|
HC NG ANTI REFLUX VALVE
|
Facility
IP
|
$39.32
|
|
| Hospital Charge Code |
41601198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$36.57 |
| Rate for Payer: Aetna Commercial |
$33.97
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cigna All Commercial |
$33.93
|
| Rate for Payer: CORVEL All Commercial |
$36.57
|
| Rate for Payer: Coventry All Commercial |
$34.60
|
| Rate for Payer: Encore All Commercial |
$36.19
|
| Rate for Payer: Frontpath All Commercial |
$36.17
|
| Rate for Payer: Humana ChoiceCare |
$33.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.39
|
| Rate for Payer: PHCS All Commercial |
$29.49
|
| Rate for Payer: PHP All Commercial |
$29.82
|
| Rate for Payer: Sagamore Health Network All Products |
$30.36
|
| Rate for Payer: Signature Care EPO |
$32.64
|
| Rate for Payer: Signature Care PPO |
$34.60
|
| Rate for Payer: United Healthcare Commercial |
$30.98
|
|
|
HC NG ANTI REFLUX VALVE
|
Facility
OP
|
$39.32
|
|
| Hospital Charge Code |
41601198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$33.19
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.27
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Centivo All Commercial |
$20.05
|
| Rate for Payer: Cigna All Commercial |
$33.93
|
| Rate for Payer: CORVEL All Commercial |
$36.57
|
| Rate for Payer: Coventry All Commercial |
$34.60
|
| Rate for Payer: Encore All Commercial |
$36.19
|
| Rate for Payer: Frontpath All Commercial |
$36.17
|
| Rate for Payer: Humana ChoiceCare |
$33.96
|
| Rate for Payer: Humana Medicare |
$20.05
|
| Rate for Payer: Lucent All Commercial |
$20.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.39
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.49
|
| Rate for Payer: PHP All Commercial |
$29.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.33
|
| Rate for Payer: Sagamore Health Network All Products |
$30.36
|
| Rate for Payer: Signature Care EPO |
$32.64
|
| Rate for Payer: Signature Care PPO |
$34.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.42
|
| Rate for Payer: United Healthcare Commercial |
$30.98
|
| Rate for Payer: United Healthcare Medicare |
$12.98
|
|
|
HC N GONORRHOEAE-AMP PROBE
|
Facility
IP
|
$137.70
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
63002048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.28 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$118.97
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Cigna All Commercial |
$118.84
|
| Rate for Payer: CORVEL All Commercial |
$128.06
|
| Rate for Payer: Coventry All Commercial |
$121.18
|
| Rate for Payer: Encore All Commercial |
$126.75
|
| Rate for Payer: Frontpath All Commercial |
$126.68
|
| Rate for Payer: Humana ChoiceCare |
$118.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.93
|
| Rate for Payer: PHCS All Commercial |
$103.28
|
| Rate for Payer: PHP All Commercial |
$104.43
|
| Rate for Payer: Sagamore Health Network All Products |
$106.30
|
| Rate for Payer: Signature Care EPO |
$114.29
|
| Rate for Payer: Signature Care PPO |
$121.18
|
| Rate for Payer: United Healthcare Commercial |
$108.51
|
|
|
HC N GONORRHOEAE-AMP PROBE
|
Facility
OP
|
$137.70
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
63002048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$116.22
|
| Rate for Payer: Aetna Medicare |
$45.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.99
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Centivo All Commercial |
$70.23
|
| Rate for Payer: Cigna All Commercial |
$118.84
|
| Rate for Payer: CORVEL All Commercial |
$128.06
|
| Rate for Payer: Coventry All Commercial |
$121.18
|
| Rate for Payer: Encore All Commercial |
$126.75
|
| Rate for Payer: Frontpath All Commercial |
$126.68
|
| Rate for Payer: Humana ChoiceCare |
$118.93
|
| Rate for Payer: Humana Medicare |
$70.23
|
| Rate for Payer: Lucent All Commercial |
$70.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.93
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$103.28
|
