|
HC TOTAL PROTEIN
|
Facility
|
OP
|
$47.12
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
63001185
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$43.82 |
| Rate for Payer: Aetna Commercial |
$39.77
|
| Rate for Payer: Aetna Medicare |
$15.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.59
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Centivo All Commercial |
$25.63
|
| Rate for Payer: Cigna All Commercial |
$40.66
|
| Rate for Payer: CORVEL All Commercial |
$43.82
|
| Rate for Payer: Coventry All Commercial |
$41.47
|
| Rate for Payer: Encore All Commercial |
$43.37
|
| Rate for Payer: Frontpath All Commercial |
$43.35
|
| Rate for Payer: Humana ChoiceCare |
$40.70
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: Lucent All Commercial |
$25.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.41
|
| Rate for Payer: Managed Health Services Medicaid |
$3.67
|
| Rate for Payer: MDWise Medicaid |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$35.34
|
| Rate for Payer: PHP All Commercial |
$35.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.38
|
| Rate for Payer: Sagamore Health Network All Products |
$36.38
|
| Rate for Payer: Signature Care EPO |
$39.11
|
| Rate for Payer: Signature Care PPO |
$41.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.05
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
| Rate for Payer: United Healthcare Medicare |
$15.08
|
|
|
HC TOTAL PROTEIN
|
Facility
|
IP
|
$47.12
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
63001185
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$43.82 |
| Rate for Payer: Aetna Commercial |
$40.71
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cigna All Commercial |
$40.66
|
| Rate for Payer: CORVEL All Commercial |
$43.82
|
| Rate for Payer: Coventry All Commercial |
$41.47
|
| Rate for Payer: Encore All Commercial |
$43.37
|
| Rate for Payer: Frontpath All Commercial |
$43.35
|
| Rate for Payer: Humana ChoiceCare |
$40.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.41
|
| Rate for Payer: PHCS All Commercial |
$35.34
|
| Rate for Payer: PHP All Commercial |
$35.74
|
| Rate for Payer: Sagamore Health Network All Products |
$36.38
|
| Rate for Payer: Signature Care EPO |
$39.11
|
| Rate for Payer: Signature Care PPO |
$41.47
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
|
|
HC TOURNI-COT LG
|
Facility
|
IP
|
$43.99
|
|
| Hospital Charge Code |
41601848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$40.91 |
| Rate for Payer: Aetna Commercial |
$38.01
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cigna All Commercial |
$37.96
|
| Rate for Payer: CORVEL All Commercial |
$40.91
|
| Rate for Payer: Coventry All Commercial |
$38.71
|
| Rate for Payer: Encore All Commercial |
$40.49
|
| Rate for Payer: Frontpath All Commercial |
$40.47
|
| Rate for Payer: Humana ChoiceCare |
$37.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.59
|
| Rate for Payer: PHCS All Commercial |
$32.99
|
| Rate for Payer: PHP All Commercial |
$33.36
|
| Rate for Payer: Sagamore Health Network All Products |
$33.96
|
| Rate for Payer: Signature Care EPO |
$36.51
|
| Rate for Payer: Signature Care PPO |
$38.71
|
| Rate for Payer: United Healthcare Commercial |
$34.66
|
|
|
HC TOURNI-COT LG
|
Facility
|
OP
|
$43.99
|
|
| Hospital Charge Code |
41601848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$40.91 |
| Rate for Payer: Aetna Commercial |
$37.13
|
| Rate for Payer: Aetna Medicare |
$14.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.48
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Centivo All Commercial |
$23.93
|
| Rate for Payer: Cigna All Commercial |
$37.96
|
| Rate for Payer: CORVEL All Commercial |
$40.91
|
| Rate for Payer: Coventry All Commercial |
$38.71
|
| Rate for Payer: Encore All Commercial |
$40.49
|
| Rate for Payer: Frontpath All Commercial |
$40.47
|
| Rate for Payer: Humana ChoiceCare |
$37.99
|
| Rate for Payer: Humana Medicare |
$14.08
|
| Rate for Payer: Lucent All Commercial |
$23.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.59
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$32.99
|
| Rate for Payer: PHP All Commercial |
$33.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.16
|
| Rate for Payer: Sagamore Health Network All Products |
$33.96
|
| Rate for Payer: Signature Care EPO |
$36.51
|
| Rate for Payer: Signature Care PPO |
