|
HC SARS-COV-2 ANTIBODIES, NUCLEOCAPSID
|
Facility
IP
|
$102.71
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
63026769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.04 |
| Max. Negotiated Rate |
$95.52 |
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Cigna All Commercial |
$88.64
|
| Rate for Payer: CORVEL All Commercial |
$95.52
|
| Rate for Payer: Coventry All Commercial |
$90.39
|
| Rate for Payer: Encore All Commercial |
$94.55
|
| Rate for Payer: Frontpath All Commercial |
$94.50
|
| Rate for Payer: Humana ChoiceCare |
$88.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.44
|
| Rate for Payer: PHCS All Commercial |
$77.04
|
| Rate for Payer: PHP All Commercial |
$77.90
|
| Rate for Payer: Sagamore Health Network All Products |
$79.30
|
| Rate for Payer: Signature Care EPO |
$85.25
|
| Rate for Payer: Signature Care PPO |
$90.39
|
| Rate for Payer: United Healthcare Commercial |
$80.94
|
|
|
HC SARS-COV-2 SEMIQUANTITATIVE TOTAL ANTIBODY, SPIKE
|
Facility
IP
|
$102.71
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
63016769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.04 |
| Max. Negotiated Rate |
$95.52 |
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Cigna All Commercial |
$88.64
|
| Rate for Payer: CORVEL All Commercial |
$95.52
|
| Rate for Payer: Coventry All Commercial |
$90.39
|
| Rate for Payer: Encore All Commercial |
$94.55
|
| Rate for Payer: Frontpath All Commercial |
$94.50
|
| Rate for Payer: Humana ChoiceCare |
$88.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.44
|
| Rate for Payer: PHCS All Commercial |
$77.04
|
| Rate for Payer: PHP All Commercial |
$77.90
|
| Rate for Payer: Sagamore Health Network All Products |
$79.30
|
| Rate for Payer: Signature Care EPO |
$85.25
|
| Rate for Payer: Signature Care PPO |
$90.39
|
| Rate for Payer: United Healthcare Commercial |
$80.94
|
|
|
HC SARS-COV-2 SEMIQUANTITATIVE TOTAL ANTIBODY, SPIKE
|
Facility
OP
|
$102.71
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
63016769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$95.52 |
| Rate for Payer: Aetna Commercial |
$86.69
|
| Rate for Payer: Aetna Medicare |
$33.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$42.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.29
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Centivo All Commercial |
$52.38
|
| Rate for Payer: Cigna All Commercial |
$88.64
|
| Rate for Payer: CORVEL All Commercial |
$95.52
|
| Rate for Payer: Coventry All Commercial |
$90.39
|
| Rate for Payer: Encore All Commercial |
$94.55
|
| Rate for Payer: Frontpath All Commercial |
$94.50
|
| Rate for Payer: Humana ChoiceCare |
$88.71
|
| Rate for Payer: Humana Medicare |
$52.38
|
| Rate for Payer: Lucent All Commercial |
$52.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.44
|
| Rate for Payer: Managed Health Services Medicaid |
$42.13
|
| Rate for Payer: MDWise Medicaid |
$42.13
|
| Rate for Payer: PHCS All Commercial |
$77.04
|
| Rate for Payer: PHP All Commercial |
$77.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.06
|
| Rate for Payer: Sagamore Health Network All Products |
$79.30
|
| Rate for Payer: Signature Care EPO |
$85.25
|
| Rate for Payer: Signature Care PPO |
$90.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.31
|
| Rate for Payer: United Healthcare Commercial |
$80.94
|
| Rate for Payer: United Healthcare Medicare |
$33.90
|
|
|
HC S BLADE SAW 18.0X1.27X90
|
Facility
IP
|
$357.00
|
|
| Hospital Charge Code |
41607604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$308.45
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Cigna All Commercial |
$308.09
|
| Rate for Payer: CORVEL All Commercial |
$332.01
|
| Rate for Payer: Coventry All Commercial |
$314.16
|
| Rate for Payer: Encore All Commercial |
$328.62
|
| Rate for Payer: Frontpath All Commercial |
$328.44
|
| Rate for Payer: Humana ChoiceCare |
$308.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.30
|
| Rate for Payer: PHCS All Commercial |
$267.75
|
| Rate for Payer: PHP All Commercial |
$270.75
|
