|
HC PROTEIN S TOTAL
|
Facility
OP
|
$282.18
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
63001742
|
|
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 TOTAL
|
Facility
IP
|
$282.18
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
63001742
|
|
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 TOTAL-24HR
|
Facility
IP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.43 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Cigna All Commercial |
$74.14
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.60
|
| Rate for Payer: Encore All Commercial |
$79.08
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: PHCS All Commercial |
$64.43
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Sagamore Health Network All Products |
$66.32
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
|
|
HC PROTEIN TOTAL-24HR
|
Facility
OP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$72.50
|
| Rate for Payer: Aetna Medicare |
$28.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.18
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Centivo All Commercial |
$43.81
|
| Rate for Payer: Cigna All Commercial |
$74.14
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.60
|
| Rate for Payer: Encore All Commercial |
$79.08
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.20
|
| Rate for Payer: Humana Medicare |
$43.81
|
| Rate for Payer: Lucent All Commercial |
$43.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: Managed Health Services Medicaid |
$3.67
|
| Rate for Payer: MDWise Medicaid |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$64.43
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.50
|
| Rate for Payer: Sagamore Health Network All Products |
$66.32
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.02
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
| Rate for Payer: United Healthcare Medicare |
$28.35
|
|
|
HC PROTEIN TOTAL URINE-24HR
|
Facility
IP
|
$71.48
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$61.76
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: Cigna All Commercial |
$61.69
|
| Rate for Payer: CORVEL All Commercial |
$66.48
|
| Rate for Payer: Coventry All Commercial |
$62.90
|
| Rate for Payer: Encore All Commercial |
$65.80
|
| Rate for Payer: Frontpath All Commercial |
$65.76
|
| Rate for Payer: Humana ChoiceCare |
$61.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.33
|
| Rate for Payer: PHCS All Commercial |
$53.61
|
| Rate for Payer: PHP All Commercial |
$54.21
|
| Rate for Payer: Sagamore Health Network All Products |
$55.18
|
| Rate for Payer: Signature Care EPO |
$59.33
|
| Rate for Payer: Signature Care PPO |
$62.90
|
| Rate for Payer: United Healthcare Commercial |
$56.33
|
|
|
HC PROTEIN TOTAL URINE-24HR
|
Facility
OP
|
$71.48
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$60.33
|
| Rate for Payer: Aetna Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.95
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: Centivo All Commercial |
$36.46
|
| Rate for Payer: Cigna All Commercial |
$61.69
|
| Rate for Payer: CORVEL All Commercial |
$66.48
|
| Rate for Payer: Coventry All Commercial |
$62.90
|
| Rate for Payer: Encore All Commercial |
$65.80
|
| Rate for Payer: Frontpath All Commercial |
$65.76
|
| Rate for Payer: Humana ChoiceCare |
$61.74
|
| Rate for Payer: Humana Medicare |
$36.46
|
| Rate for Payer: Lucent All Commercial |
$36.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.33
|
| Rate for Payer: Managed Health Services Medicaid |
$3.67
|
| Rate for Payer: MDWise Medicaid |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$53.61
|
| Rate for Payer: PHP All Commercial |
$54.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.88
|
| Rate for Payer: Sagamore Health Network All Products |
$55.18
|
| Rate for Payer: Signature Care EPO |
$59.33
|
| Rate for Payer: Signature Care PPO |
$62.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.76
|
| Rate for Payer: United Healthcare Commercial |
$56.33
|
| Rate for Payer: United Healthcare Medicare |
$23.59
|
|
|
HC PROTEIN URINE
|
Facility
OP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$72.50
|
| Rate for Payer: Aetna Medicare |
$28.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.18
