|
HC PROPOXYPHENE MS
|
Facility
OP
|
$127.31
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$107.45
|
| Rate for Payer: Aetna Medicare |
$42.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.21
|
| Rate for Payer: Cash Price |
$78.93
|
| Rate for Payer: Cash Price |
$78.93
|
| Rate for Payer: Centivo All Commercial |
$64.93
|
| 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: Humana Medicare |
$64.93
|
| Rate for Payer: Lucent All Commercial |
$64.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.65
|
| 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: Three Rivers Preferred All Commercial |
$108.21
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
| Rate for Payer: United Healthcare Medicare |
$42.01
|
|
|
HC PRO STOP SUBTALAR ARTHRO 9 X 1
|
Facility
OP
|
$5,920.20
|
|
| Hospital Charge Code |
41602208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$5,505.79 |
| Rate for Payer: Aetna Commercial |
$4,996.65
|
| Rate for Payer: Aetna Medicare |
$1,953.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,953.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,399.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,700.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,246.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,149.03
|
| Rate for Payer: Cash Price |
$3,670.52
|
| Rate for Payer: Cash Price |
$3,670.52
|
| Rate for Payer: Centivo All Commercial |
$3,019.30
|
| Rate for Payer: Cigna All Commercial |
$5,109.13
|
| Rate for Payer: CORVEL All Commercial |
$5,505.79
|
| Rate for Payer: Coventry All Commercial |
$5,209.78
|
| Rate for Payer: Encore All Commercial |
$5,449.54
|
| Rate for Payer: Frontpath All Commercial |
$5,446.58
|
| Rate for Payer: Humana ChoiceCare |
$5,113.28
|
| Rate for Payer: Humana Medicare |
$3,019.30
|
| Rate for Payer: Lucent All Commercial |
$3,019.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,328.18
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$4,440.15
|
| Rate for Payer: PHP All Commercial |
$4,489.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,308.88
|
| Rate for Payer: Sagamore Health Network All Products |
$4,570.39
|
| Rate for Payer: Signature Care EPO |
$4,913.77
|
| Rate for Payer: Signature Care PPO |
$5,209.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,032.17
|
| Rate for Payer: United Healthcare Commercial |
$4,665.12
|
| Rate for Payer: United Healthcare Medicare |
$1,953.67
|
|
|
HC PRO STOP SUBTALAR ARTHRO 9 X 1
|
Facility
IP
|
$5,920.20
|
|
| Hospital Charge Code |
41602208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,440.15 |
| Max. Negotiated Rate |
$5,505.79 |
| Rate for Payer: Aetna Commercial |
$5,115.05
|
| Rate for Payer: Cash Price |
$3,670.52
|
| Rate for Payer: Cigna All Commercial |
$5,109.13
|
| Rate for Payer: CORVEL All Commercial |
$5,505.79
|
| Rate for Payer: Coventry All Commercial |
$5,209.78
|
| Rate for Payer: Encore All Commercial |
$5,449.54
|
| Rate for Payer: Frontpath All Commercial |
$5,446.58
|
| Rate for Payer: Humana ChoiceCare |
$5,113.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,328.18
|
| Rate for Payer: PHCS All Commercial |
$4,440.15
|
| Rate for Payer: PHP All Commercial |
$4,489.88
|
| Rate for Payer: Sagamore Health Network All Products |
$4,570.39
|
| Rate for Payer: Signature Care EPO |
$4,913.77
|
| Rate for Payer: Signature Care PPO |
$5,209.78
|
| Rate for Payer: United Healthcare Commercial |
$4,665.12
|
|
|
HC PROTACK 5MM
|
Facility
OP
|
$1,495.43
|
|
| Hospital Charge Code |
41601091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$1,390.75 |
| Rate for Payer: Aetna Commercial |
$1,262.14
|
| Rate for Payer: Aetna Medicare |
$493.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$493.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$858.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$934.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$567.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$542.84