| Rate for Payer: PHP All Commercial |
$104.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.70
|
| Rate for Payer: Sagamore Health Network All Products |
$106.30
|
| Rate for Payer: Signature Care EPO |
$114.29
|
| Rate for Payer: Signature Care PPO |
$121.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.04
|
| Rate for Payer: United Healthcare Commercial |
$108.51
|
| Rate for Payer: United Healthcare Medicare |
$45.44
|
|
|
HC N GONORRHOEAE-DIR PROBE
|
Facility
OP
|
$87.23
|
|
|
Service Code
|
CPT 87590
|
| Hospital Charge Code |
63002046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$81.12 |
| Rate for Payer: Aetna Commercial |
$73.62
|
| Rate for Payer: Aetna Medicare |
$28.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$26.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.66
|
| Rate for Payer: Cash Price |
$54.08
|
| Rate for Payer: Cash Price |
$54.08
|
| Rate for Payer: Centivo All Commercial |
$44.49
|
| Rate for Payer: Cigna All Commercial |
$75.28
|
| Rate for Payer: CORVEL All Commercial |
$81.12
|
| Rate for Payer: Coventry All Commercial |
$76.76
|
| Rate for Payer: Encore All Commercial |
$80.30
|
| Rate for Payer: Frontpath All Commercial |
$80.25
|
| Rate for Payer: Humana ChoiceCare |
$75.34
|
| Rate for Payer: Humana Medicare |
$44.49
|
| Rate for Payer: Lucent All Commercial |
$44.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.51
|
| Rate for Payer: Managed Health Services Medicaid |
$26.88
|
| Rate for Payer: MDWise Medicaid |
$26.88
|
| Rate for Payer: PHCS All Commercial |
$65.42
|
| Rate for Payer: PHP All Commercial |
$66.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.02
|
| Rate for Payer: Sagamore Health Network All Products |
$67.34
|
| Rate for Payer: Signature Care EPO |
$72.40
|
| Rate for Payer: Signature Care PPO |
$76.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.15
|
| Rate for Payer: United Healthcare Commercial |
$68.74
|
| Rate for Payer: United Healthcare Medicare |
$28.79
|
|
|
HC N GONORRHOEAE-DIR PROBE
|
Facility
IP
|
$87.23
|
|
|
Service Code
|
CPT 87590
|
| Hospital Charge Code |
63002046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.42 |
| Max. Negotiated Rate |
$81.12 |
| Rate for Payer: Aetna Commercial |
$75.37
|
| Rate for Payer: Cash Price |
$54.08
|
| Rate for Payer: Cigna All Commercial |
$75.28
|
| Rate for Payer: CORVEL All Commercial |
$81.12
|
| Rate for Payer: Coventry All Commercial |
$76.76
|
| Rate for Payer: Encore All Commercial |
$80.30
|
| Rate for Payer: Frontpath All Commercial |
$80.25
|
| Rate for Payer: Humana ChoiceCare |
$75.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.51
|
| Rate for Payer: PHCS All Commercial |
$65.42
|
| Rate for Payer: PHP All Commercial |
$66.16
|
| Rate for Payer: Sagamore Health Network All Products |
$67.34
|
| Rate for Payer: Signature Care EPO |
$72.40
|
| Rate for Payer: Signature Care PPO |
$76.76
|
| Rate for Payer: United Healthcare Commercial |
$68.74
|
|
|
HC NG TUBE GUARD
|
Facility
IP
|
$17.12
|
|
| Hospital Charge Code |
41601189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cigna All Commercial |
$14.77
|
| Rate for Payer: CORVEL All Commercial |
$15.92
|
| Rate for Payer: Coventry All Commercial |
$15.07
|
| Rate for Payer: Encore All Commercial |
$15.76
|
| Rate for Payer: Frontpath All Commercial |
$15.75
|
| Rate for Payer: Humana ChoiceCare |
$14.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.41
|
| Rate for Payer: PHCS All Commercial |
$12.84
|
| Rate for Payer: PHP All Commercial |
$12.98
|
| Rate for Payer: Sagamore Health Network All Products |
$13.22
|
| Rate for Payer: Signature Care EPO |
$14.21
|
| Rate for Payer: Signature Care PPO |
$15.07
|
| Rate for Payer: United Healthcare Commercial |
$13.49
|
|
|
HC NG TUBE GUARD
|
Facility
OP
|
$17.12
|
|
| Hospital Charge Code |
41601189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Medicare |
$5.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.21
