|
HC ULTRASOUND BREAST COMPLETE BILATERAL
|
Facility
|
IP
|
$1,299.52
|
|
|
Service Code
|
CPT 76641 50
|
| Hospital Charge Code |
21649641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$974.64 |
| Max. Negotiated Rate |
$1,208.55 |
| Rate for Payer: Aetna Commercial |
$1,122.79
|
| Rate for Payer: Cash Price |
$779.71
|
| Rate for Payer: Cigna All Commercial |
$1,121.49
|
| Rate for Payer: CORVEL All Commercial |
$1,208.55
|
| Rate for Payer: Coventry All Commercial |
$1,143.58
|
| Rate for Payer: Encore All Commercial |
$1,196.21
|
| Rate for Payer: Frontpath All Commercial |
$1,195.56
|
| Rate for Payer: Humana ChoiceCare |
$1,122.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,169.57
|
| Rate for Payer: PHCS All Commercial |
$974.64
|
| Rate for Payer: PHP All Commercial |
$985.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,003.23
|
| Rate for Payer: Signature Care EPO |
$1,078.60
|
| Rate for Payer: Signature Care PPO |
$1,143.58
|
| Rate for Payer: United Healthcare Commercial |
$1,024.02
|
|
|
HC ULTRASOUND BREAST COMPLETE LT
|
Facility
|
IP
|
$866.35
|
|
|
Service Code
|
CPT 76641 LT
|
| Hospital Charge Code |
1646641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$649.76 |
| Max. Negotiated Rate |
$805.71 |
| Rate for Payer: Aetna Commercial |
$748.53
|
| Rate for Payer: Cash Price |
$519.81
|
| Rate for Payer: Cigna All Commercial |
$747.66
|
| Rate for Payer: CORVEL All Commercial |
$805.71
|
| Rate for Payer: Coventry All Commercial |
$762.39
|
| Rate for Payer: Encore All Commercial |
$797.48
|
| Rate for Payer: Frontpath All Commercial |
$797.04
|
| Rate for Payer: Humana ChoiceCare |
$748.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.72
|
| Rate for Payer: PHCS All Commercial |
$649.76
|
| Rate for Payer: PHP All Commercial |
$657.04
|
| Rate for Payer: Sagamore Health Network All Products |
$668.82
|
| Rate for Payer: Signature Care EPO |
$719.07
|
| Rate for Payer: Signature Care PPO |
$762.39
|
| Rate for Payer: United Healthcare Commercial |
$682.68
|
|
|
HC ULTRASOUND BREAST COMPLETE LT
|
Facility
|
OP
|
$866.35
|
|
|
Service Code
|
CPT 76641 LT
|
| Hospital Charge Code |
1646641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$805.71 |
| Rate for Payer: Aetna Commercial |
$731.20
|
| Rate for Payer: Aetna Medicare |
$277.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$268.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$497.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$541.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$51.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$318.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$304.96
|
| Rate for Payer: Cash Price |
$519.81
|
| Rate for Payer: Cash Price |
$519.81
|
| Rate for Payer: Centivo All Commercial |
$471.29
|
| Rate for Payer: Cigna All Commercial |
$747.66
|
| Rate for Payer: CORVEL All Commercial |
$805.71
|
| Rate for Payer: Coventry All Commercial |
$762.39
|
| Rate for Payer: Encore All Commercial |
$797.48
|
| Rate for Payer: Frontpath All Commercial |
$797.04
|
| Rate for Payer: Humana ChoiceCare |
$748.27
|
| Rate for Payer: Humana Medicare |
$277.23
|
| Rate for Payer: Lucent All Commercial |
$471.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.72
|
| Rate for Payer: Managed Health Services Medicaid |
$51.67
|
| Rate for Payer: MDWise Medicaid |
$51.67
|
| Rate for Payer: PHCS All Commercial |
$649.76
|
| Rate for Payer: PHP All Commercial |
$657.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.88
|
| Rate for Payer: Sagamore Health Network All Products |
$668.82
|
| Rate for Payer: Signature Care EPO |
$719.07
|
| Rate for Payer: Signature Care PPO |
$762.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$736.40
|
| Rate for Payer: United Healthcare Commercial |
$682.68
|
| Rate for Payer: United Healthcare Medicare |
$277.23
|
|
|
