|
HC PLUG IS1 PLUG
|
Facility
IP
|
$131.25
|
|
| Hospital Charge Code |
41607311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.44 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
|
|
HC PLUG IS1 PLUG
|
Facility
OP
|
$131.25
|
|
| Hospital Charge Code |
41607311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.31 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$110.78
|
| Rate for Payer: Aetna Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.64
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Centivo All Commercial |
$66.94
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Humana Medicare |
$66.94
|
| Rate for Payer: Lucent All Commercial |
$66.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.19
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.56
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
|
|
HC PNEUMONITIS ALLERGEN SPECIFIC IGG - EA
|
Facility
OP
|
$41.30
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
63001758
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$38.41 |
| Rate for Payer: Aetna Commercial |
$34.86
|
| Rate for Payer: Aetna Medicare |
$13.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$25.61
|
| Rate for Payer: Cash Price |
$25.61
|
| Rate for Payer: Centivo All Commercial |
$21.06
|
| Rate for Payer: Cigna All Commercial |
$35.64
|
| Rate for Payer: CORVEL All Commercial |
$38.41
|
| Rate for Payer: Coventry All Commercial |
$36.34
|
| Rate for Payer: Encore All Commercial |
$38.02
|
| Rate for Payer: Frontpath All Commercial |
$38.00
|
| Rate for Payer: Humana ChoiceCare |
$35.67
|
| Rate for Payer: Humana Medicare |
$21.06
|
| Rate for Payer: Lucent All Commercial |
$21.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.17
|
| Rate for Payer: Managed Health Services Medicaid |
$7.10
|
| Rate for Payer: MDWise Medicaid |
$7.10
|
| Rate for Payer: PHCS All Commercial |
$30.97
|
| Rate for Payer: PHP All Commercial |
$31.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.11
|
| Rate for Payer: Sagamore Health Network All Products |
$31.88
|
| Rate for Payer: Signature Care EPO |
$34.28
|
| Rate for Payer: Signature Care PPO |
$36.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$32.54
|
| Rate for Payer: United Healthcare Medicare |
$13.63
|
|
|
HC PNEUMONITIS ALLERGEN SPECIFIC IGG - EA
|
Facility
IP
|
$41.30
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
63001758
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$38.41 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: Cash Price |
$25.61
|
| Rate for Payer: Cigna All Commercial |
$35.64
|
| Rate for Payer: CORVEL All Commercial |
$38.41
|
| Rate for Payer: Coventry All Commercial |
$36.34
|
| Rate for Payer: Encore All Commercial |
$38.02
|
| Rate for Payer: Frontpath All Commercial |
$38.00
|
| Rate for Payer: Humana ChoiceCare |
$35.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.17
|
| Rate for Payer: PHCS All Commercial |
$30.97
|
| Rate for Payer: PHP All Commercial |
$31.32
|
| Rate for Payer: Sagamore Health Network All Products |
$31.88
|
| Rate for Payer: Signature Care EPO |
$34.28
|
| Rate for Payer: Signature Care PPO |
$36.34
|
| Rate for Payer: United Healthcare Commercial |
$32.54
|
|
|
HC PNEUMONITIS ASPERGILLUS AB - EA
|
Facility
IP
|
$106.82
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
63001919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$99.35 |
| Rate for Payer: Aetna Commercial |
$92.30
|
| Rate for Payer: Cash Price |
$66.23
|
| Rate for Payer: Cigna All Commercial |
$92.19
|
| Rate for Payer: CORVEL All Commercial |
$99.35
|
| Rate for Payer: Coventry All Commercial |
$94.01
|
| Rate for Payer: Encore All Commercial |
$98.33
|
| Rate for Payer: Frontpath All Commercial |
$98.28
|
| Rate for Payer: Humana ChoiceCare |
$92.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.14
|
| Rate for Payer: PHCS All Commercial |
$80.12
|
| Rate for Payer: PHP All Commercial |
$81.02
|
| Rate for Payer: Sagamore Health Network All Products |
$82.47
|
| Rate for Payer: Signature Care EPO |
$88.66
|
| Rate for Payer: Signature Care PPO |
$94.01
|
| Rate for Payer: United Healthcare Commercial |
$84.18
|
|
|
HC PNEUMONITIS ASPERGILLUS AB - EA
|
Facility
OP
|
$106.82
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
63001919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$99.35 |
| Rate for Payer: Aetna Commercial |
$90.16
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.78
|
| Rate for Payer: Cash Price |
$66.23
|
