|
HC UNLISTED MOLECULAR PATHOLOGY
|
Facility
|
OP
|
$273.33
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
63001446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$254.20 |
| Rate for Payer: Aetna Commercial |
$230.69
|
| Rate for Payer: Aetna Medicare |
$90.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.22
|
| Rate for Payer: Cash Price |
$169.46
|
| Rate for Payer: Centivo All Commercial |
$139.40
|
| Rate for Payer: Cigna All Commercial |
$235.88
|
| Rate for Payer: CORVEL All Commercial |
$254.20
|
| Rate for Payer: Coventry All Commercial |
$240.53
|
| Rate for Payer: Encore All Commercial |
$251.60
|
| Rate for Payer: Frontpath All Commercial |
$251.46
|
| Rate for Payer: Humana ChoiceCare |
$236.07
|
| Rate for Payer: Humana Medicare |
$139.40
|
| Rate for Payer: Lucent All Commercial |
$139.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.00
|
| Rate for Payer: PHCS All Commercial |
$205.00
|
| Rate for Payer: PHP All Commercial |
$207.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.60
|
| Rate for Payer: Sagamore Health Network All Products |
$211.01
|
| Rate for Payer: Signature Care EPO |
$226.86
|
| Rate for Payer: Signature Care PPO |
$240.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.33
|
| Rate for Payer: United Healthcare Commercial |
$215.38
|
| Rate for Payer: United Healthcare Medicare |
$90.20
|
|
|
HC UNLISTED MOLECULAR PATHOLOGY
|
Facility
|
IP
|
$273.33
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
63001446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$254.20 |
| Rate for Payer: Aetna Commercial |
$236.16
|
| Rate for Payer: Cash Price |
$169.46
|
| Rate for Payer: Cigna All Commercial |
$235.88
|
| Rate for Payer: CORVEL All Commercial |
$254.20
|
| Rate for Payer: Coventry All Commercial |
$240.53
|
| Rate for Payer: Encore All Commercial |
$251.60
|
| Rate for Payer: Frontpath All Commercial |
$251.46
|
| Rate for Payer: Humana ChoiceCare |
$236.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.00
|
| Rate for Payer: PHCS All Commercial |
$205.00
|
| Rate for Payer: PHP All Commercial |
$207.29
|
| Rate for Payer: Sagamore Health Network All Products |
$211.01
|
| Rate for Payer: Signature Care EPO |
$226.86
|
| Rate for Payer: Signature Care PPO |
$240.53
|
| Rate for Payer: United Healthcare Commercial |
$215.38
|
|
|
HC UNNA BOOT STRAPPING-BILATERAL PT
|
Facility
|
IP
|
$508.53
|
|
|
Service Code
|
CPT 29580 50,GP
|
| Hospital Charge Code |
01728580
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$381.40 |
| Max. Negotiated Rate |
$472.93 |
| Rate for Payer: Aetna Commercial |
$439.37
|
| Rate for Payer: Cash Price |
$315.29
|
| Rate for Payer: Cigna All Commercial |
$438.86
|
| Rate for Payer: CORVEL All Commercial |
$472.93
|
| Rate for Payer: Coventry All Commercial |
$447.51
|
| Rate for Payer: Encore All Commercial |
$468.10
|
| Rate for Payer: Frontpath All Commercial |
$467.85
|
| Rate for Payer: Humana ChoiceCare |
$439.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$457.68
|
| Rate for Payer: PHCS All Commercial |
$381.40
|
| Rate for Payer: PHP All Commercial |
$385.67
|
| Rate for Payer: Sagamore Health Network All Products |
$392.59
|
| Rate for Payer: Signature Care EPO |
$422.08
|
| Rate for Payer: Signature Care PPO |
$447.51
|
| Rate for Payer: United Healthcare Commercial |
$400.72
|
|
|
HC UNNA BOOT STRAPPING-BILATERAL PT
|
Facility
|
OP
|
$508.53
|
|
|
Service Code
|
CPT 29580 50,GP
|
| Hospital Charge Code |
01728580
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$167.82 |
| Max. Negotiated Rate |
$472.93 |
| Rate for Payer: Aetna Commercial |