| Rate for Payer: Sagamore Health Network All Products |
$275.60
|
| Rate for Payer: Signature Care EPO |
$296.31
|
| Rate for Payer: Signature Care PPO |
$314.16
|
| Rate for Payer: United Healthcare Commercial |
$281.32
|
|
|
HC S BLADE SAW 18.0X1.27X90
|
Facility
OP
|
$357.00
|
|
| Hospital Charge Code |
41607604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$301.31
|
| Rate for Payer: Aetna Medicare |
$117.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$205.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$223.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.59
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Centivo All Commercial |
$182.07
|
| Rate for Payer: Cigna All Commercial |
$308.09
|
| Rate for Payer: CORVEL All Commercial |
$332.01
|
| Rate for Payer: Coventry All Commercial |
$314.16
|
| Rate for Payer: Encore All Commercial |
$328.62
|
| Rate for Payer: Frontpath All Commercial |
$328.44
|
| Rate for Payer: Humana ChoiceCare |
$308.34
|
| Rate for Payer: Humana Medicare |
$182.07
|
| Rate for Payer: Lucent All Commercial |
$182.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$267.75
|
| Rate for Payer: PHP All Commercial |
$270.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.23
|
| Rate for Payer: Sagamore Health Network All Products |
$275.60
|
| Rate for Payer: Signature Care EPO |
$296.31
|
| Rate for Payer: Signature Care PPO |
$314.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$303.45
|
| Rate for Payer: United Healthcare Commercial |
$281.32
|
| Rate for Payer: United Healthcare Medicare |
$117.81
|
|
|
HC S BLADE SAW PREC 5.5X0.38X18
|
Facility
OP
|
$265.58
|
|
| Hospital Charge Code |
41607936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.64 |
| Max. Negotiated Rate |
$246.99 |
| Rate for Payer: Aetna Commercial |
$224.15
|
| Rate for Payer: Aetna Medicare |
$87.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$152.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.41
|
| Rate for Payer: Cash Price |
$164.66
|
| Rate for Payer: Cash Price |
$164.66
|
| Rate for Payer: Centivo All Commercial |
$135.45
|
| Rate for Payer: Cigna All Commercial |
$229.20
|
| Rate for Payer: CORVEL All Commercial |
$246.99
|
| Rate for Payer: Coventry All Commercial |
$233.71
|
| Rate for Payer: Encore All Commercial |
$244.47
|
| Rate for Payer: Frontpath All Commercial |
$244.33
|
| Rate for Payer: Humana ChoiceCare |
$229.38
|
| Rate for Payer: Humana Medicare |
$135.45
|
| Rate for Payer: Lucent All Commercial |
$135.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$199.18
|
| Rate for Payer: PHP All Commercial |
$201.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.58
|
| Rate for Payer: Sagamore Health Network All Products |
$205.03
|
| Rate for Payer: Signature Care EPO |
$220.43
|
| Rate for Payer: Signature Care PPO |
$233.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$225.74
|
| Rate for Payer: United Healthcare Commercial |
$209.28
|
| Rate for Payer: United Healthcare Medicare |
$87.64
|
|
|
HC S BLADE SAW PREC 5.5X0.38X18
|
Facility
IP
|
$265.58
|
|
| Hospital Charge Code |
41607936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.18 |
| Max. Negotiated Rate |
$246.99 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Cash Price |
$164.66
|
| Rate for Payer: Cigna All Commercial |
$229.20
|
| Rate for Payer: CORVEL All Commercial |
$246.99
|
| Rate for Payer: Coventry All Commercial |
$233.71
|
| Rate for Payer: Encore All Commercial |
$244.47
|
| Rate for Payer: Frontpath All Commercial |
$244.33
|
| Rate for Payer: Humana ChoiceCare |
$229.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.02
|
| Rate for Payer: PHCS All Commercial |
$199.18
|
| Rate for Payer: PHP All Commercial |
$201.42
|
| Rate for Payer: Sagamore Health Network All Products |
$205.03
|
| Rate for Payer: Signature Care EPO |
$220.43
|
| Rate for Payer: Signature Care PPO |
$233.71
|
| Rate for Payer: United Healthcare Commercial |
$209.28
|
|
|
HC S BLADE SAW THIN 13.3X.38X42
|
Facility
IP
|
$229.39
|
|
| Hospital Charge Code |
41606968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$213.33 |