|
| Rate for Payer: Cash Price |
$927.17
|
| Rate for Payer: Cash Price |
$927.17
|
| Rate for Payer: Centivo All Commercial |
$762.67
|
| Rate for Payer: Cigna All Commercial |
$1,290.56
|
| Rate for Payer: CORVEL All Commercial |
$1,390.75
|
| Rate for Payer: Coventry All Commercial |
$1,315.98
|
| Rate for Payer: Encore All Commercial |
$1,376.54
|
| Rate for Payer: Frontpath All Commercial |
$1,375.80
|
| Rate for Payer: Humana ChoiceCare |
$1,291.60
|
| Rate for Payer: Humana Medicare |
$762.67
|
| Rate for Payer: Lucent All Commercial |
$762.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,345.89
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$1,121.57
|
| Rate for Payer: PHP All Commercial |
$1,134.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$583.22
|
| Rate for Payer: Sagamore Health Network All Products |
$1,154.47
|
| Rate for Payer: Signature Care EPO |
$1,241.21
|
| Rate for Payer: Signature Care PPO |
$1,315.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,271.12
|
| Rate for Payer: United Healthcare Commercial |
$1,178.40
|
| Rate for Payer: United Healthcare Medicare |
$493.49
|
|
|
HC PROTACK 5MM
|
Facility
IP
|
$1,495.43
|
|
| Hospital Charge Code |
41601091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,121.57 |
| Max. Negotiated Rate |
$1,390.75 |
| Rate for Payer: Aetna Commercial |
$1,292.05
|
| Rate for Payer: Cash Price |
$927.17
|
| Rate for Payer: Cigna All Commercial |
$1,290.56
|
| Rate for Payer: CORVEL All Commercial |
$1,390.75
|
| Rate for Payer: Coventry All Commercial |
$1,315.98
|
| Rate for Payer: Encore All Commercial |
$1,376.54
|
| Rate for Payer: Frontpath All Commercial |
$1,375.80
|
| Rate for Payer: Humana ChoiceCare |
$1,291.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,345.89
|
| Rate for Payer: PHCS All Commercial |
$1,121.57
|
| Rate for Payer: PHP All Commercial |
$1,134.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,154.47
|
| Rate for Payer: Signature Care EPO |
$1,241.21
|
| Rate for Payer: Signature Care PPO |
$1,315.98
|
| Rate for Payer: United Healthcare Commercial |
$1,178.40
|
|
|
HC PROTECTOR HEEL W/WEDGE GREEN
|
Facility
IP
|
$286.56
|
|
|
Service Code
|
CPT E0191
|
| Hospital Charge Code |
41608187
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$214.92 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: Aetna Commercial |
$247.59
|
| Rate for Payer: Cash Price |
$177.67
|
| Rate for Payer: Cigna All Commercial |
$247.30
|
| Rate for Payer: CORVEL All Commercial |
$266.50
|
| Rate for Payer: Coventry All Commercial |
$252.17
|
| Rate for Payer: Encore All Commercial |
$263.78
|
| Rate for Payer: Frontpath All Commercial |
$263.64
|
| Rate for Payer: Humana ChoiceCare |
$247.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$257.90
|
| Rate for Payer: PHCS All Commercial |
$214.92
|
| Rate for Payer: PHP All Commercial |
$217.33
|
| Rate for Payer: Sagamore Health Network All Products |
$221.22
|
| Rate for Payer: Signature Care EPO |
$237.84
|
| Rate for Payer: Signature Care PPO |
$252.17
|
| Rate for Payer: United Healthcare Commercial |
$225.81
|
|
|
HC PROTECTOR HEEL W/WEDGE GREEN
|
Facility
OP
|
$286.56
|
|
|
Service Code
|
CPT E0191
|
| Hospital Charge Code |
41608187
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: Aetna Commercial |
$241.86
|
| Rate for Payer: Aetna Medicare |
$94.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$164.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$179.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$104.02
|
| Rate for Payer: Cash Price |
$177.67
|
| Rate for Payer: Cash Price |
$177.67
|
| Rate for Payer: Centivo All Commercial |
$146.15
|
