|
HC STONE BASKET NITINOL 2.8-5
|
Facility
IP
|
$1,054.85
|
|
| Hospital Charge Code |
41601364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$791.14 |
| Max. Negotiated Rate |
$981.01 |
| Rate for Payer: Aetna Commercial |
$911.39
|
| Rate for Payer: Cash Price |
$654.01
|
| Rate for Payer: Cigna All Commercial |
$910.34
|
| Rate for Payer: CORVEL All Commercial |
$981.01
|
| Rate for Payer: Coventry All Commercial |
$928.27
|
| Rate for Payer: Encore All Commercial |
$970.99
|
| Rate for Payer: Frontpath All Commercial |
$970.46
|
| Rate for Payer: Humana ChoiceCare |
$911.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$949.36
|
| Rate for Payer: PHCS All Commercial |
$791.14
|
| Rate for Payer: PHP All Commercial |
$800.00
|
| Rate for Payer: Sagamore Health Network All Products |
$814.34
|
| Rate for Payer: Signature Care EPO |
$875.53
|
| Rate for Payer: Signature Care PPO |
$928.27
|
| Rate for Payer: United Healthcare Commercial |
$831.22
|
|
|
HC STONE BASKET NITINOL 3.0
|
Facility
OP
|
$1,033.15
|
|
| Hospital Charge Code |
41602284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$960.83 |
| Rate for Payer: Aetna Commercial |
$871.98
|
| Rate for Payer: Aetna Medicare |
$340.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$340.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$593.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$645.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$392.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$375.03
|
| Rate for Payer: Cash Price |
$640.55
|
| Rate for Payer: Cash Price |
$640.55
|
| Rate for Payer: Centivo All Commercial |
$526.91
|
| Rate for Payer: Cigna All Commercial |
$891.61
|
| Rate for Payer: CORVEL All Commercial |
$960.83
|
| Rate for Payer: Coventry All Commercial |
$909.17
|
| Rate for Payer: Encore All Commercial |
$951.01
|
| Rate for Payer: Frontpath All Commercial |
$950.50
|
| Rate for Payer: Humana ChoiceCare |
$892.33
|
| Rate for Payer: Humana Medicare |
$526.91
|
| Rate for Payer: Lucent All Commercial |
$526.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$929.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$774.86
|
| Rate for Payer: PHP All Commercial |
$783.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$402.93
|
| Rate for Payer: Sagamore Health Network All Products |
$797.59
|
| Rate for Payer: Signature Care EPO |
$857.51
|
| Rate for Payer: Signature Care PPO |
$909.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$878.18
|
| Rate for Payer: United Healthcare Commercial |
$814.12
|
| Rate for Payer: United Healthcare Medicare |
$340.94
|
|
|
HC STONE BASKET NITINOL 3.0
|
Facility
IP
|
$1,033.15
|
|
| Hospital Charge Code |
41602284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.86 |
| Max. Negotiated Rate |
$960.83 |
| Rate for Payer: Aetna Commercial |
$892.64
|
| Rate for Payer: Cash Price |
$640.55
|
| Rate for Payer: Cigna All Commercial |
$891.61
|
| Rate for Payer: CORVEL All Commercial |
$960.83
|
| Rate for Payer: Coventry All Commercial |
$909.17
|
| Rate for Payer: Encore All Commercial |
$951.01
|
| Rate for Payer: Frontpath All Commercial |
$950.50
|
| Rate for Payer: Humana ChoiceCare |
$892.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$929.84
|
| Rate for Payer: PHCS All Commercial |
$774.86
|
| Rate for Payer: PHP All Commercial |
$783.54
|
| Rate for Payer: Sagamore Health Network All Products |
$797.59
|
| Rate for Payer: Signature Care EPO |
$857.51
|
| Rate for Payer: Signature Care PPO |
$909.17
|
| Rate for Payer: United Healthcare Commercial |
$814.12
|
|
|
HC STONE EXTRACTOR ATLAS 3.2 FR
|
Facility
OP
|
$957.85
|
|
| Hospital Charge Code |
41602285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$890.80 |
| Rate for Payer: Aetna Commercial |
$808.43
|
| Rate for Payer: Aetna Medicare |
