|
HC PROBE TEMP ESOPH/RECTAL 12F
|
Facility
IP
|
$39.45
|
|
| Hospital Charge Code |
41603423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.59 |
| Max. Negotiated Rate |
$36.69 |
| Rate for Payer: Aetna Commercial |
$34.08
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Cigna All Commercial |
$34.05
|
| Rate for Payer: CORVEL All Commercial |
$36.69
|
| Rate for Payer: Coventry All Commercial |
$34.72
|
| Rate for Payer: Encore All Commercial |
$36.31
|
| Rate for Payer: Frontpath All Commercial |
$36.29
|
| Rate for Payer: Humana ChoiceCare |
$34.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.50
|
| Rate for Payer: PHCS All Commercial |
$29.59
|
| Rate for Payer: PHP All Commercial |
$29.92
|
| Rate for Payer: Sagamore Health Network All Products |
$30.46
|
| Rate for Payer: Signature Care EPO |
$32.74
|
| Rate for Payer: Signature Care PPO |
$34.72
|
| Rate for Payer: United Healthcare Commercial |
$31.09
|
|
|
HC PROBE TEMP ESOPH/RECTAL 12F
|
Facility
OP
|
$39.45
|
|
| Hospital Charge Code |
41603423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.32
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Centivo All Commercial |
$20.12
|
| Rate for Payer: Cigna All Commercial |
$34.05
|
| Rate for Payer: CORVEL All Commercial |
$36.69
|
| Rate for Payer: Coventry All Commercial |
$34.72
|
| Rate for Payer: Encore All Commercial |
$36.31
|
| Rate for Payer: Frontpath All Commercial |
$36.29
|
| Rate for Payer: Humana ChoiceCare |
$34.07
|
| Rate for Payer: Humana Medicare |
$20.12
|
| Rate for Payer: Lucent All Commercial |
$20.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.59
|
| Rate for Payer: PHP All Commercial |
$29.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.39
|
| Rate for Payer: Sagamore Health Network All Products |
$30.46
|
| Rate for Payer: Signature Care EPO |
$32.74
|
| Rate for Payer: Signature Care PPO |
$34.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.53
|
| Rate for Payer: United Healthcare Commercial |
$31.09
|
| Rate for Payer: United Healthcare Medicare |
$13.02
|
|
|
HC PROBE TEMP ESOPH/RECTAL 9F
|
Facility
OP
|
$39.45
|
|
| Hospital Charge Code |
41603424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.32
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Centivo All Commercial |
$20.12
|
| Rate for Payer: Cigna All Commercial |
$34.05
|
| Rate for Payer: CORVEL All Commercial |
$36.69
|
| Rate for Payer: Coventry All Commercial |
$34.72
|
| Rate for Payer: Encore All Commercial |
$36.31
|
| Rate for Payer: Frontpath All Commercial |
$36.29
|
| Rate for Payer: Humana ChoiceCare |
$34.07
|
| Rate for Payer: Humana Medicare |
$20.12
|
| Rate for Payer: Lucent All Commercial |
$20.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.59
|
| Rate for Payer: PHP All Commercial |
$29.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.39
|
| Rate for Payer: Sagamore Health Network All Products |
$30.46
|
| Rate for Payer: Signature Care EPO |
$32.74
|
| Rate for Payer: Signature Care PPO |
$34.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.53
|
| Rate for Payer: United Healthcare Commercial |
$31.09
|
| Rate for Payer: United Healthcare Medicare |
$13.02
|
|
|
HC PROBE TEMP ESOPH/RECTAL 9F
|
Facility
IP
|
$39.45
|
|
| Hospital Charge Code |
41603424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.59 |
| Max. Negotiated Rate |
$36.69 |
| Rate for Payer: Aetna Commercial |
$34.08
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Cigna All Commercial |
$34.05
|
| Rate for Payer: CORVEL All Commercial |
$36.69
|
| Rate for Payer: Coventry All Commercial |
$34.72
|
| Rate for Payer: Encore All Commercial |
$36.31
|
| Rate for Payer: Frontpath All Commercial |
$36.29
|
| Rate for Payer: Humana ChoiceCare |
$34.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.50
|