| Rate for Payer: Cigna All Commercial |
$247.30
|
| Rate for Payer: CORVEL All Commercial |
$266.50
|
| Rate for Payer: Coventry All Commercial |
$252.17
|
| Rate for Payer: Encore All Commercial |
$263.78
|
| Rate for Payer: Frontpath All Commercial |
$263.64
|
| Rate for Payer: Humana ChoiceCare |
$247.50
|
| Rate for Payer: Humana Medicare |
$146.15
|
| Rate for Payer: Lucent All Commercial |
$146.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$257.90
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$214.92
|
| Rate for Payer: PHP All Commercial |
$217.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.76
|
| Rate for Payer: Sagamore Health Network All Products |
$221.22
|
| Rate for Payer: Signature Care EPO |
$237.84
|
| Rate for Payer: Signature Care PPO |
$252.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$243.58
|
| Rate for Payer: United Healthcare Commercial |
$225.81
|
| Rate for Payer: United Healthcare Medicare |
$94.56
|
|
|
HC PROTECTORS PIN BLUE
|
Facility
OP
|
$37.13
|
|
| Hospital Charge Code |
41602391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$31.34
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.48
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Centivo All Commercial |
$18.94
|
| Rate for Payer: Cigna All Commercial |
$32.04
|
| Rate for Payer: CORVEL All Commercial |
$34.53
|
| Rate for Payer: Coventry All Commercial |
$32.67
|
| Rate for Payer: Encore All Commercial |
$34.18
|
| Rate for Payer: Frontpath All Commercial |
$34.16
|
| Rate for Payer: Humana ChoiceCare |
$32.07
|
| Rate for Payer: Humana Medicare |
$18.94
|
| Rate for Payer: Lucent All Commercial |
$18.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.42
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$27.85
|
| Rate for Payer: PHP All Commercial |
$28.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.48
|
| Rate for Payer: Sagamore Health Network All Products |
$28.66
|
| Rate for Payer: Signature Care EPO |
$30.82
|
| Rate for Payer: Signature Care PPO |
$32.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.56
|
| Rate for Payer: United Healthcare Commercial |
$29.26
|
| Rate for Payer: United Healthcare Medicare |
$12.25
|
|
|
HC PROTECTORS PIN BLUE
|
Facility
IP
|
$37.13
|
|
| Hospital Charge Code |
41602391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$34.53 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cigna All Commercial |
$32.04
|
| Rate for Payer: CORVEL All Commercial |
$34.53
|
| Rate for Payer: Coventry All Commercial |
$32.67
|
| Rate for Payer: Encore All Commercial |
$34.18
|
| Rate for Payer: Frontpath All Commercial |
$34.16
|
| Rate for Payer: Humana ChoiceCare |
$32.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.42
|
| Rate for Payer: PHCS All Commercial |
$27.85
|
| Rate for Payer: PHP All Commercial |
$28.16
|
| Rate for Payer: Sagamore Health Network All Products |
$28.66
|
| Rate for Payer: Signature Care EPO |
$30.82
|
| Rate for Payer: Signature Care PPO |
$32.67
|
| Rate for Payer: United Healthcare Commercial |
$29.26
|
|
|
HC PROTECTORS PIN PINK
|
Facility
OP
|
$20.18
|
|
| Hospital Charge Code |
41602392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Medicare |
$6.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.33
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: Centivo All Commercial |
$10.29
|
| Rate for Payer: Cigna All Commercial |
$17.42
|
| Rate for Payer: CORVEL All Commercial |
$18.77
|
| Rate for Payer: Coventry All Commercial |
$17.76
|
| Rate for Payer: Encore All Commercial |
$18.58
|
| Rate for Payer: Frontpath All Commercial |
$18.57
|
| Rate for Payer: Humana ChoiceCare |
$17.43
|
| Rate for Payer: Humana Medicare |
$10.29
|
| Rate for Payer: Lucent All Commercial |
$10.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.16