HC ULTRASOUND BREAST COMPLETE RT
|
Facility
|
OP
|
$866.35
|
|
|
Service Code
|
CPT 76641 RT
|
| Hospital Charge Code |
21646641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$805.71 |
| Rate for Payer: Aetna Commercial |
$731.20
|
| Rate for Payer: Aetna Medicare |
$277.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$268.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$497.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$541.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$51.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$318.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$304.96
|
| Rate for Payer: Cash Price |
$519.81
|
| Rate for Payer: Cash Price |
$519.81
|
| Rate for Payer: Centivo All Commercial |
$471.29
|
| Rate for Payer: Cigna All Commercial |
$747.66
|
| Rate for Payer: CORVEL All Commercial |
$805.71
|
| Rate for Payer: Coventry All Commercial |
$762.39
|
| Rate for Payer: Encore All Commercial |
$797.48
|
| Rate for Payer: Frontpath All Commercial |
$797.04
|
| Rate for Payer: Humana ChoiceCare |
$748.27
|
| Rate for Payer: Humana Medicare |
$277.23
|
| Rate for Payer: Lucent All Commercial |
$471.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.72
|
| Rate for Payer: Managed Health Services Medicaid |
$51.67
|
| Rate for Payer: MDWise Medicaid |
$51.67
|
| Rate for Payer: PHCS All Commercial |
$649.76
|
| Rate for Payer: PHP All Commercial |
$657.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.88
|
| Rate for Payer: Sagamore Health Network All Products |
$668.82
|
| Rate for Payer: Signature Care EPO |
$719.07
|
| Rate for Payer: Signature Care PPO |
$762.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$736.40
|
| Rate for Payer: United Healthcare Commercial |
$682.68
|
| Rate for Payer: United Healthcare Medicare |
$277.23
|
|
|
HC ULTRASOUND BREAST COMPLETE RT
|
Facility
|
IP
|
$866.35
|
|
|
Service Code
|
CPT 76641 RT
|
| Hospital Charge Code |
21646641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$649.76 |
| Max. Negotiated Rate |
$805.71 |
| Rate for Payer: Aetna Commercial |
$748.53
|
| Rate for Payer: Cash Price |
$519.81
|
| Rate for Payer: Cigna All Commercial |
$747.66
|
| Rate for Payer: CORVEL All Commercial |
$805.71
|
| Rate for Payer: Coventry All Commercial |
$762.39
|
| Rate for Payer: Encore All Commercial |
$797.48
|
| Rate for Payer: Frontpath All Commercial |
$797.04
|
| Rate for Payer: Humana ChoiceCare |
$748.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.72
|
| Rate for Payer: PHCS All Commercial |
$649.76
|
| Rate for Payer: PHP All Commercial |
$657.04
|
| Rate for Payer: Sagamore Health Network All Products |
$668.82
|
| Rate for Payer: Signature Care EPO |
$719.07
|
| Rate for Payer: Signature Care PPO |
$762.39
|
| Rate for Payer: United Healthcare Commercial |
$682.68
|
|
|
HC ULTRASOUND BREAST LIMITED BILATERAL
|
Facility
|
IP
|
$665.04
|
|
|
Service Code
|
CPT 76642 50
|
| Hospital Charge Code |
21649642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$498.78 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$574.59
|
| Rate for Payer: Cash Price |
$399.02
|
| Rate for Payer: Cigna All Commercial |
$573.93
|
| Rate for Payer: CORVEL All Commercial |
$618.49
|
| Rate for Payer: Coventry All Commercial |
$585.24
|
| Rate for Payer: Encore All Commercial |
$612.17
|
| Rate for Payer: Frontpath All Commercial |
$611.84
|
| Rate for Payer: Humana ChoiceCare |
$574.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$598.54
|
| Rate for Payer: PHCS All Commercial |
$498.78
|
| Rate for Payer: PHP All Commercial |
$504.37
|
| Rate for Payer: Sagamore Health Network All Products |
$513.41
|
| Rate for Payer: Signature Care EPO |
$551.98
|
| Rate for Payer: Signature Care PPO |
$585.24
|
| Rate for Payer: United Healthcare Commercial |
$524.05
|
|
|
HC ULTRASOUND BREAST LIMITED BILATERAL
|
Facility
|
OP
|
$665.04
|