| Rate for Payer: PHCS All Commercial |
$29.59
|
| Rate for Payer: PHP All Commercial |
$29.92
|
| Rate for Payer: Sagamore Health Network All Products |
$30.46
|
| Rate for Payer: Signature Care EPO |
$32.74
|
| Rate for Payer: Signature Care PPO |
$34.72
|
| Rate for Payer: United Healthcare Commercial |
$31.09
|
|
|
HC PROCALCITONIN
|
Facility
OP
|
$466.46
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
63001663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Aetna Commercial |
$393.69
|
| Rate for Payer: Aetna Medicare |
$153.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$153.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$214.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$177.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$169.32
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Centivo All Commercial |
$237.89
|
| Rate for Payer: Cigna All Commercial |
$402.55
|
| Rate for Payer: CORVEL All Commercial |
$433.80
|
| Rate for Payer: Coventry All Commercial |
$410.48
|
| Rate for Payer: Encore All Commercial |
$429.37
|
| Rate for Payer: Frontpath All Commercial |
$429.14
|
| Rate for Payer: Humana ChoiceCare |
$402.88
|
| Rate for Payer: Humana Medicare |
$237.89
|
| Rate for Payer: Lucent All Commercial |
$237.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.81
|
| Rate for Payer: Managed Health Services Medicaid |
$27.22
|
| Rate for Payer: MDWise Medicaid |
$27.22
|
| Rate for Payer: PHCS All Commercial |
$349.84
|
| Rate for Payer: PHP All Commercial |
$353.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.92
|
| Rate for Payer: Sagamore Health Network All Products |
$360.10
|
| Rate for Payer: Signature Care EPO |
$387.16
|
| Rate for Payer: Signature Care PPO |
$410.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$396.49
|
| Rate for Payer: United Healthcare Commercial |
$367.57
|
| Rate for Payer: United Healthcare Medicare |
$153.93
|
|
|
HC PROCALCITONIN
|
Facility
IP
|
$466.46
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
63001663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$349.84 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Aetna Commercial |
$403.02
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna All Commercial |
$402.55
|
| Rate for Payer: CORVEL All Commercial |
$433.80
|
| Rate for Payer: Coventry All Commercial |
$410.48
|
| Rate for Payer: Encore All Commercial |
$429.37
|
| Rate for Payer: Frontpath All Commercial |
$429.14
|
| Rate for Payer: Humana ChoiceCare |
$402.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.81
|
| Rate for Payer: PHCS All Commercial |
$349.84
|
| Rate for Payer: PHP All Commercial |
$353.76
|
| Rate for Payer: Sagamore Health Network All Products |
$360.10
|
| Rate for Payer: Signature Care EPO |
$387.16
|
| Rate for Payer: Signature Care PPO |
$410.48
|
| Rate for Payer: United Healthcare Commercial |
$367.57
|
|
|
HC PROGESTERONE
|
Facility
OP
|
$245.49
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
63001160
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$228.31 |
| Rate for Payer: Aetna Commercial |
$207.20
|
| Rate for Payer: Aetna Medicare |
$81.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$112.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.11
|
| Rate for Payer: Cash Price |
$152.21
|
| Rate for Payer: Cash Price |
$152.21
|
| Rate for Payer: Centivo All Commercial |
$125.20
|
| Rate for Payer: Cigna All Commercial |
$211.86
|
| Rate for Payer: CORVEL All Commercial |
$228.31
|
| Rate for Payer: Coventry All Commercial |
$216.03
|
| Rate for Payer: Encore All Commercial |
$225.98
|
| Rate for Payer: Frontpath All Commercial |
$225.85
|
| Rate for Payer: Humana ChoiceCare |
$212.03
|
| Rate for Payer: Humana Medicare |
$125.20
|
| Rate for Payer: Lucent All Commercial |
$125.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.94