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$15.14
|
| Rate for Payer: PHP All Commercial |
$15.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.87
|
| Rate for Payer: Sagamore Health Network All Products |
$15.58
|
| Rate for Payer: Signature Care EPO |
$16.75
|
| Rate for Payer: Signature Care PPO |
$17.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.15
|
| Rate for Payer: United Healthcare Commercial |
$15.90
|
| Rate for Payer: United Healthcare Medicare |
$6.66
|
|
|
HC PROTECTORS PIN PINK
|
Facility
IP
|
$20.18
|
|
| Hospital Charge Code |
41602392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna Commercial |
$17.44
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: Cigna All Commercial |
$17.42
|
| Rate for Payer: CORVEL All Commercial |
$18.77
|
| Rate for Payer: Coventry All Commercial |
$17.76
|
| Rate for Payer: Encore All Commercial |
$18.58
|
| Rate for Payer: Frontpath All Commercial |
$18.57
|
| Rate for Payer: Humana ChoiceCare |
$17.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.16
|
| Rate for Payer: PHCS All Commercial |
$15.14
|
| Rate for Payer: PHP All Commercial |
$15.30
|
| Rate for Payer: Sagamore Health Network All Products |
$15.58
|
| Rate for Payer: Signature Care EPO |
$16.75
|
| Rate for Payer: Signature Care PPO |
$17.76
|
| Rate for Payer: United Healthcare Commercial |
$15.90
|
|
|
HC PROTECTORS PIN WHITE
|
Facility
OP
|
$47.02
|
|
| Hospital Charge Code |
41602393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: Aetna Medicare |
$15.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.07
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Centivo All Commercial |
$23.98
|
| Rate for Payer: Cigna All Commercial |
$40.58
|
| Rate for Payer: CORVEL All Commercial |
$43.73
|
| Rate for Payer: Coventry All Commercial |
$41.38
|
| Rate for Payer: Encore All Commercial |
$43.28
|
| Rate for Payer: Frontpath All Commercial |
$43.26
|
| Rate for Payer: Humana ChoiceCare |
$40.61
|
| Rate for Payer: Humana Medicare |
$23.98
|
| Rate for Payer: Lucent All Commercial |
$23.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$35.26
|
| Rate for Payer: PHP All Commercial |
$35.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.34
|
| Rate for Payer: Sagamore Health Network All Products |
$36.30
|
| Rate for Payer: Signature Care EPO |
$39.03
|
| Rate for Payer: Signature Care PPO |
$41.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.97
|
| Rate for Payer: United Healthcare Commercial |
$37.05
|
| Rate for Payer: United Healthcare Medicare |
$15.52
|
|
|
HC PROTECTORS PIN WHITE
|
Facility
IP
|
$47.02
|
|
| Hospital Charge Code |
41602393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.26 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna Commercial |
$40.63
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cigna All Commercial |
$40.58
|
| Rate for Payer: CORVEL All Commercial |
$43.73
|
| Rate for Payer: Coventry All Commercial |
$41.38
|
| Rate for Payer: Encore All Commercial |
$43.28
|
| Rate for Payer: Frontpath All Commercial |
$43.26
|
| Rate for Payer: Humana ChoiceCare |
$40.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.32
|
| Rate for Payer: PHCS All Commercial |
$35.26
|
| Rate for Payer: PHP All Commercial |
$35.66
|
| Rate for Payer: Sagamore Health Network All Products |
$36.30
|
| Rate for Payer: Signature Care EPO |
$39.03
|
| Rate for Payer: Signature Care PPO |
$41.38
|
| Rate for Payer: United Healthcare Commercial |
$37.05
|
|
|
HC PROTEIN BF
|
Facility
OP
|
$123.94
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
63001184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$104.61
|
| Rate for Payer: Aetna Medicare |
$40.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.99
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Centivo All Commercial |