$316.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$316.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$550.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$598.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$363.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$347.70
|
| Rate for Payer: Cash Price |
$593.87
|
| Rate for Payer: Cash Price |
$593.87
|
| Rate for Payer: Centivo All Commercial |
$488.50
|
| Rate for Payer: Cigna All Commercial |
$826.62
|
| Rate for Payer: CORVEL All Commercial |
$890.80
|
| Rate for Payer: Coventry All Commercial |
$842.91
|
| Rate for Payer: Encore All Commercial |
$881.70
|
| Rate for Payer: Frontpath All Commercial |
$881.22
|
| Rate for Payer: Humana ChoiceCare |
$827.30
|
| Rate for Payer: Humana Medicare |
$488.50
|
| Rate for Payer: Lucent All Commercial |
$488.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$862.06
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$718.39
|
| Rate for Payer: PHP All Commercial |
$726.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$373.56
|
| Rate for Payer: Sagamore Health Network All Products |
$739.46
|
| Rate for Payer: Signature Care EPO |
$795.02
|
| Rate for Payer: Signature Care PPO |
$842.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$814.17
|
| Rate for Payer: United Healthcare Commercial |
$754.79
|
| Rate for Payer: United Healthcare Medicare |
$316.09
|
|
|
HC STONE EXTRACTOR ATLAS 3.2 FR
|
Facility
IP
|
$957.85
|
|
| Hospital Charge Code |
41602285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.39 |
| Max. Negotiated Rate |
$890.80 |
| Rate for Payer: Aetna Commercial |
$827.58
|
| Rate for Payer: Cash Price |
$593.87
|
| Rate for Payer: Cigna All Commercial |
$826.62
|
| Rate for Payer: CORVEL All Commercial |
$890.80
|
| Rate for Payer: Coventry All Commercial |
$842.91
|
| Rate for Payer: Encore All Commercial |
$881.70
|
| Rate for Payer: Frontpath All Commercial |
$881.22
|
| Rate for Payer: Humana ChoiceCare |
$827.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$862.06
|
| Rate for Payer: PHCS All Commercial |
$718.39
|
| Rate for Payer: PHP All Commercial |
$726.43
|
| Rate for Payer: Sagamore Health Network All Products |
$739.46
|
| Rate for Payer: Signature Care EPO |
$795.02
|
| Rate for Payer: Signature Care PPO |
$842.91
|
| Rate for Payer: United Healthcare Commercial |
$754.79
|
|
|
HC STONE RETREIVER GEMINI
|
Facility
IP
|
$1,390.00
|
|
| Hospital Charge Code |
41602286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,042.50 |
| Max. Negotiated Rate |
$1,292.70 |
| Rate for Payer: Aetna Commercial |
$1,200.96
|
| Rate for Payer: Cash Price |
$861.80
|
| Rate for Payer: Cigna All Commercial |
$1,199.57
|
| Rate for Payer: CORVEL All Commercial |
$1,292.70
|
| Rate for Payer: Coventry All Commercial |
$1,223.20
|
| Rate for Payer: Encore All Commercial |
$1,279.50
|
| Rate for Payer: Frontpath All Commercial |
$1,278.80
|
| Rate for Payer: Humana ChoiceCare |
$1,200.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,251.00
|
| Rate for Payer: PHCS All Commercial |
$1,042.50
|
| Rate for Payer: PHP All Commercial |
$1,054.18
|
| Rate for Payer: Sagamore Health Network All Products |
$1,073.08
|
| Rate for Payer: Signature Care EPO |
$1,153.70
|
| Rate for Payer: Signature Care PPO |
$1,223.20
|
| Rate for Payer: United Healthcare Commercial |
$1,095.32
|
|
|
HC STONE RETREIVER GEMINI
|
Facility
OP
|
$1,390.00
|
|
| Hospital Charge Code |
41602286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,292.70 |
| Rate for Payer: Aetna Commercial |
$1,173.16
|
| Rate for Payer: Aetna Medicare |
$458.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$458.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$798.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$868.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$527.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$504.57
