|
HC OBSERVATION NUR 24> HR
|
Facility
IP
|
$44.21
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$33.16 |
| Max. Negotiated Rate |
$41.11 |
| Rate for Payer: Aetna Commercial |
$38.19
|
| Rate for Payer: Cash Price |
$27.41
|
| Rate for Payer: Cigna All Commercial |
$38.15
|
| Rate for Payer: CORVEL All Commercial |
$41.11
|
| Rate for Payer: Coventry All Commercial |
$38.90
|
| Rate for Payer: Encore All Commercial |
$40.69
|
| Rate for Payer: Frontpath All Commercial |
$40.67
|
| Rate for Payer: Humana ChoiceCare |
$38.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.79
|
| Rate for Payer: PHCS All Commercial |
$33.16
|
| Rate for Payer: PHP All Commercial |
$33.53
|
| Rate for Payer: Sagamore Health Network All Products |
$34.13
|
| Rate for Payer: Signature Care EPO |
$36.69
|
| Rate for Payer: Signature Care PPO |
$38.90
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
|
|
HC OBSERVATION NUR 24> HR
|
Facility
OP
|
$44.21
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$757.73 |
| Rate for Payer: Aetna Commercial |
$37.31
|
| Rate for Payer: Aetna Medicare |
$14.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.05
|
| Rate for Payer: Cash Price |
$27.41
|
| Rate for Payer: Cash Price |
$27.41
|
| Rate for Payer: Centivo All Commercial |
$22.55
|
| Rate for Payer: Cigna All Commercial |
$38.15
|
| Rate for Payer: CORVEL All Commercial |
$41.11
|
| Rate for Payer: Coventry All Commercial |
$38.90
|
| Rate for Payer: Encore All Commercial |
$40.69
|
| Rate for Payer: Frontpath All Commercial |
$40.67
|
| Rate for Payer: Humana ChoiceCare |
$38.18
|
| Rate for Payer: Humana Medicare |
$22.55
|
| Rate for Payer: Lucent All Commercial |
$22.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.79
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$33.16
|
| Rate for Payer: PHP All Commercial |
$33.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.24
|
| Rate for Payer: Sagamore Health Network All Products |
$34.13
|
| Rate for Payer: Signature Care EPO |
$36.69
|
| Rate for Payer: Signature Care PPO |
$38.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.58
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$14.59
|
|
|
HC OBSERVATION NUR INITIAL
|
Facility
OP
|
$782.35
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$258.18 |
| Max. Negotiated Rate |
$757.73 |
| Rate for Payer: Aetna Commercial |
$660.30
|
| Rate for Payer: Aetna Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$449.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$296.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$283.99
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Centivo All Commercial |
$399.00
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Humana Medicare |
$399.00
|
| Rate for Payer: Lucent All Commercial |
$399.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$305.12
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$665.00
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
| Rate for Payer: United Healthcare Medicare |
$258.18
|
|
|
HC OBSERVATION NUR INITIAL
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$675.95
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
|
|
HC OBSERVATION OB <24 HR
|
Facility
IP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684010
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC OBSERVATION OB <24 HR
|
Facility
OP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684010
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$757.73 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.99
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Centivo All Commercial |
$9.83
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$9.83
|
| Rate for Payer: Lucent All Commercial |
$9.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.51
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
|
|
HC OBSERVATION OB 24> HR
|
Facility
IP
|
$68.50
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$63.71 |
| Rate for Payer: Aetna Commercial |
$59.19
|
| Rate for Payer: Cash Price |
$42.47
|
| Rate for Payer: Cigna All Commercial |
$59.12
|
| Rate for Payer: CORVEL All Commercial |
$63.71
|
| Rate for Payer: Coventry All Commercial |
$60.28
|
| Rate for Payer: Encore All Commercial |
$63.06
|
| Rate for Payer: Frontpath All Commercial |
$63.02
|
| Rate for Payer: Humana ChoiceCare |
$59.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.65
|
| Rate for Payer: PHCS All Commercial |
$51.38
|
| Rate for Payer: PHP All Commercial |
$51.95
|
| Rate for Payer: Sagamore Health Network All Products |
$52.88
|
| Rate for Payer: Signature Care EPO |
$56.86
|
| Rate for Payer: Signature Care PPO |
$60.28
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
|
|
HC OBSERVATION OB 24> HR
|
Facility
OP
|
$68.50
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$757.73 |