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Centivo All Commercial |
$43.81
|
| Rate for Payer: Cigna All Commercial |
$74.14
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.60
|
| Rate for Payer: Encore All Commercial |
$79.08
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.20
|
| Rate for Payer: Humana Medicare |
$43.81
|
| Rate for Payer: Lucent All Commercial |
$43.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: Managed Health Services Medicaid |
$3.67
|
| Rate for Payer: MDWise Medicaid |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$64.43
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.50
|
| Rate for Payer: Sagamore Health Network All Products |
$66.32
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.02
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
| Rate for Payer: United Healthcare Medicare |
$28.35
|
|
|
HC PROTEIN URINE
|
Facility
IP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.43 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Cigna All Commercial |
$74.14
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.60
|
| Rate for Payer: Encore All Commercial |
$79.08
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: PHCS All Commercial |
$64.43
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Sagamore Health Network All Products |
$66.32
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
|
|
HC PROTEIN URINE 24HR
|
Facility
IP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.43 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Cigna All Commercial |
$74.14
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.60
|
| Rate for Payer: Encore All Commercial |
$79.08
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: PHCS All Commercial |
$64.43
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Sagamore Health Network All Products |
$66.32
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
|
|
HC PROTEIN URINE 24HR
|
Facility
OP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$72.50
|
| Rate for Payer: Aetna Medicare |
$28.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.18
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Centivo All Commercial |
$43.81
|
| Rate for Payer: Cigna All Commercial |
$74.14
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.60
|
| Rate for Payer: Encore All Commercial |
$79.08
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.20
|
| Rate for Payer: Humana Medicare |
$43.81
|
| Rate for Payer: Lucent All Commercial |
$43.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: Managed Health Services Medicaid |
$3.67
|
| Rate for Payer: MDWise Medicaid |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$64.43
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.50
|
| Rate for Payer: Sagamore Health Network All Products |
$66.32
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.02
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
| Rate for Payer: United Healthcare Medicare |
$28.35
|
|
|
HC PROTHROMBIN
|
Facility
IP
|
$51.11
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
63001272
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Aetna Commercial |
$44.16
|
| Rate for Payer: Cash Price |
$31.69
|
| Rate for Payer: Cigna All Commercial |
$44.11
|
| Rate for Payer: CORVEL All Commercial |
$47.53
|
| Rate for Payer: Coventry All Commercial |
$44.98
|
| Rate for Payer: Encore All Commercial |
$47.05
|
| Rate for Payer: Frontpath All Commercial |
$47.02
|
| Rate for Payer: Humana ChoiceCare |
$44.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.00
|
| Rate for Payer: PHCS All Commercial |
$38.33
|
| Rate for Payer: PHP All Commercial |
$38.76
|
| Rate for Payer: Sagamore Health Network All Products |
$39.46
|
| Rate for Payer: Signature Care EPO |
$42.42
|
| Rate for Payer: Signature Care PPO |
$44.98
|
| Rate for Payer: United Healthcare Commercial |
$40.28
|
|
|
HC PROTHROMBIN
|
Facility
OP
|
$51.11
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
63001272
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna Medicare |
$16.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.55
|
| Rate for Payer: Cash Price |
$31.69
|
| Rate for Payer: Cash Price |
$31.69
|
| Rate for Payer: Centivo All Commercial |
$26.07