|
| Rate for Payer: Cash Price |
$861.80
|
| Rate for Payer: Cash Price |
$861.80
|
| Rate for Payer: Centivo All Commercial |
$708.90
|
| Rate for Payer: Cigna All Commercial |
$1,199.57
|
| Rate for Payer: CORVEL All Commercial |
$1,292.70
|
| Rate for Payer: Coventry All Commercial |
$1,223.20
|
| Rate for Payer: Encore All Commercial |
$1,279.50
|
| Rate for Payer: Frontpath All Commercial |
$1,278.80
|
| Rate for Payer: Humana ChoiceCare |
$1,200.54
|
| Rate for Payer: Humana Medicare |
$708.90
|
| Rate for Payer: Lucent All Commercial |
$708.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,251.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,042.50
|
| Rate for Payer: PHP All Commercial |
$1,054.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$542.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,073.08
|
| Rate for Payer: Signature Care EPO |
$1,153.70
|
| Rate for Payer: Signature Care PPO |
$1,223.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,181.50
|
| Rate for Payer: United Healthcare Commercial |
$1,095.32
|
| Rate for Payer: United Healthcare Medicare |
$458.70
|
|
|
HC STOOL CULTURE
|
Facility
IP
|
$139.06
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
63001061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.29 |
| Max. Negotiated Rate |
$129.32 |
| Rate for Payer: Aetna Commercial |
$120.14
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cigna All Commercial |
$120.01
|
| Rate for Payer: CORVEL All Commercial |
$129.32
|
| Rate for Payer: Coventry All Commercial |
$122.37
|
| Rate for Payer: Encore All Commercial |
$128.00
|
| Rate for Payer: Frontpath All Commercial |
$127.93
|
| Rate for Payer: Humana ChoiceCare |
$120.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.15
|
| Rate for Payer: PHCS All Commercial |
$104.29
|
| Rate for Payer: PHP All Commercial |
$105.46
|
| Rate for Payer: Sagamore Health Network All Products |
$107.35
|
| Rate for Payer: Signature Care EPO |
$115.42
|
| Rate for Payer: Signature Care PPO |
$122.37
|
| Rate for Payer: United Healthcare Commercial |
$109.58
|
|
|
HC STOOL CULTURE
|
Facility
OP
|
$139.06
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
63001061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$129.32 |
| Rate for Payer: Aetna Commercial |
$117.36
|
| Rate for Payer: Aetna Medicare |
$45.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.48
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Centivo All Commercial |
$70.92
|
| Rate for Payer: Cigna All Commercial |
$120.01
|
| Rate for Payer: CORVEL All Commercial |
$129.32
|
| Rate for Payer: Coventry All Commercial |
$122.37
|
| Rate for Payer: Encore All Commercial |
$128.00
|
| Rate for Payer: Frontpath All Commercial |
$127.93
|
| Rate for Payer: Humana ChoiceCare |
$120.10
|
| Rate for Payer: Humana Medicare |
$70.92
|
| Rate for Payer: Lucent All Commercial |
$70.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.15
|
| Rate for Payer: Managed Health Services Medicaid |
$9.44
|
| Rate for Payer: MDWise Medicaid |
$9.44
|
| Rate for Payer: PHCS All Commercial |
$104.29
|
| Rate for Payer: PHP All Commercial |
$105.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.23
|
| Rate for Payer: Sagamore Health Network All Products |
$107.35
|
| Rate for Payer: Signature Care EPO |
$115.42
|
| Rate for Payer: Signature Care PPO |
$122.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.20
|
| Rate for Payer: United Healthcare Commercial |
$109.58
|
| Rate for Payer: United Healthcare Medicare |
$45.89
|
|
|
HC STOOL MULTIPLE PATH
|
Facility
IP
|
$40.96
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
63001987
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$38.10 |
| Rate for Payer: Aetna Commercial |
$35.39
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cigna All Commercial |