$63.21
|
| Rate for Payer: Cigna All Commercial |
$106.96
|
| Rate for Payer: CORVEL All Commercial |
$115.26
|
| Rate for Payer: Coventry All Commercial |
$109.07
|
| Rate for Payer: Encore All Commercial |
$114.09
|
| Rate for Payer: Frontpath All Commercial |
$114.02
|
| Rate for Payer: Humana ChoiceCare |
$107.05
|
| Rate for Payer: Humana Medicare |
$63.21
|
| Rate for Payer: Lucent All Commercial |
$63.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.55
|
| Rate for Payer: Managed Health Services Medicaid |
$4.00
|
| Rate for Payer: MDWise Medicaid |
$4.00
|
| Rate for Payer: PHCS All Commercial |
$92.96
|
| Rate for Payer: PHP All Commercial |
$94.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.34
|
| Rate for Payer: Sagamore Health Network All Products |
$95.68
|
| Rate for Payer: Signature Care EPO |
$102.87
|
| Rate for Payer: Signature Care PPO |
$109.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.35
|
| Rate for Payer: United Healthcare Commercial |
$97.66
|
| Rate for Payer: United Healthcare Medicare |
$40.90
|
|
|
HC PROTEIN BF
|
Facility
IP
|
$123.94
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
63001184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.96 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$107.08
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cigna All Commercial |
$106.96
|
| Rate for Payer: CORVEL All Commercial |
$115.26
|
| Rate for Payer: Coventry All Commercial |
$109.07
|
| Rate for Payer: Encore All Commercial |
$114.09
|
| Rate for Payer: Frontpath All Commercial |
$114.02
|
| Rate for Payer: Humana ChoiceCare |
$107.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.55
|
| Rate for Payer: PHCS All Commercial |
$92.96
|
| Rate for Payer: PHP All Commercial |
$94.00
|
| Rate for Payer: Sagamore Health Network All Products |
$95.68
|
| Rate for Payer: Signature Care EPO |
$102.87
|
| Rate for Payer: Signature Care PPO |
$109.07
|
| Rate for Payer: United Healthcare Commercial |
$97.66
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
IP
|
$330.99
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
63001741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$248.24 |
| Max. Negotiated Rate |
$307.82 |
| Rate for Payer: Aetna Commercial |
$285.98
|
| Rate for Payer: Cash Price |
$205.21
|
| Rate for Payer: Cigna All Commercial |
$285.64
|
| Rate for Payer: CORVEL All Commercial |
$307.82
|
| Rate for Payer: Coventry All Commercial |
$291.27
|
| Rate for Payer: Encore All Commercial |
$304.68
|
| Rate for Payer: Frontpath All Commercial |
$304.51
|
| Rate for Payer: Humana ChoiceCare |
$285.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.89
|
| Rate for Payer: PHCS All Commercial |
$248.24
|
| Rate for Payer: PHP All Commercial |
$251.02
|
| Rate for Payer: Sagamore Health Network All Products |
$255.52
|
| Rate for Payer: Signature Care EPO |
$274.72
|
| Rate for Payer: Signature Care PPO |
$291.27
|
| Rate for Payer: United Healthcare Commercial |
$260.82
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
OP
|
$330.99
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
63001741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$307.82 |
| Rate for Payer: Aetna Commercial |
$279.36
|
| Rate for Payer: Aetna Medicare |
$109.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$109.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$190.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$206.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.15
|
| Rate for Payer: Cash Price |
$205.21
|
| Rate for Payer: Cash Price |
$205.21
|
| Rate for Payer: Centivo All Commercial |
$168.80
|
| Rate for Payer: Cigna All Commercial |
$285.64
|
| Rate for Payer: CORVEL All Commercial |
$307.82
|
| Rate for Payer: Coventry All Commercial |
$291.27
|
| Rate for Payer: Encore All Commercial |
