Humana Medicare |
$1,597.14
|
| Rate for Payer: Lucent All Commercial |
$1,597.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,818.48
|
| Rate for Payer: Managed Health Services Medicaid |
$1,019.85
|
| Rate for Payer: MDWise Medicaid |
$1,019.85
|
| Rate for Payer: PHCS All Commercial |
$2,348.73
|
| Rate for Payer: PHP All Commercial |
$2,375.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,221.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,417.63
|
| Rate for Payer: Signature Care EPO |
$2,599.27
|
| Rate for Payer: Signature Care PPO |
$2,755.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,661.90
|
| Rate for Payer: United Healthcare Commercial |
$2,467.74
|
| Rate for Payer: United Healthcare Medicare |
$1,033.44
|
|
|
HC MYOCARDIAL PERFUSION SINGLE PLANAR
|
Facility
OP
|
$2,348.74
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
01639013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$707.19 |
| Max. Negotiated Rate |
$2,184.33 |
| Rate for Payer: Aetna Commercial |
$1,982.34
|
| Rate for Payer: Aetna Medicare |
$775.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$775.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,348.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,468.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$707.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$891.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$852.59
|
| Rate for Payer: Cash Price |
$1,456.22
|
| Rate for Payer: Cash Price |
$1,456.22
|
| Rate for Payer: Centivo All Commercial |
$1,197.86
|
| Rate for Payer: Cigna All Commercial |
$2,026.97
|
| Rate for Payer: CORVEL All Commercial |
$2,184.33
|
| Rate for Payer: Coventry All Commercial |
$2,066.89
|
| Rate for Payer: Encore All Commercial |
$2,162.02
|
| Rate for Payer: Frontpath All Commercial |
$2,160.84
|
| Rate for Payer: Humana ChoiceCare |
$2,028.61
|
| Rate for Payer: Humana Medicare |
$1,197.86
|
| Rate for Payer: Lucent All Commercial |
$1,197.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,113.87
|
| Rate for Payer: Managed Health Services Medicaid |
$707.19
|
| Rate for Payer: MDWise Medicaid |
$707.19
|
| Rate for Payer: PHCS All Commercial |
$1,761.56
|
| Rate for Payer: PHP All Commercial |
$1,781.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$916.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,813.23
|
| Rate for Payer: Signature Care EPO |
$1,949.46
|
| Rate for Payer: Signature Care PPO |
$2,066.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,996.43
|
| Rate for Payer: United Healthcare Commercial |
$1,850.81
|
| Rate for Payer: United Healthcare Medicare |
$775.09
|
|
|
HC MYOCARDIAL PERFUSION SINGLE PLANAR
|
Facility
IP
|
$2,348.74
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
01639013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,761.56 |
| Max. Negotiated Rate |
$2,184.33 |
| Rate for Payer: Aetna Commercial |
$2,029.31
|
| Rate for Payer: Cash Price |
$1,456.22
|
| Rate for Payer: Cigna All Commercial |
$2,026.97
|
| Rate for Payer: CORVEL All Commercial |
$2,184.33
|
| Rate for Payer: Coventry All Commercial |
$2,066.89
|
| Rate for Payer: Encore All Commercial |
$2,162.02
|
| Rate for Payer: Frontpath All Commercial |
$2,160.84
|
| Rate for Payer: Humana ChoiceCare |
$2,028.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,113.87
|
| Rate for Payer: PHCS All Commercial |
$1,761.56
|
| Rate for Payer: PHP All Commercial |
$1,781.29
|
| Rate for Payer: Sagamore Health Network All Products |
$1,813.23
|
| Rate for Payer: Signature Care EPO |
$1,949.46
|
| Rate for Payer: Signature Care PPO |
$2,066.89
|
| Rate for Payer: United Healthcare Commercial |
$1,850.81
|
|
|
HC MYOGLOBIN UR
|
Facility
OP
|
$80.78
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
63001639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$68.18
|
| Rate for Payer: Aetna Medicare |
$26.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.32
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Centivo All Commercial |
$41.20
|
| Rate for Payer: Cigna All Commercial |
$69.72
|
| Rate for Payer: CORVEL All Commercial |
$75.13
|
| Rate for Payer: Coventry All Commercial |
$71.09
|
| Rate for Payer: Encore All Commercial |
$74.36
|
| Rate for Payer: Frontpath All Commercial |
$74.32
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Humana Medicare |
$41.20
|
| Rate for Payer: Lucent All Commercial |