| Rate for Payer: Aetna Commercial |
$198.19
|
| Rate for Payer: Cash Price |
$142.22
|
| Rate for Payer: Cigna All Commercial |
$197.96
|
| Rate for Payer: CORVEL All Commercial |
$213.33
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Encore All Commercial |
$211.15
|
| Rate for Payer: Frontpath All Commercial |
$211.04
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.45
|
| Rate for Payer: PHCS All Commercial |
$172.04
|
| Rate for Payer: PHP All Commercial |
$173.97
|
| Rate for Payer: Sagamore Health Network All Products |
$177.09
|
| Rate for Payer: Signature Care EPO |
$190.39
|
| Rate for Payer: Signature Care PPO |
$201.86
|
| Rate for Payer: United Healthcare Commercial |
$180.76
|
|
|
HC S BLADE SAW THIN 13.3X.38X42
|
Facility
OP
|
$229.39
|
|
| Hospital Charge Code |
41606968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.70 |
| Max. Negotiated Rate |
$213.33 |
| Rate for Payer: Aetna Commercial |
$193.61
|
| Rate for Payer: Aetna Medicare |
$75.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$131.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.27
|
| Rate for Payer: Cash Price |
$142.22
|
| Rate for Payer: Cash Price |
$142.22
|
| Rate for Payer: Centivo All Commercial |
$116.99
|
| Rate for Payer: Cigna All Commercial |
$197.96
|
| Rate for Payer: CORVEL All Commercial |
$213.33
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Encore All Commercial |
$211.15
|
| Rate for Payer: Frontpath All Commercial |
$211.04
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Humana Medicare |
$116.99
|
| Rate for Payer: Lucent All Commercial |
$116.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$172.04
|
| Rate for Payer: PHP All Commercial |
$173.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.46
|
| Rate for Payer: Sagamore Health Network All Products |
$177.09
|
| Rate for Payer: Signature Care EPO |
$190.39
|
| Rate for Payer: Signature Care PPO |
$201.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194.98
|
| Rate for Payer: United Healthcare Commercial |
$180.76
|
| Rate for Payer: United Healthcare Medicare |
$75.70
|
|
|
HC SCABIES EXAMINATION
|
Facility
OP
|
$81.98
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
63044073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$76.24 |
| Rate for Payer: Aetna Commercial |
$69.19
|
| Rate for Payer: Aetna Medicare |
$27.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.76
|
| Rate for Payer: Cash Price |
$50.83
|
| Rate for Payer: Cash Price |
$50.83
|
| Rate for Payer: Centivo All Commercial |
$41.81
|
| Rate for Payer: Cigna All Commercial |
$70.75
|
| Rate for Payer: CORVEL All Commercial |
$76.24
|
| Rate for Payer: Coventry All Commercial |
$72.14
|
| Rate for Payer: Encore All Commercial |
$75.46
|
| Rate for Payer: Frontpath All Commercial |
$75.42
|
| Rate for Payer: Humana ChoiceCare |
$70.80
|
| Rate for Payer: Humana Medicare |
$41.81
|
| Rate for Payer: Lucent All Commercial |
$41.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.78
|
| Rate for Payer: Managed Health Services Medicaid |
$4.31
|
| Rate for Payer: MDWise Medicaid |
$4.31
|
| Rate for Payer: PHCS All Commercial |
$61.48
|
| Rate for Payer: PHP All Commercial |
$62.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.97
|
| Rate for Payer: Sagamore Health Network All Products |
$63.29
|
| Rate for Payer: Signature Care EPO |
$68.04
|
| Rate for Payer: Signature Care PPO |
$72.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69.68
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Medicare |
$27.05
|
|
|
HC SCABIES EXAMINATION
|
Facility
IP
|
$81.98
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
63044073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.48 |
| Max. Negotiated Rate |
$76.24 |
| Rate for Payer: Aetna Commercial |
$70.83
|
| Rate for Payer: Cash Price |
$50.83
|
| Rate for Payer: Cigna All Commercial |
$70.75
|
| Rate for Payer: CORVEL All Commercial |
$76.24
|
| Rate for Payer: Coventry All Commercial |
$72.14
|
| Rate for Payer: Encore All Commercial |
$75.46
|
