|
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
|
|
|
HC URIC UR
|
Facility
|
OP
|
$90.88
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
63001176
|
|
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 UR
|
Facility
|
IP
|
$90.88
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
63001176
|
|
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 URINE MEASURE 24 HR
|
Facility
|
OP
|
$56.10
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
63001054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna Medicare |
$18.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Centivo All Commercial |
$28.61
|
| Rate for Payer: Cigna All Commercial |
$48.41
|
| Rate for Payer: CORVEL All Commercial |
$52.17
|
| Rate for Payer: Coventry All Commercial |
$49.37
|
| Rate for Payer: Encore All Commercial |
$51.64
|
| Rate for Payer: Frontpath All Commercial |
$51.61
|
| Rate for Payer: Humana ChoiceCare |
$48.45
|
| Rate for Payer: Humana Medicare |
$28.61
|
| Rate for Payer: Lucent All Commercial |
$28.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.49
|
| Rate for Payer: Managed Health Services Medicaid |
$3.64
|
| Rate for Payer: MDWise Medicaid |
$3.64
|
| Rate for Payer: PHCS All Commercial |
$42.08
|
| Rate for Payer: PHP All Commercial |
$42.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.88
|
| Rate for Payer: Sagamore Health Network All Products |
$43.31
|
| Rate for Payer: Signature Care EPO |
$46.56
|
| Rate for Payer: Signature Care PPO |
$49.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.68
|
| Rate for Payer: United Healthcare Commercial |
$44.21
|
| Rate for Payer: United Healthcare Medicare |
$18.51
|
|
|
HC URINE MEASURE 24 HR
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
63001054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: Aetna Commercial |
$48.47
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cigna All Commercial |
$48.41
|
| Rate for Payer: CORVEL All Commercial |
$52.17
|
| Rate for Payer: Coventry All Commercial |
$49.37
|
| Rate for Payer: Encore All Commercial |
$51.64
|
| Rate for Payer: Frontpath All Commercial |
$51.61
|
| Rate for Payer: Humana ChoiceCare |
$48.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.49
|
| Rate for Payer: PHCS All Commercial |
$42.08
|
| Rate for Payer: PHP All Commercial |
$42.55
|
| Rate for Payer: Sagamore Health Network All Products |
$43.31
|
| Rate for Payer: Signature Care EPO |
$46.56
|
| Rate for Payer: Signature Care PPO |
$49.37
|
| Rate for Payer: United Healthcare Commercial |
$44.21
|
|
|
HC URINE MICROSCOPIC
|
Facility
|
OP
|
$71.81
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
63001293
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$60.61
|
| Rate for Payer: Aetna Medicare |
$23.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$44.52
|
| Rate for Payer: Cash Price |
$44.52
|
| Rate for Payer: Centivo All Commercial |
$36.62
|
| Rate for Payer: Cigna All Commercial |
$61.97
|
| Rate for Payer: CORVEL All Commercial |
$66.78
|
| Rate for Payer: Coventry All Commercial |
$63.19
|
| Rate for Payer: Encore All Commercial |
$66.10
|
| Rate for Payer: Frontpath All Commercial |
$66.06
|
| Rate for Payer: Humana ChoiceCare |
$62.02
|
| Rate for Payer: Humana Medicare |
$36.62
|
| Rate for Payer: Lucent All Commercial |
$36.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.63
|
| Rate for Payer: Managed Health Services Medicaid |
$3.17
|
| Rate for Payer: MDWise Medicaid |
$3.17
|
| Rate for Payer: PHCS All Commercial |
$53.86
|
| Rate for Payer: PHP All Commercial |
$54.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.01
|
| Rate for Payer: Sagamore Health Network All Products |
$55.44
|
| Rate for Payer: Signature Care EPO |
$59.60
|
| Rate for Payer: Signature Care PPO |
$63.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.04
|
| Rate for Payer: United Healthcare Commercial |
$56.58
|
| Rate for Payer: United Healthcare Medicare |
$23.70
|
|
|
HC URINE MICROSCOPIC
|
Facility
|
IP
|
$71.81
