|
HC TOXOPLASMOSIS IGG
|
Facility
|
OP
|
$118.83
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
63001203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$100.29
|
| Rate for Payer: Aetna Medicare |
$39.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.14
|
| Rate for Payer: Cash Price |
$73.68
|
| Rate for Payer: Cash Price |
$73.68
|
| Rate for Payer: Centivo All Commercial |
$60.60
|
| Rate for Payer: Cigna All Commercial |
$102.55
|
| Rate for Payer: CORVEL All Commercial |
$110.51
|
| Rate for Payer: Coventry All Commercial |
$104.57
|
| Rate for Payer: Encore All Commercial |
$109.38
|
| Rate for Payer: Frontpath All Commercial |
$109.32
|
| Rate for Payer: Humana ChoiceCare |
$102.63
|
| Rate for Payer: Humana Medicare |
$60.60
|
| Rate for Payer: Lucent All Commercial |
$60.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.95
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$89.12
|
| Rate for Payer: PHP All Commercial |
$90.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.34
|
| Rate for Payer: Sagamore Health Network All Products |
$91.74
|
| Rate for Payer: Signature Care EPO |
$98.63
|
| Rate for Payer: Signature Care PPO |
$104.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.01
|
| Rate for Payer: United Healthcare Commercial |
$93.64
|
| Rate for Payer: United Healthcare Medicare |
$39.21
|
|
|
HC TOXOPLASMOSIS IGM
|
Facility
|
OP
|
$198.75
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
63001280
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$184.83 |
| Rate for Payer: Aetna Commercial |
$167.74
|
| Rate for Payer: Aetna Medicare |
$65.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$114.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.15
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Centivo All Commercial |
$101.36
|
| Rate for Payer: Cigna All Commercial |
$171.52
|
| Rate for Payer: CORVEL All Commercial |
$184.83
|
| Rate for Payer: Coventry All Commercial |
$174.90
|
| Rate for Payer: Encore All Commercial |
$182.95
|
| Rate for Payer: Frontpath All Commercial |
$182.85
|
| Rate for Payer: Humana ChoiceCare |
$171.66
|
| Rate for Payer: Humana Medicare |
$101.36
|
| Rate for Payer: Lucent All Commercial |
$101.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.87
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$149.06
|
| Rate for Payer: PHP All Commercial |
$150.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.51
|
| Rate for Payer: Sagamore Health Network All Products |
$153.43
|
| Rate for Payer: Signature Care EPO |
$164.96
|
| Rate for Payer: Signature Care PPO |
$174.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$168.93
|
| Rate for Payer: United Healthcare Commercial |
$156.61
|
| Rate for Payer: United Healthcare Medicare |
$65.59
|
|
|
HC TOXOPLASMOSIS IGM
|
Facility
|
IP
|
$198.75
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
63001280
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$184.83 |
| Rate for Payer: Aetna Commercial |
$171.72
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cigna All Commercial |
$171.52
|
| Rate for Payer: CORVEL All Commercial |
$184.83
|
| Rate for Payer: Coventry All Commercial |
$174.90
|
| Rate for Payer: Encore All Commercial |
$182.95
|
| Rate for Payer: Frontpath All Commercial |
$182.85
|
| Rate for Payer: Humana ChoiceCare |
$171.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.87
|
| Rate for Payer: PHCS All Commercial |
$149.06
|
| Rate for Payer: PHP All Commercial |
$150.73
|
| Rate for Payer: Sagamore Health Network All Products |
$153.43
|
| Rate for Payer: Signature Care EPO |
$164.96
|
| Rate for Payer: Signature Care PPO |
$174.90
|
| Rate for Payer: United Healthcare Commercial |
$156.61
|
|
|
HC T PALLIDUM AB,TP-PA
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
63001971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.62 |
| Max. Negotiated Rate |
$102.45 |
| Rate for Payer: Aetna Commercial |
$95.18
|
| Rate for Payer: Cash Price |
$68.30
|
| Rate for Payer: Cigna All Commercial |
$95.07
|
| Rate for Payer: CORVEL All Commercial |
$102.45
|
| Rate for Payer: Coventry All Commercial |
$96.94
|
| Rate for Payer: Encore All Commercial |
$101.40
|