|
|
Service Code
|
CPT 76642 50
|
| Hospital Charge Code |
21649642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$561.29
|
| Rate for Payer: Aetna Medicare |
$212.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$39.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$206.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$381.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$415.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$39.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$244.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$234.09
|
| Rate for Payer: Cash Price |
$399.02
|
| Rate for Payer: Cash Price |
$399.02
|
| Rate for Payer: Centivo All Commercial |
$361.78
|
| Rate for Payer: Cigna All Commercial |
$573.93
|
| Rate for Payer: CORVEL All Commercial |
$618.49
|
| Rate for Payer: Coventry All Commercial |
$585.24
|
| Rate for Payer: Encore All Commercial |
$612.17
|
| Rate for Payer: Frontpath All Commercial |
$611.84
|
| Rate for Payer: Humana ChoiceCare |
$574.40
|
| Rate for Payer: Humana Medicare |
$212.81
|
| Rate for Payer: Lucent All Commercial |
$361.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$598.54
|
| Rate for Payer: Managed Health Services Medicaid |
$39.50
|
| Rate for Payer: MDWise Medicaid |
$39.50
|
| Rate for Payer: PHCS All Commercial |
$498.78
|
| Rate for Payer: PHP All Commercial |
$504.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$259.37
|
| Rate for Payer: Sagamore Health Network All Products |
$513.41
|
| Rate for Payer: Signature Care EPO |
$551.98
|
| Rate for Payer: Signature Care PPO |
$585.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$565.28
|
| Rate for Payer: United Healthcare Commercial |
$524.05
|
| Rate for Payer: United Healthcare Medicare |
$212.81
|
|
|
HC ULTRASOUND BREAST LIMITED LT
|
Facility
|
OP
|
$649.77
|
|
|
Service Code
|
CPT 76642 LT
|
| Hospital Charge Code |
1646642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$604.29 |
| Rate for Payer: Aetna Commercial |
$548.41
|
| Rate for Payer: Aetna Medicare |
$207.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$39.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$201.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$373.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$39.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$239.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.72
|
| Rate for Payer: Cash Price |
$389.86
|
| Rate for Payer: Cash Price |
$389.86
|
| Rate for Payer: Centivo All Commercial |
$353.47
|
| Rate for Payer: Cigna All Commercial |
$560.75
|
| Rate for Payer: CORVEL All Commercial |
$604.29
|
| Rate for Payer: Coventry All Commercial |
$571.80
|
| Rate for Payer: Encore All Commercial |
$598.11
|
| Rate for Payer: Frontpath All Commercial |
$597.79
|
| Rate for Payer: Humana ChoiceCare |
$561.21
|
| Rate for Payer: Humana Medicare |
$207.93
|
| Rate for Payer: Lucent All Commercial |
$353.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.79
|
| Rate for Payer: Managed Health Services Medicaid |
$39.50
|
| Rate for Payer: MDWise Medicaid |
$39.50
|
| Rate for Payer: PHCS All Commercial |
$487.33
|
| Rate for Payer: PHP All Commercial |
$492.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.41
|
| Rate for Payer: Sagamore Health Network All Products |
$501.62
|
| Rate for Payer: Signature Care EPO |
$539.31
|
| Rate for Payer: Signature Care PPO |
$571.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$552.30
|
| Rate for Payer: United Healthcare Commercial |
$512.02
|
| Rate for Payer: United Healthcare Medicare |
$207.93
|
|
|
HC ULTRASOUND BREAST LIMITED LT
|
Facility
|
IP
|
$649.77
|
|
|
Service Code
|
CPT 76642 LT
|
| Hospital Charge Code |
1646642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$487.33 |
| Max. Negotiated Rate |
$604.29 |
| Rate for Payer: Aetna Commercial |
$561.40
|