$429.20
|
| Rate for Payer: Aetna Medicare |
$167.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$167.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$292.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$184.60
|
| Rate for Payer: Cash Price |
$315.29
|
| Rate for Payer: Centivo All Commercial |
$259.35
|
| Rate for Payer: Cigna All Commercial |
$438.86
|
| Rate for Payer: CORVEL All Commercial |
$472.93
|
| Rate for Payer: Coventry All Commercial |
$447.51
|
| Rate for Payer: Encore All Commercial |
$468.10
|
| Rate for Payer: Frontpath All Commercial |
$467.85
|
| Rate for Payer: Humana ChoiceCare |
$439.22
|
| Rate for Payer: Humana Medicare |
$259.35
|
| Rate for Payer: Lucent All Commercial |
$259.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$457.68
|
| Rate for Payer: PHCS All Commercial |
$381.40
|
| Rate for Payer: PHP All Commercial |
$385.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.33
|
| Rate for Payer: Sagamore Health Network All Products |
$392.59
|
| Rate for Payer: Signature Care EPO |
$422.08
|
| Rate for Payer: Signature Care PPO |
$447.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$432.25
|
| Rate for Payer: United Healthcare Commercial |
$400.72
|
| Rate for Payer: United Healthcare Medicare |
$167.82
|
|
|
HC UNNA BOOT STRAPPING - LT PT
|
Facility
|
IP
|
$508.53
|
|
|
Service Code
|
CPT 29580 LT,GP
|
| Hospital Charge Code |
01727580
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$381.40 |
| Max. Negotiated Rate |
$472.93 |
| Rate for Payer: Aetna Commercial |
$439.37
|
| Rate for Payer: Cash Price |
$315.29
|
| Rate for Payer: Cigna All Commercial |
$438.86
|
| Rate for Payer: CORVEL All Commercial |
$472.93
|
| Rate for Payer: Coventry All Commercial |
$447.51
|
| Rate for Payer: Encore All Commercial |
$468.10
|
| Rate for Payer: Frontpath All Commercial |
$467.85
|
| Rate for Payer: Humana ChoiceCare |
$439.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$457.68
|
| Rate for Payer: PHCS All Commercial |
$381.40
|
| Rate for Payer: PHP All Commercial |
$385.67
|
| Rate for Payer: Sagamore Health Network All Products |
$392.59
|
| Rate for Payer: Signature Care EPO |
$422.08
|
| Rate for Payer: Signature Care PPO |
$447.51
|
| Rate for Payer: United Healthcare Commercial |
$400.72
|
|
|
HC UNNA BOOT STRAPPING - LT PT
|
Facility
|
OP
|
$508.53
|
|
|
Service Code
|
CPT 29580 LT,GP
|
| Hospital Charge Code |
01727580
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$167.82 |
| Max. Negotiated Rate |
$472.93 |
| Rate for Payer: Aetna Commercial |
$429.20
|
| Rate for Payer: Aetna Medicare |
$167.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$167.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$292.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$184.60
|
| Rate for Payer: Cash Price |
$315.29
|
| Rate for Payer: Centivo All Commercial |
$259.35
|
| Rate for Payer: Cigna All Commercial |
$438.86
|
| Rate for Payer: CORVEL All Commercial |
$472.93
|
| Rate for Payer: Coventry All Commercial |
$447.51
|
| Rate for Payer: Encore All Commercial |
$468.10
|
| Rate for Payer: Frontpath All Commercial |
$467.85
|
| Rate for Payer: Humana ChoiceCare |
$439.22
|
| Rate for Payer: Humana Medicare |
$259.35
|
| Rate for Payer: Lucent All Commercial |
$259.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$457.68
|
| Rate for Payer: PHCS All Commercial |
$381.40
|
| Rate for Payer: PHP All Commercial |
$385.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.33
|
| Rate for Payer: Sagamore Health Network All Products |
$392.59
|
| Rate for Payer: Signature Care EPO |
$422.08
|