| Rate for Payer: Frontpath All Commercial |
$75.42
|
| Rate for Payer: Humana ChoiceCare |
$70.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.78
|
| Rate for Payer: PHCS All Commercial |
$61.48
|
| Rate for Payer: PHP All Commercial |
$62.17
|
| Rate for Payer: Sagamore Health Network All Products |
$63.29
|
| Rate for Payer: Signature Care EPO |
$68.04
|
| Rate for Payer: Signature Care PPO |
$72.14
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
|
|
HC S CASSETTE CROSSFLOW
|
Facility
IP
|
$440.65
|
|
| Hospital Charge Code |
41607426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.49 |
| Max. Negotiated Rate |
$409.80 |
| Rate for Payer: Aetna Commercial |
$380.72
|
| Rate for Payer: Cash Price |
$273.20
|
| Rate for Payer: Cigna All Commercial |
$380.28
|
| Rate for Payer: CORVEL All Commercial |
$409.80
|
| Rate for Payer: Coventry All Commercial |
$387.77
|
| Rate for Payer: Encore All Commercial |
$405.62
|
| Rate for Payer: Frontpath All Commercial |
$405.40
|
| Rate for Payer: Humana ChoiceCare |
$380.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$396.58
|
| Rate for Payer: PHCS All Commercial |
$330.49
|
| Rate for Payer: PHP All Commercial |
$334.19
|
| Rate for Payer: Sagamore Health Network All Products |
$340.18
|
| Rate for Payer: Signature Care EPO |
$365.74
|
| Rate for Payer: Signature Care PPO |
$387.77
|
| Rate for Payer: United Healthcare Commercial |
$347.23
|
|
|
HC S CASSETTE CROSSFLOW
|
Facility
OP
|
$440.65
|
|
| Hospital Charge Code |
41607426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$409.80 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Aetna Medicare |
$145.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$253.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$275.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.96
|
| Rate for Payer: Cash Price |
$273.20
|
| Rate for Payer: Cash Price |
$273.20
|
| Rate for Payer: Centivo All Commercial |
$224.73
|
| Rate for Payer: Cigna All Commercial |
$380.28
|
| Rate for Payer: CORVEL All Commercial |
$409.80
|
| Rate for Payer: Coventry All Commercial |
$387.77
|
| Rate for Payer: Encore All Commercial |
$405.62
|
| Rate for Payer: Frontpath All Commercial |
$405.40
|
| Rate for Payer: Humana ChoiceCare |
$380.59
|
| Rate for Payer: Humana Medicare |
$224.73
|
| Rate for Payer: Lucent All Commercial |
$224.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$396.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$330.49
|
| Rate for Payer: PHP All Commercial |
$334.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.85
|
| Rate for Payer: Sagamore Health Network All Products |
$340.18
|
| Rate for Payer: Signature Care EPO |
$365.74
|
| Rate for Payer: Signature Care PPO |
$387.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$374.55
|
| Rate for Payer: United Healthcare Commercial |
$347.23
|
| Rate for Payer: United Healthcare Medicare |
$145.41
|
|
|
HC S CEMENT SPEEDSET
|
Facility
OP
|
$617.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.74 |
| Max. Negotiated Rate |
$574.18 |
| Rate for Payer: Aetna Commercial |
$521.09
|
| Rate for Payer: Aetna Medicare |
$203.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$354.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$234.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$224.12
|
| Rate for Payer: Cash Price |
$382.79
|
| Rate for Payer: Cash Price |
$382.79
|
| Rate for Payer: Centivo All Commercial |
$314.87
|
| Rate for Payer: Cigna All Commercial |
$532.82
|
| Rate for Payer: CORVEL All Commercial |
$574.18
|
| Rate for Payer: Coventry All Commercial |
$543.31
|
| Rate for Payer: Encore All Commercial |
$568.32
|
| Rate for Payer: Frontpath All Commercial |
$568.01
|
| Rate for Payer: Humana ChoiceCare |
$533.25
|
| Rate for Payer: Humana Medicare |
$314.87
|
| Rate for Payer: Lucent All Commercial |
$314.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$463.05
|
| Rate for Payer: PHP All Commercial |
$468.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.79
|
| Rate for Payer: Sagamore Health Network All Products |