| Rate for Payer: Frontpath All Commercial |
$101.35
|
| Rate for Payer: Humana ChoiceCare |
$95.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.14
|
| Rate for Payer: PHCS All Commercial |
$82.62
|
| Rate for Payer: PHP All Commercial |
$83.55
|
| Rate for Payer: Sagamore Health Network All Products |
$85.04
|
| Rate for Payer: Signature Care EPO |
$91.43
|
| Rate for Payer: Signature Care PPO |
$96.94
|
| Rate for Payer: United Healthcare Commercial |
$86.81
|
|
|
HC T PALLIDUM AB,TP-PA
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
63001971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$102.45 |
| Rate for Payer: Aetna Commercial |
$92.98
|
| Rate for Payer: Aetna Medicare |
$36.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.99
|
| Rate for Payer: Cash Price |
$68.30
|
| Rate for Payer: Cash Price |
$68.30
|
| Rate for Payer: Centivo All Commercial |
$56.18
|
| Rate for Payer: Cigna All Commercial |
$95.07
|
| Rate for Payer: CORVEL All Commercial |
$102.45
|
| Rate for Payer: Coventry All Commercial |
$96.94
|
| Rate for Payer: Encore All Commercial |
$101.40
|
| Rate for Payer: Frontpath All Commercial |
$101.35
|
| Rate for Payer: Humana ChoiceCare |
$95.15
|
| Rate for Payer: Humana Medicare |
$56.18
|
| Rate for Payer: Lucent All Commercial |
$56.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.14
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: MDWise Medicaid |
$13.24
|
| Rate for Payer: PHCS All Commercial |
$82.62
|
| Rate for Payer: PHP All Commercial |
$83.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.96
|
| Rate for Payer: Sagamore Health Network All Products |
$85.04
|
| Rate for Payer: Signature Care EPO |
$91.43
|
| Rate for Payer: Signature Care PPO |
$96.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.64
|
| Rate for Payer: United Healthcare Commercial |
$86.81
|
| Rate for Payer: United Healthcare Medicare |
$36.35
|
|
|
HC TRACH QUICK LARGE 4.0
|
Facility
|
IP
|
$800.10
|
|
| Hospital Charge Code |
41601815
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$600.08 |
| Max. Negotiated Rate |
$744.09 |
| Rate for Payer: Aetna Commercial |
$691.29
|
| Rate for Payer: Cash Price |
$496.06
|
| Rate for Payer: Cigna All Commercial |
$690.49
|
| Rate for Payer: CORVEL All Commercial |
$744.09
|
| Rate for Payer: Coventry All Commercial |
$704.09
|
| Rate for Payer: Encore All Commercial |
$736.49
|
| Rate for Payer: Frontpath All Commercial |
$736.09
|
| Rate for Payer: Humana ChoiceCare |
$691.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.09
|
| Rate for Payer: PHCS All Commercial |
$600.08
|
| Rate for Payer: PHP All Commercial |
$606.80
|
| Rate for Payer: Sagamore Health Network All Products |
$617.68
|
| Rate for Payer: Signature Care EPO |
$664.08
|
| Rate for Payer: Signature Care PPO |
$704.09
|
| Rate for Payer: United Healthcare Commercial |
$630.48
|
|
|
HC TRACH QUICK LARGE 4.0
|
Facility
|
OP
|
$800.10
|
|
| Hospital Charge Code |
41601815
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$744.09 |
| Rate for Payer: Aetna Commercial |
$675.28
|
| Rate for Payer: Aetna Medicare |
$264.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$264.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.44
|
| Rate for Payer: Cash Price |
$496.06
|
| Rate for Payer: Cash Price |
$496.06
|
| Rate for Payer: Centivo All Commercial |
$408.05
|
| Rate for Payer: Cigna All Commercial |
$690.49
|
| Rate for Payer: CORVEL All Commercial |
$744.09
|
| Rate for Payer: Coventry All Commercial |
$704.09
|
| Rate for Payer: Encore All Commercial |
$736.49
|
| Rate for Payer: Frontpath All Commercial |
$736.09
|
| Rate for Payer: Humana ChoiceCare |
$691.05
|
| Rate for Payer: Humana Medicare |
$408.05
|
| Rate for Payer: Lucent All Commercial |
$408.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.09
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$600.08
|
| Rate for Payer: PHP All Commercial |
$606.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.04
|
| Rate for Payer: Sagamore Health Network All Products |
$617.68
|
| Rate for Payer: Signature Care EPO |
$664.08
|
| Rate for Payer: Signature Care PPO |
$704.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.08