| Rate for Payer: Signature Care PPO |
$447.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$432.25
|
| Rate for Payer: United Healthcare Commercial |
$400.72
|
| Rate for Payer: United Healthcare Medicare |
$167.82
|
|
|
HC UNNA BOOT STRAPPING - RT PT
|
Facility
|
OP
|
$508.53
|
|
|
Service Code
|
CPT 29580 RT,GP
|
| Hospital Charge Code |
01729580
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$167.82 |
| Max. Negotiated Rate |
$472.93 |
| Rate for Payer: Aetna Commercial |
$429.20
|
| Rate for Payer: Aetna Medicare |
$167.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$167.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$292.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$184.60
|
| Rate for Payer: Cash Price |
$315.29
|
| Rate for Payer: Centivo All Commercial |
$259.35
|
| Rate for Payer: Cigna All Commercial |
$438.86
|
| Rate for Payer: CORVEL All Commercial |
$472.93
|
| Rate for Payer: Coventry All Commercial |
$447.51
|
| Rate for Payer: Encore All Commercial |
$468.10
|
| Rate for Payer: Frontpath All Commercial |
$467.85
|
| Rate for Payer: Humana ChoiceCare |
$439.22
|
| Rate for Payer: Humana Medicare |
$259.35
|
| Rate for Payer: Lucent All Commercial |
$259.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$457.68
|
| Rate for Payer: PHCS All Commercial |
$381.40
|
| Rate for Payer: PHP All Commercial |
$385.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.33
|
| Rate for Payer: Sagamore Health Network All Products |
$392.59
|
| Rate for Payer: Signature Care EPO |
$422.08
|
| Rate for Payer: Signature Care PPO |
$447.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$432.25
|
| Rate for Payer: United Healthcare Commercial |
$400.72
|
| Rate for Payer: United Healthcare Medicare |
$167.82
|
|
|
HC UNNA BOOT STRAPPING - RT PT
|
Facility
|
IP
|
$508.53
|
|
|
Service Code
|
CPT 29580 RT,GP
|
| Hospital Charge Code |
01729580
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$381.40 |
| Max. Negotiated Rate |
$472.93 |
| Rate for Payer: Aetna Commercial |
$439.37
|
| Rate for Payer: Cash Price |
$315.29
|
| Rate for Payer: Cigna All Commercial |
$438.86
|
| Rate for Payer: CORVEL All Commercial |
$472.93
|
| Rate for Payer: Coventry All Commercial |
$447.51
|
| Rate for Payer: Encore All Commercial |
$468.10
|
| Rate for Payer: Frontpath All Commercial |
$467.85
|
| Rate for Payer: Humana ChoiceCare |
$439.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$457.68
|
| Rate for Payer: PHCS All Commercial |
$381.40
|
| Rate for Payer: PHP All Commercial |
$385.67
|
| Rate for Payer: Sagamore Health Network All Products |
$392.59
|
| Rate for Payer: Signature Care EPO |
$422.08
|
| Rate for Payer: Signature Care PPO |
$447.51
|
| Rate for Payer: United Healthcare Commercial |
$400.72
|
|
|
HC UNNA BOOT UNNA FLEX 4IN X 10YDS
|
Facility
|
OP
|
$37.60
|
|
| Hospital Charge Code |
41601820
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$31.73
|
| Rate for Payer: Aetna Medicare |
$12.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.65
|
| Rate for Payer: Cash Price |
$23.31
|
| Rate for Payer: Cash Price |
$23.31
|
| Rate for Payer: Centivo All Commercial |
$19.18
|
| Rate for Payer: Cigna All Commercial |
$32.45
|
| Rate for Payer: CORVEL All Commercial |
$34.97
|
| Rate for Payer: Coventry All Commercial |
$33.09
|
| Rate for Payer: Encore All Commercial |
$34.61
|
| Rate for Payer: Frontpath All Commercial |
$34.59
|
| Rate for Payer: Humana ChoiceCare |
$32.48
|
| Rate for Payer: Humana Medicare |
$19.18
|
| Rate for Payer: Lucent All Commercial |
$19.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.84