$38.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.39
|
| Rate for Payer: United Healthcare Commercial |
$34.66
|
| Rate for Payer: United Healthcare Medicare |
$14.08
|
|
|
HC TOURNI-COT MED
|
Facility
|
IP
|
$44.22
|
|
| Hospital Charge Code |
41601849
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.16 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Aetna Commercial |
$38.21
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: Cigna All Commercial |
$38.16
|
| Rate for Payer: CORVEL All Commercial |
$41.12
|
| Rate for Payer: Coventry All Commercial |
$38.91
|
| Rate for Payer: Encore All Commercial |
$40.70
|
| Rate for Payer: Frontpath All Commercial |
$40.68
|
| Rate for Payer: Humana ChoiceCare |
$38.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.80
|
| Rate for Payer: PHCS All Commercial |
$33.16
|
| Rate for Payer: PHP All Commercial |
$33.54
|
| Rate for Payer: Sagamore Health Network All Products |
$34.14
|
| Rate for Payer: Signature Care EPO |
$36.70
|
| Rate for Payer: Signature Care PPO |
$38.91
|
| Rate for Payer: United Healthcare Commercial |
$34.85
|
|
|
HC TOURNI-COT MED
|
Facility
|
OP
|
$44.22
|
|
| Hospital Charge Code |
41601849
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Aetna Commercial |
$37.32
|
| Rate for Payer: Aetna Medicare |
$14.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.57
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: Centivo All Commercial |
$24.06
|
| Rate for Payer: Cigna All Commercial |
$38.16
|
| Rate for Payer: CORVEL All Commercial |
$41.12
|
| Rate for Payer: Coventry All Commercial |
$38.91
|
| Rate for Payer: Encore All Commercial |
$40.70
|
| Rate for Payer: Frontpath All Commercial |
$40.68
|
| Rate for Payer: Humana ChoiceCare |
$38.19
|
| Rate for Payer: Humana Medicare |
$14.15
|
| Rate for Payer: Lucent All Commercial |
$24.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$33.16
|
| Rate for Payer: PHP All Commercial |
$33.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.25
|
| Rate for Payer: Sagamore Health Network All Products |
$34.14
|
| Rate for Payer: Signature Care EPO |
$36.70
|
| Rate for Payer: Signature Care PPO |
$38.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.59
|
| Rate for Payer: United Healthcare Commercial |
$34.85
|
| Rate for Payer: United Healthcare Medicare |
$14.15
|
|
|
HC TOURNI-COT XLG
|
Facility
|
IP
|
$41.49
|
|
| Hospital Charge Code |
41601850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$38.59 |
| Rate for Payer: Aetna Commercial |
$35.85
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cigna All Commercial |
$35.81
|
| Rate for Payer: CORVEL All Commercial |
$38.59
|
| Rate for Payer: Coventry All Commercial |
$36.51
|
| Rate for Payer: Encore All Commercial |
$38.19
|
| Rate for Payer: Frontpath All Commercial |
$38.17
|
| Rate for Payer: Humana ChoiceCare |
$35.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.34
|
| Rate for Payer: PHCS All Commercial |
$31.12
|
| Rate for Payer: PHP All Commercial |
$31.47
|
| Rate for Payer: Sagamore Health Network All Products |
$32.03
|
| Rate for Payer: Signature Care EPO |
$34.44
|
| Rate for Payer: Signature Care PPO |
$36.51
|
| Rate for Payer: United Healthcare Commercial |
$32.69
|
|
|
HC TOURNI-COT XLG
|
Facility
|
OP
|
$41.49
|
|
| Hospital Charge Code |
41601850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$38.59 |
| Rate for Payer: Aetna Commercial |
$35.02
|
| Rate for Payer: Aetna Medicare |
$13.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.60
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Centivo All Commercial |
$22.57
|
| Rate for Payer: Cigna All Commercial |
$35.81
|
| Rate for Payer: CORVEL All Commercial |
$38.59
|
| Rate for Payer: Coventry All Commercial |
$36.51
|
| Rate for Payer: Encore All Commercial |
$38.19
|
| Rate for Payer: Frontpath All Commercial |
$38.17
|
| Rate for Payer: Humana ChoiceCare |
$35.83
|
| Rate for Payer: Humana Medicare |
$13.28
|
| Rate for Payer: Lucent All Commercial |
$22.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.34
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$31.12
|
| Rate for Payer: PHP All Commercial |
$31.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.18
|
| Rate for Payer: Sagamore Health Network All Products |
$32.03
|
| Rate for Payer: Signature Care EPO |
$34.44
|
| Rate for Payer: Signature Care PPO |