| Rate for Payer: Cash Price |
$389.86
|
| Rate for Payer: Cigna All Commercial |
$560.75
|
| Rate for Payer: CORVEL All Commercial |
$604.29
|
| Rate for Payer: Coventry All Commercial |
$571.80
|
| Rate for Payer: Encore All Commercial |
$598.11
|
| Rate for Payer: Frontpath All Commercial |
$597.79
|
| Rate for Payer: Humana ChoiceCare |
$561.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.79
|
| Rate for Payer: PHCS All Commercial |
$487.33
|
| Rate for Payer: PHP All Commercial |
$492.79
|
| Rate for Payer: Sagamore Health Network All Products |
$501.62
|
| Rate for Payer: Signature Care EPO |
$539.31
|
| Rate for Payer: Signature Care PPO |
$571.80
|
| Rate for Payer: United Healthcare Commercial |
$512.02
|
|
|
HC ULTRASOUND BREAST LIMITED RT
|
Facility
|
OP
|
$649.77
|
|
|
Service Code
|
CPT 76642 RT
|
| Hospital Charge Code |
21646642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$604.29 |
| Rate for Payer: Aetna Commercial |
$548.41
|
| Rate for Payer: Aetna Medicare |
$207.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$39.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$201.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$373.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$39.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$239.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.72
|
| Rate for Payer: Cash Price |
$389.86
|
| Rate for Payer: Cash Price |
$389.86
|
| Rate for Payer: Centivo All Commercial |
$353.47
|
| Rate for Payer: Cigna All Commercial |
$560.75
|
| Rate for Payer: CORVEL All Commercial |
$604.29
|
| Rate for Payer: Coventry All Commercial |
$571.80
|
| Rate for Payer: Encore All Commercial |
$598.11
|
| Rate for Payer: Frontpath All Commercial |
$597.79
|
| Rate for Payer: Humana ChoiceCare |
$561.21
|
| Rate for Payer: Humana Medicare |
$207.93
|
| Rate for Payer: Lucent All Commercial |
$353.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.79
|
| Rate for Payer: Managed Health Services Medicaid |
$39.50
|
| Rate for Payer: MDWise Medicaid |
$39.50
|
| Rate for Payer: PHCS All Commercial |
$487.33
|
| Rate for Payer: PHP All Commercial |
$492.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.41
|
| Rate for Payer: Sagamore Health Network All Products |
$501.62
|
| Rate for Payer: Signature Care EPO |
$539.31
|
| Rate for Payer: Signature Care PPO |
$571.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$552.30
|
| Rate for Payer: United Healthcare Commercial |
$512.02
|
| Rate for Payer: United Healthcare Medicare |
$207.93
|
|
|
HC ULTRASOUND BREAST LIMITED RT
|
Facility
|
IP
|
$649.77
|
|
|
Service Code
|
CPT 76642 RT
|
| Hospital Charge Code |
21646642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$487.33 |
| Max. Negotiated Rate |
$604.29 |
| Rate for Payer: Aetna Commercial |
$561.40
|
| Rate for Payer: Cash Price |
$389.86
|
| Rate for Payer: Cigna All Commercial |
$560.75
|
| Rate for Payer: CORVEL All Commercial |
$604.29
|
| Rate for Payer: Coventry All Commercial |
$571.80
|
| Rate for Payer: Encore All Commercial |
$598.11
|
| Rate for Payer: Frontpath All Commercial |
$597.79
|
| Rate for Payer: Humana ChoiceCare |
$561.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.79
|
| Rate for Payer: PHCS All Commercial |
$487.33
|
| Rate for Payer: PHP All Commercial |
$492.79
|
| Rate for Payer: Sagamore Health Network All Products |
$501.62
|
| Rate for Payer: Signature Care EPO |
$539.31
|
| Rate for Payer: Signature Care PPO |
$571.80
|
| Rate for Payer: United Healthcare Commercial |
$512.02
|
|
|
HC ULTRASOUND-NEONATAL HEADS
|
Facility
|
IP
|
$599.78
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
1646506
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.83 |
| Max. Negotiated Rate |
$557.80 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Cash Price |
$359.87
|
| Rate for Payer: Cigna All Commercial |