|
| Rate for Payer: Managed Health Services Medicaid |
$20.86
|
| Rate for Payer: MDWise Medicaid |
$20.86
|
| Rate for Payer: PHCS All Commercial |
$184.12
|
| Rate for Payer: PHP All Commercial |
$186.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.74
|
| Rate for Payer: Sagamore Health Network All Products |
$189.52
|
| Rate for Payer: Signature Care EPO |
$203.76
|
| Rate for Payer: Signature Care PPO |
$216.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.67
|
| Rate for Payer: United Healthcare Commercial |
$193.45
|
| Rate for Payer: United Healthcare Medicare |
$81.01
|
|
|
HC PROGESTERONE
|
Facility
IP
|
$245.49
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
63001160
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$184.12 |
| Max. Negotiated Rate |
$228.31 |
| Rate for Payer: Aetna Commercial |
$212.11
|
| Rate for Payer: Cash Price |
$152.21
|
| Rate for Payer: Cigna All Commercial |
$211.86
|
| Rate for Payer: CORVEL All Commercial |
$228.31
|
| Rate for Payer: Coventry All Commercial |
$216.03
|
| Rate for Payer: Encore All Commercial |
$225.98
|
| Rate for Payer: Frontpath All Commercial |
$225.85
|
| Rate for Payer: Humana ChoiceCare |
$212.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.94
|
| Rate for Payer: PHCS All Commercial |
$184.12
|
| Rate for Payer: PHP All Commercial |
$186.18
|
| Rate for Payer: Sagamore Health Network All Products |
$189.52
|
| Rate for Payer: Signature Care EPO |
$203.76
|
| Rate for Payer: Signature Care PPO |
$216.03
|
| Rate for Payer: United Healthcare Commercial |
$193.45
|
|
|
HC PROGRESSA BED/DAY
|
Facility
IP
|
$307.63
|
|
| Hospital Charge Code |
01895001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$230.72 |
| Max. Negotiated Rate |
$286.10 |
| Rate for Payer: Aetna Commercial |
$265.79
|
| Rate for Payer: Cash Price |
$190.73
|
| Rate for Payer: Cigna All Commercial |
$265.49
|
| Rate for Payer: CORVEL All Commercial |
$286.10
|
| Rate for Payer: Coventry All Commercial |
$270.72
|
| Rate for Payer: Encore All Commercial |
$283.18
|
| Rate for Payer: Frontpath All Commercial |
$283.02
|
| Rate for Payer: Humana ChoiceCare |
$265.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.87
|
| Rate for Payer: PHCS All Commercial |
$230.72
|
| Rate for Payer: PHP All Commercial |
$233.31
|
| Rate for Payer: Sagamore Health Network All Products |
$237.49
|
| Rate for Payer: Signature Care EPO |
$255.33
|
| Rate for Payer: Signature Care PPO |
$270.72
|
| Rate for Payer: United Healthcare Commercial |
$242.41
|
|
|
HC PROGRESSA BED/DAY
|
Facility
OP
|
$307.63
|
|
| Hospital Charge Code |
01895001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$286.10 |
| Rate for Payer: Aetna Commercial |
$259.64
|
| Rate for Payer: Aetna Medicare |
$101.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$176.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$192.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.67
|
| Rate for Payer: Cash Price |
$190.73
|
| Rate for Payer: Cash Price |
$190.73
|
| Rate for Payer: Centivo All Commercial |
$156.89
|
| Rate for Payer: Cigna All Commercial |
$265.49
|
| Rate for Payer: CORVEL All Commercial |
$286.10
|
| Rate for Payer: Coventry All Commercial |
$270.72
|
| Rate for Payer: Encore All Commercial |
$283.18
|
| Rate for Payer: Frontpath All Commercial |
$283.02
|
| Rate for Payer: Humana ChoiceCare |
$265.70
|
| Rate for Payer: Humana Medicare |
$156.89
|
| Rate for Payer: Lucent All Commercial |
$156.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.87
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$230.72
|
| Rate for Payer: PHP All Commercial |
$233.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.98
|
| Rate for Payer: Sagamore Health Network All Products |
$237.49
|
| Rate for Payer: Signature Care EPO |