$304.68
|
| Rate for Payer: Frontpath All Commercial |
$304.51
|
| Rate for Payer: Humana ChoiceCare |
$285.88
|
| Rate for Payer: Humana Medicare |
$168.80
|
| Rate for Payer: Lucent All Commercial |
$168.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.89
|
| Rate for Payer: Managed Health Services Medicaid |
$13.84
|
| Rate for Payer: MDWise Medicaid |
$13.84
|
| Rate for Payer: PHCS All Commercial |
$248.24
|
| Rate for Payer: PHP All Commercial |
$251.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$129.09
|
| Rate for Payer: Sagamore Health Network All Products |
$255.52
|
| Rate for Payer: Signature Care EPO |
$274.72
|
| Rate for Payer: Signature Care PPO |
$291.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$281.34
|
| Rate for Payer: United Healthcare Commercial |
$260.82
|
| Rate for Payer: United Healthcare Medicare |
$109.23
|
|
|
HC PROTEIN C ANTIGEN AND PROTEIN S ANTIGEN PANEL
|
Facility
OP
|
$273.77
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
63044077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna Commercial |
$231.06
|
| Rate for Payer: Aetna Medicare |
$90.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$157.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.38
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Centivo All Commercial |
$139.62
|
| Rate for Payer: Cigna All Commercial |
$236.26
|
| Rate for Payer: CORVEL All Commercial |
$254.60
|
| Rate for Payer: Coventry All Commercial |
$240.92
|
| Rate for Payer: Encore All Commercial |
$252.00
|
| Rate for Payer: Frontpath All Commercial |
$251.87
|
| Rate for Payer: Humana ChoiceCare |
$236.45
|
| Rate for Payer: Humana Medicare |
$139.62
|
| Rate for Payer: Lucent All Commercial |
$139.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.39
|
| Rate for Payer: Managed Health Services Medicaid |
$12.01
|
| Rate for Payer: MDWise Medicaid |
$12.01
|
| Rate for Payer: PHCS All Commercial |
$205.33
|
| Rate for Payer: PHP All Commercial |
$207.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.77
|
| Rate for Payer: Sagamore Health Network All Products |
$211.35
|
| Rate for Payer: Signature Care EPO |
$227.23
|
| Rate for Payer: Signature Care PPO |
$240.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.70
|
| Rate for Payer: United Healthcare Commercial |
$215.73
|
| Rate for Payer: United Healthcare Medicare |
$90.34
|
|
|
HC PROTEIN C ANTIGEN AND PROTEIN S ANTIGEN PANEL
|
Facility
IP
|
$273.77
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
63044077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.33 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna Commercial |
$236.54
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cigna All Commercial |
$236.26
|
| Rate for Payer: CORVEL All Commercial |
$254.60
|
| Rate for Payer: Coventry All Commercial |
$240.92
|
| Rate for Payer: Encore All Commercial |
$252.00
|
| Rate for Payer: Frontpath All Commercial |
$251.87
|
| Rate for Payer: Humana ChoiceCare |
$236.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.39
|
| Rate for Payer: PHCS All Commercial |
$205.33
|
| Rate for Payer: PHP All Commercial |
$207.63
|
| Rate for Payer: Sagamore Health Network All Products |
$211.35
|
| Rate for Payer: Signature Care EPO |
$227.23
|
| Rate for Payer: Signature Care PPO |
$240.92
|
| Rate for Payer: United Healthcare Commercial |
$215.73
|
|
|
HC PROTEIN C ANTIGEN AND PROTEIN S ANTIGEN PANEL-B
|
Facility
IP
|
$282.18
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
63044078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$211.64 |
| Max. Negotiated Rate |
$262.43 |
| Rate for Payer: Aetna Commercial |
$243.81
|
| Rate for Payer: Cash Price |
$174.95
|
| Rate for Payer: Cigna All Commercial |
$243.52
|
| Rate for Payer: CORVEL All Commercial |
$262.43
|