$35.35
|
| Rate for Payer: CORVEL All Commercial |
$38.10
|
| Rate for Payer: Coventry All Commercial |
$36.05
|
| Rate for Payer: Encore All Commercial |
$37.71
|
| Rate for Payer: Frontpath All Commercial |
$37.69
|
| Rate for Payer: Humana ChoiceCare |
$35.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.87
|
| Rate for Payer: PHCS All Commercial |
$30.72
|
| Rate for Payer: PHP All Commercial |
$31.07
|
| Rate for Payer: Sagamore Health Network All Products |
$31.62
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$36.05
|
| Rate for Payer: United Healthcare Commercial |
$32.28
|
|
|
HC STOOL MULTIPLE PATH
|
Facility
OP
|
$40.96
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
63001987
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$38.10 |
| Rate for Payer: Aetna Commercial |
$34.57
|
| Rate for Payer: Aetna Medicare |
$13.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.87
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Centivo All Commercial |
$20.89
|
| Rate for Payer: Cigna All Commercial |
$35.35
|
| Rate for Payer: CORVEL All Commercial |
$38.10
|
| Rate for Payer: Coventry All Commercial |
$36.05
|
| Rate for Payer: Encore All Commercial |
$37.71
|
| Rate for Payer: Frontpath All Commercial |
$37.69
|
| Rate for Payer: Humana ChoiceCare |
$35.38
|
| Rate for Payer: Humana Medicare |
$20.89
|
| Rate for Payer: Lucent All Commercial |
$20.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.87
|
| Rate for Payer: Managed Health Services Medicaid |
$3.22
|
| Rate for Payer: MDWise Medicaid |
$3.22
|
| Rate for Payer: PHCS All Commercial |
$30.72
|
| Rate for Payer: PHP All Commercial |
$31.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.98
|
| Rate for Payer: Sagamore Health Network All Products |
$31.62
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$36.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.82
|
| Rate for Payer: United Healthcare Commercial |
$32.28
|
| Rate for Payer: United Healthcare Medicare |
$13.52
|
|
|
HC STREP A
|
Facility
OP
|
$216.40
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
63087561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$201.25 |
| Rate for Payer: Aetna Commercial |
$182.64
|
| Rate for Payer: Aetna Medicare |
$71.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.55
|
| Rate for Payer: Cash Price |
$134.17
|
| Rate for Payer: Cash Price |
$134.17
|
| Rate for Payer: Centivo All Commercial |
$110.37
|
| Rate for Payer: Cigna All Commercial |
$186.76
|
| Rate for Payer: CORVEL All Commercial |
$201.25
|
| Rate for Payer: Coventry All Commercial |
$190.43
|
| Rate for Payer: Encore All Commercial |
$199.20
|
| Rate for Payer: Frontpath All Commercial |
$199.09
|
| Rate for Payer: Humana ChoiceCare |
$186.91
|
| Rate for Payer: Humana Medicare |
$110.37
|
| Rate for Payer: Lucent All Commercial |
$110.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.76
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$162.30
|
| Rate for Payer: PHP All Commercial |
$164.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.40
|
| Rate for Payer: Sagamore Health Network All Products |
$167.06
|
| Rate for Payer: Signature Care EPO |
$179.61
|
| Rate for Payer: Signature Care PPO |
$190.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$183.94
|
| Rate for Payer: United Healthcare Commercial |
$170.53
|
| Rate for Payer: United Healthcare Medicare |
$71.41
|
|
|
HC STREP A
|
Facility
IP
|
$216.40
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
63087561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.30 |
| Max. Negotiated Rate |
$201.25 |
| Rate for Payer: Aetna Commercial |
$186.97
|
| Rate for Payer: Cash Price |
$134.17
|
| Rate for Payer: Cigna All Commercial |
$186.76
|
| Rate for Payer: CORVEL All Commercial |
$201.25
|