$517.61
|
| Rate for Payer: CORVEL All Commercial |
$557.80
|
| Rate for Payer: Coventry All Commercial |
$527.81
|
| Rate for Payer: Encore All Commercial |
$552.10
|
| Rate for Payer: Frontpath All Commercial |
$551.80
|
| Rate for Payer: Humana ChoiceCare |
$518.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$539.80
|
| Rate for Payer: PHCS All Commercial |
$449.83
|
| Rate for Payer: PHP All Commercial |
$454.87
|
| Rate for Payer: Sagamore Health Network All Products |
$463.03
|
| Rate for Payer: Signature Care EPO |
$497.82
|
| Rate for Payer: Signature Care PPO |
$527.81
|
| Rate for Payer: United Healthcare Commercial |
$472.63
|
|
|
HC ULTRASOUND-NEONATAL HEADS
|
Facility
|
OP
|
$599.78
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
1646506
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$64.08 |
| Max. Negotiated Rate |
$557.80 |
| Rate for Payer: Aetna Commercial |
$506.21
|
| Rate for Payer: Aetna Medicare |
$191.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$64.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$185.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$344.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$374.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$64.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.12
|
| Rate for Payer: Cash Price |
$359.87
|
| Rate for Payer: Cash Price |
$359.87
|
| Rate for Payer: Centivo All Commercial |
$326.28
|
| Rate for Payer: Cigna All Commercial |
$517.61
|
| Rate for Payer: CORVEL All Commercial |
$557.80
|
| Rate for Payer: Coventry All Commercial |
$527.81
|
| Rate for Payer: Encore All Commercial |
$552.10
|
| Rate for Payer: Frontpath All Commercial |
$551.80
|
| Rate for Payer: Humana ChoiceCare |
$518.03
|
| Rate for Payer: Humana Medicare |
$191.93
|
| Rate for Payer: Lucent All Commercial |
$326.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$539.80
|
| Rate for Payer: Managed Health Services Medicaid |
$64.08
|
| Rate for Payer: MDWise Medicaid |
$64.08
|
| Rate for Payer: PHCS All Commercial |
$449.83
|
| Rate for Payer: PHP All Commercial |
$454.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$233.91
|
| Rate for Payer: Sagamore Health Network All Products |
$463.03
|
| Rate for Payer: Signature Care EPO |
$497.82
|
| Rate for Payer: Signature Care PPO |
$527.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$509.81
|
| Rate for Payer: United Healthcare Commercial |
$472.63
|
| Rate for Payer: United Healthcare Medicare |
$191.93
|
|
|
HC UMBILICAL CORD TESTING
|
Facility
|
IP
|
$380.97
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63080307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$285.73 |
| Max. Negotiated Rate |
$354.30 |
| Rate for Payer: Aetna Commercial |
$329.16
|
| Rate for Payer: Cash Price |
$228.58
|
| Rate for Payer: Cigna All Commercial |
$328.78
|
| Rate for Payer: CORVEL All Commercial |
$354.30
|
| Rate for Payer: Coventry All Commercial |
$335.25
|
| Rate for Payer: Encore All Commercial |
$350.68
|
| Rate for Payer: Frontpath All Commercial |
$350.49
|
| Rate for Payer: Humana ChoiceCare |
$329.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$342.87
|
| Rate for Payer: PHCS All Commercial |
$285.73
|
| Rate for Payer: PHP All Commercial |
$288.93
|
| Rate for Payer: Sagamore Health Network All Products |
$294.11
|
| Rate for Payer: Signature Care EPO |
$316.21
|
| Rate for Payer: Signature Care PPO |
$335.25
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
|
|
HC UMBILICAL CORD TESTING
|
Facility
|
OP
|
$380.97
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63080307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$354.30 |
| Rate for Payer: Aetna Commercial |
$321.54
|
| Rate for Payer: Aetna Medicare |
$121.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$118.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$175.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.10