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$28.20
|
| Rate for Payer: PHP All Commercial |
$28.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.66
|
| Rate for Payer: Sagamore Health Network All Products |
$29.03
|
| Rate for Payer: Signature Care EPO |
$31.21
|
| Rate for Payer: Signature Care PPO |
$33.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.96
|
| Rate for Payer: United Healthcare Commercial |
$29.63
|
| Rate for Payer: United Healthcare Medicare |
$12.41
|
|
|
HC UNNA BOOT UNNA FLEX 4IN X 10YDS
|
Facility
|
IP
|
$37.60
|
|
| Hospital Charge Code |
41601820
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$34.97 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$23.31
|
| Rate for Payer: Cigna All Commercial |
$32.45
|
| Rate for Payer: CORVEL All Commercial |
$34.97
|
| Rate for Payer: Coventry All Commercial |
$33.09
|
| Rate for Payer: Encore All Commercial |
$34.61
|
| Rate for Payer: Frontpath All Commercial |
$34.59
|
| Rate for Payer: Humana ChoiceCare |
$32.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.84
|
| Rate for Payer: PHCS All Commercial |
$28.20
|
| Rate for Payer: PHP All Commercial |
$28.52
|
| Rate for Payer: Sagamore Health Network All Products |
$29.03
|
| Rate for Payer: Signature Care EPO |
$31.21
|
| Rate for Payer: Signature Care PPO |
$33.09
|
| Rate for Payer: United Healthcare Commercial |
$29.63
|
|
|
HC UREA 24U
|
Facility
|
OP
|
$77.53
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
63001705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$65.44
|
| Rate for Payer: Aetna Medicare |
$25.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.14
|
| Rate for Payer: Cash Price |
$48.07
|
| Rate for Payer: Cash Price |
$48.07
|
| Rate for Payer: Centivo All Commercial |
$39.54
|
| Rate for Payer: Cigna All Commercial |
$66.91
|
| Rate for Payer: CORVEL All Commercial |
$72.10
|
| Rate for Payer: Coventry All Commercial |
$68.23
|
| Rate for Payer: Encore All Commercial |
$71.37
|
| Rate for Payer: Frontpath All Commercial |
$71.33
|
| Rate for Payer: Humana ChoiceCare |
$66.96
|
| Rate for Payer: Humana Medicare |
$39.54
|
| Rate for Payer: Lucent All Commercial |
$39.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.78
|
| Rate for Payer: Managed Health Services Medicaid |
$3.92
|
| Rate for Payer: MDWise Medicaid |
$3.92
|
| Rate for Payer: PHCS All Commercial |
$58.15
|
| Rate for Payer: PHP All Commercial |
$58.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.24
|
| Rate for Payer: Sagamore Health Network All Products |
$59.85
|
| Rate for Payer: Signature Care EPO |
$64.35
|
| Rate for Payer: Signature Care PPO |
$68.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.90
|
| Rate for Payer: United Healthcare Commercial |
$61.09
|
| Rate for Payer: United Healthcare Medicare |
$25.58
|
|
|
HC UREA 24U
|
Facility
|
IP
|
$77.53
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
63001705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Cash Price |
$48.07
|
| Rate for Payer: Cigna All Commercial |
$66.91
|
| Rate for Payer: CORVEL All Commercial |
$72.10
|
| Rate for Payer: Coventry All Commercial |
$68.23
|
| Rate for Payer: Encore All Commercial |
$71.37
|
| Rate for Payer: Frontpath All Commercial |
$71.33
|
| Rate for Payer: Humana ChoiceCare |
$66.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.78
|
| Rate for Payer: PHCS All Commercial |
$58.15
|
| Rate for Payer: PHP All Commercial |
$58.80
|
| Rate for Payer: Sagamore Health Network All Products |
$59.85
|
| Rate for Payer: Signature Care EPO |
$64.35
|
| Rate for Payer: Signature Care PPO |
$68.23
|