$476.63
|
| Rate for Payer: Signature Care EPO |
$512.44
|
| Rate for Payer: Signature Care PPO |
$543.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$524.79
|
| Rate for Payer: United Healthcare Commercial |
$486.51
|
| Rate for Payer: United Healthcare Medicare |
$203.74
|
|
|
HC S CEMENT SPEEDSET
|
Facility
IP
|
$617.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$463.05 |
| Max. Negotiated Rate |
$574.18 |
| Rate for Payer: Aetna Commercial |
$533.43
|
| Rate for Payer: Cash Price |
$382.79
|
| Rate for Payer: Cigna All Commercial |
$532.82
|
| Rate for Payer: CORVEL All Commercial |
$574.18
|
| Rate for Payer: Coventry All Commercial |
$543.31
|
| Rate for Payer: Encore All Commercial |
$568.32
|
| Rate for Payer: Frontpath All Commercial |
$568.01
|
| Rate for Payer: Humana ChoiceCare |
$533.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.66
|
| Rate for Payer: PHCS All Commercial |
$463.05
|
| Rate for Payer: PHP All Commercial |
$468.24
|
| Rate for Payer: Sagamore Health Network All Products |
$476.63
|
| Rate for Payer: Signature Care EPO |
$512.44
|
| Rate for Payer: Signature Care PPO |
$543.31
|
| Rate for Payer: United Healthcare Commercial |
$486.51
|
|
|
HC SCLERODERMA AB
|
Facility
OP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$131.32
|
| Rate for Payer: Aetna Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.48
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Centivo All Commercial |
$79.35
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Humana Medicare |
$79.35
|
| Rate for Payer: Lucent All Commercial |
$79.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.68
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.25
|
| Rate for Payer: United Healthcare Commercial |
$122.61
|
| Rate for Payer: United Healthcare Medicare |
$51.34
|
|
|
HC SCLERODERMA AB
|
Facility
IP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$134.43
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: United Healthcare Commercial |
$122.61
|
|
|
HC SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL
|
Facility
IP
|
$83.25
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
01617063
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$71.93
|
| Rate for Payer: Cash Price |
$51.62
|
| Rate for Payer: Cigna All Commercial |
$71.85
|
| Rate for Payer: CORVEL All Commercial |
$77.42
|
| Rate for Payer: Coventry All Commercial |
$73.26
|
| Rate for Payer: Encore All Commercial |
$76.63
|
| Rate for Payer: Frontpath All Commercial |
$76.59
|
| Rate for Payer: Humana ChoiceCare |
$71.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.93
|
| Rate for Payer: PHCS All Commercial |
$62.44
|
| Rate for Payer: PHP All Commercial |
$63.14
|
| Rate for Payer: Sagamore Health Network All Products |
$64.27
|
| Rate for Payer: Signature Care EPO |
$69.10
|
| Rate for Payer: Signature Care PPO |
$73.26
|
| Rate for Payer: United Healthcare Commercial |
$65.60
|
|
|
HC SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL
|
Facility
OP
|
$83.25
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
01617063
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$27.47 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$70.27
|
| Rate for Payer: Aetna Medicare |
$27.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$72.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.22
|
| Rate for Payer: Cash Price |
$51.62
|
| Rate for Payer: Cash Price |
$51.62
|
| Rate for Payer: Centivo All Commercial |
$42.46
|
| Rate for Payer: Cigna All Commercial |
$71.85
|
| Rate for Payer: CORVEL All Commercial |
$77.42
|
| Rate for Payer: Coventry All Commercial |
$73.26
|
| Rate for Payer: Encore All Commercial |
$76.63
|
| Rate for Payer: Frontpath All Commercial |
$76.59
|
| Rate for Payer: Humana ChoiceCare |
$71.91
|
| Rate for Payer: Humana Medicare |
$42.46
|
| Rate for Payer: Lucent All Commercial |
$42.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.93
|
| Rate for Payer: Managed Health Services Medicaid |
$72.27
|
| Rate for Payer: MDWise Medicaid |
$72.27
|
| Rate for Payer: PHCS All Commercial |