|
| Rate for Payer: United Healthcare Commercial |
$630.48
|
| Rate for Payer: United Healthcare Medicare |
$264.03
|
|
|
HC TRACH QUICK SMALL 2.0
|
Facility
|
IP
|
$872.25
|
|
| Hospital Charge Code |
41601816
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$654.19 |
| Max. Negotiated Rate |
$811.19 |
| Rate for Payer: Aetna Commercial |
$753.62
|
| Rate for Payer: Cash Price |
$540.80
|
| Rate for Payer: Cigna All Commercial |
$752.75
|
| Rate for Payer: CORVEL All Commercial |
$811.19
|
| Rate for Payer: Coventry All Commercial |
$767.58
|
| Rate for Payer: Encore All Commercial |
$802.91
|
| Rate for Payer: Frontpath All Commercial |
$802.47
|
| Rate for Payer: Humana ChoiceCare |
$753.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$785.02
|
| Rate for Payer: PHCS All Commercial |
$654.19
|
| Rate for Payer: PHP All Commercial |
$661.51
|
| Rate for Payer: Sagamore Health Network All Products |
$673.38
|
| Rate for Payer: Signature Care EPO |
$723.97
|
| Rate for Payer: Signature Care PPO |
$767.58
|
| Rate for Payer: United Healthcare Commercial |
$687.33
|
|
|
HC TRACH QUICK SMALL 2.0
|
Facility
|
OP
|
$872.25
|
|
| Hospital Charge Code |
41601816
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$811.19 |
| Rate for Payer: Aetna Commercial |
$736.18
|
| Rate for Payer: Aetna Medicare |
$287.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$287.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$500.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$545.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$331.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$316.63
|
| Rate for Payer: Cash Price |
$540.80
|
| Rate for Payer: Cash Price |
$540.80
|
| Rate for Payer: Centivo All Commercial |
$444.85
|
| Rate for Payer: Cigna All Commercial |
$752.75
|
| Rate for Payer: CORVEL All Commercial |
$811.19
|
| Rate for Payer: Coventry All Commercial |
$767.58
|
| Rate for Payer: Encore All Commercial |
$802.91
|
| Rate for Payer: Frontpath All Commercial |
$802.47
|
| Rate for Payer: Humana ChoiceCare |
$753.36
|
| Rate for Payer: Humana Medicare |
$444.85
|
| Rate for Payer: Lucent All Commercial |
$444.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$785.02
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$654.19
|
| Rate for Payer: PHP All Commercial |
$661.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$340.18
|
| Rate for Payer: Sagamore Health Network All Products |
$673.38
|
| Rate for Payer: Signature Care EPO |
$723.97
|
| Rate for Payer: Signature Care PPO |
$767.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$741.41
|
| Rate for Payer: United Healthcare Commercial |
$687.33
|
| Rate for Payer: United Healthcare Medicare |
$287.84
|
|
|
HC TRACKER ENT INSTRUMENT
|
Facility
|
OP
|
$982.80
|
|
| Hospital Charge Code |
41602441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna Commercial |
$829.48
|
| Rate for Payer: Aetna Medicare |
$324.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$324.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$564.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$614.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$372.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$356.76
|
| Rate for Payer: Cash Price |
$609.34
|
| Rate for Payer: Cash Price |
$609.34
|
| Rate for Payer: Centivo All Commercial |
$501.23
|
| Rate for Payer: Cigna All Commercial |
$848.16
|
| Rate for Payer: CORVEL All Commercial |
$914.00
|
| Rate for Payer: Coventry All Commercial |
$864.86
|
| Rate for Payer: Encore All Commercial |
$904.67
|
| Rate for Payer: Frontpath All Commercial |
$904.18
|
| Rate for Payer: Humana ChoiceCare |
$848.84
|
| Rate for Payer: Humana Medicare |
$501.23
|
| Rate for Payer: Lucent All Commercial |
$501.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$884.52
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$737.10
|
| Rate for Payer: PHP All Commercial |
$745.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$383.29
|
| Rate for Payer: Sagamore Health Network All Products |
$758.72
|
| Rate for Payer: Signature Care EPO |
$815.72
|
| Rate for Payer: Signature Care PPO |