$36.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.27
|
| Rate for Payer: United Healthcare Commercial |
$32.69
|
| Rate for Payer: United Healthcare Medicare |
$13.28
|
|
|
HC TOXOPLASMOS IGA
|
Facility
|
OP
|
$118.83
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
63001048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$100.29
|
| Rate for Payer: Aetna Medicare |
$38.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.83
|
| Rate for Payer: Cash Price |
$71.30
|
| Rate for Payer: Cash Price |
$71.30
|
| Rate for Payer: Centivo All Commercial |
$64.64
|
| Rate for Payer: Cigna All Commercial |
$102.55
|
| Rate for Payer: CORVEL All Commercial |
$110.51
|
| Rate for Payer: Coventry All Commercial |
$104.57
|
| Rate for Payer: Encore All Commercial |
$109.38
|
| Rate for Payer: Frontpath All Commercial |
$109.32
|
| Rate for Payer: Humana ChoiceCare |
$102.63
|
| Rate for Payer: Humana Medicare |
$38.03
|
| Rate for Payer: Lucent All Commercial |
$64.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.95
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$89.12
|
| Rate for Payer: PHP All Commercial |
$90.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.34
|
| Rate for Payer: Sagamore Health Network All Products |
$91.74
|
| Rate for Payer: Signature Care EPO |
$98.63
|
| Rate for Payer: Signature Care PPO |
$104.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.01
|
| Rate for Payer: United Healthcare Commercial |
$93.64
|
| Rate for Payer: United Healthcare Medicare |
$38.03
|
|
|
HC TOXOPLASMOS IGA
|
Facility
|
IP
|
$118.83
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
63001048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.12 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$102.67
|
| Rate for Payer: Cash Price |
$71.30
|
| Rate for Payer: Cigna All Commercial |
$102.55
|
| Rate for Payer: CORVEL All Commercial |
$110.51
|
| Rate for Payer: Coventry All Commercial |
$104.57
|
| Rate for Payer: Encore All Commercial |
$109.38
|
| Rate for Payer: Frontpath All Commercial |
$109.32
|
| Rate for Payer: Humana ChoiceCare |
$102.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.95
|
| Rate for Payer: PHCS All Commercial |
$89.12
|
| Rate for Payer: PHP All Commercial |
$90.12
|
| Rate for Payer: Sagamore Health Network All Products |
$91.74
|
| Rate for Payer: Signature Care EPO |
$98.63
|
| Rate for Payer: Signature Care PPO |
$104.57
|
| Rate for Payer: United Healthcare Commercial |
$93.64
|
|
|
HC TOXOPLASMOSIS IGG
|
Facility
|
IP
|
$118.83
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
63001203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.12 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$102.67
|
| Rate for Payer: Cash Price |
$71.30
|
| Rate for Payer: Cigna All Commercial |
$102.55
|
| Rate for Payer: CORVEL All Commercial |
$110.51
|
| Rate for Payer: Coventry All Commercial |
$104.57
|
| Rate for Payer: Encore All Commercial |
$109.38
|
| Rate for Payer: Frontpath All Commercial |
$109.32
|
| Rate for Payer: Humana ChoiceCare |
$102.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.95
|
| Rate for Payer: PHCS All Commercial |
$89.12
|
| Rate for Payer: PHP All Commercial |
$90.12
|
| Rate for Payer: Sagamore Health Network All Products |
$91.74
|
| Rate for Payer: Signature Care EPO |
$98.63
|
| Rate for Payer: Signature Care PPO |
$104.57
|
| Rate for Payer: United Healthcare Commercial |
$93.64
|
|
|
HC TOXOPLASMOSIS IGG
|
Facility
|
OP
|
$118.83
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
63001203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$100.29
|
| Rate for Payer: Aetna Medicare |
$38.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.83
|
| Rate for Payer: Cash Price |
$71.30
|
| Rate for Payer: Cash Price |
$71.30
|
| Rate for Payer: Centivo All Commercial |
$64.64
|
| Rate for Payer: Cigna All Commercial |
$102.55
|
| Rate for Payer: CORVEL All Commercial |
$110.51
|
| Rate for Payer: Coventry All Commercial |
$104.57
|
| Rate for Payer: Encore All Commercial |
$109.38
|
| Rate for Payer: Frontpath All Commercial |
$109.32
|
| Rate for Payer: Humana ChoiceCare |
$102.63
|
| Rate for Payer: Humana Medicare |
$38.03
|
| Rate for Payer: Lucent All Commercial |
$64.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.95
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$89.12
|
| Rate for Payer: PHP All Commercial |