|
| Rate for Payer: Cash Price |
$228.58
|
| Rate for Payer: Cash Price |
$228.58
|
| Rate for Payer: Centivo All Commercial |
$207.25
|
| Rate for Payer: Cigna All Commercial |
$328.78
|
| Rate for Payer: CORVEL All Commercial |
$354.30
|
| Rate for Payer: Coventry All Commercial |
$335.25
|
| Rate for Payer: Encore All Commercial |
$350.68
|
| Rate for Payer: Frontpath All Commercial |
$350.49
|
| Rate for Payer: Humana ChoiceCare |
$329.04
|
| Rate for Payer: Humana Medicare |
$121.91
|
| Rate for Payer: Lucent All Commercial |
$207.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$342.87
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$285.73
|
| Rate for Payer: PHP All Commercial |
$288.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.58
|
| Rate for Payer: Sagamore Health Network All Products |
$294.11
|
| Rate for Payer: Signature Care EPO |
$316.21
|
| Rate for Payer: Signature Care PPO |
$335.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$323.82
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
| Rate for Payer: United Healthcare Medicare |
$121.91
|
|
|
HC UNIL APP MULTI COMPRESS LOW LEG; ANKLE/FOOT PT
|
Facility
|
IP
|
$393.76
|
|
|
Service Code
|
CPT 29581 GP
|
| Hospital Charge Code |
1722006
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$295.32 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$340.21
|
| Rate for Payer: Cash Price |
$236.26
|
| Rate for Payer: Cigna All Commercial |
$339.81
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
|
|
HC UNIL APP MULTI COMPRESS LOW LEG; ANKLE/FOOT PT
|
Facility
|
OP
|
$393.76
|
|
|
Service Code
|
CPT 29581 GP
|
| Hospital Charge Code |
1722006
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$332.33
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$226.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.60
|
| Rate for Payer: Cash Price |
$236.26
|
| Rate for Payer: Cash Price |
$236.26
|
| Rate for Payer: Centivo All Commercial |
$214.21
|
| Rate for Payer: Cigna All Commercial |
$339.81
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Humana Medicare |
$126.00
|
| Rate for Payer: Lucent All Commercial |
$214.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.57
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$334.70
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
| Rate for Payer: United Healthcare Medicare |
$126.00
|
|
|
HC UNIL APP MULTI COMPRESS UPPER ARM/FA/H/F PT
|
Facility
|
IP
|
$393.76
|
|
|
Service Code
|
CPT 29584 GP
|
| Hospital Charge Code |
1722009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$295.32 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$340.21
|
| Rate for Payer: Cash Price |
$236.26
|
| Rate for Payer: Cigna All Commercial |
$339.81
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
|
|
HC UNIL APP MULTI COMPRESS UPPER ARM/FA/H/F PT
|
Facility
|
OP
|
$393.76
|
|
|
Service Code
|
CPT 29584 GP
|
| Hospital Charge Code |
1722009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$366.20 |
| Rate for Payer: Aetna Commercial |
$332.33
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$226.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.60
|
| Rate for Payer: Cash Price |
$236.26
|
| Rate for Payer: Cash Price |
$236.26
|
| Rate for Payer: Centivo All Commercial |
$214.21
|
| Rate for Payer: Cigna All Commercial |
$339.81
|
| Rate for Payer: CORVEL All Commercial |
$366.20
|
| Rate for Payer: Coventry All Commercial |
$346.51
|
| Rate for Payer: Encore All Commercial |
$362.46
|
| Rate for Payer: Frontpath All Commercial |
$362.26
|
| Rate for Payer: Humana ChoiceCare |
$340.09
|
| Rate for Payer: Humana Medicare |
$126.00
|
| Rate for Payer: Lucent All Commercial |
$214.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$354.38
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$295.32