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Centivo All Commercial |
$8.73
|
| Rate for Payer: Cigna All Commercial |
$14.77
|
| Rate for Payer: CORVEL All Commercial |
$15.92
|
| Rate for Payer: Coventry All Commercial |
$15.07
|
| Rate for Payer: Encore All Commercial |
$15.76
|
| Rate for Payer: Frontpath All Commercial |
$15.75
|
| Rate for Payer: Humana ChoiceCare |
$14.79
|
| Rate for Payer: Humana Medicare |
$8.73
|
| Rate for Payer: Lucent All Commercial |
$8.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.41
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.84
|
| Rate for Payer: PHP All Commercial |
$12.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.68
|
| Rate for Payer: Sagamore Health Network All Products |
$13.22
|
| Rate for Payer: Signature Care EPO |
$14.21
|
| Rate for Payer: Signature Care PPO |
$15.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.55
|
| Rate for Payer: United Healthcare Commercial |
$13.49
|
| Rate for Payer: United Healthcare Medicare |
$5.65
|
|
|
HC NICOTINE & METABOLITES
|
Facility
IP
|
$187.75
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.81 |
| Max. Negotiated Rate |
$174.61 |
| Rate for Payer: Aetna Commercial |
$162.22
|
| Rate for Payer: Cash Price |
$116.41
|
| Rate for Payer: Cigna All Commercial |
$162.03
|
| Rate for Payer: CORVEL All Commercial |
$174.61
|
| Rate for Payer: Coventry All Commercial |
$165.22
|
| Rate for Payer: Encore All Commercial |
$172.83
|
| Rate for Payer: Frontpath All Commercial |
$172.73
|
| Rate for Payer: Humana ChoiceCare |
$162.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.98
|
| Rate for Payer: PHCS All Commercial |
$140.81
|
| Rate for Payer: PHP All Commercial |
$142.39
|
| Rate for Payer: Sagamore Health Network All Products |
$144.94
|
| Rate for Payer: Signature Care EPO |
$155.83
|
| Rate for Payer: Signature Care PPO |
$165.22
|
| Rate for Payer: United Healthcare Commercial |
$147.95
|
|
|
HC NICOTINE & METABOLITES
|
Facility
OP
|
$187.75
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.96 |
| Max. Negotiated Rate |
$174.61 |
| Rate for Payer: Aetna Commercial |
$158.46
|
| Rate for Payer: Aetna Medicare |
$61.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.15
|
| Rate for Payer: Cash Price |
$116.41
|
| Rate for Payer: Cash Price |
$116.41
|
| Rate for Payer: Centivo All Commercial |
$95.75
|
| Rate for Payer: Cigna All Commercial |
$162.03
|
| Rate for Payer: CORVEL All Commercial |
$174.61
|
| Rate for Payer: Coventry All Commercial |
$165.22
|
| Rate for Payer: Encore All Commercial |
$172.83
|
| Rate for Payer: Frontpath All Commercial |
$172.73
|
| Rate for Payer: Humana ChoiceCare |
$162.16
|
| Rate for Payer: Humana Medicare |
$95.75
|
| Rate for Payer: Lucent All Commercial |
$95.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.98
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$140.81
|
| Rate for Payer: PHP All Commercial |
$142.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.22
|
| Rate for Payer: Sagamore Health Network All Products |
$144.94
|
| Rate for Payer: Signature Care EPO |
$155.83
|
| Rate for Payer: Signature Care PPO |
$165.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.59
|
| Rate for Payer: United Healthcare Commercial |
$147.95
|
| Rate for Payer: United Healthcare Medicare |
$61.96
|
|
|
HC NMR LIPOPROFILE (WITH GRAPH)
|
Facility
OP
|
$127.91
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63044059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Commercial |
$107.95
|
| Rate for Payer: Aetna Medicare |
$42.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.43
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Centivo All Commercial |
$65.23
|
| Rate for Payer: Cigna All Commercial |
$110.38
|
| Rate for Payer: CORVEL All Commercial |
$118.95
|
| Rate for Payer: Coventry All Commercial |
$112.56
|
| Rate for Payer: Encore All Commercial |
$117.74
|
| Rate for Payer: Frontpath All Commercial |
$117.68
|
| Rate for Payer: Humana ChoiceCare |