$90.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.34
|
| Rate for Payer: Sagamore Health Network All Products |
$91.74
|
| Rate for Payer: Signature Care EPO |
$98.63
|
| Rate for Payer: Signature Care PPO |
$104.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.01
|
| Rate for Payer: United Healthcare Commercial |
$93.64
|
| Rate for Payer: United Healthcare Medicare |
$38.03
|
|
|
HC TOXOPLASMOSIS IGM
|
Facility
|
OP
|
$198.75
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
63001280
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$184.84 |
| Rate for Payer: Aetna Commercial |
$167.75
|
| Rate for Payer: Aetna Medicare |
$63.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$91.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.96
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Centivo All Commercial |
$108.12
|
| Rate for Payer: Cigna All Commercial |
$171.52
|
| Rate for Payer: CORVEL All Commercial |
$184.84
|
| Rate for Payer: Coventry All Commercial |
$174.90
|
| Rate for Payer: Encore All Commercial |
$182.95
|
| Rate for Payer: Frontpath All Commercial |
$182.85
|
| Rate for Payer: Humana ChoiceCare |
$171.66
|
| Rate for Payer: Humana Medicare |
$63.60
|
| Rate for Payer: Lucent All Commercial |
$108.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.88
|
| Rate for Payer: Managed Health Services Medicaid |
$14.41
|
| Rate for Payer: MDWise Medicaid |
$14.41
|
| Rate for Payer: PHCS All Commercial |
$149.06
|
| Rate for Payer: PHP All Commercial |
$150.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.51
|
| Rate for Payer: Sagamore Health Network All Products |
$153.44
|
| Rate for Payer: Signature Care EPO |
$164.96
|
| Rate for Payer: Signature Care PPO |
$174.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$168.94
|
| Rate for Payer: United Healthcare Commercial |
$156.62
|
| Rate for Payer: United Healthcare Medicare |
$63.60
|
|
|
HC TOXOPLASMOSIS IGM
|
Facility
|
IP
|
$198.75
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
63001280
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$184.84 |
| Rate for Payer: Aetna Commercial |
$171.72
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna All Commercial |
$171.52
|
| Rate for Payer: CORVEL All Commercial |
$184.84
|
| Rate for Payer: Coventry All Commercial |
$174.90
|
| Rate for Payer: Encore All Commercial |
$182.95
|
| Rate for Payer: Frontpath All Commercial |
$182.85
|
| Rate for Payer: Humana ChoiceCare |
$171.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.88
|
| Rate for Payer: PHCS All Commercial |
$149.06
|
| Rate for Payer: PHP All Commercial |
$150.73
|
| Rate for Payer: Sagamore Health Network All Products |
$153.44
|
| Rate for Payer: Signature Care EPO |
$164.96
|
| Rate for Payer: Signature Care PPO |
$174.90
|
| Rate for Payer: United Healthcare Commercial |
$156.62
|
|
|
HC T PALLIDUM AB,TP-PA
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
63001971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.62 |
| Max. Negotiated Rate |
$102.45 |
| Rate for Payer: Aetna Commercial |
$95.18
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cigna All Commercial |
$95.07
|
| Rate for Payer: CORVEL All Commercial |
$102.45
|
| Rate for Payer: Coventry All Commercial |
$96.94
|
| Rate for Payer: Encore All Commercial |
$101.40
|
| Rate for Payer: Frontpath All Commercial |
$101.35
|
| Rate for Payer: Humana ChoiceCare |
$95.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.14
|
| Rate for Payer: PHCS All Commercial |
$82.62
|
| Rate for Payer: PHP All Commercial |
$83.55
|
| Rate for Payer: Sagamore Health Network All Products |
$85.04
|
| Rate for Payer: Signature Care EPO |
$91.43
|
| Rate for Payer: Signature Care PPO |
$96.94
|
| Rate for Payer: United Healthcare Commercial |
$86.81
|
|
|
HC T PALLIDUM AB,TP-PA
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
63001971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$102.45 |
| Rate for Payer: Aetna Commercial |
$92.98
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$50.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.24
|
| 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 |
$66.10
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Centivo All Commercial |
$59.93
|
| Rate for Payer: Cigna All Commercial |
$95.07
|
| Rate for Payer: CORVEL All Commercial |
$102.45
|