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
63001293
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$62.04
|
| Rate for Payer: Cash Price |
$44.52
|
| Rate for Payer: Cigna All Commercial |
$61.97
|
| Rate for Payer: CORVEL All Commercial |
$66.78
|
| Rate for Payer: Coventry All Commercial |
$63.19
|
| Rate for Payer: Encore All Commercial |
$66.10
|
| Rate for Payer: Frontpath All Commercial |
$66.06
|
| Rate for Payer: Humana ChoiceCare |
$62.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.63
|
| Rate for Payer: PHCS All Commercial |
$53.86
|
| Rate for Payer: PHP All Commercial |
$54.46
|
| Rate for Payer: Sagamore Health Network All Products |
$55.44
|
| Rate for Payer: Signature Care EPO |
$59.60
|
| Rate for Payer: Signature Care PPO |
$63.19
|
| Rate for Payer: United Healthcare Commercial |
$56.58
|
|
|
HC URINE PREGNANCY POC
|
Facility
|
OP
|
$125.38
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
01422000
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$116.60 |
| Rate for Payer: Aetna Commercial |
$105.82
|
| Rate for Payer: Aetna Medicare |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.51
|
| Rate for Payer: Cash Price |
$77.74
|
| Rate for Payer: Cash Price |
$77.74
|
| Rate for Payer: Centivo All Commercial |
$63.94
|
| Rate for Payer: Cigna All Commercial |
$108.20
|
| Rate for Payer: CORVEL All Commercial |
$116.60
|
| Rate for Payer: Coventry All Commercial |
$110.33
|
| Rate for Payer: Encore All Commercial |
$115.41
|
| Rate for Payer: Frontpath All Commercial |
$115.35
|
| Rate for Payer: Humana ChoiceCare |
$108.29
|
| Rate for Payer: Humana Medicare |
$63.94
|
| Rate for Payer: Lucent All Commercial |
$63.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.84
|
| Rate for Payer: Managed Health Services Medicaid |
$8.61
|
| Rate for Payer: MDWise Medicaid |
$8.61
|
| Rate for Payer: PHCS All Commercial |
$94.03
|
| Rate for Payer: PHP All Commercial |
$95.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.90
|
| Rate for Payer: Sagamore Health Network All Products |
$96.79
|
| Rate for Payer: Signature Care EPO |
$104.06
|
| Rate for Payer: Signature Care PPO |
$110.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.57
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
| Rate for Payer: United Healthcare Medicare |
$41.37
|
|
|
HC URINE PREGNANCY POC
|
Facility
|
IP
|
$125.38
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
01422000
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$116.60 |
| Rate for Payer: Aetna Commercial |
$108.33
|
| Rate for Payer: Cash Price |
$77.74
|
| Rate for Payer: Cigna All Commercial |
$108.20
|
| Rate for Payer: CORVEL All Commercial |
$116.60
|
| Rate for Payer: Coventry All Commercial |
$110.33
|
| Rate for Payer: Encore All Commercial |
$115.41
|
| Rate for Payer: Frontpath All Commercial |
$115.35
|
| Rate for Payer: Humana ChoiceCare |
$108.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.84
|
| Rate for Payer: PHCS All Commercial |
$94.03
|
| Rate for Payer: PHP All Commercial |
$95.09
|
| Rate for Payer: Sagamore Health Network All Products |
$96.79
|
| Rate for Payer: Signature Care EPO |
$104.06
|
| Rate for Payer: Signature Care PPO |
$110.33
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
|
|
HC URINE PREGNANCY TEST
|
Facility
|
IP
|
$130.08
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
63080125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.56 |
| Max. Negotiated Rate |
$120.97 |
| Rate for Payer: Aetna Commercial |
$112.39
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cigna All Commercial |
$112.26
|
| Rate for Payer: CORVEL All Commercial |
$120.97
|
| Rate for Payer: Coventry All Commercial |
$114.47
|
| Rate for Payer: Encore All Commercial |
$119.74
|
| Rate for Payer: Frontpath All Commercial |
$119.67
|
| Rate for Payer: Humana ChoiceCare |
$112.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.07
|
| Rate for Payer: PHCS All Commercial |
$97.56
|
| Rate for Payer: PHP All Commercial |
$98.65
|