$110.47
|
| Rate for Payer: Humana Medicare |
$65.23
|
| Rate for Payer: Lucent All Commercial |
$65.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.12
|
| Rate for Payer: Managed Health Services Medicaid |
$13.39
|
| Rate for Payer: MDWise Medicaid |
$13.39
|
| Rate for Payer: PHCS All Commercial |
$95.93
|
| Rate for Payer: PHP All Commercial |
$97.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.88
|
| Rate for Payer: Sagamore Health Network All Products |
$98.74
|
| Rate for Payer: Signature Care EPO |
$106.16
|
| Rate for Payer: Signature Care PPO |
$112.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.72
|
| Rate for Payer: United Healthcare Commercial |
$100.79
|
| Rate for Payer: United Healthcare Medicare |
$42.21
|
|
|
HC NMR LIPOPROFILE (WITH GRAPH)
|
Facility
IP
|
$127.91
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63044059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.93 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Commercial |
$110.51
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cigna All Commercial |
$110.38
|
| Rate for Payer: CORVEL All Commercial |
$118.95
|
| Rate for Payer: Coventry All Commercial |
$112.56
|
| Rate for Payer: Encore All Commercial |
$117.74
|
| Rate for Payer: Frontpath All Commercial |
$117.68
|
| Rate for Payer: Humana ChoiceCare |
$110.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.12
|
| Rate for Payer: PHCS All Commercial |
$95.93
|
| Rate for Payer: PHP All Commercial |
$97.01
|
| Rate for Payer: Sagamore Health Network All Products |
$98.74
|
| Rate for Payer: Signature Care EPO |
$106.16
|
| Rate for Payer: Signature Care PPO |
$112.56
|
| Rate for Payer: United Healthcare Commercial |
$100.79
|
|
|
HC NMR LIPOPROFILE (WITH GRAPH)-B
|
Facility
IP
|
$216.07
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
63044060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$200.94 |
| Rate for Payer: Cigna All Commercial |
$186.47
|
| Rate for Payer: Aetna Commercial |
$186.68
|
| Rate for Payer: Cash Price |
$133.96
|
| Rate for Payer: CORVEL All Commercial |
$200.94
|
| Rate for Payer: Coventry All Commercial |
$190.14
|
| Rate for Payer: Encore All Commercial |
$198.89
|
| Rate for Payer: Frontpath All Commercial |
$198.78
|
| Rate for Payer: Humana ChoiceCare |
$186.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.46
|
| Rate for Payer: PHCS All Commercial |
$162.05
|
| Rate for Payer: PHP All Commercial |
$163.86
|
| Rate for Payer: Sagamore Health Network All Products |
$166.80
|
| Rate for Payer: Signature Care EPO |
$179.34
|
| Rate for Payer: Signature Care PPO |
$190.14
|
| Rate for Payer: United Healthcare Commercial |
$170.26
|
|
|
HC NMR LIPOPROFILE (WITH GRAPH)-B
|
Facility
OP
|
$216.07
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
63044060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$200.94 |
| Rate for Payer: Aetna Commercial |
$182.36
|
| Rate for Payer: Aetna Medicare |
$71.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$124.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$34.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.43
|
| Rate for Payer: Cash Price |
$133.96
|
| Rate for Payer: Cash Price |
$133.96
|
| Rate for Payer: Centivo All Commercial |
$110.19
|
| Rate for Payer: Cigna All Commercial |
$186.47
|
| Rate for Payer: CORVEL All Commercial |
$200.94
|
| Rate for Payer: Coventry All Commercial |
$190.14
|
| Rate for Payer: Encore All Commercial |
$198.89
|
| Rate for Payer: Frontpath All Commercial |
$198.78
|
| Rate for Payer: Humana ChoiceCare |
$186.62
|
| Rate for Payer: Humana Medicare |
$110.19
|
| Rate for Payer: Lucent All Commercial |
$110.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.46
|
| Rate for Payer: Managed Health Services Medicaid |
$34.19
|
| Rate for Payer: MDWise Medicaid |
$34.19
|
| Rate for Payer: PHCS All Commercial |
$162.05
|
| Rate for Payer: PHP All Commercial |
$163.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.27
|