$255.33
|
| Rate for Payer: Signature Care PPO |
$270.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$261.49
|
| Rate for Payer: United Healthcare Commercial |
$242.41
|
| Rate for Payer: United Healthcare Medicare |
$101.52
|
|
|
HC PROLACTIN
|
Facility
OP
|
$168.30
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
63001178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.09
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Centivo All Commercial |
$85.83
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$85.83
|
| Rate for Payer: Lucent All Commercial |
$85.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$19.38
|
| Rate for Payer: MDWise Medicaid |
$19.38
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$55.54
|
|
|
HC PROLACTIN
|
Facility
IP
|
$168.30
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
63001178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC PROMETHEUS GLIADIN IGA
|
Facility
IP
|
$218.15
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.61 |
| Max. Negotiated Rate |
$202.88 |
| Rate for Payer: Aetna Commercial |
$188.48
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cigna All Commercial |
$188.26
|
| Rate for Payer: CORVEL All Commercial |
$202.88
|
| Rate for Payer: Coventry All Commercial |
$191.97
|
| Rate for Payer: Encore All Commercial |
$200.80
|
| Rate for Payer: Frontpath All Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$188.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.33
|
| Rate for Payer: PHCS All Commercial |
$163.61
|
| Rate for Payer: PHP All Commercial |
$165.44
|
| Rate for Payer: Sagamore Health Network All Products |
$168.41
|
| Rate for Payer: Signature Care EPO |
$181.06
|
| Rate for Payer: Signature Care PPO |
$191.97
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
|
|
HC PROMETHEUS GLIADIN IGA
|
Facility
OP
|
$218.15
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$202.88 |
| Rate for Payer: Aetna Commercial |
$184.12
|
| Rate for Payer: Aetna Medicare |
$71.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$125.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$136.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.19
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Centivo All Commercial |
$111.26
|
| Rate for Payer: Cigna All Commercial |
$188.26
|
| Rate for Payer: CORVEL All Commercial |
$202.88
|
| Rate for Payer: Coventry All Commercial |
$191.97
|
| Rate for Payer: Encore All Commercial |
$200.80
|
| Rate for Payer: Frontpath All Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$188.41
|
| Rate for Payer: Humana Medicare |
$111.26
|
| Rate for Payer: Lucent All Commercial |
$111.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.33
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$163.61
|
| Rate for Payer: PHP All Commercial |
$165.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.08
|
| Rate for Payer: Sagamore Health Network All Products |
$168.41
|
| Rate for Payer: Signature Care EPO |
$181.06
|
| Rate for Payer: Signature Care PPO |
$191.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.43
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Medicare |
$71.99
|
|
|
HC PROMETHEUS LTG IGA
|
Facility
IP
|
$218.15
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.61 |
| Max. Negotiated Rate |
$202.88 |
| Rate for Payer: Aetna Commercial |
$188.48
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cigna All Commercial |
$188.26
|
| Rate for Payer: CORVEL All Commercial |
$202.88
|
| Rate for Payer: Coventry All Commercial |
$191.97
|
| Rate for Payer: Encore All Commercial |
$200.80
|
| Rate for Payer: Frontpath All Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$188.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.33
|
| Rate for Payer: PHCS All Commercial |
$163.61
|