| Rate for Payer: Sagamore Health Network All Products |
$100.42
|
| Rate for Payer: Signature Care EPO |
$107.97
|
| Rate for Payer: Signature Care PPO |
$114.47
|
| Rate for Payer: United Healthcare Commercial |
$102.50
|
|
|
HC URINE PREGNANCY TEST
|
Facility
|
IP
|
$101.05
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
63003030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$93.98 |
| Rate for Payer: Aetna Commercial |
$87.31
|
| Rate for Payer: Cash Price |
$62.65
|
| Rate for Payer: Cigna All Commercial |
$87.21
|
| Rate for Payer: CORVEL All Commercial |
$93.98
|
| Rate for Payer: Coventry All Commercial |
$88.93
|
| Rate for Payer: Encore All Commercial |
$93.02
|
| Rate for Payer: Frontpath All Commercial |
$92.97
|
| Rate for Payer: Humana ChoiceCare |
$87.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.95
|
| Rate for Payer: PHCS All Commercial |
$75.79
|
| Rate for Payer: PHP All Commercial |
$76.64
|
| Rate for Payer: Sagamore Health Network All Products |
$78.01
|
| Rate for Payer: Signature Care EPO |
$83.87
|
| Rate for Payer: Signature Care PPO |
$88.93
|
| Rate for Payer: United Healthcare Commercial |
$79.63
|
|
|
HC URINE PREGNANCY TEST
|
Facility
|
OP
|
$130.08
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
63080125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$120.97 |
| Rate for Payer: Aetna Commercial |
$109.79
|
| Rate for Payer: Aetna Medicare |
$42.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.22
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Centivo All Commercial |
$66.34
|
| Rate for Payer: Cigna All Commercial |
$112.26
|
| Rate for Payer: CORVEL All Commercial |
$120.97
|
| Rate for Payer: Coventry All Commercial |
$114.47
|
| Rate for Payer: Encore All Commercial |
$119.74
|
| Rate for Payer: Frontpath All Commercial |
$119.67
|
| Rate for Payer: Humana ChoiceCare |
$112.35
|
| Rate for Payer: Humana Medicare |
$66.34
|
| Rate for Payer: Lucent All Commercial |
$66.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.07
|
| Rate for Payer: Managed Health Services Medicaid |
$8.61
|
| Rate for Payer: MDWise Medicaid |
$8.61
|
| Rate for Payer: PHCS All Commercial |
$97.56
|
| Rate for Payer: PHP All Commercial |
$98.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.73
|
| Rate for Payer: Sagamore Health Network All Products |
$100.42
|
| Rate for Payer: Signature Care EPO |
$107.97
|
| Rate for Payer: Signature Care PPO |
$114.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.57
|
| Rate for Payer: United Healthcare Commercial |
$102.50
|
| Rate for Payer: United Healthcare Medicare |
$42.93
|
|
|
HC URINE PREGNANCY TEST
|
Facility
|
OP
|
$101.05
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
63003030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$93.98 |
| Rate for Payer: Aetna Commercial |
$85.29
|
| Rate for Payer: Aetna Medicare |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.68
|
| Rate for Payer: Cash Price |
$62.65
|
| Rate for Payer: Cash Price |
$62.65
|
| Rate for Payer: Centivo All Commercial |
$51.54
|
| Rate for Payer: Cigna All Commercial |
$87.21
|
| Rate for Payer: CORVEL All Commercial |
$93.98
|
| Rate for Payer: Coventry All Commercial |
$88.93
|
| Rate for Payer: Encore All Commercial |
$93.02
|
| Rate for Payer: Frontpath All Commercial |
$92.97
|
| Rate for Payer: Humana ChoiceCare |
$87.28
|
| Rate for Payer: Humana Medicare |
$51.54
|
| Rate for Payer: Lucent All Commercial |
$51.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.95
|
| Rate for Payer: Managed Health Services Medicaid |
$8.61
|
| Rate for Payer: MDWise Medicaid |
$8.61
|
| Rate for Payer: PHCS All Commercial |
$75.79
|
| Rate for Payer: PHP All Commercial |
$76.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.41
|
| Rate for Payer: Sagamore Health Network All Products |
$78.01
|
| Rate for Payer: Signature Care EPO |
$83.87
|
| Rate for Payer: Signature Care PPO |
$88.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85.89
|
| Rate for Payer: United Healthcare Commercial |