| Rate for Payer: Aetna Commercial |
$57.82
|
| Rate for Payer: Aetna Medicare |
$22.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.87
|
| Rate for Payer: Cash Price |
$42.47
|
| Rate for Payer: Cash Price |
$42.47
|
| Rate for Payer: Centivo All Commercial |
$34.94
|
| Rate for Payer: Cigna All Commercial |
$59.12
|
| Rate for Payer: CORVEL All Commercial |
$63.71
|
| Rate for Payer: Coventry All Commercial |
$60.28
|
| Rate for Payer: Encore All Commercial |
$63.06
|
| Rate for Payer: Frontpath All Commercial |
$63.02
|
| Rate for Payer: Humana ChoiceCare |
$59.17
|
| Rate for Payer: Humana Medicare |
$34.94
|
| Rate for Payer: Lucent All Commercial |
$34.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.65
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$51.38
|
| Rate for Payer: PHP All Commercial |
$51.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.72
|
| Rate for Payer: Sagamore Health Network All Products |
$52.88
|
| Rate for Payer: Signature Care EPO |
$56.86
|
| Rate for Payer: Signature Care PPO |
$60.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.23
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare |
$22.61
|
|
|
HC OBSERVATION OB INITIAL
|
Facility
OP
|
$1,154.97
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$381.14 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$974.79
|
| Rate for Payer: Aetna Medicare |
$381.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$381.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$663.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$438.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$419.25
|
| Rate for Payer: Cash Price |
$716.08
|
| Rate for Payer: Cash Price |
$716.08
|
| Rate for Payer: Centivo All Commercial |
$589.03
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.54
|
| Rate for Payer: Humana Medicare |
$589.03
|
| Rate for Payer: Lucent All Commercial |
$589.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$866.22
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$450.44
|
| Rate for Payer: Sagamore Health Network All Products |
$891.63
|
| Rate for Payer: Signature Care EPO |
$958.62
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$981.72
|
| Rate for Payer: United Healthcare Commercial |
$910.11
|
| Rate for Payer: United Healthcare Medicare |
$381.14
|
|
|
HC OBSERVATION OB INITIAL
|
Facility
IP
|
$1,154.97
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
01684012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$866.22 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$997.89
|
| Rate for Payer: Cash Price |
$716.08
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: PHCS All Commercial |
$866.22
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Sagamore Health Network All Products |
$891.63
|
| Rate for Payer: Signature Care EPO |
$958.62
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: United Healthcare Commercial |
$910.11
|
|
|
HC OBTRYX II HALO BLADDER SLING
|
Facility
OP
|
$6,052.93
|
|
| Hospital Charge Code |
41603891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,629.22 |
| Rate for Payer: Aetna Commercial |
$5,108.67
|
| Rate for Payer: Aetna Medicare |
$1,997.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,997.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,476.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,783.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,297.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,197.21
|
| Rate for Payer: Cash Price |
$3,752.82
|
| Rate for Payer: Cash Price |
$3,752.82
|
| Rate for Payer: Centivo All Commercial |
$3,086.99
|
| Rate for Payer: Cigna All Commercial |
$5,223.68
|
| Rate for Payer: CORVEL All Commercial |
$5,629.22
|
| Rate for Payer: Coventry All Commercial |
$5,326.58
|
| Rate for Payer: Encore All Commercial |
$5,571.72
|
| Rate for Payer: Frontpath All Commercial |
$5,568.70
|
| Rate for Payer: Humana ChoiceCare |
$5,227.92
|
| Rate for Payer: Humana Medicare |
$3,086.99
|
| Rate for Payer: Lucent All Commercial |
$3,086.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,447.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,539.70
|
| Rate for Payer: PHP All Commercial |
$4,590.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,360.64
|
| Rate for Payer: Sagamore Health Network All Products |
$4,672.86
|
| Rate for Payer: Signature Care EPO |
$5,023.93
|
| Rate for Payer: Signature Care PPO |
$5,326.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,144.99
|
| Rate for Payer: United Healthcare Commercial |
$4,769.71
|
| Rate for Payer: United Healthcare Medicare |
$1,997.47
|
|
|
HC OBTRYX II HALO BLADDER SLING
|
Facility
IP
|
$6,052.93
|
|
| Hospital Charge Code |
41603891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,539.70 |
| Max. Negotiated Rate |
$5,629.22 |