| Rate for Payer: Coventry All Commercial |
$96.94
|
| Rate for Payer: Encore All Commercial |
$101.40
|
| Rate for Payer: Frontpath All Commercial |
$101.35
|
| Rate for Payer: Humana ChoiceCare |
$95.15
|
| Rate for Payer: Humana Medicare |
$35.25
|
| Rate for Payer: Lucent All Commercial |
$59.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.14
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: MDWise Medicaid |
$13.24
|
| Rate for Payer: PHCS All Commercial |
$82.62
|
| Rate for Payer: PHP All Commercial |
$83.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.96
|
| Rate for Payer: Sagamore Health Network All Products |
$85.04
|
| Rate for Payer: Signature Care EPO |
$91.43
|
| Rate for Payer: Signature Care PPO |
$96.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.64
|
| Rate for Payer: United Healthcare Commercial |
$86.81
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
|
|
HC TRACH QUICK LARGE 4.0
|
Facility
|
OP
|
$1,090.80
|
|
| Hospital Charge Code |
41601815
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$1,014.44 |
| Rate for Payer: Aetna Commercial |
$920.64
|
| Rate for Payer: Aetna Medicare |
$349.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$626.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$681.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$401.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$383.96
|
| Rate for Payer: Cash Price |
$654.48
|
| Rate for Payer: Cash Price |
$654.48
|
| Rate for Payer: Centivo All Commercial |
$593.40
|
| Rate for Payer: Cigna All Commercial |
$941.36
|
| Rate for Payer: CORVEL All Commercial |
$1,014.44
|
| Rate for Payer: Coventry All Commercial |
$959.90
|
| Rate for Payer: Encore All Commercial |
$1,004.08
|
| Rate for Payer: Frontpath All Commercial |
$1,003.54
|
| Rate for Payer: Humana ChoiceCare |
$942.12
|
| Rate for Payer: Humana Medicare |
$349.06
|
| Rate for Payer: Lucent All Commercial |
$593.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.72
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$818.10
|
| Rate for Payer: PHP All Commercial |
$827.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$425.41
|
| Rate for Payer: Sagamore Health Network All Products |
$842.10
|
| Rate for Payer: Signature Care EPO |
$905.36
|
| Rate for Payer: Signature Care PPO |
$959.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$927.18
|
| Rate for Payer: United Healthcare Commercial |
$859.55
|
| Rate for Payer: United Healthcare Medicare |
$349.06
|
|
|
HC TRACH QUICK LARGE 4.0
|
Facility
|
IP
|
$1,090.80
|
|
| Hospital Charge Code |
41601815
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$818.10 |
| Max. Negotiated Rate |
$1,014.44 |
| Rate for Payer: Aetna Commercial |
$942.45
|
| Rate for Payer: Cash Price |
$654.48
|
| Rate for Payer: Cigna All Commercial |
$941.36
|
| Rate for Payer: CORVEL All Commercial |
$1,014.44
|
| Rate for Payer: Coventry All Commercial |
$959.90
|
| Rate for Payer: Encore All Commercial |
$1,004.08
|
| Rate for Payer: Frontpath All Commercial |
$1,003.54
|
| Rate for Payer: Humana ChoiceCare |
$942.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.72
|
| Rate for Payer: PHCS All Commercial |
$818.10
|
| Rate for Payer: PHP All Commercial |
$827.26
|
| Rate for Payer: Sagamore Health Network All Products |
$842.10
|
| Rate for Payer: Signature Care EPO |
$905.36
|
| Rate for Payer: Signature Care PPO |
$959.90
|
| Rate for Payer: United Healthcare Commercial |
$859.55
|
|
|
HC TRACTION MECHANICAL-PT
|
Facility
|
OP
|
$123.66
|
|
|
Service Code
|
CPT 97012 GP
|
| Hospital Charge Code |
1728084
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$104.37
|
| Rate for Payer: Aetna Medicare |
$39.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.53
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Centivo All Commercial |
$67.27
|
| Rate for Payer: Cigna All Commercial |
$106.72
|
| Rate for Payer: CORVEL All Commercial |
$115.00
|
| Rate for Payer: Coventry All Commercial |
$108.82
|
| Rate for Payer: Encore All Commercial |
$113.83
|
| Rate for Payer: Frontpath All Commercial |
$113.77
|
| Rate for Payer: Humana ChoiceCare |
$106.81
|
| Rate for Payer: Humana Medicare |
$39.57
|
| Rate for Payer: Lucent All Commercial |
$67.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.29
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$92.75
|
| Rate for Payer: PHP All Commercial |