|
| Rate for Payer: PHP All Commercial |
$298.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.57
|
| Rate for Payer: Sagamore Health Network All Products |
$303.98
|
| Rate for Payer: Signature Care EPO |
$326.82
|
| Rate for Payer: Signature Care PPO |
$346.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$334.70
|
| Rate for Payer: United Healthcare Commercial |
$310.28
|
| Rate for Payer: United Healthcare Medicare |
$126.00
|
|
|
HC UNLISTED MOLECULAR PATHOLOGY
|
Facility
|
OP
|
$273.33
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
63001446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.73 |
| Max. Negotiated Rate |
$254.20 |
| Rate for Payer: Aetna Commercial |
$230.69
|
| Rate for Payer: Aetna Medicare |
$87.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$246.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$125.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$246.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.21
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Centivo All Commercial |
$148.69
|
| Rate for Payer: Cigna All Commercial |
$235.88
|
| Rate for Payer: CORVEL All Commercial |
$254.20
|
| Rate for Payer: Coventry All Commercial |
$240.53
|
| Rate for Payer: Encore All Commercial |
$251.60
|
| Rate for Payer: Frontpath All Commercial |
$251.46
|
| Rate for Payer: Humana ChoiceCare |
$236.08
|
| Rate for Payer: Humana Medicare |
$87.47
|
| Rate for Payer: Lucent All Commercial |
$148.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.00
|
| Rate for Payer: Managed Health Services Medicaid |
$246.00
|
| Rate for Payer: MDWise Medicaid |
$246.00
|
| Rate for Payer: PHCS All Commercial |
$205.00
|
| Rate for Payer: PHP All Commercial |
$207.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.60
|
| Rate for Payer: Sagamore Health Network All Products |
$211.01
|
| Rate for Payer: Signature Care EPO |
$226.86
|
| Rate for Payer: Signature Care PPO |
$240.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.33
|
| Rate for Payer: United Healthcare Commercial |
$215.38
|
| Rate for Payer: United Healthcare Medicare |
$87.47
|
|
|
HC UNLISTED MOLECULAR PATHOLOGY
|
Facility
|
IP
|
$273.33
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
63001446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$254.20 |
| Rate for Payer: Aetna Commercial |
$236.16
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna All Commercial |
$235.88
|
| Rate for Payer: CORVEL All Commercial |
$254.20
|
| Rate for Payer: Coventry All Commercial |
$240.53
|
| Rate for Payer: Encore All Commercial |
$251.60
|
| Rate for Payer: Frontpath All Commercial |
$251.46
|
| Rate for Payer: Humana ChoiceCare |
$236.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.00
|
| Rate for Payer: PHCS All Commercial |
$205.00
|
| Rate for Payer: PHP All Commercial |
$207.29
|
| Rate for Payer: Sagamore Health Network All Products |
$211.01
|
| Rate for Payer: Signature Care EPO |
$226.86
|
| Rate for Payer: Signature Care PPO |
$240.53
|
| Rate for Payer: United Healthcare Commercial |
$215.38
|
|
|
HC UREA 24U
|
Facility
|
OP
|
$77.53
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
63001705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$65.44
|
| Rate for Payer: Aetna Medicare |
$24.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.29
|
| Rate for Payer: Cash Price |
$46.52
|
| Rate for Payer: Cash Price |
$46.52
|
| Rate for Payer: Centivo All Commercial |
$42.18
|
| Rate for Payer: Cigna All Commercial |
$66.91
|
| Rate for Payer: CORVEL All Commercial |
$72.10
|
| Rate for Payer: Coventry All Commercial |
$68.23
|
| Rate for Payer: Encore All Commercial |
$71.37
|
| Rate for Payer: Frontpath All Commercial |
$71.33
|
| Rate for Payer: Humana ChoiceCare |
$66.96
|
| Rate for Payer: Humana Medicare |
$24.81
|
| Rate for Payer: Lucent All Commercial |