| Rate for Payer: PHP All Commercial |
$165.44
|
| Rate for Payer: Sagamore Health Network All Products |
$168.41
|
| Rate for Payer: Signature Care EPO |
$181.06
|
| Rate for Payer: Signature Care PPO |
$191.97
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
|
|
HC PROMETHEUS LTG IGA
|
Facility
OP
|
$218.15
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$202.88 |
| Rate for Payer: Aetna Commercial |
$184.12
|
| Rate for Payer: Aetna Medicare |
$71.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$125.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$136.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.19
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Centivo All Commercial |
$111.26
|
| Rate for Payer: Cigna All Commercial |
$188.26
|
| Rate for Payer: CORVEL All Commercial |
$202.88
|
| Rate for Payer: Coventry All Commercial |
$191.97
|
| Rate for Payer: Encore All Commercial |
$200.80
|
| Rate for Payer: Frontpath All Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$188.41
|
| Rate for Payer: Humana Medicare |
$111.26
|
| Rate for Payer: Lucent All Commercial |
$111.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.33
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$163.61
|
| Rate for Payer: PHP All Commercial |
$165.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.08
|
| Rate for Payer: Sagamore Health Network All Products |
$168.41
|
| Rate for Payer: Signature Care EPO |
$181.06
|
| Rate for Payer: Signature Care PPO |
$191.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.43
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Medicare |
$71.99
|
|
|
HC PROMETHEUS THIOPURINE METABOLITES
|
Facility
IP
|
$161.44
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.08 |
| Max. Negotiated Rate |
$150.13 |
| Rate for Payer: Aetna Commercial |
$139.48
|
| Rate for Payer: Cash Price |
$100.09
|
| Rate for Payer: Cigna All Commercial |
$139.32
|
| Rate for Payer: CORVEL All Commercial |
$150.13
|
| Rate for Payer: Coventry All Commercial |
$142.06
|
| Rate for Payer: Encore All Commercial |
$148.60
|
| Rate for Payer: Frontpath All Commercial |
$148.52
|
| Rate for Payer: Humana ChoiceCare |
$139.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.29
|
| Rate for Payer: PHCS All Commercial |
$121.08
|
| Rate for Payer: PHP All Commercial |
$122.43
|
| Rate for Payer: Sagamore Health Network All Products |
$124.63
|
| Rate for Payer: Signature Care EPO |
$133.99
|
| Rate for Payer: Signature Care PPO |
$142.06
|
| Rate for Payer: United Healthcare Commercial |
$127.21
|
|
|
HC PROMETHEUS THIOPURINE METABOLITES
|
Facility
OP
|
$161.44
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$150.13 |
| Rate for Payer: Aetna Commercial |
$136.25
|
| Rate for Payer: Aetna Medicare |
$53.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.60
|
| Rate for Payer: Cash Price |
$100.09
|
| Rate for Payer: Cash Price |
$100.09
|
| Rate for Payer: Centivo All Commercial |
$82.33
|
| Rate for Payer: Cigna All Commercial |
$139.32
|
| Rate for Payer: CORVEL All Commercial |
$150.13
|
| Rate for Payer: Coventry All Commercial |
$142.06
|
| Rate for Payer: Encore All Commercial |
$148.60
|
| Rate for Payer: Frontpath All Commercial |
$148.52
|
| Rate for Payer: Humana ChoiceCare |
$139.43
|
| Rate for Payer: Humana Medicare |
$82.33
|
| Rate for Payer: Lucent All Commercial |
$82.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.29
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$121.08
|
| Rate for Payer: PHP All Commercial |
$122.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.96
|
| Rate for Payer: Sagamore Health Network All Products |
$124.63
|
| Rate for Payer: Signature Care EPO |
$133.99
|
| Rate for Payer: Signature Care PPO |
$142.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.22
|
