|
HC VITAMIN K
|
Facility
|
IP
|
$417.38
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
63001717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$388.17 |
| Rate for Payer: Aetna Commercial |
$360.62
|
| Rate for Payer: Cash Price |
$258.78
|
| Rate for Payer: Cigna All Commercial |
$360.20
|
| Rate for Payer: CORVEL All Commercial |
$388.17
|
| Rate for Payer: Coventry All Commercial |
$367.30
|
| Rate for Payer: Encore All Commercial |
$384.20
|
| Rate for Payer: Frontpath All Commercial |
$383.99
|
| Rate for Payer: Humana ChoiceCare |
$360.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.65
|
| Rate for Payer: PHCS All Commercial |
$313.04
|
| Rate for Payer: PHP All Commercial |
$316.54
|
| Rate for Payer: Sagamore Health Network All Products |
$322.22
|
| Rate for Payer: Signature Care EPO |
$346.43
|
| Rate for Payer: Signature Care PPO |
$367.30
|
| Rate for Payer: United Healthcare Commercial |
$328.90
|
|
|
HC VITAMIN K
|
Facility
|
OP
|
$417.38
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
63001717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$388.17 |
| Rate for Payer: Aetna Commercial |
$352.27
|
| Rate for Payer: Aetna Medicare |
$137.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$158.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.51
|
| Rate for Payer: Cash Price |
$258.78
|
| Rate for Payer: Cash Price |
$258.78
|
| Rate for Payer: Centivo All Commercial |
$212.87
|
| Rate for Payer: Cigna All Commercial |
$360.20
|
| Rate for Payer: CORVEL All Commercial |
$388.17
|
| Rate for Payer: Coventry All Commercial |
$367.30
|
| Rate for Payer: Encore All Commercial |
$384.20
|
| Rate for Payer: Frontpath All Commercial |
$383.99
|
| Rate for Payer: Humana ChoiceCare |
$360.49
|
| Rate for Payer: Humana Medicare |
$212.87
|
| Rate for Payer: Lucent All Commercial |
$212.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.65
|
| Rate for Payer: Managed Health Services Medicaid |
$13.72
|
| Rate for Payer: MDWise Medicaid |
$13.72
|
| Rate for Payer: PHCS All Commercial |
$313.04
|
| Rate for Payer: PHP All Commercial |
$316.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.78
|
| Rate for Payer: Sagamore Health Network All Products |
$322.22
|
| Rate for Payer: Signature Care EPO |
$346.43
|
| Rate for Payer: Signature Care PPO |
$367.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$354.78
|
| Rate for Payer: United Healthcare Commercial |
$328.90
|
| Rate for Payer: United Healthcare Medicare |
$137.74
|
|
|
HC VIT D 1 25
|
Facility
|
OP
|
$303.79
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
63001530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$282.52 |
| Rate for Payer: Aetna Commercial |
$256.40
|
| Rate for Payer: Aetna Medicare |
$100.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$139.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$38.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.27
|
| Rate for Payer: Cash Price |
$188.35
|
| Rate for Payer: Cash Price |
$188.35
|
| Rate for Payer: Centivo All Commercial |
$154.93
|
| Rate for Payer: Cigna All Commercial |
$262.17
|
| Rate for Payer: CORVEL All Commercial |
$282.52
|
| Rate for Payer: Coventry All Commercial |
$267.33
|
| Rate for Payer: Encore All Commercial |
$279.64
|
| Rate for Payer: Frontpath All Commercial |
$279.48
|
| Rate for Payer: Humana ChoiceCare |
$262.38
|
| Rate for Payer: Humana Medicare |
$154.93
|
| Rate for Payer: Lucent All Commercial |
$154.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.41
|
| Rate for Payer: Managed Health Services Medicaid |
$38.50
|
| Rate for Payer: MDWise Medicaid |
$38.50
|
| Rate for Payer: PHCS All Commercial |
$227.84
|
| Rate for Payer: PHP All Commercial |
$230.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.48