$41.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.71
|
| Rate for Payer: Managed Health Services Medicaid |
$12.92
|
| Rate for Payer: MDWise Medicaid |
$12.92
|
| Rate for Payer: PHCS All Commercial |
$60.59
|
| Rate for Payer: PHP All Commercial |
$61.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.51
|
| Rate for Payer: Sagamore Health Network All Products |
$62.37
|
| Rate for Payer: Signature Care EPO |
$67.05
|
| Rate for Payer: Signature Care PPO |
$71.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.67
|
| Rate for Payer: United Healthcare Commercial |
$63.66
|
| Rate for Payer: United Healthcare Medicare |
$26.66
|
|
|
HC MYOGLOBIN UR
|
Facility
IP
|
$80.78
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
63001639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.59 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$69.80
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cigna All Commercial |
$69.72
|
| Rate for Payer: CORVEL All Commercial |
$75.13
|
| Rate for Payer: Coventry All Commercial |
$71.09
|
| Rate for Payer: Encore All Commercial |
$74.36
|
| Rate for Payer: Frontpath All Commercial |
$74.32
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.71
|
| Rate for Payer: PHCS All Commercial |
$60.59
|
| Rate for Payer: PHP All Commercial |
$61.27
|
| Rate for Payer: Sagamore Health Network All Products |
$62.37
|
| Rate for Payer: Signature Care EPO |
$67.05
|
| Rate for Payer: Signature Care PPO |
$71.09
|
| Rate for Payer: United Healthcare Commercial |
$63.66
|
|
|
HC MYOSURE ROD LENS SEALS
|
Facility
OP
|
$72.10
|
|
| Hospital Charge Code |
41602184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$60.85
|
| Rate for Payer: Aetna Medicare |
$23.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.17
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Centivo All Commercial |
$36.77
|
| Rate for Payer: Cigna All Commercial |
$62.22
|
| Rate for Payer: CORVEL All Commercial |
$67.05
|
| Rate for Payer: Coventry All Commercial |
$63.45
|
| Rate for Payer: Encore All Commercial |
$66.37
|
| Rate for Payer: Frontpath All Commercial |
$66.33
|
| Rate for Payer: Humana ChoiceCare |
$62.27
|
| Rate for Payer: Humana Medicare |
$36.77
|
| Rate for Payer: Lucent All Commercial |
$36.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.89
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$54.08
|
| Rate for Payer: PHP All Commercial |
$54.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.12
|
| Rate for Payer: Sagamore Health Network All Products |
$55.66
|
| Rate for Payer: Signature Care EPO |
$59.84
|
| Rate for Payer: Signature Care PPO |
$63.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.28
|
| Rate for Payer: United Healthcare Commercial |
$56.81
|
| Rate for Payer: United Healthcare Medicare |
$23.79
|
|
|
HC MYOSURE ROD LENS SEALS
|
Facility
IP
|
$72.10
|
|
| Hospital Charge Code |
41602184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$67.05 |
| Rate for Payer: Aetna Commercial |
$62.29
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cigna All Commercial |
$62.22
|
| Rate for Payer: CORVEL All Commercial |
$67.05
|
| Rate for Payer: Coventry All Commercial |
$63.45
|
| Rate for Payer: Encore All Commercial |
$66.37
|
| Rate for Payer: Frontpath All Commercial |
$66.33
|
| Rate for Payer: Humana ChoiceCare |
$62.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.89
|
| Rate for Payer: PHCS All Commercial |
$54.08
|
| Rate for Payer: PHP All Commercial |
$54.68
|
| Rate for Payer: Sagamore Health Network All Products |
$55.66
|
| Rate for Payer: Signature Care EPO |
$59.84
|
| Rate for Payer: Signature Care PPO |
$63.45
|
| Rate for Payer: United Healthcare Commercial |
$56.81
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
IP
|
$556.92
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
01542511
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$417.69 |
| Max. Negotiated Rate |
$517.94 |
| Rate for Payer: Aetna Commercial |
$481.18
|
| Rate for Payer: Cash Price |
$345.29
|
| Rate for Payer: Cigna All Commercial |
$480.62
|
| Rate for Payer: CORVEL All Commercial |
$517.94
|
| Rate for Payer: Coventry All Commercial |
$490.09
|
| Rate for Payer: Encore All Commercial |
$512.64
|
| Rate for Payer: Frontpath All Commercial |
$512.37
|
| Rate for Payer: Humana ChoiceCare |
$481.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$501.23
|