| Rate for Payer: Cash Price |
$66.23
|
| Rate for Payer: Centivo All Commercial |
$54.48
|
| Rate for Payer: Cigna All Commercial |
$92.19
|
| Rate for Payer: CORVEL All Commercial |
$99.35
|
| Rate for Payer: Coventry All Commercial |
$94.01
|
| Rate for Payer: Encore All Commercial |
$98.33
|
| Rate for Payer: Frontpath All Commercial |
$98.28
|
| Rate for Payer: Humana ChoiceCare |
$92.26
|
| Rate for Payer: Humana Medicare |
$54.48
|
| Rate for Payer: Lucent All Commercial |
$54.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.14
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$80.12
|
| Rate for Payer: PHP All Commercial |
$81.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.66
|
| Rate for Payer: Sagamore Health Network All Products |
$82.47
|
| Rate for Payer: Signature Care EPO |
$88.66
|
| Rate for Payer: Signature Care PPO |
$94.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.80
|
| Rate for Payer: United Healthcare Commercial |
$84.18
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
|
|
HC PNEUMONITIS BACTERIUM AB
|
Facility
IP
|
$28.83
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
63001920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$26.81 |
| Rate for Payer: Aetna Commercial |
$24.90
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cigna All Commercial |
$24.88
|
| Rate for Payer: CORVEL All Commercial |
$26.81
|
| Rate for Payer: Coventry All Commercial |
$25.37
|
| Rate for Payer: Encore All Commercial |
$26.53
|
| Rate for Payer: Frontpath All Commercial |
$26.52
|
| Rate for Payer: Humana ChoiceCare |
$24.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.94
|
| Rate for Payer: PHCS All Commercial |
$21.62
|
| Rate for Payer: PHP All Commercial |
$21.86
|
| Rate for Payer: Sagamore Health Network All Products |
$22.25
|
| Rate for Payer: Signature Care EPO |
$23.92
|
| Rate for Payer: Signature Care PPO |
$25.37
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
|
|
HC PNEUMONITIS BACTERIUM AB
|
Facility
OP
|
$28.83
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
63001920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$26.81 |
| Rate for Payer: Aetna Commercial |
$24.33
|
| Rate for Payer: Aetna Medicare |
$9.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.46
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Centivo All Commercial |
$14.70
|
| Rate for Payer: Cigna All Commercial |
$24.88
|
| Rate for Payer: CORVEL All Commercial |
$26.81
|
| Rate for Payer: Coventry All Commercial |
$25.37
|
| Rate for Payer: Encore All Commercial |
$26.53
|
| Rate for Payer: Frontpath All Commercial |
$26.52
|
| Rate for Payer: Humana ChoiceCare |
$24.90
|
| Rate for Payer: Humana Medicare |
$14.70
|
| Rate for Payer: Lucent All Commercial |
$14.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.94
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: MDWise Medicaid |
$12.88
|
| Rate for Payer: PHCS All Commercial |
$21.62
|
| Rate for Payer: PHP All Commercial |
$21.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.24
|
| Rate for Payer: Sagamore Health Network All Products |
$22.25
|
| Rate for Payer: Signature Care EPO |
$23.92
|
| Rate for Payer: Signature Care PPO |
$25.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.50
|
| Rate for Payer: United Healthcare Commercial |
$22.71
|
| Rate for Payer: United Healthcare Medicare |
$9.51
|
|
|
HC POLIOVIRUS ABS
|
Facility
OP
|
$207.77
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
63001936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$193.23 |
| Rate for Payer: Aetna Commercial |
$175.36
|
| Rate for Payer: Aetna Medicare |
$68.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$119.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.42
|
| Rate for Payer: Cash Price |
$128.82
|
| Rate for Payer: Cash Price |
$128.82
|
| Rate for Payer: Centivo All Commercial |
$105.96
|
| Rate for Payer: Cigna All Commercial |
$179.31
|
| Rate for Payer: CORVEL All Commercial |
$193.23
|
| Rate for Payer: Coventry All Commercial |
$182.84
|
| Rate for Payer: Encore All Commercial |
$191.26
|
| Rate for Payer: Frontpath All Commercial |
$191.15
|
| Rate for Payer: Humana ChoiceCare |
$179.45
|
| Rate for Payer: Humana Medicare |
$105.96
|
| Rate for Payer: Lucent All Commercial |
$105.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.03
|
| Rate for Payer: MDWise Medicaid |
$13.03
|
| Rate for Payer: PHCS All Commercial |
$155.83
|
| Rate for Payer: PHP All Commercial |