$79.63
|
| Rate for Payer: United Healthcare Medicare |
$33.35
|
|
|
HC URINE REAG STRIP
|
Facility
|
IP
|
$56.98
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
63001294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.73 |
| Max. Negotiated Rate |
$52.99 |
| Rate for Payer: Aetna Commercial |
$49.23
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cigna All Commercial |
$49.17
|
| Rate for Payer: CORVEL All Commercial |
$52.99
|
| Rate for Payer: Coventry All Commercial |
$50.14
|
| Rate for Payer: Encore All Commercial |
$52.45
|
| Rate for Payer: Frontpath All Commercial |
$52.42
|
| Rate for Payer: Humana ChoiceCare |
$49.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.28
|
| Rate for Payer: PHCS All Commercial |
$42.73
|
| Rate for Payer: PHP All Commercial |
$43.21
|
| Rate for Payer: Sagamore Health Network All Products |
$43.99
|
| Rate for Payer: Signature Care EPO |
$47.29
|
| Rate for Payer: Signature Care PPO |
$50.14
|
| Rate for Payer: United Healthcare Commercial |
$44.90
|
|
|
HC URINE REAG STRIP
|
Facility
|
OP
|
$56.98
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
63001294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$52.99 |
| Rate for Payer: Aetna Commercial |
$48.09
|
| Rate for Payer: Aetna Medicare |
$18.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.68
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Centivo All Commercial |
$29.06
|
| Rate for Payer: Cigna All Commercial |
$49.17
|
| Rate for Payer: CORVEL All Commercial |
$52.99
|
| Rate for Payer: Coventry All Commercial |
$50.14
|
| Rate for Payer: Encore All Commercial |
$52.45
|
| Rate for Payer: Frontpath All Commercial |
$52.42
|
| Rate for Payer: Humana ChoiceCare |
$49.21
|
| Rate for Payer: Humana Medicare |
$29.06
|
| Rate for Payer: Lucent All Commercial |
$29.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.28
|
| Rate for Payer: Managed Health Services Medicaid |
$2.25
|
| Rate for Payer: MDWise Medicaid |
$2.25
|
| Rate for Payer: PHCS All Commercial |
$42.73
|
| Rate for Payer: PHP All Commercial |
$43.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.22
|
| Rate for Payer: Sagamore Health Network All Products |
$43.99
|
| Rate for Payer: Signature Care EPO |
$47.29
|
| Rate for Payer: Signature Care PPO |
$50.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.43
|
| Rate for Payer: United Healthcare Commercial |
$44.90
|
| Rate for Payer: United Healthcare Medicare |
$18.80
|
|
|
HC URINE TRIC
|
Facility
|
OP
|
$235.41
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
63087591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$218.93 |
| Rate for Payer: Aetna Commercial |
$198.68
|
| Rate for Payer: Aetna Medicare |
$77.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$135.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$147.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.45
|
| Rate for Payer: Cash Price |
$145.95
|
| Rate for Payer: Cash Price |
$145.95
|
| Rate for Payer: Centivo All Commercial |
$120.06
|
| Rate for Payer: Cigna All Commercial |
$203.16
|
| Rate for Payer: CORVEL All Commercial |
$218.93
|
| Rate for Payer: Coventry All Commercial |
$207.16
|
| Rate for Payer: Encore All Commercial |
$216.69
|
| Rate for Payer: Frontpath All Commercial |
$216.57
|
| Rate for Payer: Humana ChoiceCare |
$203.32
|
| Rate for Payer: Humana Medicare |
$120.06
|
| Rate for Payer: Lucent All Commercial |
$120.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.87
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$176.55
|
| Rate for Payer: PHP All Commercial |
$178.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.81
|
| Rate for Payer: Sagamore Health Network All Products |
$181.73
|
| Rate for Payer: Signature Care EPO |
$195.39
|
| Rate for Payer: Signature Care PPO |
$207.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.09
|
| Rate for Payer: United Healthcare Commercial |
$185.50
|
| Rate for Payer: United Healthcare Medicare |
$77.68
|
|
|
HC URINE TRIC
|
Facility
|
IP
|