| Rate for Payer: United Healthcare Commercial |
$61.09
|
|
|
HC UREA CLEARANCE
|
Facility
|
IP
|
$158.01
|
|
|
Service Code
|
CPT 84545
|
| Hospital Charge Code |
63001172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.51 |
| Max. Negotiated Rate |
$146.95 |
| Rate for Payer: Aetna Commercial |
$136.52
|
| Rate for Payer: Cash Price |
$97.97
|
| Rate for Payer: Cigna All Commercial |
$136.36
|
| Rate for Payer: CORVEL All Commercial |
$146.95
|
| Rate for Payer: Coventry All Commercial |
$139.05
|
| Rate for Payer: Encore All Commercial |
$145.45
|
| Rate for Payer: Frontpath All Commercial |
$145.37
|
| Rate for Payer: Humana ChoiceCare |
$136.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.21
|
| Rate for Payer: PHCS All Commercial |
$118.51
|
| Rate for Payer: PHP All Commercial |
$119.83
|
| Rate for Payer: Sagamore Health Network All Products |
$121.98
|
| Rate for Payer: Signature Care EPO |
$131.15
|
| Rate for Payer: Signature Care PPO |
$139.05
|
| Rate for Payer: United Healthcare Commercial |
$124.51
|
|
|
HC UREA CLEARANCE
|
Facility
|
OP
|
$158.01
|
|
|
Service Code
|
CPT 84545
|
| Hospital Charge Code |
63001172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$146.95 |
| Rate for Payer: Aetna Commercial |
$133.36
|
| Rate for Payer: Aetna Medicare |
$52.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.36
|
| Rate for Payer: Cash Price |
$97.97
|
| Rate for Payer: Cash Price |
$97.97
|
| Rate for Payer: Centivo All Commercial |
$80.58
|
| Rate for Payer: Cigna All Commercial |
$136.36
|
| Rate for Payer: CORVEL All Commercial |
$146.95
|
| Rate for Payer: Coventry All Commercial |
$139.05
|
| Rate for Payer: Encore All Commercial |
$145.45
|
| Rate for Payer: Frontpath All Commercial |
$145.37
|
| Rate for Payer: Humana ChoiceCare |
$136.47
|
| Rate for Payer: Humana Medicare |
$80.58
|
| Rate for Payer: Lucent All Commercial |
$80.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.21
|
| Rate for Payer: Managed Health Services Medicaid |
$7.20
|
| Rate for Payer: MDWise Medicaid |
$7.20
|
| Rate for Payer: PHCS All Commercial |
$118.51
|
| Rate for Payer: PHP All Commercial |
$119.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.62
|
| Rate for Payer: Sagamore Health Network All Products |
$121.98
|
| Rate for Payer: Signature Care EPO |
$131.15
|
| Rate for Payer: Signature Care PPO |
$139.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$134.31
|
| Rate for Payer: United Healthcare Commercial |
$124.51
|
| Rate for Payer: United Healthcare Medicare |
$52.14
|
|
|
HC UREA URINE
|
Facility
|
IP
|
$100.98
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
63001165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.74 |
| Max. Negotiated Rate |
$93.91 |
| Rate for Payer: Aetna Commercial |
$87.25
|
| Rate for Payer: Cash Price |
$62.61
|
| Rate for Payer: Cigna All Commercial |
$87.15
|
| Rate for Payer: CORVEL All Commercial |
$93.91
|
| Rate for Payer: Coventry All Commercial |
$88.86
|
| Rate for Payer: Encore All Commercial |
$92.95
|
| Rate for Payer: Frontpath All Commercial |
$92.90
|
| Rate for Payer: Humana ChoiceCare |
$87.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.88
|
| Rate for Payer: PHCS All Commercial |
$75.74
|
| Rate for Payer: PHP All Commercial |
$76.58
|
| Rate for Payer: Sagamore Health Network All Products |
$77.96
|
| Rate for Payer: Signature Care EPO |
$83.81
|
| Rate for Payer: Signature Care PPO |
$88.86
|
| Rate for Payer: United Healthcare Commercial |
$79.57
|
|
|
HC UREA URINE
|
Facility
|
OP
|
$100.98
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