$157.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.03
|
| Rate for Payer: Sagamore Health Network All Products |
$160.40
|
| Rate for Payer: Signature Care EPO |
$172.45
|
| Rate for Payer: Signature Care PPO |
$182.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$176.61
|
| Rate for Payer: United Healthcare Commercial |
$163.73
|
| Rate for Payer: United Healthcare Medicare |
$68.57
|
|
|
HC POLIOVIRUS ABS
|
Facility
IP
|
$207.77
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
63001936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.83 |
| Max. Negotiated Rate |
$193.23 |
| Rate for Payer: Aetna Commercial |
$179.52
|
| Rate for Payer: Cash Price |
$128.82
|
| Rate for Payer: Cigna All Commercial |
$179.31
|
| Rate for Payer: CORVEL All Commercial |
$193.23
|
| Rate for Payer: Coventry All Commercial |
$182.84
|
| Rate for Payer: Encore All Commercial |
$191.26
|
| Rate for Payer: Frontpath All Commercial |
$191.15
|
| Rate for Payer: Humana ChoiceCare |
$179.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.00
|
| Rate for Payer: PHCS All Commercial |
$155.83
|
| Rate for Payer: PHP All Commercial |
$157.58
|
| Rate for Payer: Sagamore Health Network All Products |
$160.40
|
| Rate for Payer: Signature Care EPO |
$172.45
|
| Rate for Payer: Signature Care PPO |
$182.84
|
| Rate for Payer: United Healthcare Commercial |
$163.73
|
|
|
HC PORPHOBILINOGEN (PBG), QUANTITATIVE, RANDOM URINE
|
Facility
OP
|
$91.80
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
63044075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: Aetna Medicare |
$30.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.32
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Centivo All Commercial |
$46.82
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Humana Medicare |
$46.82
|
| Rate for Payer: Lucent All Commercial |
$46.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: Managed Health Services Medicaid |
$8.44
|
| Rate for Payer: MDWise Medicaid |
$8.44
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.80
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.03
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
| Rate for Payer: United Healthcare Medicare |
$30.29
|
|
|
HC PORPHOBILINOGEN (PBG), QUANTITATIVE, RANDOM URINE
|
Facility
IP
|
$91.80
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
63044075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
|
|
HC PORPHOBILINOGEN-RANDOM UR
|
Facility
OP
|
$84.64
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
63001659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$78.71 |
| Rate for Payer: Aetna Commercial |
$71.44
|
| Rate for Payer: Aetna Medicare |
$27.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.72
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Centivo All Commercial |
$43.17
|
| Rate for Payer: Cigna All Commercial |
$73.04
|
| Rate for Payer: CORVEL All Commercial |
$78.71
|
| Rate for Payer: Coventry All Commercial |
$74.48
|
| Rate for Payer: Encore All Commercial |
$77.91
|
| Rate for Payer: Frontpath All Commercial |
$77.87
|
| Rate for Payer: Humana ChoiceCare |
$73.10
|
| Rate for Payer: Humana Medicare |
$43.17
|
| Rate for Payer: Lucent All Commercial |
$43.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.18
|
| Rate for Payer: Managed Health Services Medicaid |
$8.44
|
| Rate for Payer: MDWise Medicaid |
$8.44
|
| Rate for Payer: PHCS All Commercial |
$63.48
|
| Rate for Payer: PHP All Commercial |
$64.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.01
|
| Rate for Payer: Sagamore Health Network All Products |
$65.34
|
| Rate for Payer: Signature Care EPO |
$70.25
|
| Rate for Payer: Signature Care PPO |
$74.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.94
|
| Rate for Payer: United Healthcare Commercial |
$66.70
|
| Rate for Payer: United Healthcare Medicare |
$27.93
|
|
|
HC PORPHOBILINOGEN-RANDOM UR
|
Facility
IP
|
$84.64
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
63001659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.48 |
| Max. Negotiated Rate |
$78.71 |
| Rate for Payer: Aetna Commercial |
$73.13
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Cigna All Commercial |
$73.04
|
| Rate for Payer: CORVEL All Commercial |
$78.71
|
| Rate for Payer: Coventry All Commercial |
$74.48
|
| Rate for Payer: Encore All Commercial |
$77.91
|
| Rate for Payer: Frontpath All Commercial |
$77.87
|
| Rate for Payer: Humana ChoiceCare |
$73.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.18