| Rate for Payer: Sagamore Health Network All Products |
$166.80
|
| Rate for Payer: Signature Care EPO |
$179.34
|
| Rate for Payer: Signature Care PPO |
$190.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$183.66
|
| Rate for Payer: United Healthcare Commercial |
$170.26
|
| Rate for Payer: United Healthcare Medicare |
$71.30
|
|
|
HC NMR LIPOPROFILE WITH INSULIN RESISTANCE MARKERS (WITH GRAPH)
|
Facility
IP
|
$53.55
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63044061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
|
HC NMR LIPOPROFILE WITH INSULIN RESISTANCE MARKERS (WITH GRAPH)
|
Facility
OP
|
$53.55
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63044061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.44
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Centivo All Commercial |
$27.31
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$27.31
|
| Rate for Payer: Lucent All Commercial |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$13.39
|
| Rate for Payer: MDWise Medicaid |
$13.39
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.67
|
|
|
HC NMR LIPOPROFILE WITH INSULIN RESISTANCE MARKERS (WITH GRAPH)-B
|
Facility
IP
|
$53.55
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
63044062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
|
HC NMR LIPOPROFILE WITH INSULIN RESISTANCE MARKERS (WITH GRAPH)-B
|
Facility
OP
|
$53.55
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
63044062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$34.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.44
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Centivo All Commercial |
$27.31
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$27.31
|
| Rate for Payer: Lucent All Commercial |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$34.19
|
| Rate for Payer: MDWise Medicaid |
$34.19
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.67
|
|
|
HC NMR LIPOPROFILE WITHOUT LIPIDS (WITH GRAPH)
|
Facility
OP
|
$107.10
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
63044025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna Commercial |
$90.39
|
| Rate for Payer: Aetna Medicare |
$35.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$34.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.88
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Centivo All Commercial |
$54.62
|
| Rate for Payer: Cigna All Commercial |
$92.43
|
| Rate for Payer: CORVEL All Commercial |
$99.60
|
| Rate for Payer: Coventry All Commercial |
$94.25
|
| Rate for Payer: Encore All Commercial |
$98.59
|
| Rate for Payer: Frontpath All Commercial |
$98.53
|
| Rate for Payer: Humana ChoiceCare |
$92.50
|
| Rate for Payer: Humana Medicare |
$54.62
|
| Rate for Payer: Lucent All Commercial |
$54.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.39
|
| Rate for Payer: Managed Health Services Medicaid |
$34.19
|
| Rate for Payer: MDWise Medicaid |
$34.19
|
| Rate for Payer: PHCS All Commercial |
$80.32
|
| Rate for Payer: PHP All Commercial |
$81.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.77
|
| Rate for Payer: Sagamore Health Network All Products |
$82.68
|
| Rate for Payer: Signature Care EPO |
$88.89
|
| Rate for Payer: Signature Care PPO |
$94.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.04
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$35.34
|
|
|
HC NMR LIPOPROFILE WITHOUT LIPIDS (WITH GRAPH)
|
Facility
IP
|
$107.10
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
63044025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.32 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna Commercial |
$92.53
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cigna All Commercial |
$92.43
|
| Rate for Payer: CORVEL All Commercial |
$99.60
|
| Rate for Payer: Coventry All Commercial |
$94.25
|
| Rate for Payer: Encore All Commercial |
$98.59
|
| Rate for Payer: Frontpath All Commercial |
$98.53
|
| Rate for Payer: Humana ChoiceCare |