|
| Rate for Payer: Cigna All Commercial |
$44.11
|
| Rate for Payer: CORVEL All Commercial |
$47.53
|
| Rate for Payer: Coventry All Commercial |
$44.98
|
| Rate for Payer: Encore All Commercial |
$47.05
|
| Rate for Payer: Frontpath All Commercial |
$47.02
|
| Rate for Payer: Humana ChoiceCare |
$44.15
|
| Rate for Payer: Humana Medicare |
$26.07
|
| Rate for Payer: Lucent All Commercial |
$26.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.00
|
| Rate for Payer: Managed Health Services Medicaid |
$4.29
|
| Rate for Payer: MDWise Medicaid |
$4.29
|
| Rate for Payer: PHCS All Commercial |
$38.33
|
| Rate for Payer: PHP All Commercial |
$38.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.93
|
| Rate for Payer: Sagamore Health Network All Products |
$39.46
|
| Rate for Payer: Signature Care EPO |
$42.42
|
| Rate for Payer: Signature Care PPO |
$44.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.45
|
| Rate for Payer: United Healthcare Commercial |
$40.28
|
| Rate for Payer: United Healthcare Medicare |
$16.87
|
|
|
HC PROTHROMBIN 20210 GENE MUTATION
|
Facility
OP
|
$415.38
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
63001144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.08 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$350.58
|
| Rate for Payer: Aetna Medicare |
$137.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$238.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.78
|
| Rate for Payer: Cash Price |
$257.54
|
| Rate for Payer: Centivo All Commercial |
$211.85
|
| Rate for Payer: Cigna All Commercial |
$358.48
|
| Rate for Payer: CORVEL All Commercial |
$386.31
|
| Rate for Payer: Coventry All Commercial |
$365.54
|
| Rate for Payer: Encore All Commercial |
$382.36
|
| Rate for Payer: Frontpath All Commercial |
$382.15
|
| Rate for Payer: Humana ChoiceCare |
$358.77
|
| Rate for Payer: Humana Medicare |
$211.85
|
| Rate for Payer: Lucent All Commercial |
$211.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.85
|
| Rate for Payer: PHCS All Commercial |
$311.54
|
| Rate for Payer: PHP All Commercial |
$315.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.00
|
| Rate for Payer: Sagamore Health Network All Products |
$320.68
|
| Rate for Payer: Signature Care EPO |
$344.77
|
| Rate for Payer: Signature Care PPO |
$365.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.08
|
| Rate for Payer: United Healthcare Commercial |
$327.32
|
| Rate for Payer: United Healthcare Medicare |
$137.08
|
|
|
HC PROTHROMBIN 20210 GENE MUTATION
|
Facility
IP
|
$415.38
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
63001144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$311.54 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$358.89
|
| Rate for Payer: Cash Price |
$257.54
|
| Rate for Payer: Cigna All Commercial |
$358.48
|
| Rate for Payer: CORVEL All Commercial |
$386.31
|
| Rate for Payer: Coventry All Commercial |
$365.54
|
| Rate for Payer: Encore All Commercial |
$382.36
|
| Rate for Payer: Frontpath All Commercial |
$382.15
|
| Rate for Payer: Humana ChoiceCare |
$358.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.85
|
| Rate for Payer: PHCS All Commercial |
$311.54
|
| Rate for Payer: PHP All Commercial |
$315.03
|
| Rate for Payer: Sagamore Health Network All Products |
$320.68
|
| Rate for Payer: Signature Care EPO |
$344.77
|
| Rate for Payer: Signature Care PPO |
$365.54
|
| Rate for Payer: United Healthcare Commercial |
$327.32
|
|
|
HC PROTHROMBIN TIME
|
Facility
OP
|
$44.19
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
00410671
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna Commercial |
$37.29
|
| Rate for Payer: Aetna Medicare |
$14.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.04
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Centivo All Commercial |
$22.54
|
| Rate for Payer: Cigna All Commercial |
$38.13
|
| Rate for Payer: CORVEL All Commercial |
$41.09
|
| Rate for Payer: Coventry All Commercial |
$38.88
|
| Rate for Payer: Encore All Commercial |
$40.67
|
| Rate for Payer: Frontpath All Commercial |
$40.65
|
| Rate for Payer: Humana ChoiceCare |
$38.16
|
| Rate for Payer: Humana Medicare |
$22.54
|
| Rate for Payer: Lucent All Commercial |