63001165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$93.91 |
| Rate for Payer: Aetna Commercial |
$85.23
|
| Rate for Payer: Aetna Medicare |
$33.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.66
|
| Rate for Payer: Cash Price |
$62.61
|
| Rate for Payer: Cash Price |
$62.61
|
| Rate for Payer: Centivo All Commercial |
$51.50
|
| Rate for Payer: Cigna All Commercial |
$87.15
|
| Rate for Payer: CORVEL All Commercial |
$93.91
|
| Rate for Payer: Coventry All Commercial |
$88.86
|
| Rate for Payer: Encore All Commercial |
$92.95
|
| Rate for Payer: Frontpath All Commercial |
$92.90
|
| Rate for Payer: Humana ChoiceCare |
$87.22
|
| Rate for Payer: Humana Medicare |
$51.50
|
| Rate for Payer: Lucent All Commercial |
$51.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.88
|
| Rate for Payer: Managed Health Services Medicaid |
$3.92
|
| Rate for Payer: MDWise Medicaid |
$3.92
|
| Rate for Payer: PHCS All Commercial |
$75.74
|
| Rate for Payer: PHP All Commercial |
$76.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.38
|
| Rate for Payer: Sagamore Health Network All Products |
$77.96
|
| Rate for Payer: Signature Care EPO |
$83.81
|
| Rate for Payer: Signature Care PPO |
$88.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85.83
|
| Rate for Payer: United Healthcare Commercial |
$79.57
|
| Rate for Payer: United Healthcare Medicare |
$33.32
|
|
|
HC URETHRAL SLING COOK
|
Facility
|
OP
|
$3,942.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
41602289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,666.06 |
| Rate for Payer: Aetna Commercial |
$3,327.05
|
| Rate for Payer: Aetna Medicare |
$1,300.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,300.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,263.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,464.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,495.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,430.95
|
| Rate for Payer: Cash Price |
$2,444.04
|
| Rate for Payer: Cash Price |
$2,444.04
|
| Rate for Payer: Centivo All Commercial |
$2,010.42
|
| Rate for Payer: Cigna All Commercial |
$3,401.95
|
| Rate for Payer: CORVEL All Commercial |
$3,666.06
|
| Rate for Payer: Coventry All Commercial |
$3,468.96
|
| Rate for Payer: Encore All Commercial |
$3,628.61
|
| Rate for Payer: Frontpath All Commercial |
$3,626.64
|
| Rate for Payer: Humana ChoiceCare |
$3,404.71
|
| Rate for Payer: Humana Medicare |
$2,010.42
|
| Rate for Payer: Lucent All Commercial |
$2,010.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,547.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,956.50
|
| Rate for Payer: PHP All Commercial |
$2,989.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,537.38
|
| Rate for Payer: Sagamore Health Network All Products |
$3,043.22
|
| Rate for Payer: Signature Care EPO |
$3,271.86
|
| Rate for Payer: Signature Care PPO |
$3,468.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,350.70
|
| Rate for Payer: United Healthcare Commercial |
$3,106.30
|
| Rate for Payer: United Healthcare Medicare |
$1,300.86
|
|
|
HC URETHRAL SLING COOK
|
Facility
|
IP
|
$3,942.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
41602289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,956.50 |
| Max. Negotiated Rate |
$3,666.06 |
| Rate for Payer: Aetna Commercial |
$3,405.89
|
| Rate for Payer: Cash Price |
$2,444.04
|
| Rate for Payer: Cigna All Commercial |
$3,401.95
|
| Rate for Payer: CORVEL All Commercial |
$3,666.06
|
| Rate for Payer: Coventry All Commercial |
$3,468.96
|
| Rate for Payer: Encore All Commercial |
$3,628.61
|
| Rate for Payer: Frontpath All Commercial |
$3,626.64