|
| Rate for Payer: Sagamore Health Network All Products |
$234.52
|
| Rate for Payer: Signature Care EPO |
$252.14
|
| Rate for Payer: Signature Care PPO |
$267.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$258.22
|
| Rate for Payer: United Healthcare Commercial |
$239.38
|
| Rate for Payer: United Healthcare Medicare |
$100.25
|
|
|
HC VIT D 1 25
|
Facility
|
IP
|
$303.79
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
63001530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$227.84 |
| Max. Negotiated Rate |
$282.52 |
| Rate for Payer: Aetna Commercial |
$262.47
|
| Rate for Payer: Cash Price |
$188.35
|
| Rate for Payer: Cigna All Commercial |
$262.17
|
| Rate for Payer: CORVEL All Commercial |
$282.52
|
| Rate for Payer: Coventry All Commercial |
$267.33
|
| Rate for Payer: Encore All Commercial |
$279.64
|
| Rate for Payer: Frontpath All Commercial |
$279.48
|
| Rate for Payer: Humana ChoiceCare |
$262.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.41
|
| Rate for Payer: PHCS All Commercial |
$227.84
|
| Rate for Payer: PHP All Commercial |
$230.39
|
| Rate for Payer: Sagamore Health Network All Products |
$234.52
|
| Rate for Payer: Signature Care EPO |
$252.14
|
| Rate for Payer: Signature Care PPO |
$267.33
|
| Rate for Payer: United Healthcare Commercial |
$239.38
|
|
|
HC VIT D 25 HYDROXYQ
|
Facility
|
IP
|
$225.59
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
63001126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$209.80 |
| Rate for Payer: Aetna Commercial |
$194.91
|
| Rate for Payer: Cash Price |
$139.87
|
| Rate for Payer: Cigna All Commercial |
$194.69
|
| Rate for Payer: CORVEL All Commercial |
$209.80
|
| Rate for Payer: Coventry All Commercial |
$198.52
|
| Rate for Payer: Encore All Commercial |
$207.66
|
| Rate for Payer: Frontpath All Commercial |
$207.55
|
| Rate for Payer: Humana ChoiceCare |
$194.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$203.03
|
| Rate for Payer: PHCS All Commercial |
$169.20
|
| Rate for Payer: PHP All Commercial |
$171.09
|
| Rate for Payer: Sagamore Health Network All Products |
$174.16
|
| Rate for Payer: Signature Care EPO |
$187.24
|
| Rate for Payer: Signature Care PPO |
$198.52
|
| Rate for Payer: United Healthcare Commercial |
$177.77
|
|
|
HC VIT D 25 HYDROXYQ
|
Facility
|
OP
|
$225.59
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
63001126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$209.80 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna Medicare |
$74.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$103.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$29.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.89
|
| Rate for Payer: Cash Price |
$139.87
|
| Rate for Payer: Cash Price |
$139.87
|
| Rate for Payer: Centivo All Commercial |
$115.05
|
| Rate for Payer: Cigna All Commercial |
$194.69
|
| Rate for Payer: CORVEL All Commercial |
$209.80
|
| Rate for Payer: Coventry All Commercial |
$198.52
|
| Rate for Payer: Encore All Commercial |
$207.66
|
| Rate for Payer: Frontpath All Commercial |
$207.55
|
| Rate for Payer: Humana ChoiceCare |
$194.85
|
| Rate for Payer: Humana Medicare |
$115.05
|
| Rate for Payer: Lucent All Commercial |
$115.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$203.03
|
| Rate for Payer: Managed Health Services Medicaid |
$29.60
|
| Rate for Payer: MDWise Medicaid |
$29.60
|
| Rate for Payer: PHCS All Commercial |
$169.20
|
| Rate for Payer: PHP All Commercial |
$171.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.98
|
| Rate for Payer: Sagamore Health Network All Products |
$174.16
|
| Rate for Payer: Signature Care EPO |
$187.24
|
| Rate for Payer: Signature Care PPO |
$198.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$191.75