| Rate for Payer: Coventry All Commercial |
$190.43
|
| Rate for Payer: Encore All Commercial |
$199.20
|
| Rate for Payer: Frontpath All Commercial |
$199.09
|
| Rate for Payer: Humana ChoiceCare |
$186.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.76
|
| Rate for Payer: PHCS All Commercial |
$162.30
|
| Rate for Payer: PHP All Commercial |
$164.12
|
| Rate for Payer: Sagamore Health Network All Products |
$167.06
|
| Rate for Payer: Signature Care EPO |
$179.61
|
| Rate for Payer: Signature Care PPO |
$190.43
|
| Rate for Payer: United Healthcare Commercial |
$170.53
|
|
|
HC STREP A ANTIGEN SCREEN
|
Facility
OP
|
$90.17
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
63001282
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$83.86 |
| Rate for Payer: Aetna Commercial |
$76.10
|
| Rate for Payer: Aetna Medicare |
$29.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.73
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Centivo All Commercial |
$45.99
|
| Rate for Payer: Cigna All Commercial |
$77.81
|
| Rate for Payer: CORVEL All Commercial |
$83.86
|
| Rate for Payer: Coventry All Commercial |
$79.35
|
| Rate for Payer: Encore All Commercial |
$83.00
|
| Rate for Payer: Frontpath All Commercial |
$82.95
|
| Rate for Payer: Humana ChoiceCare |
$77.88
|
| Rate for Payer: Humana Medicare |
$45.99
|
| Rate for Payer: Lucent All Commercial |
$45.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.15
|
| Rate for Payer: Managed Health Services Medicaid |
$16.32
|
| Rate for Payer: MDWise Medicaid |
$16.32
|
| Rate for Payer: PHCS All Commercial |
$67.63
|
| Rate for Payer: PHP All Commercial |
$68.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.17
|
| Rate for Payer: Sagamore Health Network All Products |
$69.61
|
| Rate for Payer: Signature Care EPO |
$74.84
|
| Rate for Payer: Signature Care PPO |
$79.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.64
|
| Rate for Payer: United Healthcare Commercial |
$71.05
|
| Rate for Payer: United Healthcare Medicare |
$29.76
|
|
|
HC STREP A ANTIGEN SCREEN
|
Facility
IP
|
$90.17
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
63001282
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.63 |
| Max. Negotiated Rate |
$83.86 |
| Rate for Payer: Aetna Commercial |
$77.91
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cigna All Commercial |
$77.81
|
| Rate for Payer: CORVEL All Commercial |
$83.86
|
| Rate for Payer: Coventry All Commercial |
$79.35
|
| Rate for Payer: Encore All Commercial |
$83.00
|
| Rate for Payer: Frontpath All Commercial |
$82.95
|
| Rate for Payer: Humana ChoiceCare |
$77.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.15
|
| Rate for Payer: PHCS All Commercial |
$67.63
|
| Rate for Payer: PHP All Commercial |
$68.38
|
| Rate for Payer: Sagamore Health Network All Products |
$69.61
|
| Rate for Payer: Signature Care EPO |
$74.84
|
| Rate for Payer: Signature Care PPO |
$79.35
|
| Rate for Payer: United Healthcare Commercial |
$71.05
|
|
|
HC STREP A SCREEN CONFIRMATION
|
Facility
OP
|
$144.62
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
63002050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$134.49 |
| Rate for Payer: Aetna Commercial |
$122.06
|
| Rate for Payer: Aetna Medicare |
$47.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.50
|
| Rate for Payer: Cash Price |
$89.66
|
| Rate for Payer: Cash Price |
$89.66
|
| Rate for Payer: Centivo All Commercial |
$73.75
|
| Rate for Payer: Cigna All Commercial |
$124.80
|
| Rate for Payer: CORVEL All Commercial |
$134.49
|
| Rate for Payer: Coventry All Commercial |
$127.26
|
| Rate for Payer: Encore All Commercial |
$133.12
|
| Rate for Payer: Frontpath All Commercial |
$133.05
|
| Rate for Payer: Humana ChoiceCare |
$124.90
|
| Rate for Payer: Humana Medicare |
$73.75
|
| Rate for Payer: Lucent All Commercial |