| Rate for Payer: Aetna Commercial |
$5,229.73
|
| Rate for Payer: Cash Price |
$3,752.82
|
| Rate for Payer: Cigna All Commercial |
$5,223.68
|
| Rate for Payer: CORVEL All Commercial |
$5,629.22
|
| Rate for Payer: Coventry All Commercial |
$5,326.58
|
| Rate for Payer: Encore All Commercial |
$5,571.72
|
| Rate for Payer: Frontpath All Commercial |
$5,568.70
|
| Rate for Payer: Humana ChoiceCare |
$5,227.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,447.64
|
| Rate for Payer: PHCS All Commercial |
$4,539.70
|
| Rate for Payer: PHP All Commercial |
$4,590.54
|
| Rate for Payer: Sagamore Health Network All Products |
$4,672.86
|
| Rate for Payer: Signature Care EPO |
$5,023.93
|
| Rate for Payer: Signature Care PPO |
$5,326.58
|
| Rate for Payer: United Healthcare Commercial |
$4,769.71
|
|
|
HC OCC BLOOD IMM SCREEN
|
Facility
IP
|
$108.30
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
63001166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.23 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$93.57
|
| Rate for Payer: Cash Price |
$67.15
|
| Rate for Payer: Cigna All Commercial |
$93.47
|
| Rate for Payer: CORVEL All Commercial |
$100.72
|
| Rate for Payer: Coventry All Commercial |
$95.31
|
| Rate for Payer: Encore All Commercial |
$99.69
|
| Rate for Payer: Frontpath All Commercial |
$99.64
|
| Rate for Payer: Humana ChoiceCare |
$93.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.47
|
| Rate for Payer: PHCS All Commercial |
$81.23
|
| Rate for Payer: PHP All Commercial |
$82.14
|
| Rate for Payer: Sagamore Health Network All Products |
$83.61
|
| Rate for Payer: Signature Care EPO |
$89.89
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
|
|
HC OCC BLOOD IMM SCREEN
|
Facility
OP
|
$108.30
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
63001166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$91.41
|
| Rate for Payer: Aetna Medicare |
$35.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.31
|
| Rate for Payer: Cash Price |
$67.15
|
| Rate for Payer: Cash Price |
$67.15
|
| Rate for Payer: Centivo All Commercial |
$55.23
|
| Rate for Payer: Cigna All Commercial |
$93.47
|
| Rate for Payer: CORVEL All Commercial |
$100.72
|
| Rate for Payer: Coventry All Commercial |
$95.31
|
| Rate for Payer: Encore All Commercial |
$99.69
|
| Rate for Payer: Frontpath All Commercial |
$99.64
|
| Rate for Payer: Humana ChoiceCare |
$93.54
|
| Rate for Payer: Humana Medicare |
$55.23
|
| Rate for Payer: Lucent All Commercial |
$55.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.47
|
| Rate for Payer: Managed Health Services Medicaid |
$15.92
|
| Rate for Payer: MDWise Medicaid |
$15.92
|
| Rate for Payer: PHCS All Commercial |
$81.23
|
| Rate for Payer: PHP All Commercial |
$82.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.24
|
| Rate for Payer: Sagamore Health Network All Products |
$83.61
|
| Rate for Payer: Signature Care EPO |
$89.89
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.06
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
| Rate for Payer: United Healthcare Medicare |
$35.74
|
|
|
HC OCC BLOOD IMM SCR-HI RISK
|
Facility
IP
|
$65.05
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
63002208
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.78 |
| Max. Negotiated Rate |
$60.49 |
| Rate for Payer: Aetna Commercial |
$56.20
|
| Rate for Payer: Cash Price |
$40.33
|
| Rate for Payer: Cigna All Commercial |
$56.13
|
| Rate for Payer: CORVEL All Commercial |
$60.49
|
| Rate for Payer: Coventry All Commercial |
$57.24
|
| Rate for Payer: Encore All Commercial |
$59.87
|
| Rate for Payer: Frontpath All Commercial |
$59.84
|
| Rate for Payer: Humana ChoiceCare |
$56.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.54
|
| Rate for Payer: PHCS All Commercial |
$48.78
|
| Rate for Payer: PHP All Commercial |
$49.33
|
| Rate for Payer: Sagamore Health Network All Products |
$50.22
|
| Rate for Payer: Signature Care EPO |
$53.99
|
| Rate for Payer: Signature Care PPO |
$57.24
|
| Rate for Payer: United Healthcare Commercial |
$51.26
|
|
|
HC OCC BLOOD IMM SCR-HI RISK
|
Facility
OP
|
$65.05
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
63002208
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.46 |
| Max. Negotiated Rate |
$60.49 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Medicare |
$21.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.61
|
| Rate for Payer: Cash Price |
$40.33
|
| Rate for Payer: Centivo All Commercial |
$33.17
|
| Rate for Payer: Cigna All Commercial |
$56.13
|
| Rate for Payer: CORVEL All Commercial |
$60.49
|
| Rate for Payer: Coventry All Commercial |
$57.24
|
| Rate for Payer: Encore All Commercial |
$59.87
|
| Rate for Payer: Frontpath All Commercial |
$59.84
|
| Rate for Payer: Humana ChoiceCare |
$56.18
|
| Rate for Payer: Humana Medicare |