|
| Rate for Payer: Humana ChoiceCare |
$3,404.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,547.80
|
| Rate for Payer: PHCS All Commercial |
$2,956.50
|
| Rate for Payer: PHP All Commercial |
$2,989.61
|
| Rate for Payer: Sagamore Health Network All Products |
$3,043.22
|
| Rate for Payer: Signature Care EPO |
$3,271.86
|
| Rate for Payer: Signature Care PPO |
$3,468.96
|
| Rate for Payer: United Healthcare Commercial |
$3,106.30
|
|
|
HC URETHRAL SLING TVTO
|
Facility
|
OP
|
$5,270.54
|
|
| Hospital Charge Code |
41602064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,901.60 |
| Rate for Payer: Aetna Commercial |
$4,448.34
|
| Rate for Payer: Aetna Medicare |
$1,739.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,739.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,026.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,294.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,000.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,913.21
|
| Rate for Payer: Cash Price |
$3,267.74
|
| Rate for Payer: Cash Price |
$3,267.74
|
| Rate for Payer: Centivo All Commercial |
$2,687.98
|
| Rate for Payer: Cigna All Commercial |
$4,548.48
|
| Rate for Payer: CORVEL All Commercial |
$4,901.60
|
| Rate for Payer: Coventry All Commercial |
$4,638.08
|
| Rate for Payer: Encore All Commercial |
$4,851.53
|
| Rate for Payer: Frontpath All Commercial |
$4,848.90
|
| Rate for Payer: Humana ChoiceCare |
$4,552.17
|
| Rate for Payer: Humana Medicare |
$2,687.98
|
| Rate for Payer: Lucent All Commercial |
$2,687.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,743.49
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,952.90
|
| Rate for Payer: PHP All Commercial |
$3,997.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,055.51
|
| Rate for Payer: Sagamore Health Network All Products |
$4,068.86
|
| Rate for Payer: Signature Care EPO |
$4,374.55
|
| Rate for Payer: Signature Care PPO |
$4,638.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,479.96
|
| Rate for Payer: United Healthcare Commercial |
$4,153.19
|
| Rate for Payer: United Healthcare Medicare |
$1,739.28
|
|
|
HC URETHRAL SLING TVTO
|
Facility
|
IP
|
$5,270.54
|
|
| Hospital Charge Code |
41602064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.90 |
| Max. Negotiated Rate |
$4,901.60 |
| Rate for Payer: Aetna Commercial |
$4,553.75
|
| Rate for Payer: Cash Price |
$3,267.74
|
| Rate for Payer: Cigna All Commercial |
$4,548.48
|
| Rate for Payer: CORVEL All Commercial |
$4,901.60
|
| Rate for Payer: Coventry All Commercial |
$4,638.08
|
| Rate for Payer: Encore All Commercial |
$4,851.53
|
| Rate for Payer: Frontpath All Commercial |
$4,848.90
|
| Rate for Payer: Humana ChoiceCare |
$4,552.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,743.49
|
| Rate for Payer: PHCS All Commercial |
$3,952.90
|
| Rate for Payer: PHP All Commercial |
$3,997.18
|
| Rate for Payer: Sagamore Health Network All Products |
$4,068.86
|
| Rate for Payer: Signature Care EPO |
$4,374.55
|
| Rate for Payer: Signature Care PPO |
$4,638.08
|
| Rate for Payer: United Healthcare Commercial |
$4,153.19
|
|
|
HC URIC ACID SERUM
|
Facility
|
OP
|
$57.22
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
63001104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$48.30
|
| Rate for Payer: Aetna Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.77
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Centivo All Commercial |
$29.18
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Humana Medicare |
$29.18
|
| Rate for Payer: Lucent All Commercial |