|
| Rate for Payer: PHCS All Commercial |
$63.48
|
| Rate for Payer: PHP All Commercial |
$64.19
|
| Rate for Payer: Sagamore Health Network All Products |
$65.34
|
| Rate for Payer: Signature Care EPO |
$70.25
|
| Rate for Payer: Signature Care PPO |
$74.48
|
| Rate for Payer: United Healthcare Commercial |
$66.70
|
|
|
HC PORPHYRIN FECES
|
Facility
IP
|
$382.13
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
63001661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$286.60 |
| Max. Negotiated Rate |
$355.38 |
| Rate for Payer: Aetna Commercial |
$330.16
|
| Rate for Payer: Cash Price |
$236.92
|
| Rate for Payer: Cigna All Commercial |
$329.78
|
| Rate for Payer: CORVEL All Commercial |
$355.38
|
| Rate for Payer: Coventry All Commercial |
$336.28
|
| Rate for Payer: Encore All Commercial |
$351.75
|
| Rate for Payer: Frontpath All Commercial |
$351.56
|
| Rate for Payer: Humana ChoiceCare |
$330.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.92
|
| Rate for Payer: PHCS All Commercial |
$286.60
|
| Rate for Payer: PHP All Commercial |
$289.81
|
| Rate for Payer: Sagamore Health Network All Products |
$295.01
|
| Rate for Payer: Signature Care EPO |
$317.17
|
| Rate for Payer: Signature Care PPO |
$336.28
|
| Rate for Payer: United Healthcare Commercial |
$301.12
|
|
|
HC PORPHYRIN FECES
|
Facility
OP
|
$382.13
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
63001661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$355.38 |
| Rate for Payer: Aetna Commercial |
$322.52
|
| Rate for Payer: Aetna Medicare |
$126.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$219.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.71
|
| Rate for Payer: Cash Price |
$236.92
|
| Rate for Payer: Cash Price |
$236.92
|
| Rate for Payer: Centivo All Commercial |
$194.89
|
| Rate for Payer: Cigna All Commercial |
$329.78
|
| Rate for Payer: CORVEL All Commercial |
$355.38
|
| Rate for Payer: Coventry All Commercial |
$336.28
|
| Rate for Payer: Encore All Commercial |
$351.75
|
| Rate for Payer: Frontpath All Commercial |
$351.56
|
| Rate for Payer: Humana ChoiceCare |
$330.05
|
| Rate for Payer: Humana Medicare |
$194.89
|
| Rate for Payer: Lucent All Commercial |
$194.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.92
|
| Rate for Payer: Managed Health Services Medicaid |
$20.14
|
| Rate for Payer: MDWise Medicaid |
$20.14
|
| Rate for Payer: PHCS All Commercial |
$286.60
|
| Rate for Payer: PHP All Commercial |
$289.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.03
|
| Rate for Payer: Sagamore Health Network All Products |
$295.01
|
| Rate for Payer: Signature Care EPO |
$317.17
|
| Rate for Payer: Signature Care PPO |
$336.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$324.81
|
| Rate for Payer: United Healthcare Commercial |
$301.12
|
| Rate for Payer: United Healthcare Medicare |
$126.10
|
|
|
HC PORPHYRINS 24H
|
Facility
IP
|
$132.93
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
63001042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.69 |
| Max. Negotiated Rate |
$123.62 |
| Rate for Payer: Aetna Commercial |
$114.85
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Cigna All Commercial |
$114.72
|
| Rate for Payer: CORVEL All Commercial |
$123.62
|
| Rate for Payer: Coventry All Commercial |
$116.98
|
| Rate for Payer: Encore All Commercial |
$122.36
|
| Rate for Payer: Frontpath All Commercial |
$122.29
|
| Rate for Payer: Humana ChoiceCare |
$114.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.63
|
| Rate for Payer: PHCS All Commercial |
$99.69
|
| Rate for Payer: PHP All Commercial |
$100.81
|
| Rate for Payer: Sagamore Health Network All Products |
$102.62
|
| Rate for Payer: Signature Care EPO |
$110.33
|
| Rate for Payer: Signature Care PPO |
$116.98
|
| Rate for Payer: United Healthcare Commercial |
$104.75
|
|
|
HC PORPHYRINS 24H
|
Facility
OP
|
$132.93
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
63001042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$123.62 |
| Rate for Payer: Aetna Commercial |
$112.19
|
| Rate for Payer: Aetna Medicare |
$43.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.25
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Centivo All Commercial |
$67.79
|
| Rate for Payer: Cigna All Commercial |
$114.72
|
| Rate for Payer: CORVEL All Commercial |
$123.62
|
| Rate for Payer: Coventry All Commercial |
$116.98
|
| Rate for Payer: Encore All Commercial |
$122.36
|
| Rate for Payer: Frontpath All Commercial |