$33.17
|
| Rate for Payer: Lucent All Commercial |
$33.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.54
|
| Rate for Payer: PHCS All Commercial |
$48.78
|
| Rate for Payer: PHP All Commercial |
$49.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.37
|
| Rate for Payer: Sagamore Health Network All Products |
$50.22
|
| Rate for Payer: Signature Care EPO |
$53.99
|
| Rate for Payer: Signature Care PPO |
$57.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.29
|
| Rate for Payer: United Healthcare Commercial |
$51.26
|
| Rate for Payer: United Healthcare Medicare |
$21.46
|
|
|
HC OCCULT BLOOD IMMUNOASSAY
|
Facility
IP
|
$117.29
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
63001167
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$101.34
|
| Rate for Payer: Cash Price |
$72.72
|
| Rate for Payer: Cigna All Commercial |
$101.22
|
| Rate for Payer: CORVEL All Commercial |
$109.08
|
| Rate for Payer: Coventry All Commercial |
$103.22
|
| Rate for Payer: Encore All Commercial |
$107.97
|
| Rate for Payer: Frontpath All Commercial |
$107.91
|
| Rate for Payer: Humana ChoiceCare |
$101.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.56
|
| Rate for Payer: PHCS All Commercial |
$87.97
|
| Rate for Payer: PHP All Commercial |
$88.95
|
| Rate for Payer: Sagamore Health Network All Products |
$90.55
|
| Rate for Payer: Signature Care EPO |
$97.35
|
| Rate for Payer: Signature Care PPO |
$103.22
|
| Rate for Payer: United Healthcare Commercial |
$92.42
|
|
|
HC OCCULT BLOOD IMMUNOASSAY
|
Facility
OP
|
$117.29
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
63001167
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$98.99
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.58
|
| Rate for Payer: Cash Price |
$72.72
|
| Rate for Payer: Cash Price |
$72.72
|
| Rate for Payer: Centivo All Commercial |
$59.82
|
| Rate for Payer: Cigna All Commercial |
$101.22
|
| Rate for Payer: CORVEL All Commercial |
$109.08
|
| Rate for Payer: Coventry All Commercial |
$103.22
|
| Rate for Payer: Encore All Commercial |
$107.97
|
| Rate for Payer: Frontpath All Commercial |
$107.91
|
| Rate for Payer: Humana ChoiceCare |
$101.30
|
| Rate for Payer: Humana Medicare |
$59.82
|
| Rate for Payer: Lucent All Commercial |
$59.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.56
|
| Rate for Payer: Managed Health Services Medicaid |
$15.92
|
| Rate for Payer: MDWise Medicaid |
$15.92
|
| Rate for Payer: PHCS All Commercial |
$87.97
|
| Rate for Payer: PHP All Commercial |
$88.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.74
|
| Rate for Payer: Sagamore Health Network All Products |
$90.55
|
| Rate for Payer: Signature Care EPO |
$97.35
|
| Rate for Payer: Signature Care PPO |
$103.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99.70
|
| Rate for Payer: United Healthcare Commercial |
$92.42
|
| Rate for Payer: United Healthcare Medicare |
$38.71
|
|
|
HC OL ELEVIEW
|
Facility
OP
|
$2,090.00
|
|
| Hospital Charge Code |
41606540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,943.70 |
| Rate for Payer: Aetna Commercial |
$1,763.96
|
| Rate for Payer: Aetna Medicare |
$689.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$689.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,200.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,306.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$793.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$758.67
|
| Rate for Payer: Cash Price |
$1,295.80
|
| Rate for Payer: Cash Price |
$1,295.80
|
| Rate for Payer: Centivo All Commercial |
$1,065.90
|
| Rate for Payer: Cigna All Commercial |
$1,803.67
|
| Rate for Payer: CORVEL All Commercial |
$1,943.70
|
| Rate for Payer: Coventry All Commercial |
$1,839.20
|
| Rate for Payer: Encore All Commercial |
$1,923.84
|
| Rate for Payer: Frontpath All Commercial |
$1,922.80
|
| Rate for Payer: Humana ChoiceCare |
$1,805.13
|
| Rate for Payer: Humana Medicare |
$1,065.90
|
| Rate for Payer: Lucent All Commercial |
$1,065.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,881.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,567.50
|
| Rate for Payer: PHP All Commercial |
$1,585.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$815.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,613.48
|
| Rate for Payer: Signature Care EPO |
$1,734.70
|
| Rate for Payer: Signature Care PPO |
$1,839.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,776.50
|
| Rate for Payer: United Healthcare Commercial |
$1,646.92
|
| Rate for Payer: United Healthcare Medicare |
$689.70
|
|
|
HC OL ELEVIEW
|
Facility
IP
|
$2,090.00
|
|
| Hospital Charge Code |
41606540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,567.50 |
| Max. Negotiated Rate |
$1,943.70 |
| Rate for Payer: Aetna Commercial |
$1,805.76
|