| Rate for Payer: PHCS All Commercial |
$417.69
|
| Rate for Payer: PHP All Commercial |
$422.37
|
| Rate for Payer: Sagamore Health Network All Products |
$429.94
|
| Rate for Payer: Signature Care EPO |
$462.24
|
| Rate for Payer: Signature Care PPO |
$490.09
|
| Rate for Payer: United Healthcare Commercial |
$438.85
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
OP
|
$556.92
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
01542511
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$183.78 |
| Max. Negotiated Rate |
$517.94 |
| Rate for Payer: Aetna Commercial |
$470.04
|
| Rate for Payer: Aetna Medicare |
$183.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$183.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$319.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$348.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$211.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$202.16
|
| Rate for Payer: Cash Price |
$345.29
|
| Rate for Payer: Cash Price |
$345.29
|
| Rate for Payer: Centivo All Commercial |
$284.03
|
| Rate for Payer: Cigna All Commercial |
$480.62
|
| Rate for Payer: CORVEL All Commercial |
$517.94
|
| Rate for Payer: Coventry All Commercial |
$490.09
|
| Rate for Payer: Encore All Commercial |
$512.64
|
| Rate for Payer: Frontpath All Commercial |
$512.37
|
| Rate for Payer: Humana ChoiceCare |
$481.01
|
| Rate for Payer: Humana Medicare |
$284.03
|
| Rate for Payer: Lucent All Commercial |
$284.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$501.23
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$417.69
|
| Rate for Payer: PHP All Commercial |
$422.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$217.20
|
| Rate for Payer: Sagamore Health Network All Products |
$429.94
|
| Rate for Payer: Signature Care EPO |
$462.24
|
| Rate for Payer: Signature Care PPO |
$490.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$473.38
|
| Rate for Payer: United Healthcare Commercial |
$438.85
|
| Rate for Payer: United Healthcare Medicare |
$183.78
|
|
|
HC NEC URINE ALCOHOL
|
Facility
IP
|
$24.98
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001404
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Cigna All Commercial |
$21.56
|
| Rate for Payer: CORVEL All Commercial |
$23.23
|
| Rate for Payer: Coventry All Commercial |
$21.98
|
| Rate for Payer: Encore All Commercial |
$22.99
|
| Rate for Payer: Frontpath All Commercial |
$22.98
|
| Rate for Payer: Humana ChoiceCare |
$21.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.48
|
| Rate for Payer: PHCS All Commercial |
$18.73
|
| Rate for Payer: PHP All Commercial |
$18.94
|
| Rate for Payer: Sagamore Health Network All Products |
$19.28
|
| Rate for Payer: Signature Care EPO |
$20.73
|
| Rate for Payer: Signature Care PPO |
$21.98
|
| Rate for Payer: United Healthcare Commercial |
$19.68
|
|
|
HC NEC URINE ALCOHOL
|
Facility
OP
|
$24.98
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001404
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$77.12 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna Medicare |
$8.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.07
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Centivo All Commercial |
$12.74
|
| Rate for Payer: Cigna All Commercial |
$21.56
|
| Rate for Payer: CORVEL All Commercial |
$23.23
|
| Rate for Payer: Coventry All Commercial |
$21.98
|
| Rate for Payer: Encore All Commercial |
$22.99
|
| Rate for Payer: Frontpath All Commercial |
$22.98
|
| Rate for Payer: Humana ChoiceCare |
$21.58
|
| Rate for Payer: Humana Medicare |
$12.74
|
| Rate for Payer: Lucent All Commercial |
$12.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.48
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$18.73
|
| Rate for Payer: PHP All Commercial |
$18.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.74
|
| Rate for Payer: Sagamore Health Network All Products |
$19.28
|
| Rate for Payer: Signature Care EPO |
$20.73
|
| Rate for Payer: Signature Care PPO |
$21.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.23
|
| Rate for Payer: United Healthcare Commercial |
$19.68
|
| Rate for Payer: United Healthcare Medicare |
$8.24
|
|
|
HC NEEDLE 13G 7.8 CM TRUGUIDE
|
Facility
OP
|
$92.92
|
|
| Hospital Charge Code |
41601874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$78.42
|
| Rate for Payer: Aetna Medicare |
$30.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.73