$864.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$835.38
|
| Rate for Payer: United Healthcare Commercial |
$774.45
|
| Rate for Payer: United Healthcare Medicare |
$324.32
|
|
|
HC TRACKER ENT INSTRUMENT
|
Facility
|
IP
|
$982.80
|
|
| Hospital Charge Code |
41602441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$737.10 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna Commercial |
$849.14
|
| Rate for Payer: Cash Price |
$609.34
|
| Rate for Payer: Cigna All Commercial |
$848.16
|
| Rate for Payer: CORVEL All Commercial |
$914.00
|
| Rate for Payer: Coventry All Commercial |
$864.86
|
| Rate for Payer: Encore All Commercial |
$904.67
|
| Rate for Payer: Frontpath All Commercial |
$904.18
|
| Rate for Payer: Humana ChoiceCare |
$848.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$884.52
|
| Rate for Payer: PHCS All Commercial |
$737.10
|
| Rate for Payer: PHP All Commercial |
$745.36
|
| Rate for Payer: Sagamore Health Network All Products |
$758.72
|
| Rate for Payer: Signature Care EPO |
$815.72
|
| Rate for Payer: Signature Care PPO |
$864.86
|
| Rate for Payer: United Healthcare Commercial |
$774.45
|
|
|
HC TRACKER ENT PATIENT
|
Facility
|
IP
|
$855.00
|
|
| Hospital Charge Code |
41602442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.25 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Aetna Commercial |
$738.72
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cigna All Commercial |
$737.86
|
| Rate for Payer: CORVEL All Commercial |
$795.15
|
| Rate for Payer: Coventry All Commercial |
$752.40
|
| Rate for Payer: Encore All Commercial |
$787.03
|
| Rate for Payer: Frontpath All Commercial |
$786.60
|
| Rate for Payer: Humana ChoiceCare |
$738.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$769.50
|
| Rate for Payer: PHCS All Commercial |
$641.25
|
| Rate for Payer: PHP All Commercial |
$648.43
|
| Rate for Payer: Sagamore Health Network All Products |
$660.06
|
| Rate for Payer: Signature Care EPO |
$709.65
|
| Rate for Payer: Signature Care PPO |
$752.40
|
| Rate for Payer: United Healthcare Commercial |
$673.74
|
|
|
HC TRACKER ENT PATIENT
|
Facility
|
OP
|
$855.00
|
|
| Hospital Charge Code |
41602442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Aetna Commercial |
$721.62
|
| Rate for Payer: Aetna Medicare |
$282.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$282.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$491.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$534.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$324.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$310.36
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Centivo All Commercial |
$436.05
|
| Rate for Payer: Cigna All Commercial |
$737.86
|
| Rate for Payer: CORVEL All Commercial |
$795.15
|
| Rate for Payer: Coventry All Commercial |
$752.40
|
| Rate for Payer: Encore All Commercial |
$787.03
|
| Rate for Payer: Frontpath All Commercial |
$786.60
|
| Rate for Payer: Humana ChoiceCare |
$738.46
|
| Rate for Payer: Humana Medicare |
$436.05
|
| Rate for Payer: Lucent All Commercial |
$436.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$769.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$641.25
|
| Rate for Payer: PHP All Commercial |
$648.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$333.45
|
| Rate for Payer: Sagamore Health Network All Products |
$660.06
|
| Rate for Payer: Signature Care EPO |
$709.65
|
| Rate for Payer: Signature Care PPO |
$752.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$726.75
|
| Rate for Payer: United Healthcare Commercial |
$673.74
|
| Rate for Payer: United Healthcare Medicare |
$282.15
|
|
|
HC TRACTION BOOT UNIV
|
Facility
|
IP
|
$168.21
|
|
| Hospital Charge Code |
41601229
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.16 |
| Max. Negotiated Rate |
$156.44 |
| Rate for Payer: Aetna Commercial |
$145.33
|
| Rate for Payer: Cash Price |
$104.29
|
| Rate for Payer: Cigna All Commercial |
$145.17
|
| Rate for Payer: CORVEL All Commercial |
$156.44
|
| Rate for Payer: Coventry All Commercial |
$148.02
|
| Rate for Payer: Encore All Commercial |
$154.84
|
| Rate for Payer: Frontpath All Commercial |
$154.75
|
| Rate for Payer: Humana ChoiceCare |