| Rate for Payer: Coventry All Commercial |
$248.32
|
| Rate for Payer: Encore All Commercial |
$259.75
|
| Rate for Payer: Frontpath All Commercial |
$259.61
|
| Rate for Payer: Humana ChoiceCare |
$243.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.96
|
| Rate for Payer: PHCS All Commercial |
$211.64
|
| Rate for Payer: PHP All Commercial |
$214.01
|
| Rate for Payer: Sagamore Health Network All Products |
$217.85
|
| Rate for Payer: Signature Care EPO |
$234.21
|
| Rate for Payer: Signature Care PPO |
$248.32
|
| Rate for Payer: United Healthcare Commercial |
$222.36
|
|
|
HC PROTEIN C ANTIGEN AND PROTEIN S ANTIGEN PANEL-B
|
Facility
OP
|
$282.18
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
63044078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$262.43 |
| Rate for Payer: Aetna Commercial |
$238.16
|
| Rate for Payer: Aetna Medicare |
$93.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$93.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$162.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$176.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.43
|
| Rate for Payer: Cash Price |
$174.95
|
| Rate for Payer: Cash Price |
$174.95
|
| Rate for Payer: Centivo All Commercial |
$143.91
|
| Rate for Payer: Cigna All Commercial |
$243.52
|
| Rate for Payer: CORVEL All Commercial |
$262.43
|
| Rate for Payer: Coventry All Commercial |
$248.32
|
| Rate for Payer: Encore All Commercial |
$259.75
|
| Rate for Payer: Frontpath All Commercial |
$259.61
|
| Rate for Payer: Humana ChoiceCare |
$243.72
|
| Rate for Payer: Humana Medicare |
$143.91
|
| Rate for Payer: Lucent All Commercial |
$143.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.96
|
| Rate for Payer: Managed Health Services Medicaid |
$11.61
|
| Rate for Payer: MDWise Medicaid |
$11.61
|
| Rate for Payer: PHCS All Commercial |
$211.64
|
| Rate for Payer: PHP All Commercial |
$214.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.05
|
| Rate for Payer: Sagamore Health Network All Products |
$217.85
|
| Rate for Payer: Signature Care EPO |
$234.21
|
| Rate for Payer: Signature Care PPO |
$248.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.86
|
| Rate for Payer: United Healthcare Commercial |
$222.36
|
| Rate for Payer: United Healthcare Medicare |
$93.12
|
|
|
HC PROTEIN S, FREE ANTIGEN
|
Facility
OP
|
$518.87
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
63001744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$482.55 |
| Rate for Payer: Aetna Commercial |
$437.93
|
| Rate for Payer: Aetna Medicare |
$171.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$171.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$297.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$324.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.35
|
| Rate for Payer: Cash Price |
$321.70
|
| Rate for Payer: Cash Price |
$321.70
|
| Rate for Payer: Centivo All Commercial |
$264.63
|
| Rate for Payer: Cigna All Commercial |
$447.79
|
| Rate for Payer: CORVEL All Commercial |
$482.55
|
| Rate for Payer: Coventry All Commercial |
$456.61
|
| Rate for Payer: Encore All Commercial |
$477.62
|
| Rate for Payer: Frontpath All Commercial |
$477.36
|
| Rate for Payer: Humana ChoiceCare |
$448.15
|
| Rate for Payer: Humana Medicare |
$264.63
|
| Rate for Payer: Lucent All Commercial |
$264.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.99
|
| Rate for Payer: Managed Health Services Medicaid |
$15.32
|
| Rate for Payer: MDWise Medicaid |
$15.32
|
| Rate for Payer: PHCS All Commercial |
$389.16
|
| Rate for Payer: PHP All Commercial |
$393.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.36
|
| Rate for Payer: Sagamore Health Network All Products |
$400.57
|
| Rate for Payer: Signature Care EPO |
$430.67
|
| Rate for Payer: Signature Care PPO |