| Rate for Payer: United Healthcare Commercial |
$127.21
|
| Rate for Payer: United Healthcare Medicare |
$53.27
|
|
|
HC PROMETHEUS TPMT GENETICS
|
Facility
IP
|
$906.09
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
63001445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$679.56 |
| Max. Negotiated Rate |
$842.66 |
| Rate for Payer: Aetna Commercial |
$782.86
|
| Rate for Payer: Cash Price |
$561.77
|
| Rate for Payer: Cigna All Commercial |
$781.95
|
| Rate for Payer: CORVEL All Commercial |
$842.66
|
| Rate for Payer: Coventry All Commercial |
$797.36
|
| Rate for Payer: Encore All Commercial |
$834.05
|
| Rate for Payer: Frontpath All Commercial |
$833.60
|
| Rate for Payer: Humana ChoiceCare |
$782.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$815.48
|
| Rate for Payer: PHCS All Commercial |
$679.56
|
| Rate for Payer: PHP All Commercial |
$687.18
|
| Rate for Payer: Sagamore Health Network All Products |
$699.50
|
| Rate for Payer: Signature Care EPO |
$752.05
|
| Rate for Payer: Signature Care PPO |
$797.36
|
| Rate for Payer: United Healthcare Commercial |
$714.00
|
|
|
HC PROMETHEUS TPMT GENETICS
|
Facility
OP
|
$906.09
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
63001445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$299.01 |
| Max. Negotiated Rate |
$842.66 |
| Rate for Payer: Aetna Commercial |
$764.74
|
| Rate for Payer: Aetna Medicare |
$299.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$299.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$520.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$566.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$343.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$328.91
|
| Rate for Payer: Cash Price |
$561.77
|
| Rate for Payer: Centivo All Commercial |
$462.10
|
| Rate for Payer: Cigna All Commercial |
$781.95
|
| Rate for Payer: CORVEL All Commercial |
$842.66
|
| Rate for Payer: Coventry All Commercial |
$797.36
|
| Rate for Payer: Encore All Commercial |
$834.05
|
| Rate for Payer: Frontpath All Commercial |
$833.60
|
| Rate for Payer: Humana ChoiceCare |
$782.59
|
| Rate for Payer: Humana Medicare |
$462.10
|
| Rate for Payer: Lucent All Commercial |
$462.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$815.48
|
| Rate for Payer: PHCS All Commercial |
$679.56
|
| Rate for Payer: PHP All Commercial |
$687.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$353.37
|
| Rate for Payer: Sagamore Health Network All Products |
$699.50
|
| Rate for Payer: Signature Care EPO |
$752.05
|
| Rate for Payer: Signature Care PPO |
$797.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$770.17
|
| Rate for Payer: United Healthcare Commercial |
$714.00
|
| Rate for Payer: United Healthcare Medicare |
$299.01
|
|
|
HC PROMETHIUS ENDO IGA
|
Facility
OP
|
$245.57
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna Commercial |
$207.26
|
| Rate for Payer: Aetna Medicare |
$81.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.14
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Centivo All Commercial |
$125.24
|
| Rate for Payer: Cigna All Commercial |
$211.92
|
| Rate for Payer: CORVEL All Commercial |
$228.38
|
| Rate for Payer: Coventry All Commercial |
$216.10
|
| Rate for Payer: Encore All Commercial |
$226.04
|
| Rate for Payer: Frontpath All Commercial |
$225.92
|
| Rate for Payer: Humana ChoiceCare |
$212.09
|
| Rate for Payer: Humana Medicare |
$125.24
|
| Rate for Payer: Lucent All Commercial |
$125.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.01
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$184.17
|
| Rate for Payer: PHP All Commercial |
$186.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.77
|
| Rate for Payer: Sagamore Health Network All Products |
$189.58
|
| Rate for Payer: Signature Care EPO |
$203.82
|
| Rate for Payer: Signature Care PPO |