$145.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.39
|
| Rate for Payer: PHCS All Commercial |
$126.16
|
| Rate for Payer: PHP All Commercial |
$127.57
|
| Rate for Payer: Sagamore Health Network All Products |
$129.86
|
| Rate for Payer: Signature Care EPO |
$139.61
|
| Rate for Payer: Signature Care PPO |
$148.02
|
| Rate for Payer: United Healthcare Commercial |
$132.55
|
|
|
HC TRACTION BOOT UNIV
|
Facility
|
OP
|
$168.21
|
|
| Hospital Charge Code |
41601229
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.51 |
| Max. Negotiated Rate |
$156.44 |
| Rate for Payer: Aetna Commercial |
$141.97
|
| Rate for Payer: Aetna Medicare |
$55.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.06
|
| Rate for Payer: Cash Price |
$104.29
|
| Rate for Payer: Cash Price |
$104.29
|
| Rate for Payer: Centivo All Commercial |
$85.79
|
| Rate for Payer: Cigna All Commercial |
$145.17
|
| Rate for Payer: CORVEL All Commercial |
$156.44
|
| Rate for Payer: Coventry All Commercial |
$148.02
|
| Rate for Payer: Encore All Commercial |
$154.84
|
| Rate for Payer: Frontpath All Commercial |
$154.75
|
| Rate for Payer: Humana ChoiceCare |
$145.28
|
| Rate for Payer: Humana Medicare |
$85.79
|
| Rate for Payer: Lucent All Commercial |
$85.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.39
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$126.16
|
| Rate for Payer: PHP All Commercial |
$127.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.60
|
| Rate for Payer: Sagamore Health Network All Products |
$129.86
|
| Rate for Payer: Signature Care EPO |
$139.61
|
| Rate for Payer: Signature Care PPO |
$148.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.98
|
| Rate for Payer: United Healthcare Commercial |
$132.55
|
| Rate for Payer: United Healthcare Medicare |
$55.51
|
|
|
HC TRACTION MECHANICAL-PT
|
Facility
|
IP
|
$123.66
|
|
|
Service Code
|
CPT 97012 GP
|
| Hospital Charge Code |
01728084
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$115.01 |
| Rate for Payer: Aetna Commercial |
$106.85
|
| Rate for Payer: Cash Price |
$76.67
|
| Rate for Payer: Cigna All Commercial |
$106.72
|
| Rate for Payer: CORVEL All Commercial |
$115.01
|
| Rate for Payer: Coventry All Commercial |
$108.83
|
| Rate for Payer: Encore All Commercial |
$113.83
|
| Rate for Payer: Frontpath All Commercial |
$113.77
|
| Rate for Payer: Humana ChoiceCare |
$106.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.30
|
| Rate for Payer: PHCS All Commercial |
$92.75
|
| Rate for Payer: PHP All Commercial |
$93.79
|
| Rate for Payer: Sagamore Health Network All Products |
$95.47
|
| Rate for Payer: Signature Care EPO |
$102.64
|
| Rate for Payer: Signature Care PPO |
$108.83
|
| Rate for Payer: United Healthcare Commercial |
$97.45
|
|
|
HC TRACTION MECHANICAL-PT
|
Facility
|
OP
|
$123.66
|
|
|
Service Code
|
CPT 97012 GP
|
| Hospital Charge Code |
01728084
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.81 |
| Max. Negotiated Rate |
$115.01 |
| Rate for Payer: Aetna Commercial |
$104.37
|
| Rate for Payer: Aetna Medicare |
$40.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.89
|
| Rate for Payer: Cash Price |
$76.67
|
| Rate for Payer: Centivo All Commercial |
$63.07
|
| Rate for Payer: Cigna All Commercial |
$106.72
|
| Rate for Payer: CORVEL All Commercial |
$115.01
|
| Rate for Payer: Coventry All Commercial |
$108.83
|
| Rate for Payer: Encore All Commercial |
$113.83
|
| Rate for Payer: Frontpath All Commercial |
$113.77
|
| Rate for Payer: Humana ChoiceCare |
$106.81
|
| Rate for Payer: Humana Medicare |
$63.07
|
| Rate for Payer: Lucent All Commercial |
$63.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.30
|
| Rate for Payer: PHCS All Commercial |
$92.75
|
| Rate for Payer: PHP All Commercial |
$93.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.23
|
| Rate for Payer: Sagamore Health Network All Products |
$95.47
|
| Rate for Payer: Signature Care EPO |
$102.64
|
| Rate for Payer: Signature Care PPO |
$108.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.12
|
| Rate for Payer: United Healthcare Commercial |
$97.45
|
| Rate for Payer: United Healthcare Medicare |
$40.81
|
|
|
HC TRAMADOL CONFIRMATION (LABCORP MEDWATCH)