$456.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.04
|
| Rate for Payer: United Healthcare Commercial |
$408.87
|
| Rate for Payer: United Healthcare Medicare |
$171.23
|
|
|
HC PROTEIN S, FREE ANTIGEN
|
Facility
IP
|
$518.87
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
63001744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$389.16 |
| Max. Negotiated Rate |
$482.55 |
| Rate for Payer: Aetna Commercial |
$448.31
|
| Rate for Payer: Cash Price |
$321.70
|
| Rate for Payer: Cigna All Commercial |
$447.79
|
| Rate for Payer: CORVEL All Commercial |
$482.55
|
| Rate for Payer: Coventry All Commercial |
$456.61
|
| Rate for Payer: Encore All Commercial |
$477.62
|
| Rate for Payer: Frontpath All Commercial |
$477.36
|
| Rate for Payer: Humana ChoiceCare |
$448.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.99
|
| Rate for Payer: PHCS All Commercial |
$389.16
|
| Rate for Payer: PHP All Commercial |
$393.51
|
| Rate for Payer: Sagamore Health Network All Products |
$400.57
|
| Rate for Payer: Signature Care EPO |
$430.67
|
| Rate for Payer: Signature Care PPO |
$456.61
|
| Rate for Payer: United Healthcare Commercial |
$408.87
|
|
|
HC PROTEIN S FUNCTIONAL
|
Facility
IP
|
$518.87
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
63001743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$389.16 |
| Max. Negotiated Rate |
$482.55 |
| Rate for Payer: Aetna Commercial |
$448.31
|
| Rate for Payer: Cash Price |
$321.70
|
| Rate for Payer: Cigna All Commercial |
$447.79
|
| Rate for Payer: CORVEL All Commercial |
$482.55
|
| Rate for Payer: Coventry All Commercial |
$456.61
|
| Rate for Payer: Encore All Commercial |
$477.62
|
| Rate for Payer: Frontpath All Commercial |
$477.36
|
| Rate for Payer: Humana ChoiceCare |
$448.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.99
|
| Rate for Payer: PHCS All Commercial |
$389.16
|
| Rate for Payer: PHP All Commercial |
$393.51
|
| Rate for Payer: Sagamore Health Network All Products |
$400.57
|
| Rate for Payer: Signature Care EPO |
$430.67
|
| Rate for Payer: Signature Care PPO |
$456.61
|
| Rate for Payer: United Healthcare Commercial |
$408.87
|
|
|
HC PROTEIN S FUNCTIONAL
|
Facility
OP
|
$518.87
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
63001743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$482.55 |
| Rate for Payer: Aetna Commercial |
$437.93
|
| Rate for Payer: Aetna Medicare |
$171.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$171.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$297.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$324.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.35
|
| Rate for Payer: Cash Price |
$321.70
|
| Rate for Payer: Cash Price |
$321.70
|
| Rate for Payer: Centivo All Commercial |
$264.63
|
| Rate for Payer: Cigna All Commercial |
$447.79
|
| Rate for Payer: CORVEL All Commercial |
$482.55
|
| Rate for Payer: Coventry All Commercial |
$456.61
|
| Rate for Payer: Encore All Commercial |
$477.62
|
| Rate for Payer: Frontpath All Commercial |
$477.36
|
| Rate for Payer: Humana ChoiceCare |
$448.15
|
| Rate for Payer: Humana Medicare |
$264.63
|
| Rate for Payer: Lucent All Commercial |
$264.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.99
|
| Rate for Payer: Managed Health Services Medicaid |
$15.32
|
| Rate for Payer: MDWise Medicaid |
$15.32
|
| Rate for Payer: PHCS All Commercial |
$389.16
|
| Rate for Payer: PHP All Commercial |
$393.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.36
|
| Rate for Payer: Sagamore Health Network All Products |
$400.57
|
| Rate for Payer: Signature Care EPO |
$430.67
|
| Rate for Payer: Signature Care PPO |
$456.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.04
|
| Rate for Payer: United Healthcare Commercial |
$408.87
|
| Rate for Payer: United Healthcare Medicare |
$171.23
|
|