$22.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.77
|
| Rate for Payer: Managed Health Services Medicaid |
$4.29
|
| Rate for Payer: MDWise Medicaid |
$4.29
|
| Rate for Payer: PHCS All Commercial |
$33.14
|
| Rate for Payer: PHP All Commercial |
$33.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.23
|
| Rate for Payer: Sagamore Health Network All Products |
$34.11
|
| Rate for Payer: Signature Care EPO |
$36.67
|
| Rate for Payer: Signature Care PPO |
$38.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.56
|
| Rate for Payer: United Healthcare Commercial |
$34.82
|
| Rate for Payer: United Healthcare Medicare |
$14.58
|
|
|
HC PROTHROMBIN TIME
|
Facility
IP
|
$44.19
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
00410671
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cigna All Commercial |
$38.13
|
| Rate for Payer: CORVEL All Commercial |
$41.09
|
| Rate for Payer: Coventry All Commercial |
$38.88
|
| Rate for Payer: Encore All Commercial |
$40.67
|
| Rate for Payer: Frontpath All Commercial |
$40.65
|
| Rate for Payer: Humana ChoiceCare |
$38.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.77
|
| Rate for Payer: PHCS All Commercial |
$33.14
|
| Rate for Payer: PHP All Commercial |
$33.51
|
| Rate for Payer: Sagamore Health Network All Products |
$34.11
|
| Rate for Payer: Signature Care EPO |
$36.67
|
| Rate for Payer: Signature Care PPO |
$38.88
|
| Rate for Payer: United Healthcare Commercial |
$34.82
|
|
|
HC PROTHROMBIN TIME POCT
|
Facility
IP
|
$44.19
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
01695610
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cigna All Commercial |
$38.13
|
| Rate for Payer: CORVEL All Commercial |
$41.09
|
| Rate for Payer: Coventry All Commercial |
$38.88
|
| Rate for Payer: Encore All Commercial |
$40.67
|
| Rate for Payer: Frontpath All Commercial |
$40.65
|
| Rate for Payer: Humana ChoiceCare |
$38.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.77
|
| Rate for Payer: PHCS All Commercial |
$33.14
|
| Rate for Payer: PHP All Commercial |
$33.51
|
| Rate for Payer: Sagamore Health Network All Products |
$34.11
|
| Rate for Payer: Signature Care EPO |
$36.67
|
| Rate for Payer: Signature Care PPO |
$38.88
|
| Rate for Payer: United Healthcare Commercial |
$34.82
|
|
|
HC PROTHROMBIN TIME POCT
|
Facility
OP
|
$44.19
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
01695610
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna Commercial |
$37.29
|
| Rate for Payer: Aetna Medicare |
$14.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.04
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Centivo All Commercial |
$22.54
|
| Rate for Payer: Cigna All Commercial |
$38.13
|
| Rate for Payer: CORVEL All Commercial |
$41.09
|
| Rate for Payer: Coventry All Commercial |
$38.88
|
| Rate for Payer: Encore All Commercial |
$40.67
|
| Rate for Payer: Frontpath All Commercial |
$40.65
|
| Rate for Payer: Humana ChoiceCare |
$38.16
|
| Rate for Payer: Humana Medicare |
$22.54
|
| Rate for Payer: Lucent All Commercial |
$22.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.77
|
| Rate for Payer: Managed Health Services Medicaid |
$4.29
|
| Rate for Payer: MDWise Medicaid |
$4.29
|
| Rate for Payer: PHCS All Commercial |
$33.14
|
| Rate for Payer: PHP All Commercial |
$33.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.23
|
| Rate for Payer: Sagamore Health Network All Products |
$34.11
|
| Rate for Payer: Signature Care EPO |
$36.67
|
| Rate for Payer: Signature Care PPO |
$38.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.56
|
| Rate for Payer: United Healthcare Commercial |
$34.82
|
| Rate for Payer: United Healthcare Medicare |
$14.58
|
|
|
HC PROTIME W/MIXING STUDIES, IF IND
|
Facility
OP
|
$39.86
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
63001749
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$37.07 |
| Rate for Payer: Aetna Commercial |
$33.64
|
| Rate for Payer: Aetna Medicare |
$13.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.47
|
| Rate for Payer: Cash Price |
$24.71
|
| Rate for Payer: Cash Price |
$24.71
|
| Rate for Payer: Centivo All Commercial |
$20.33
|
| Rate for Payer: Cigna All Commercial |
$34.40
|
| Rate for Payer: CORVEL All Commercial |
$37.07