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.32 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna Commercial |
$92.53
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cigna All Commercial |
$92.43
|
| Rate for Payer: CORVEL All Commercial |
$99.60
|
| Rate for Payer: Coventry All Commercial |
$94.25
|
| Rate for Payer: Encore All Commercial |
$98.59
|
| Rate for Payer: Frontpath All Commercial |
$98.53
|
| Rate for Payer: Humana ChoiceCare |
$92.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.39
|
| Rate for Payer: PHCS All Commercial |
$80.32
|
| Rate for Payer: PHP All Commercial |
$81.22
|
| Rate for Payer: Sagamore Health Network All Products |
$82.68
|
| Rate for Payer: Signature Care EPO |
$88.89
|
| Rate for Payer: Signature Care PPO |
$94.25
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
|
|
HC TRAMADOL CONFIRMATION (LABCORP MEDWATCH)
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Aetna Commercial |
$90.39
|
| Rate for Payer: Aetna Medicare |
$35.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.88
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Centivo All Commercial |
$54.62
|
| Rate for Payer: Cigna All Commercial |
$92.43
|
| Rate for Payer: CORVEL All Commercial |
$99.60
|
| Rate for Payer: Coventry All Commercial |
$94.25
|
| Rate for Payer: Encore All Commercial |
$98.59
|
| Rate for Payer: Frontpath All Commercial |
$98.53
|
| Rate for Payer: Humana ChoiceCare |
$92.50
|
| Rate for Payer: Humana Medicare |
$54.62
|
| Rate for Payer: Lucent All Commercial |
$54.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.39
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$80.32
|
| Rate for Payer: PHP All Commercial |
$81.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.77
|
| Rate for Payer: Sagamore Health Network All Products |
$82.68
|
| Rate for Payer: Signature Care EPO |
$88.89
|
| Rate for Payer: Signature Care PPO |
$94.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.04
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$35.34
|
|
|
HC TRANSCUTANEOUS BILIRUBIN
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
01028400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$89.53
|
| Rate for Payer: Aetna Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.51
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Centivo All Commercial |
$54.10
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Humana Medicare |
$54.10
|
| Rate for Payer: Lucent All Commercial |
$54.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: Managed Health Services Medicaid |
$3.47
|
| Rate for Payer: MDWise Medicaid |
$3.47
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.37
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.17
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
| Rate for Payer: United Healthcare Medicare |
$35.01
|
|
|
HC TRANSCUTANEOUS BILIRUBIN
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
01028400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$91.65
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
|
|
HC TRANSESOPHAGEAL ECHO
|
Facility
|
OP
|
$2,378.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
01643312
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$784.74 |
| Max. Negotiated Rate |
$2,211.54 |
| Rate for Payer: Aetna Commercial |
$2,007.03
|
| Rate for Payer: Aetna Medicare |
$784.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$784.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,365.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,486.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,728.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$902.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$863.21
|
| Rate for Payer: Cash Price |
$1,474.36
|
| Rate for Payer: Cash Price |
$1,474.36
|
| Rate for Payer: Centivo All Commercial |
$1,212.78
|
| Rate for Payer: Cigna All Commercial |
$2,052.21
|
| Rate for Payer: CORVEL All Commercial |
$2,211.54
|
| Rate for Payer: Coventry All Commercial |
$2,092.64
|
| Rate for Payer: Encore All Commercial |
$2,188.95
|
| Rate for Payer: Frontpath All Commercial |
$2,187.76
|
| Rate for Payer: Humana ChoiceCare |
$2,053.88
|
| Rate for Payer: Humana Medicare |