$122.29
|
| Rate for Payer: Humana ChoiceCare |
$114.81
|
| Rate for Payer: Humana Medicare |
$67.79
|
| Rate for Payer: Lucent All Commercial |
$67.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.63
|
| Rate for Payer: Managed Health Services Medicaid |
$14.71
|
| Rate for Payer: MDWise Medicaid |
$14.71
|
| Rate for Payer: PHCS All Commercial |
$99.69
|
| Rate for Payer: PHP All Commercial |
$100.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.84
|
| Rate for Payer: Sagamore Health Network All Products |
$102.62
|
| Rate for Payer: Signature Care EPO |
$110.33
|
| Rate for Payer: Signature Care PPO |
$116.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.99
|
| Rate for Payer: United Healthcare Commercial |
$104.75
|
| Rate for Payer: United Healthcare Medicare |
$43.87
|
|
|
HC PORPHYRINS, QUANTITATIVE, RANDOM URINE
|
Facility
IP
|
$94.49
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
63044076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.87 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna Commercial |
$81.64
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cigna All Commercial |
$81.55
|
| Rate for Payer: CORVEL All Commercial |
$87.88
|
| Rate for Payer: Coventry All Commercial |
$83.15
|
| Rate for Payer: Encore All Commercial |
$86.98
|
| Rate for Payer: Frontpath All Commercial |
$86.93
|
| Rate for Payer: Humana ChoiceCare |
$81.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.04
|
| Rate for Payer: PHCS All Commercial |
$70.87
|
| Rate for Payer: PHP All Commercial |
$71.66
|
| Rate for Payer: Sagamore Health Network All Products |
$72.95
|
| Rate for Payer: Signature Care EPO |
$78.43
|
| Rate for Payer: Signature Care PPO |
$83.15
|
| Rate for Payer: United Healthcare Commercial |
$74.46
|
|
|
HC PORPHYRINS, QUANTITATIVE, RANDOM URINE
|
Facility
OP
|
$94.49
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
63044076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna Commercial |
$79.75
|
| Rate for Payer: Aetna Medicare |
$31.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.30
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Centivo All Commercial |
$48.19
|
| Rate for Payer: Cigna All Commercial |
$81.55
|
| Rate for Payer: CORVEL All Commercial |
$87.88
|
| Rate for Payer: Coventry All Commercial |
$83.15
|
| Rate for Payer: Encore All Commercial |
$86.98
|
| Rate for Payer: Frontpath All Commercial |
$86.93
|
| Rate for Payer: Humana ChoiceCare |
$81.61
|
| Rate for Payer: Humana Medicare |
$48.19
|
| Rate for Payer: Lucent All Commercial |
$48.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.04
|
| Rate for Payer: Managed Health Services Medicaid |
$14.71
|
| Rate for Payer: MDWise Medicaid |
$14.71
|
| Rate for Payer: PHCS All Commercial |
$70.87
|
| Rate for Payer: PHP All Commercial |
$71.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.85
|
| Rate for Payer: Sagamore Health Network All Products |
$72.95
|
| Rate for Payer: Signature Care EPO |
$78.43
|
| Rate for Payer: Signature Care PPO |
$83.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.32
|
| Rate for Payer: United Healthcare Commercial |
$74.46
|
| Rate for Payer: United Healthcare Medicare |
$31.18
|
|
|
HC PORT FILM - ONE
|
Facility
OP
|
$318.24
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
01547417
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$295.96 |
| Rate for Payer: Aetna Commercial |
$268.59
|
| Rate for Payer: Aetna Medicare |
$105.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$182.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$198.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$101.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.52
|
| Rate for Payer: Cash Price |
$197.31
|
| Rate for Payer: Cash Price |
$197.31
|
| Rate for Payer: Centivo All Commercial |
$162.30
|
| Rate for Payer: Cigna All Commercial |
$274.64
|
| Rate for Payer: CORVEL All Commercial |
$295.96
|
| Rate for Payer: Coventry All Commercial |
$280.05
|
| Rate for Payer: Encore All Commercial |
$292.94
|
| Rate for Payer: Frontpath All Commercial |
$292.78
|
| Rate for Payer: Humana ChoiceCare |
$274.86
|
| Rate for Payer: Humana Medicare |
$162.30
|
| Rate for Payer: Lucent All Commercial |
$162.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$286.42
|
| Rate for Payer: Managed Health Services Medicaid |
$101.60
|
| Rate for Payer: MDWise Medicaid |
$101.60
|
| Rate for Payer: PHCS All Commercial |
$238.68
|
| Rate for Payer: PHP All Commercial |