|
| Rate for Payer: Cash Price |
$57.61
|
| Rate for Payer: Cash Price |
$57.61
|
| Rate for Payer: Centivo All Commercial |
$47.39
|
| Rate for Payer: Cigna All Commercial |
$80.19
|
| Rate for Payer: CORVEL All Commercial |
$86.42
|
| Rate for Payer: Coventry All Commercial |
$81.77
|
| Rate for Payer: Encore All Commercial |
$85.53
|
| Rate for Payer: Frontpath All Commercial |
$85.49
|
| Rate for Payer: Humana ChoiceCare |
$80.26
|
| Rate for Payer: Humana Medicare |
$47.39
|
| Rate for Payer: Lucent All Commercial |
$47.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$69.69
|
| Rate for Payer: PHP All Commercial |
$70.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.24
|
| Rate for Payer: Sagamore Health Network All Products |
$71.73
|
| Rate for Payer: Signature Care EPO |
$77.12
|
| Rate for Payer: Signature Care PPO |
$81.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.98
|
| Rate for Payer: United Healthcare Commercial |
$73.22
|
| Rate for Payer: United Healthcare Medicare |
$30.66
|
|
|
HC NEEDLE 13G 7.8 CM TRUGUIDE
|
Facility
IP
|
$92.92
|
|
| Hospital Charge Code |
41601874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.69 |
| Max. Negotiated Rate |
$86.42 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Cash Price |
$57.61
|
| Rate for Payer: Cigna All Commercial |
$80.19
|
| Rate for Payer: CORVEL All Commercial |
$86.42
|
| Rate for Payer: Coventry All Commercial |
$81.77
|
| Rate for Payer: Encore All Commercial |
$85.53
|
| Rate for Payer: Frontpath All Commercial |
$85.49
|
| Rate for Payer: Humana ChoiceCare |
$80.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.63
|
| Rate for Payer: PHCS All Commercial |
$69.69
|
| Rate for Payer: PHP All Commercial |
$70.47
|
| Rate for Payer: Sagamore Health Network All Products |
$71.73
|
| Rate for Payer: Signature Care EPO |
$77.12
|
| Rate for Payer: Signature Care PPO |
$81.77
|
| Rate for Payer: United Healthcare Commercial |
$73.22
|
|
|
HC NEEDLE BIOPSY 14GX10CM
|
Facility
OP
|
$227.71
|
|
| Hospital Charge Code |
41601335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.14 |
| Max. Negotiated Rate |
$211.77 |
| Rate for Payer: Aetna Commercial |
$192.19
|
| Rate for Payer: Aetna Medicare |
$75.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$130.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.66
|
| Rate for Payer: Cash Price |
$141.18
|
| Rate for Payer: Cash Price |
$141.18
|
| Rate for Payer: Centivo All Commercial |
$116.13
|
| Rate for Payer: Cigna All Commercial |
$196.51
|
| Rate for Payer: CORVEL All Commercial |
$211.77
|
| Rate for Payer: Coventry All Commercial |
$200.38
|
| Rate for Payer: Encore All Commercial |
$209.61
|
| Rate for Payer: Frontpath All Commercial |
$209.49
|
| Rate for Payer: Humana ChoiceCare |
$196.67
|
| Rate for Payer: Humana Medicare |
$116.13
|
| Rate for Payer: Lucent All Commercial |
$116.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.94
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$170.78
|
| Rate for Payer: PHP All Commercial |
$172.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.81
|
| Rate for Payer: Sagamore Health Network All Products |
$175.79
|
| Rate for Payer: Signature Care EPO |
$189.00
|
| Rate for Payer: Signature Care PPO |
$200.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$193.55
|
| Rate for Payer: United Healthcare Commercial |
$179.44
|
| Rate for Payer: United Healthcare Medicare |
$75.14
|
|
|
HC NEEDLE BIOPSY 14GX10CM
|
Facility
IP
|
$227.71
|
|
| Hospital Charge Code |
41601335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.78 |
| Max. Negotiated Rate |
$211.77 |
| Rate for Payer: Aetna Commercial |
$196.74
|
| Rate for Payer: Cash Price |
$141.18
|
| Rate for Payer: Cigna All Commercial |
$196.51
|
| Rate for Payer: CORVEL All Commercial |
$211.77
|
| Rate for Payer: Coventry All Commercial |
$200.38
|
| Rate for Payer: Encore All Commercial |
$209.61
|
| Rate for Payer: Frontpath All Commercial |
$209.49
|
| Rate for Payer: Humana ChoiceCare |
$196.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.94
|
| Rate for Payer: PHCS All Commercial |
$170.78
|
| Rate for Payer: PHP All Commercial |
$172.70
|
| Rate for Payer: Sagamore Health Network All Products |
$175.79
|
| Rate for Payer: Signature Care EPO |
$189.00
|
| Rate for Payer: Signature Care PPO |
$200.38
|
| Rate for Payer: United Healthcare Commercial |
$179.44
|
|