$92.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.39
|
| Rate for Payer: PHCS All Commercial |
$80.32
|
| Rate for Payer: PHP All Commercial |
$81.22
|
| Rate for Payer: Sagamore Health Network All Products |
$82.68
|
| Rate for Payer: Signature Care EPO |
$88.89
|
| Rate for Payer: Signature Care PPO |
$94.25
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
|
|
HC NON SP GEN AAC TX
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92606 GN
|
| Hospital Charge Code |
01742606
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
|
HC NON SP GEN AAC TX
|
Facility
IP
|
$369.69
|
|
|
Service Code
|
CPT 92606 GN
|
| Hospital Charge Code |
01742606
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$319.41
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
|
|
HC NOROVIRUS, BY EIA, FECES
|
Facility
OP
|
$171.11
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
63002033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna Commercial |
$144.41
|
| Rate for Payer: Aetna Medicare |
$56.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.11
|
| Rate for Payer: Cash Price |
$106.09
|
| Rate for Payer: Cash Price |
$106.09
|
| Rate for Payer: Centivo All Commercial |
$87.26
|
| Rate for Payer: Cigna All Commercial |
$147.66
|
| Rate for Payer: CORVEL All Commercial |
$159.13
|
| Rate for Payer: Coventry All Commercial |
$150.57
|
| Rate for Payer: Encore All Commercial |
$157.50
|
| Rate for Payer: Frontpath All Commercial |
$157.42
|
| Rate for Payer: Humana ChoiceCare |
$147.78
|
| Rate for Payer: Humana Medicare |
$87.26
|
| Rate for Payer: Lucent All Commercial |
$87.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.99
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$128.33
|
| Rate for Payer: PHP All Commercial |
$129.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.73
|
| Rate for Payer: Sagamore Health Network All Products |
$132.09
|
| Rate for Payer: Signature Care EPO |
$142.02
|
| Rate for Payer: Signature Care PPO |
$150.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.44
|
| Rate for Payer: United Healthcare Commercial |
$134.83
|
| Rate for Payer: United Healthcare Medicare |
$56.46
|
|
|
HC NOROVIRUS, BY EIA, FECES
|
Facility
IP
|
$171.11
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
63002033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna Commercial |
$147.83
|
| Rate for Payer: Cash Price |
$106.09
|
| Rate for Payer: Cigna All Commercial |
$147.66
|
| Rate for Payer: CORVEL All Commercial |
$159.13
|
| Rate for Payer: Coventry All Commercial |
$150.57
|
| Rate for Payer: Encore All Commercial |
$157.50
|
| Rate for Payer: Frontpath All Commercial |
$157.42
|
| Rate for Payer: Humana ChoiceCare |
$147.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.99
|
| Rate for Payer: PHCS All Commercial |
$128.33
|
| Rate for Payer: PHP All Commercial |
$129.77
|
| Rate for Payer: Sagamore Health Network All Products |
$132.09
|
| Rate for Payer: Signature Care EPO |
$142.02
|
| Rate for Payer: Signature Care PPO |
$150.57
|
| Rate for Payer: United Healthcare Commercial |
$134.83
|
|
|
HC NORTRIPTYLINE
|
Facility
IP
|
$155.23
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.43 |
| Max. Negotiated Rate |
$144.37 |
| Rate for Payer: Aetna Commercial |
$134.12
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: Cigna All Commercial |
$133.97
|
| Rate for Payer: CORVEL All Commercial |
$144.37
|
| Rate for Payer: Coventry All Commercial |
$136.61
|
| Rate for Payer: Encore All Commercial |
$142.89
|
| Rate for Payer: Frontpath All Commercial |
$142.82
|
| Rate for Payer: Humana ChoiceCare |
$134.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.71
|
| Rate for Payer: PHCS All Commercial |
$116.43
|
| Rate for Payer: PHP All Commercial |
$117.73
|
| Rate for Payer: Sagamore Health Network All Products |
$119.84
|
| Rate for Payer: Signature Care EPO |
$128.84
|
| Rate for Payer: Signature Care PPO |
$136.61
|
| Rate for Payer: United Healthcare Commercial |
$122.32
|
|