$73.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.15
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$108.46
|
| Rate for Payer: PHP All Commercial |
$109.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.40
|
| Rate for Payer: Sagamore Health Network All Products |
$111.64
|
| Rate for Payer: Signature Care EPO |
$120.03
|
| Rate for Payer: Signature Care PPO |
$127.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.92
|
| Rate for Payer: United Healthcare Commercial |
$113.96
|
| Rate for Payer: United Healthcare Medicare |
$47.72
|
|
|
HC STREP A SCREEN CONFIRMATION
|
Facility
IP
|
$144.62
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
63002050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.46 |
| Max. Negotiated Rate |
$134.49 |
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Cash Price |
$89.66
|
| Rate for Payer: Cigna All Commercial |
$124.80
|
| Rate for Payer: CORVEL All Commercial |
$134.49
|
| Rate for Payer: Coventry All Commercial |
$127.26
|
| Rate for Payer: Encore All Commercial |
$133.12
|
| Rate for Payer: Frontpath All Commercial |
$133.05
|
| Rate for Payer: Humana ChoiceCare |
$124.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.15
|
| Rate for Payer: PHCS All Commercial |
$108.46
|
| Rate for Payer: PHP All Commercial |
$109.68
|
| Rate for Payer: Sagamore Health Network All Products |
$111.64
|
| Rate for Payer: Signature Care EPO |
$120.03
|
| Rate for Payer: Signature Care PPO |
$127.26
|
| Rate for Payer: United Healthcare Commercial |
$113.96
|
|
|
HC STREP GROUPING-EA
|
Facility
OP
|
$71.99
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
63002011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna Commercial |
$60.76
|
| Rate for Payer: Aetna Medicare |
$23.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.13
|
| Rate for Payer: Cash Price |
$44.64
|
| Rate for Payer: Cash Price |
$44.64
|
| Rate for Payer: Centivo All Commercial |
$36.72
|
| Rate for Payer: Cigna All Commercial |
$62.13
|
| Rate for Payer: CORVEL All Commercial |
$66.95
|
| Rate for Payer: Coventry All Commercial |
$63.35
|
| Rate for Payer: Encore All Commercial |
$66.27
|
| Rate for Payer: Frontpath All Commercial |
$66.23
|
| Rate for Payer: Humana ChoiceCare |
$62.18
|
| Rate for Payer: Humana Medicare |
$36.72
|
| Rate for Payer: Lucent All Commercial |
$36.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.79
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$53.99
|
| Rate for Payer: PHP All Commercial |
$54.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.08
|
| Rate for Payer: Sagamore Health Network All Products |
$55.58
|
| Rate for Payer: Signature Care EPO |
$59.75
|
| Rate for Payer: Signature Care PPO |
$63.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.19
|
| Rate for Payer: United Healthcare Commercial |
$56.73
|
| Rate for Payer: United Healthcare Medicare |
$23.76
|
|
|
HC STREP GROUPING-EA
|
Facility
IP
|
$71.99
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
63002011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.99 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna Commercial |
$62.20
|
| Rate for Payer: Cash Price |
$44.64
|
| Rate for Payer: Cigna All Commercial |
$62.13
|
| Rate for Payer: CORVEL All Commercial |
$66.95
|
| Rate for Payer: Coventry All Commercial |
$63.35
|
| Rate for Payer: Encore All Commercial |
$66.27
|
| Rate for Payer: Frontpath All Commercial |
$66.23
|
| Rate for Payer: Humana ChoiceCare |
$62.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.79
|
| Rate for Payer: PHCS All Commercial |
$53.99
|
| Rate for Payer: PHP All Commercial |
$54.60
|
| Rate for Payer: Sagamore Health Network All Products |
$55.58
|
| Rate for Payer: Signature Care EPO |
$59.75
|
| Rate for Payer: Signature Care PPO |
$63.35
|
| Rate for Payer: United Healthcare Commercial |
$56.73
|