| Rate for Payer: Cash Price |
$1,295.80
|
| Rate for Payer: Cigna All Commercial |
$1,803.67
|
| Rate for Payer: CORVEL All Commercial |
$1,943.70
|
| Rate for Payer: Coventry All Commercial |
$1,839.20
|
| Rate for Payer: Encore All Commercial |
$1,923.84
|
| Rate for Payer: Frontpath All Commercial |
$1,922.80
|
| Rate for Payer: Humana ChoiceCare |
$1,805.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,881.00
|
| Rate for Payer: PHCS All Commercial |
$1,567.50
|
| Rate for Payer: PHP All Commercial |
$1,585.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,613.48
|
| Rate for Payer: Signature Care EPO |
$1,734.70
|
| Rate for Payer: Signature Care PPO |
$1,839.20
|
| Rate for Payer: United Healthcare Commercial |
$1,646.92
|
|
|
HC OPIATES,QT-URINE CHARGE2
|
Facility
IP
|
$38.36
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.77 |
| Max. Negotiated Rate |
$35.68 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: Cigna All Commercial |
$33.11
|
| Rate for Payer: CORVEL All Commercial |
$35.68
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.53
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Sagamore Health Network All Products |
$29.62
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
|
|
HC OPIATES,QT-URINE CHARGE2
|
Facility
OP
|
$38.36
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$77.12 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$12.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.93
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: Centivo All Commercial |
$19.56
|
| Rate for Payer: Cigna All Commercial |
$33.11
|
| Rate for Payer: CORVEL All Commercial |
$35.68
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Humana Medicare |
$19.56
|
| Rate for Payer: Lucent All Commercial |
$19.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.53
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.96
|
| Rate for Payer: Sagamore Health Network All Products |
$29.62
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.61
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
| Rate for Payer: United Healthcare Medicare |
$12.66
|
|
|
HC OPIATES QT-URINE CHARGE3
|
Facility
IP
|
$38.36
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.77 |
| Max. Negotiated Rate |
$35.68 |
| Rate for Payer: Cigna All Commercial |
$33.11
|
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: CORVEL All Commercial |
$35.68
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.53
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Sagamore Health Network All Products |
$29.62
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
|
|
HC OPIATES QT-URINE CHARGE3
|
Facility
OP
|
$38.36
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$77.12 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$12.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.93
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: Centivo All Commercial |
$19.56
|
| Rate for Payer: Cigna All Commercial |
$33.11
|
| Rate for Payer: CORVEL All Commercial |
$35.68
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Humana Medicare |
$19.56
|
| Rate for Payer: Lucent All Commercial |
$19.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.53
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.96
|
| Rate for Payer: Sagamore Health Network All Products |
$29.62
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.61
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
| Rate for Payer: United Healthcare Medicare |
$12.66
|
|
|
HC OPIATES,QUANTITATIVE-URINE
|
Facility
OP
|
$38.36
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001421
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$77.12 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$12.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.93
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: Centivo All Commercial |
$19.56
|
| Rate for Payer: Cigna All Commercial |
$33.11
|
| Rate for Payer: CORVEL All Commercial |
$35.68
|
| Rate for Payer: Coventry All Commercial |
$33.76
|
| Rate for Payer: Encore All Commercial |
$35.31
|
| Rate for Payer: Frontpath All Commercial |
$35.29
|
| Rate for Payer: Humana ChoiceCare |
$33.13
|
| Rate for Payer: Humana Medicare |
$19.56
|
| Rate for Payer: Lucent All Commercial |
$19.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.53
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$28.77
|
| Rate for Payer: PHP All Commercial |
$29.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.96
|
| Rate for Payer: Sagamore Health Network All Products |
$29.62
|
| Rate for Payer: Signature Care EPO |
$31.84
|
| Rate for Payer: Signature Care PPO |
$33.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.61
|
| Rate for Payer: United Healthcare Commercial |
$30.23
|
| Rate for Payer: United Healthcare Medicare |
$12.66
|
|