$241.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.11
|
| Rate for Payer: Sagamore Health Network All Products |
$245.68
|
| Rate for Payer: Signature Care EPO |
$264.14
|
| Rate for Payer: Signature Care PPO |
$280.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$270.50
|
| Rate for Payer: United Healthcare Commercial |
$250.77
|
| Rate for Payer: United Healthcare Medicare |
$105.02
|
|
|
HC PORT FILM - ONE
|
Facility
IP
|
$318.24
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
01547417
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$238.68 |
| Max. Negotiated Rate |
$295.96 |
| Rate for Payer: Aetna Commercial |
$274.96
|
| Rate for Payer: Cash Price |
$197.31
|
| Rate for Payer: Cigna All Commercial |
$274.64
|
| Rate for Payer: CORVEL All Commercial |
$295.96
|
| Rate for Payer: Coventry All Commercial |
$280.05
|
| Rate for Payer: Encore All Commercial |
$292.94
|
| Rate for Payer: Frontpath All Commercial |
$292.78
|
| Rate for Payer: Humana ChoiceCare |
$274.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$286.42
|
| Rate for Payer: PHCS All Commercial |
$238.68
|
| Rate for Payer: PHP All Commercial |
$241.35
|
| Rate for Payer: Sagamore Health Network All Products |
$245.68
|
| Rate for Payer: Signature Care EPO |
$264.14
|
| Rate for Payer: Signature Care PPO |
$280.05
|
| Rate for Payer: United Healthcare Commercial |
$250.77
|
|
|
HC PORT FILMS - EIGHT
|
Facility
IP
|
$2,550.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
01547424
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,912.50 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
|
|
HC PORT FILMS - EIGHT
|
Facility
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
01547424
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,152.20
|
| Rate for Payer: Aetna Medicare |
$841.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$841.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,464.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,594.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$101.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$967.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$925.65
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Centivo All Commercial |
$1,300.50
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.44
|
| Rate for Payer: Humana Medicare |
$1,300.50
|
| Rate for Payer: Lucent All Commercial |
$1,300.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: Managed Health Services Medicaid |
$101.60
|
| Rate for Payer: MDWise Medicaid |
$101.60
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$994.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,167.50
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
| Rate for Payer: United Healthcare Medicare |
$841.50
|
|
|
HC PORT FILMS - FIVE
|
Facility
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
01547421
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Aetna Commercial |
$1,291.32
|
| Rate for Payer: Aetna Medicare |
$504.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$504.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$878.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$956.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$101.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$580.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$555.39
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Centivo All Commercial |
$780.30
|
| Rate for Payer: Cigna All Commercial |
$1,320.39
|
| Rate for Payer: CORVEL All Commercial |
$1,422.90
|
| Rate for Payer: Coventry All Commercial |
$1,346.40
|
| Rate for Payer: Encore All Commercial |
$1,408.36
|
| Rate for Payer: Frontpath All Commercial |
$1,407.60
|
| Rate for Payer: Humana ChoiceCare |
$1,321.46
|
| Rate for Payer: Humana Medicare |
$780.30
|
| Rate for Payer: Lucent All Commercial |
$780.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,377.00
|
| Rate for Payer: Managed Health Services Medicaid |
$101.60
|
| Rate for Payer: MDWise Medicaid |
$101.60
|
| Rate for Payer: PHCS All Commercial |
$1,147.50
|
| Rate for Payer: PHP All Commercial |
$1,160.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$596.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,181.16
|
| Rate for Payer: Signature Care EPO |
$1,269.90
|
| Rate for Payer: Signature Care PPO |
$1,346.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare Commercial |
$1,205.64
|
| Rate for Payer: United Healthcare Medicare |
$504.90
|
|