$235.41
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
63087591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.55 |
| Max. Negotiated Rate |
$218.93 |
| Rate for Payer: Aetna Commercial |
$203.39
|
| Rate for Payer: Cash Price |
$145.95
|
| Rate for Payer: Cigna All Commercial |
$203.16
|
| Rate for Payer: CORVEL All Commercial |
$218.93
|
| Rate for Payer: Coventry All Commercial |
$207.16
|
| Rate for Payer: Encore All Commercial |
$216.69
|
| Rate for Payer: Frontpath All Commercial |
$216.57
|
| Rate for Payer: Humana ChoiceCare |
$203.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.87
|
| Rate for Payer: PHCS All Commercial |
$176.55
|
| Rate for Payer: PHP All Commercial |
$178.53
|
| Rate for Payer: Sagamore Health Network All Products |
$181.73
|
| Rate for Payer: Signature Care EPO |
$195.39
|
| Rate for Payer: Signature Care PPO |
$207.16
|
| Rate for Payer: United Healthcare Commercial |
$185.50
|
|
|
HC UROLIFT
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
41602497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.50 |
| Max. Negotiated Rate |
$3,264.30 |
| Rate for Payer: Aetna Commercial |
$3,032.64
|
| Rate for Payer: Cash Price |
$2,176.20
|
| Rate for Payer: Cigna All Commercial |
$3,029.13
|
| Rate for Payer: CORVEL All Commercial |
$3,264.30
|
| Rate for Payer: Coventry All Commercial |
$3,088.80
|
| Rate for Payer: Encore All Commercial |
$3,230.96
|
| Rate for Payer: Frontpath All Commercial |
$3,229.20
|
| Rate for Payer: Humana ChoiceCare |
$3,031.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,159.00
|
| Rate for Payer: PHCS All Commercial |
$2,632.50
|
| Rate for Payer: PHP All Commercial |
$2,661.98
|
| Rate for Payer: Sagamore Health Network All Products |
$2,709.72
|
| Rate for Payer: Signature Care EPO |
$2,913.30
|
| Rate for Payer: Signature Care PPO |
$3,088.80
|
| Rate for Payer: United Healthcare Commercial |
$2,765.88
|
|
|
HC UROLIFT
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
41602497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,264.30 |
| Rate for Payer: Aetna Commercial |
$2,962.44
|
| Rate for Payer: Aetna Medicare |
$1,158.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,158.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,015.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,194.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,332.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,274.13
|
| Rate for Payer: Cash Price |
$2,176.20
|
| Rate for Payer: Cash Price |
$2,176.20
|
| Rate for Payer: Centivo All Commercial |
$1,790.10
|
| Rate for Payer: Cigna All Commercial |
$3,029.13
|
| Rate for Payer: CORVEL All Commercial |
$3,264.30
|
| Rate for Payer: Coventry All Commercial |
$3,088.80
|
| Rate for Payer: Encore All Commercial |
$3,230.96
|
| Rate for Payer: Frontpath All Commercial |
$3,229.20
|
| Rate for Payer: Humana ChoiceCare |
$3,031.59
|
| Rate for Payer: Humana Medicare |
$1,790.10
|
| Rate for Payer: Lucent All Commercial |
$1,790.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,159.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,632.50
|
| Rate for Payer: PHP All Commercial |
$2,661.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,368.90
|
| Rate for Payer: Sagamore Health Network All Products |
$2,709.72
|
| Rate for Payer: Signature Care EPO |
$2,913.30
|
| Rate for Payer: Signature Care PPO |
$3,088.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,983.50
|
| Rate for Payer: United Healthcare Commercial |
$2,765.88
|
| Rate for Payer: United Healthcare Medicare |
$1,158.30
|
|
|
HC UROVYSION FISH
|
Facility
|
IP
|
$981.50
|
|
|
Service Code
|
CPT 88121
|
| Hospital Charge Code |
63002062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$736.12 |
| Max. Negotiated Rate |
$912.79 |
| Rate for Payer: Aetna Commercial |
$848.01
|
| Rate for Payer: Cash Price |
$608.53
|
| Rate for Payer: Cigna All Commercial |
$847.03
|
| Rate for Payer: CORVEL All Commercial |
$912.79
|
| Rate for Payer: Coventry All Commercial |