$93.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.23
|
| Rate for Payer: Sagamore Health Network All Products |
$95.47
|
| Rate for Payer: Signature Care EPO |
$102.64
|
| Rate for Payer: Signature Care PPO |
$108.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.11
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
| Rate for Payer: United Healthcare Medicare |
$39.57
|
|
|
HC TRACTION MECHANICAL-PT
|
Facility
|
IP
|
$123.66
|
|
|
Service Code
|
CPT 97012 GP
|
| Hospital Charge Code |
1728084
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$106.84
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cigna All Commercial |
$106.72
|
| Rate for Payer: CORVEL All Commercial |
$115.00
|
| Rate for Payer: Coventry All Commercial |
$108.82
|
| Rate for Payer: Encore All Commercial |
$113.83
|
| Rate for Payer: Frontpath All Commercial |
$113.77
|
| Rate for Payer: Humana ChoiceCare |
$106.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.29
|
| Rate for Payer: PHCS All Commercial |
$92.75
|
| Rate for Payer: PHP All Commercial |
$93.78
|
| Rate for Payer: Sagamore Health Network All Products |
$95.47
|
| Rate for Payer: Signature Care EPO |
$102.64
|
| Rate for Payer: Signature Care PPO |
$108.82
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
|
|
HC TRAMADOL CONFIRMATION (LABCORP MEDWATCH)
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
63044080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.33 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna Commercial |
$92.53
|
| Rate for Payer: Cash Price |
$64.26
|
| 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 |
$80.33
|
| 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 TRAMADOL CONFIRMATION (LABCORP MEDWATCH)
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$114.43 |
| Rate for Payer: Aetna Commercial |
$90.39
|
| Rate for Payer: Aetna Medicare |
$34.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$49.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.70
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Centivo All Commercial |
$58.26
|
| 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 |
$34.27
|
| Rate for Payer: Lucent All Commercial |
$58.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.39
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$80.33
|
| 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 |
$91.03
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$34.27
|
|
|
HC TRAMADOL CONFIRMATION (LABCORP MEDWATCH)
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
63044080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna Commercial |
$90.39
|
| Rate for Payer: Aetna Medicare |
$34.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$49.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.70
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Centivo All Commercial |
$58.26
|
| 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 |
$34.27
|
| Rate for Payer: Lucent All Commercial |
$58.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.39
|
| Rate for Payer: PHCS All Commercial |
$80.33
|
| 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 |
$91.03
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$34.27
|
|
|
HC TRAMADOL CONFIRMATION (LABCORP MEDWATCH)
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.33 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna Commercial |
$92.53
|
| Rate for Payer: Cash Price |
$64.26
|
| 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 |
$80.33
|
| 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 TRANSCUTANEOUS BILIRUBIN
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
1028400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$89.53
|
| Rate for Payer: Aetna Medicare |
$33.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.34
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Centivo All Commercial |
$57.71
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Humana Medicare |
$33.95
|
| Rate for Payer: Lucent All Commercial |
$57.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: Managed Health Services Medicaid |
$5.02
|
| Rate for Payer: MDWise Medicaid |
$5.02
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.37
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.17
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
| Rate for Payer: United Healthcare Medicare |
$33.95
|
|