$62.44
|
| Rate for Payer: PHP All Commercial |
$63.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.47
|
| Rate for Payer: Sagamore Health Network All Products |
$64.27
|
| Rate for Payer: Signature Care EPO |
$69.10
|
| Rate for Payer: Signature Care PPO |
$73.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$65.60
|
| Rate for Payer: United Healthcare Medicare |
$27.47
|
|
|
HC SCREENING DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL
|
Facility
IP
|
$55.90
|
|
|
Service Code
|
CPT 77063 52
|
| Hospital Charge Code |
01617064
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$51.98 |
| Rate for Payer: Aetna Commercial |
$48.29
|
| Rate for Payer: Cash Price |
$34.66
|
| Rate for Payer: Cigna All Commercial |
$48.24
|
| Rate for Payer: CORVEL All Commercial |
$51.98
|
| Rate for Payer: Coventry All Commercial |
$49.19
|
| Rate for Payer: Encore All Commercial |
$51.45
|
| Rate for Payer: Frontpath All Commercial |
$51.42
|
| Rate for Payer: Humana ChoiceCare |
$48.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.31
|
| Rate for Payer: PHCS All Commercial |
$41.92
|
| Rate for Payer: PHP All Commercial |
$42.39
|
| Rate for Payer: Sagamore Health Network All Products |
$43.15
|
| Rate for Payer: Signature Care EPO |
$46.39
|
| Rate for Payer: Signature Care PPO |
$49.19
|
| Rate for Payer: United Healthcare Commercial |
$44.05
|
|
|
HC SCREENING DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL
|
Facility
OP
|
$55.90
|
|
|
Service Code
|
CPT 77063 52
|
| Hospital Charge Code |
01617064
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$51.98 |
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Aetna Medicare |
$18.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.29
|
| Rate for Payer: Cash Price |
$34.66
|
| Rate for Payer: Centivo All Commercial |
$28.51
|
| Rate for Payer: Cigna All Commercial |
$48.24
|
| Rate for Payer: CORVEL All Commercial |
$51.98
|
| Rate for Payer: Coventry All Commercial |
$49.19
|
| Rate for Payer: Encore All Commercial |
$51.45
|
| Rate for Payer: Frontpath All Commercial |
$51.42
|
| Rate for Payer: Humana ChoiceCare |
$48.28
|
| Rate for Payer: Humana Medicare |
$28.51
|
| Rate for Payer: Lucent All Commercial |
$28.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.31
|
| Rate for Payer: PHCS All Commercial |
$41.92
|
| Rate for Payer: PHP All Commercial |
$42.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.80
|
| Rate for Payer: Sagamore Health Network All Products |
$43.15
|
| Rate for Payer: Signature Care EPO |
$46.39
|
| Rate for Payer: Signature Care PPO |
$49.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.51
|
| Rate for Payer: United Healthcare Commercial |
$44.05
|
| Rate for Payer: United Healthcare Medicare |
$18.45
|
|
|
HC SCREW CORTEX 2.7 X 20 ST PL
|
Facility
IP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
|
|
HC SCREW CORTEX 2.7 X 20 ST PL
|
Facility
OP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Aetna Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.49
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Centivo All Commercial |
$55.48
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Lucent All Commercial |
$55.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.42
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.46
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
| Rate for Payer: United Healthcare Medicare |
$35.90
|
|
|
HC SCREW CORTEX 2.7 X 22 ST PL
|
Facility
IP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
|
|
HC SCREW CORTEX 2.7 X 22 ST PL
|
Facility
OP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Aetna Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.49
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Centivo All Commercial |
$55.48
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Lucent All Commercial |
$55.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.42
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.46
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
| Rate for Payer: United Healthcare Medicare |
$35.90
|
|