$42.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.78
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: MDWise Medicaid |
$5.56
|
| Rate for Payer: PHCS All Commercial |
$58.15
|
| Rate for Payer: PHP All Commercial |
$58.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.24
|
| Rate for Payer: Sagamore Health Network All Products |
$59.85
|
| Rate for Payer: Signature Care EPO |
$64.35
|
| Rate for Payer: Signature Care PPO |
$68.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.90
|
| Rate for Payer: United Healthcare Commercial |
$61.09
|
| Rate for Payer: United Healthcare Medicare |
$24.81
|
|
|
HC UREA 24U
|
Facility
|
IP
|
$77.53
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
63001705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Cash Price |
$46.52
|
| Rate for Payer: Cigna All Commercial |
$66.91
|
| Rate for Payer: CORVEL All Commercial |
$72.10
|
| Rate for Payer: Coventry All Commercial |
$68.23
|
| Rate for Payer: Encore All Commercial |
$71.37
|
| Rate for Payer: Frontpath All Commercial |
$71.33
|
| Rate for Payer: Humana ChoiceCare |
$66.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.78
|
| Rate for Payer: PHCS All Commercial |
$58.15
|
| Rate for Payer: PHP All Commercial |
$58.80
|
| Rate for Payer: Sagamore Health Network All Products |
$59.85
|
| Rate for Payer: Signature Care EPO |
$64.35
|
| Rate for Payer: Signature Care PPO |
$68.23
|
| Rate for Payer: United Healthcare Commercial |
$61.09
|
|
|
HC UREA URINE
|
Facility
|
OP
|
$100.98
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
63001165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$93.91 |
| Rate for Payer: Aetna Commercial |
$85.23
|
| Rate for Payer: Aetna Medicare |
$32.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$46.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.54
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Centivo All Commercial |
$54.93
|
| Rate for Payer: Cigna All Commercial |
$87.15
|
| Rate for Payer: CORVEL All Commercial |
$93.91
|
| Rate for Payer: Coventry All Commercial |
$88.86
|
| Rate for Payer: Encore All Commercial |
$92.95
|
| Rate for Payer: Frontpath All Commercial |
$92.90
|
| Rate for Payer: Humana ChoiceCare |
$87.22
|
| Rate for Payer: Humana Medicare |
$32.31
|
| Rate for Payer: Lucent All Commercial |
$54.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.88
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: MDWise Medicaid |
$5.56
|
| Rate for Payer: PHCS All Commercial |
$75.73
|
| Rate for Payer: PHP All Commercial |
$76.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.38
|
| Rate for Payer: Sagamore Health Network All Products |
$77.96
|
| Rate for Payer: Signature Care EPO |
$83.81
|
| Rate for Payer: Signature Care PPO |
$88.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85.83
|
| Rate for Payer: United Healthcare Commercial |
$79.57
|
| Rate for Payer: United Healthcare Medicare |
$32.31
|
|
|
HC UREA URINE
|
Facility
|
IP
|
$100.98
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
63001165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.73 |
| Max. Negotiated Rate |
$93.91 |
| Rate for Payer: Aetna Commercial |
$87.25
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Cigna All Commercial |
$87.15
|
| Rate for Payer: CORVEL All Commercial |
$93.91
|
| Rate for Payer: Coventry All Commercial |
$88.86
|
| Rate for Payer: Encore All Commercial |
$92.95
|
| Rate for Payer: Frontpath All Commercial |
$92.90
|
| Rate for Payer: Humana ChoiceCare |
$87.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.88
|
| Rate for Payer: PHCS All Commercial |
$75.73
|
| Rate for Payer: PHP All Commercial |
$76.58
|
| Rate for Payer: Sagamore Health Network All Products |
$77.96
|
| Rate for Payer: Signature Care EPO |
$83.81
|
| Rate for Payer: Signature Care PPO |
$88.86
|
| Rate for Payer: United Healthcare Commercial |
$79.57
|
|