$29.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: Managed Health Services Medicaid |
$4.52
|
| Rate for Payer: MDWise Medicaid |
$4.52
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.32
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
| Rate for Payer: United Healthcare Medicare |
$18.88
|
|
|
HC URIC ACID SERUM
|
Facility
|
IP
|
$57.22
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
63001104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
|
|
HC URIC BF
|
Facility
|
IP
|
$90.88
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
63001173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna Commercial |
$78.52
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cigna All Commercial |
$78.43
|
| Rate for Payer: CORVEL All Commercial |
$84.52
|
| Rate for Payer: Coventry All Commercial |
$79.98
|
| Rate for Payer: Encore All Commercial |
$83.66
|
| Rate for Payer: Frontpath All Commercial |
$83.61
|
| Rate for Payer: Humana ChoiceCare |
$78.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.79
|
| Rate for Payer: PHCS All Commercial |
$68.16
|
| Rate for Payer: PHP All Commercial |
$68.92
|
| Rate for Payer: Sagamore Health Network All Products |
$70.16
|
| Rate for Payer: Signature Care EPO |
$75.43
|
| Rate for Payer: Signature Care PPO |
$79.98
|
| Rate for Payer: United Healthcare Commercial |
$71.62
|
|
|
HC URIC BF
|
Facility
|
OP
|
$90.88
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
63001173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna Commercial |
$76.70
|
| Rate for Payer: Aetna Medicare |
$29.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.99
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Centivo All Commercial |
$46.35
|
| Rate for Payer: Cigna All Commercial |
$78.43
|
| Rate for Payer: CORVEL All Commercial |
$84.52
|
| Rate for Payer: Coventry All Commercial |
$79.98
|
| Rate for Payer: Encore All Commercial |
$83.66
|
| Rate for Payer: Frontpath All Commercial |
$83.61
|
| Rate for Payer: Humana ChoiceCare |
$78.49
|
| Rate for Payer: Humana Medicare |
$46.35
|
| Rate for Payer: Lucent All Commercial |
$46.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.79
|
| Rate for Payer: Managed Health Services Medicaid |
$5.08
|
| Rate for Payer: MDWise Medicaid |
$5.08
|
| Rate for Payer: PHCS All Commercial |
$68.16
|
| Rate for Payer: PHP All Commercial |
$68.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.44
|
| Rate for Payer: Sagamore Health Network All Products |
$70.16
|
| Rate for Payer: Signature Care EPO |
$75.43
|
| Rate for Payer: Signature Care PPO |
$79.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.25
|
| Rate for Payer: United Healthcare Commercial |
$71.62
|
| Rate for Payer: United Healthcare Medicare |
$29.99
|
|
|
HC URIC OTHER SOURCE 24H
|
Facility
|
IP
|
$90.88
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
63001709
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna Commercial |
$78.52
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cigna All Commercial |
$78.43
|
| Rate for Payer: CORVEL All Commercial |
$84.52
|
| Rate for Payer: Coventry All Commercial |
$79.98
|
| Rate for Payer: Encore All Commercial |
$83.66
|
| Rate for Payer: Frontpath All Commercial |
$83.61
|
| Rate for Payer: Humana ChoiceCare |
$78.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.79
|
| Rate for Payer: PHCS All Commercial |
$68.16
|
| Rate for Payer: PHP All Commercial |
$68.92
|
| Rate for Payer: Sagamore Health Network All Products |
$70.16
|
| Rate for Payer: Signature Care EPO |
$75.43
|
| Rate for Payer: Signature Care PPO |
$79.98
|
| Rate for Payer: United Healthcare Commercial |
$71.62
|
|