$216.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.73
|
| Rate for Payer: United Healthcare Commercial |
$193.51
|
| Rate for Payer: United Healthcare Medicare |
$81.04
|
|
|
HC PROMETHIUS ENDO IGA
|
Facility
IP
|
$245.57
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$184.17 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna Commercial |
$212.17
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Cigna All Commercial |
$211.92
|
| Rate for Payer: CORVEL All Commercial |
$228.38
|
| Rate for Payer: Coventry All Commercial |
$216.10
|
| Rate for Payer: Encore All Commercial |
$226.04
|
| Rate for Payer: Frontpath All Commercial |
$225.92
|
| Rate for Payer: Humana ChoiceCare |
$212.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.01
|
| Rate for Payer: PHCS All Commercial |
$184.17
|
| Rate for Payer: PHP All Commercial |
$186.24
|
| Rate for Payer: Sagamore Health Network All Products |
$189.58
|
| Rate for Payer: Signature Care EPO |
$203.82
|
| Rate for Payer: Signature Care PPO |
$216.10
|
| Rate for Payer: United Healthcare Commercial |
$193.51
|
|
|
HC PROPOXY CONFIRM-SERUM
|
Facility
IP
|
$233.69
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.27 |
| Max. Negotiated Rate |
$217.33 |
| Rate for Payer: Aetna Commercial |
$201.91
|
| Rate for Payer: Cash Price |
$144.89
|
| Rate for Payer: Cigna All Commercial |
$201.68
|
| Rate for Payer: CORVEL All Commercial |
$217.33
|
| Rate for Payer: Coventry All Commercial |
$205.65
|
| Rate for Payer: Encore All Commercial |
$215.11
|
| Rate for Payer: Frontpath All Commercial |
$215.00
|
| Rate for Payer: Humana ChoiceCare |
$201.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.32
|
| Rate for Payer: PHCS All Commercial |
$175.27
|
| Rate for Payer: PHP All Commercial |
$177.23
|
| Rate for Payer: Sagamore Health Network All Products |
$180.41
|
| Rate for Payer: Signature Care EPO |
$193.96
|
| Rate for Payer: Signature Care PPO |
$205.65
|
| Rate for Payer: United Healthcare Commercial |
$184.15
|
|
|
HC PROPOXY CONFIRM-SERUM
|
Facility
OP
|
$233.69
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.12 |
| Max. Negotiated Rate |
$217.33 |
| Rate for Payer: Aetna Commercial |
$197.24
|
| Rate for Payer: Aetna Medicare |
$77.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.83
|
| Rate for Payer: Cash Price |
$144.89
|
| Rate for Payer: Cash Price |
$144.89
|
| Rate for Payer: Centivo All Commercial |
$119.18
|
| Rate for Payer: Cigna All Commercial |
$201.68
|
| Rate for Payer: CORVEL All Commercial |
$217.33
|
| Rate for Payer: Coventry All Commercial |
$205.65
|
| Rate for Payer: Encore All Commercial |
$215.11
|
| Rate for Payer: Frontpath All Commercial |
$215.00
|
| Rate for Payer: Humana ChoiceCare |
$201.84
|
| Rate for Payer: Humana Medicare |
$119.18
|
| Rate for Payer: Lucent All Commercial |
$119.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.32
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$175.27
|
| Rate for Payer: PHP All Commercial |
$177.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.14
|
| Rate for Payer: Sagamore Health Network All Products |
$180.41
|
| Rate for Payer: Signature Care EPO |
$193.96
|
| Rate for Payer: Signature Care PPO |
$205.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.64
|
| Rate for Payer: United Healthcare Commercial |
$184.15
|
| Rate for Payer: United Healthcare Medicare |
$77.12
|
|
|
HC PROPOXYPHENE MS
|
Facility
IP
|
$127.31
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$109.99
|
| Rate for Payer: Cash Price |
$78.93
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.39
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.12
|
| Rate for Payer: Humana ChoiceCare |
$109.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.66
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
|