$863.72
|
| Rate for Payer: Encore All Commercial |
$903.47
|
| Rate for Payer: Frontpath All Commercial |
$902.98
|
| Rate for Payer: Humana ChoiceCare |
$847.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$883.35
|
| Rate for Payer: PHCS All Commercial |
$736.12
|
| Rate for Payer: PHP All Commercial |
$744.37
|
| Rate for Payer: Sagamore Health Network All Products |
$757.71
|
| Rate for Payer: Signature Care EPO |
$814.64
|
| Rate for Payer: Signature Care PPO |
$863.72
|
| Rate for Payer: United Healthcare Commercial |
$773.42
|
|
|
HC UROVYSION FISH
|
Facility
|
OP
|
$981.50
|
|
|
Service Code
|
CPT 88121
|
| Hospital Charge Code |
63002062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$220.04 |
| Max. Negotiated Rate |
$912.79 |
| Rate for Payer: Aetna Commercial |
$828.38
|
| Rate for Payer: Aetna Medicare |
$323.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$323.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$563.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$613.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$220.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$372.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$356.28
|
| Rate for Payer: Cash Price |
$608.53
|
| Rate for Payer: Cash Price |
$608.53
|
| Rate for Payer: Centivo All Commercial |
$500.56
|
| Rate for Payer: Cigna All Commercial |
$847.03
|
| Rate for Payer: CORVEL All Commercial |
$912.79
|
| Rate for Payer: Coventry All Commercial |
$863.72
|
| Rate for Payer: Encore All Commercial |
$903.47
|
| Rate for Payer: Frontpath All Commercial |
$902.98
|
| Rate for Payer: Humana ChoiceCare |
$847.72
|
| Rate for Payer: Humana Medicare |
$500.56
|
| Rate for Payer: Lucent All Commercial |
$500.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$883.35
|
| Rate for Payer: Managed Health Services Medicaid |
$220.04
|
| Rate for Payer: MDWise Medicaid |
$220.04
|
| Rate for Payer: PHCS All Commercial |
$736.12
|
| Rate for Payer: PHP All Commercial |
$744.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$382.78
|
| Rate for Payer: Sagamore Health Network All Products |
$757.71
|
| Rate for Payer: Signature Care EPO |
$814.64
|
| Rate for Payer: Signature Care PPO |
$863.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$834.27
|
| Rate for Payer: United Healthcare Commercial |
$773.42
|
| Rate for Payer: United Healthcare Medicare |
$323.89
|
|
|
HC U/S AAA SCREEN
|
Facility
|
OP
|
$652.90
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
01640389
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$607.20 |
| Rate for Payer: Aetna Commercial |
$551.05
|
| Rate for Payer: Aetna Medicare |
$215.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$215.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$374.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$408.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$439.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$247.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.00
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Centivo All Commercial |
$332.98
|
| Rate for Payer: Cigna All Commercial |
$563.45
|
| Rate for Payer: CORVEL All Commercial |
$607.20
|
| Rate for Payer: Coventry All Commercial |
$574.55
|
| Rate for Payer: Encore All Commercial |
$601.00
|
| Rate for Payer: Frontpath All Commercial |
$600.67
|
| Rate for Payer: Humana ChoiceCare |
$563.91
|
| Rate for Payer: Humana Medicare |
$332.98
|
| Rate for Payer: Lucent All Commercial |
$332.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$587.61
|
| Rate for Payer: Managed Health Services Medicaid |
$439.65
|
| Rate for Payer: MDWise Medicaid |
$439.65
|
| Rate for Payer: PHCS All Commercial |
$489.68
|
| Rate for Payer: PHP All Commercial |
$495.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$254.63
|
| Rate for Payer: Sagamore Health Network All Products |
$504.04
|
| Rate for Payer: Signature Care EPO |
$541.91
|
| Rate for Payer: Signature Care PPO |
$574.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$554.97