|
|
HC STREP PNEUMO IGG-SEROTYP
|
Facility
OP
|
$55.44
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63001899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$51.56 |
| Rate for Payer: Aetna Commercial |
$46.79
|
| Rate for Payer: Aetna Medicare |
$18.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.12
|
| Rate for Payer: Cash Price |
$34.37
|
| Rate for Payer: Cash Price |
$34.37
|
| Rate for Payer: Centivo All Commercial |
$28.27
|
| Rate for Payer: Cigna All Commercial |
$47.84
|
| Rate for Payer: CORVEL All Commercial |
$51.56
|
| Rate for Payer: Coventry All Commercial |
$48.78
|
| Rate for Payer: Encore All Commercial |
$51.03
|
| Rate for Payer: Frontpath All Commercial |
$51.00
|
| Rate for Payer: Humana ChoiceCare |
$47.88
|
| Rate for Payer: Humana Medicare |
$28.27
|
| Rate for Payer: Lucent All Commercial |
$28.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.89
|
| Rate for Payer: Managed Health Services Medicaid |
$14.99
|
| Rate for Payer: MDWise Medicaid |
$14.99
|
| Rate for Payer: PHCS All Commercial |
$41.58
|
| Rate for Payer: PHP All Commercial |
$42.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.62
|
| Rate for Payer: Sagamore Health Network All Products |
$42.80
|
| Rate for Payer: Signature Care EPO |
$46.01
|
| Rate for Payer: Signature Care PPO |
$48.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$43.68
|
| Rate for Payer: United Healthcare Medicare |
$18.29
|
|
|
HC STREP PNEUMO IGG-SEROTYP
|
Facility
IP
|
$55.44
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63001899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$51.56 |
| Rate for Payer: Aetna Commercial |
$47.90
|
| Rate for Payer: Cash Price |
$34.37
|
| Rate for Payer: Cigna All Commercial |
$47.84
|
| Rate for Payer: CORVEL All Commercial |
$51.56
|
| Rate for Payer: Coventry All Commercial |
$48.78
|
| Rate for Payer: Encore All Commercial |
$51.03
|
| Rate for Payer: Frontpath All Commercial |
$51.00
|
| Rate for Payer: Humana ChoiceCare |
$47.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.89
|
| Rate for Payer: PHCS All Commercial |
$41.58
|
| Rate for Payer: PHP All Commercial |
$42.04
|
| Rate for Payer: Sagamore Health Network All Products |
$42.80
|
| Rate for Payer: Signature Care EPO |
$46.01
|
| Rate for Payer: Signature Care PPO |
$48.78
|
| Rate for Payer: United Healthcare Commercial |
$43.68
|
|
|
HC STREP PYOGENES
|
Facility
OP
|
$110.68
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
63001914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$102.93 |
| Rate for Payer: Aetna Commercial |
$93.41
|
| Rate for Payer: Aetna Medicare |
$36.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.18
|
| Rate for Payer: Cash Price |
$68.62
|
| Rate for Payer: Cash Price |
$68.62
|
| Rate for Payer: Centivo All Commercial |
$56.45
|
| Rate for Payer: Cigna All Commercial |
$95.52
|
| Rate for Payer: CORVEL All Commercial |
$102.93
|
| Rate for Payer: Coventry All Commercial |
$97.40
|
| Rate for Payer: Encore All Commercial |
$101.88
|
| Rate for Payer: Frontpath All Commercial |
$101.83
|
| Rate for Payer: Humana ChoiceCare |
$95.59
|
| Rate for Payer: Humana Medicare |
$56.45
|
| Rate for Payer: Lucent All Commercial |
$56.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.61
|
| Rate for Payer: Managed Health Services Medicaid |
$11.54
|
| Rate for Payer: MDWise Medicaid |
$11.54
|
| Rate for Payer: PHCS All Commercial |
$83.01
|
| Rate for Payer: PHP All Commercial |
$83.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.17
|
| Rate for Payer: Sagamore Health Network All Products |
$85.45
|
| Rate for Payer: Signature Care EPO |
$91.86
|
| Rate for Payer: Signature Care PPO |
$97.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.08
|
| Rate for Payer: United Healthcare Commercial |
$87.22
|
| Rate for Payer: United Healthcare Medicare |