|
| Rate for Payer: Coventry All Commercial |
$35.08
|
| Rate for Payer: Encore All Commercial |
$36.69
|
| Rate for Payer: Frontpath All Commercial |
$36.67
|
| Rate for Payer: Humana ChoiceCare |
$34.43
|
| Rate for Payer: Humana Medicare |
$20.33
|
| Rate for Payer: Lucent All Commercial |
$20.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.88
|
| Rate for Payer: Managed Health Services Medicaid |
$4.29
|
| Rate for Payer: MDWise Medicaid |
$4.29
|
| Rate for Payer: PHCS All Commercial |
$29.90
|
| Rate for Payer: PHP All Commercial |
$30.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.55
|
| Rate for Payer: Sagamore Health Network All Products |
$30.77
|
| Rate for Payer: Signature Care EPO |
$33.09
|
| Rate for Payer: Signature Care PPO |
$35.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.88
|
| Rate for Payer: United Healthcare Commercial |
$31.41
|
| Rate for Payer: United Healthcare Medicare |
$13.15
|
|
|
HC PROTIME W/MIXING STUDIES, IF IND
|
Facility
IP
|
$39.86
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
63001749
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$37.07 |
| Rate for Payer: Aetna Commercial |
$34.44
|
| Rate for Payer: Cash Price |
$24.71
|
| Rate for Payer: Cigna All Commercial |
$34.40
|
| Rate for Payer: CORVEL All Commercial |
$37.07
|
| Rate for Payer: Coventry All Commercial |
$35.08
|
| Rate for Payer: Encore All Commercial |
$36.69
|
| Rate for Payer: Frontpath All Commercial |
$36.67
|
| Rate for Payer: Humana ChoiceCare |
$34.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.88
|
| Rate for Payer: PHCS All Commercial |
$29.90
|
| Rate for Payer: PHP All Commercial |
$30.23
|
| Rate for Payer: Sagamore Health Network All Products |
$30.77
|
| Rate for Payer: Signature Care EPO |
$33.09
|
| Rate for Payer: Signature Care PPO |
$35.08
|
| Rate for Payer: United Healthcare Commercial |
$31.41
|
|
|
HC PROX CUTTER 55MM BLUE
|
Facility
IP
|
$640.78
|
|
| Hospital Charge Code |
41607888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.58 |
| Max. Negotiated Rate |
$595.93 |
| Rate for Payer: Aetna Commercial |
$553.63
|
| Rate for Payer: Cash Price |
$397.28
|
| Rate for Payer: Cigna All Commercial |
$552.99
|
| Rate for Payer: CORVEL All Commercial |
$595.93
|
| Rate for Payer: Coventry All Commercial |
$563.89
|
| Rate for Payer: Encore All Commercial |
$589.84
|
| Rate for Payer: Frontpath All Commercial |
$589.52
|
| Rate for Payer: Humana ChoiceCare |
$553.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.70
|
| Rate for Payer: PHCS All Commercial |
$480.58
|
| Rate for Payer: PHP All Commercial |
$485.97
|
| Rate for Payer: Sagamore Health Network All Products |
$494.68
|
| Rate for Payer: Signature Care EPO |
$531.85
|
| Rate for Payer: Signature Care PPO |
$563.89
|
| Rate for Payer: United Healthcare Commercial |
$504.93
|
|
|
HC PROX CUTTER 55MM BLUE
|
Facility
OP
|
$640.78
|
|
| Hospital Charge Code |
41607888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$595.93 |
| Rate for Payer: Aetna Commercial |
$540.82
|
| Rate for Payer: Aetna Medicare |
$211.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$211.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$368.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$400.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$243.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$232.60
|
| Rate for Payer: Cash Price |
$397.28
|
| Rate for Payer: Cash Price |
$397.28
|
| Rate for Payer: Centivo All Commercial |
$326.80
|
| Rate for Payer: Cigna All Commercial |
$552.99
|
| Rate for Payer: CORVEL All Commercial |
$595.93
|
| Rate for Payer: Coventry All Commercial |
$563.89
|
| Rate for Payer: Encore All Commercial |
$589.84
|
| Rate for Payer: Frontpath All Commercial |
$589.52
|
| Rate for Payer: Humana ChoiceCare |
$553.44
|
| Rate for Payer: Humana Medicare |
$326.80
|
| Rate for Payer: Lucent All Commercial |
$326.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$480.58
|
| Rate for Payer: PHP All Commercial |
$485.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.90
|
| Rate for Payer: Sagamore Health Network All Products |
$494.68
|
| Rate for Payer: Signature Care EPO |
$531.85
|
| Rate for Payer: Signature Care PPO |