|
| Rate for Payer: United Healthcare Commercial |
$514.49
|
| Rate for Payer: United Healthcare Medicare |
$215.46
|
|
|
HC U/S AAA SCREEN
|
Facility
|
IP
|
$652.90
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
01640389
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$489.68 |
| Max. Negotiated Rate |
$607.20 |
| Rate for Payer: Aetna Commercial |
$564.11
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cigna All Commercial |
$563.45
|
| Rate for Payer: CORVEL All Commercial |
$607.20
|
| Rate for Payer: Coventry All Commercial |
$574.55
|
| Rate for Payer: Encore All Commercial |
$601.00
|
| Rate for Payer: Frontpath All Commercial |
$600.67
|
| Rate for Payer: Humana ChoiceCare |
$563.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$587.61
|
| Rate for Payer: PHCS All Commercial |
$489.68
|
| Rate for Payer: PHP All Commercial |
$495.16
|
| Rate for Payer: Sagamore Health Network All Products |
$504.04
|
| Rate for Payer: Signature Care EPO |
$541.91
|
| Rate for Payer: Signature Care PPO |
$574.55
|
| Rate for Payer: United Healthcare Commercial |
$514.49
|
|
|
HC U/S ABDOMEN COMPLETE
|
Facility
|
IP
|
$1,292.16
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
01646700
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$969.12 |
| Max. Negotiated Rate |
$1,201.71 |
| Rate for Payer: Aetna Commercial |
$1,116.42
|
| Rate for Payer: Cash Price |
$801.14
|
| Rate for Payer: Cigna All Commercial |
$1,115.13
|
| Rate for Payer: CORVEL All Commercial |
$1,201.71
|
| Rate for Payer: Coventry All Commercial |
$1,137.10
|
| Rate for Payer: Encore All Commercial |
$1,189.43
|
| Rate for Payer: Frontpath All Commercial |
$1,188.78
|
| Rate for Payer: Humana ChoiceCare |
$1,116.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,162.94
|
| Rate for Payer: PHCS All Commercial |
$969.12
|
| Rate for Payer: PHP All Commercial |
$979.97
|
| Rate for Payer: Sagamore Health Network All Products |
$997.54
|
| Rate for Payer: Signature Care EPO |
$1,072.49
|
| Rate for Payer: Signature Care PPO |
$1,137.10
|
| Rate for Payer: United Healthcare Commercial |
$1,018.22
|
|
|
HC U/S ABDOMEN COMPLETE
|
Facility
|
OP
|
$1,292.16
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
01646700
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$274.05 |
| Max. Negotiated Rate |
$1,201.71 |
| Rate for Payer: Aetna Commercial |
$1,090.58
|
| Rate for Payer: Aetna Medicare |
$426.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$426.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$742.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$807.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$274.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$490.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$469.05
|
| Rate for Payer: Cash Price |
$801.14
|
| Rate for Payer: Cash Price |
$801.14
|
| Rate for Payer: Centivo All Commercial |
$659.00
|
| Rate for Payer: Cigna All Commercial |
$1,115.13
|
| Rate for Payer: CORVEL All Commercial |
$1,201.71
|
| Rate for Payer: Coventry All Commercial |
$1,137.10
|
| Rate for Payer: Encore All Commercial |
$1,189.43
|
| Rate for Payer: Frontpath All Commercial |
$1,188.78
|
| Rate for Payer: Humana ChoiceCare |
$1,116.04
|
| Rate for Payer: Humana Medicare |
$659.00
|
| Rate for Payer: Lucent All Commercial |
$659.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,162.94
|
| Rate for Payer: Managed Health Services Medicaid |
$274.05
|
| Rate for Payer: MDWise Medicaid |
$274.05
|
| Rate for Payer: PHCS All Commercial |
$969.12
|
| Rate for Payer: PHP All Commercial |
$979.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$503.94
|
| Rate for Payer: Sagamore Health Network All Products |
$997.54
|
| Rate for Payer: Signature Care EPO |
$1,072.49
|
| Rate for Payer: Signature Care PPO |
$1,137.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,098.33
|
| Rate for Payer: United Healthcare Commercial |
$1,018.22
|
| Rate for Payer: United Healthcare Medicare |
$426.41
|
|