$1,212.78
|
| Rate for Payer: Lucent All Commercial |
$1,212.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,140.20
|
| Rate for Payer: Managed Health Services Medicaid |
$1,728.79
|
| Rate for Payer: MDWise Medicaid |
$1,728.79
|
| Rate for Payer: PHCS All Commercial |
$1,783.50
|
| Rate for Payer: PHP All Commercial |
$1,803.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$927.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,835.81
|
| Rate for Payer: Signature Care EPO |
$1,973.74
|
| Rate for Payer: Signature Care PPO |
$2,092.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,021.30
|
| Rate for Payer: United Healthcare Commercial |
$1,873.86
|
| Rate for Payer: United Healthcare Medicare |
$784.74
|
|
|
HC TRANSESOPHAGEAL ECHO
|
Facility
|
IP
|
$2,378.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
01643312
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,783.50 |
| Max. Negotiated Rate |
$2,211.54 |
| Rate for Payer: Aetna Commercial |
$2,054.59
|
| Rate for Payer: Cash Price |
$1,474.36
|
| Rate for Payer: Cigna All Commercial |
$2,052.21
|
| Rate for Payer: CORVEL All Commercial |
$2,211.54
|
| Rate for Payer: Coventry All Commercial |
$2,092.64
|
| Rate for Payer: Encore All Commercial |
$2,188.95
|
| Rate for Payer: Frontpath All Commercial |
$2,187.76
|
| Rate for Payer: Humana ChoiceCare |
$2,053.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,140.20
|
| Rate for Payer: PHCS All Commercial |
$1,783.50
|
| Rate for Payer: PHP All Commercial |
$1,803.47
|
| Rate for Payer: Sagamore Health Network All Products |
$1,835.81
|
| Rate for Payer: Signature Care EPO |
$1,973.74
|
| Rate for Payer: Signature Care PPO |
$2,092.64
|
| Rate for Payer: United Healthcare Commercial |
$1,873.86
|
|
|
HC TRANSFERRIN
|
Facility
|
OP
|
$211.97
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
63001162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$178.90
|
| Rate for Payer: Aetna Medicare |
$69.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.94
|
| Rate for Payer: Cash Price |
$131.42
|
| Rate for Payer: Cash Price |
$131.42
|
| Rate for Payer: Centivo All Commercial |
$108.10
|
| Rate for Payer: Cigna All Commercial |
$182.93
|
| Rate for Payer: CORVEL All Commercial |
$197.13
|
| Rate for Payer: Coventry All Commercial |
$186.53
|
| Rate for Payer: Encore All Commercial |
$195.11
|
| Rate for Payer: Frontpath All Commercial |
$195.01
|
| Rate for Payer: Humana ChoiceCare |
$183.08
|
| Rate for Payer: Humana Medicare |
$108.10
|
| Rate for Payer: Lucent All Commercial |
$108.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.77
|
| Rate for Payer: Managed Health Services Medicaid |
$12.76
|
| Rate for Payer: MDWise Medicaid |
$12.76
|
| Rate for Payer: PHCS All Commercial |
$158.97
|
| Rate for Payer: PHP All Commercial |
$160.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.67
|
| Rate for Payer: Sagamore Health Network All Products |
$163.64
|
| Rate for Payer: Signature Care EPO |
$175.93
|
| Rate for Payer: Signature Care PPO |
$186.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$180.17
|
| Rate for Payer: United Healthcare Commercial |
$167.03
|
| Rate for Payer: United Healthcare Medicare |
$69.95
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$211.97
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
63001162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.97 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$183.14
|
| Rate for Payer: Cash Price |
$131.42
|
| Rate for Payer: Cigna All Commercial |
$182.93
|
| Rate for Payer: CORVEL All Commercial |
$197.13
|
| Rate for Payer: Coventry All Commercial |
$186.53
|
| Rate for Payer: Encore All Commercial |
$195.11
|
| Rate for Payer: Frontpath All Commercial |
$195.01
|
| Rate for Payer: Humana ChoiceCare |
$183.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.77
|
| Rate for Payer: PHCS All Commercial |
$158.97
|
| Rate for Payer: PHP All Commercial |
$160.76
|
| Rate for Payer: Sagamore Health Network All Products |
$163.64
|
| Rate for Payer: Signature Care EPO |
$175.93
|
| Rate for Payer: Signature Care PPO |
$186.53
|
| Rate for Payer: United Healthcare Commercial |
$167.03
|
|