$36.52
|
|
|
HC STREP PYOGENES
|
Facility
IP
|
$110.68
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
63001914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.01 |
| Max. Negotiated Rate |
$102.93 |
| Rate for Payer: Aetna Commercial |
$95.63
|
| Rate for Payer: Cash Price |
$68.62
|
| Rate for Payer: Cigna All Commercial |
$95.52
|
| Rate for Payer: CORVEL All Commercial |
$102.93
|
| Rate for Payer: Coventry All Commercial |
$97.40
|
| Rate for Payer: Encore All Commercial |
$101.88
|
| Rate for Payer: Frontpath All Commercial |
$101.83
|
| Rate for Payer: Humana ChoiceCare |
$95.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.61
|
| Rate for Payer: PHCS All Commercial |
$83.01
|
| Rate for Payer: PHP All Commercial |
$83.94
|
| Rate for Payer: Sagamore Health Network All Products |
$85.45
|
| Rate for Payer: Signature Care EPO |
$91.86
|
| Rate for Payer: Signature Care PPO |
$97.40
|
| Rate for Payer: United Healthcare Commercial |
$87.22
|
|
|
HC STRESS 2D&M-MODE W/EKG
|
Facility
IP
|
$2,528.07
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
00869351
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,896.05 |
| Max. Negotiated Rate |
$2,351.11 |
| Rate for Payer: Aetna Commercial |
$2,184.25
|
| Rate for Payer: Cash Price |
$1,567.40
|
| Rate for Payer: Cigna All Commercial |
$2,181.72
|
| Rate for Payer: CORVEL All Commercial |
$2,351.11
|
| Rate for Payer: Coventry All Commercial |
$2,224.70
|
| Rate for Payer: Encore All Commercial |
$2,327.09
|
| Rate for Payer: Frontpath All Commercial |
$2,325.82
|
| Rate for Payer: Humana ChoiceCare |
$2,183.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,275.26
|
| Rate for Payer: PHCS All Commercial |
$1,896.05
|
| Rate for Payer: PHP All Commercial |
$1,917.29
|
| Rate for Payer: Sagamore Health Network All Products |
$1,951.67
|
| Rate for Payer: Signature Care EPO |
$2,098.30
|
| Rate for Payer: Signature Care PPO |
$2,224.70
|
| Rate for Payer: United Healthcare Commercial |
$1,992.12
|
|
|
HC STRESS 2D&M-MODE W/EKG
|
Facility
OP
|
$2,528.07
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
00869351
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$788.70 |
| Max. Negotiated Rate |
$2,351.11 |
| Rate for Payer: Aetna Commercial |
$2,133.69
|
| Rate for Payer: Aetna Medicare |
$834.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$834.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,451.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,580.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$959.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$917.69
|
| Rate for Payer: Cash Price |
$1,567.40
|
| Rate for Payer: Cash Price |
$1,567.40
|
| Rate for Payer: Centivo All Commercial |
$1,289.32
|
| Rate for Payer: Cigna All Commercial |
$2,181.72
|
| Rate for Payer: CORVEL All Commercial |
$2,351.11
|
| Rate for Payer: Coventry All Commercial |
$2,224.70
|
| Rate for Payer: Encore All Commercial |
$2,327.09
|
| Rate for Payer: Frontpath All Commercial |
$2,325.82
|
| Rate for Payer: Humana ChoiceCare |
$2,183.49
|
| Rate for Payer: Humana Medicare |
$1,289.32
|
| Rate for Payer: Lucent All Commercial |
$1,289.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,275.26
|
| Rate for Payer: Managed Health Services Medicaid |
$788.70
|
| Rate for Payer: MDWise Medicaid |
$788.70
|
| Rate for Payer: PHCS All Commercial |
$1,896.05
|
| Rate for Payer: PHP All Commercial |
$1,917.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$985.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,951.67
|
| Rate for Payer: Signature Care EPO |
$2,098.30
|
| Rate for Payer: Signature Care PPO |
$2,224.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,148.86
|
| Rate for Payer: United Healthcare Commercial |
$1,992.12
|
| Rate for Payer: United Healthcare Medicare |
$834.26
|
|