$563.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$544.66
|
| Rate for Payer: United Healthcare Commercial |
$504.93
|
| Rate for Payer: United Healthcare Medicare |
$211.46
|
|
|
HC PROX CUTTER 75MM BLUE
|
Facility
IP
|
$956.27
|
|
| Hospital Charge Code |
41607889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$717.20 |
| Max. Negotiated Rate |
$889.33 |
| Rate for Payer: Aetna Commercial |
$826.22
|
| Rate for Payer: Cash Price |
$592.89
|
| Rate for Payer: Cigna All Commercial |
$825.26
|
| Rate for Payer: CORVEL All Commercial |
$889.33
|
| Rate for Payer: Coventry All Commercial |
$841.52
|
| Rate for Payer: Encore All Commercial |
$880.25
|
| Rate for Payer: Frontpath All Commercial |
$879.77
|
| Rate for Payer: Humana ChoiceCare |
$825.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$860.64
|
| Rate for Payer: PHCS All Commercial |
$717.20
|
| Rate for Payer: PHP All Commercial |
$725.24
|
| Rate for Payer: Sagamore Health Network All Products |
$738.24
|
| Rate for Payer: Signature Care EPO |
$793.70
|
| Rate for Payer: Signature Care PPO |
$841.52
|
| Rate for Payer: United Healthcare Commercial |
$753.54
|
|
|
HC PROX CUTTER 75MM BLUE
|
Facility
OP
|
$956.27
|
|
| Hospital Charge Code |
41607889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$889.33 |
| Rate for Payer: Aetna Commercial |
$807.09
|
| Rate for Payer: Aetna Medicare |
$315.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$315.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$549.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$597.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$362.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$347.13
|
| Rate for Payer: Cash Price |
$592.89
|
| Rate for Payer: Cash Price |
$592.89
|
| Rate for Payer: Centivo All Commercial |
$487.70
|
| Rate for Payer: Cigna All Commercial |
$825.26
|
| Rate for Payer: CORVEL All Commercial |
$889.33
|
| Rate for Payer: Coventry All Commercial |
$841.52
|
| Rate for Payer: Encore All Commercial |
$880.25
|
| Rate for Payer: Frontpath All Commercial |
$879.77
|
| Rate for Payer: Humana ChoiceCare |
$825.93
|
| Rate for Payer: Humana Medicare |
$487.70
|
| Rate for Payer: Lucent All Commercial |
$487.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$860.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$717.20
|
| Rate for Payer: PHP All Commercial |
$725.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$372.95
|
| Rate for Payer: Sagamore Health Network All Products |
$738.24
|
| Rate for Payer: Signature Care EPO |
$793.70
|
| Rate for Payer: Signature Care PPO |
$841.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$812.83
|
| Rate for Payer: United Healthcare Commercial |
$753.54
|
| Rate for Payer: United Healthcare Medicare |
$315.57
|
|
|
HC PSA FREE & TOTAL
|
Facility
OP
|
$188.94
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
63001123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$159.47
|
| Rate for Payer: Aetna Medicare |
$62.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.59
|
| Rate for Payer: Cash Price |
$117.15
|
| Rate for Payer: Cash Price |
$117.15
|
| Rate for Payer: Centivo All Commercial |
$96.36
|
| Rate for Payer: Cigna All Commercial |
$163.06
|
| Rate for Payer: CORVEL All Commercial |
$175.72
|
| Rate for Payer: Coventry All Commercial |
$166.27
|
| Rate for Payer: Encore All Commercial |
$173.92
|
| Rate for Payer: Frontpath All Commercial |
$173.83
|
| Rate for Payer: Humana ChoiceCare |
$163.19
|
| Rate for Payer: Humana Medicare |
$96.36
|
| Rate for Payer: Lucent All Commercial |
$96.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.05
|
| Rate for Payer: Managed Health Services Medicaid |
$18.39
|
| Rate for Payer: MDWise Medicaid |
$18.39
|
| Rate for Payer: PHCS All Commercial |
$141.71
|
| Rate for Payer: PHP All Commercial |
$143.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.69
|
| Rate for Payer: Sagamore Health Network All Products |
$145.87
|
| Rate for Payer: Signature Care EPO |
$156.82
|
| Rate for Payer: Signature Care PPO |
$166.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.60
|
| Rate for Payer: United Healthcare Commercial |
$148.89
|
| Rate for Payer: United Healthcare Medicare |
$62.35
|
|