|
| Rate for Payer: United Healthcare Commercial |
$177.77
|
| Rate for Payer: United Healthcare Medicare |
$74.45
|
|
|
HC VOIDING CYSTOGRAM
|
Facility
|
OP
|
$1,288.63
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
01614456
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$185.17 |
| Max. Negotiated Rate |
$1,198.42 |
| Rate for Payer: Aetna Commercial |
$1,087.60
|
| Rate for Payer: Aetna Medicare |
$425.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$425.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$740.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$805.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$185.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$489.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$467.77
|
| Rate for Payer: Cash Price |
$798.95
|
| Rate for Payer: Cash Price |
$798.95
|
| Rate for Payer: Centivo All Commercial |
$657.20
|
| Rate for Payer: Cigna All Commercial |
$1,112.09
|
| Rate for Payer: CORVEL All Commercial |
$1,198.42
|
| Rate for Payer: Coventry All Commercial |
$1,133.99
|
| Rate for Payer: Encore All Commercial |
$1,186.18
|
| Rate for Payer: Frontpath All Commercial |
$1,185.54
|
| Rate for Payer: Humana ChoiceCare |
$1,112.99
|
| Rate for Payer: Humana Medicare |
$657.20
|
| Rate for Payer: Lucent All Commercial |
$657.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,159.76
|
| Rate for Payer: Managed Health Services Medicaid |
$185.17
|
| Rate for Payer: MDWise Medicaid |
$185.17
|
| Rate for Payer: PHCS All Commercial |
$966.47
|
| Rate for Payer: PHP All Commercial |
$977.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$502.56
|
| Rate for Payer: Sagamore Health Network All Products |
$994.82
|
| Rate for Payer: Signature Care EPO |
$1,069.56
|
| Rate for Payer: Signature Care PPO |
$1,133.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,095.33
|
| Rate for Payer: United Healthcare Commercial |
$1,015.44
|
| Rate for Payer: United Healthcare Medicare |
$425.25
|
|
|
HC VOIDING CYSTOGRAM
|
Facility
|
IP
|
$1,288.63
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
01614456
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$966.47 |
| Max. Negotiated Rate |
$1,198.42 |
| Rate for Payer: Aetna Commercial |
$1,113.37
|
| Rate for Payer: Cash Price |
$798.95
|
| Rate for Payer: Cigna All Commercial |
$1,112.09
|
| Rate for Payer: CORVEL All Commercial |
$1,198.42
|
| Rate for Payer: Coventry All Commercial |
$1,133.99
|
| Rate for Payer: Encore All Commercial |
$1,186.18
|
| Rate for Payer: Frontpath All Commercial |
$1,185.54
|
| Rate for Payer: Humana ChoiceCare |
$1,112.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,159.76
|
| Rate for Payer: PHCS All Commercial |
$966.47
|
| Rate for Payer: PHP All Commercial |
$977.29
|
| Rate for Payer: Sagamore Health Network All Products |
$994.82
|
| Rate for Payer: Signature Care EPO |
$1,069.56
|
| Rate for Payer: Signature Care PPO |
$1,133.99
|
| Rate for Payer: United Healthcare Commercial |
$1,015.44
|
|
|
HC VON WILLEBRAND FACTOR AG
|
Facility
|
IP
|
$281.62
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
63001737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$211.22 |
| Max. Negotiated Rate |
$261.91 |
| Rate for Payer: Aetna Commercial |
$243.32
|
| Rate for Payer: Cash Price |
$174.61
|
| Rate for Payer: Cigna All Commercial |
$243.04
|
| Rate for Payer: CORVEL All Commercial |
$261.91
|
| Rate for Payer: Coventry All Commercial |
$247.83
|
| Rate for Payer: Encore All Commercial |
$259.23
|
| Rate for Payer: Frontpath All Commercial |
$259.09
|
| Rate for Payer: Humana ChoiceCare |
$243.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.46
|
| Rate for Payer: PHCS All Commercial |
$211.22
|
| Rate for Payer: PHP All Commercial |
$213.58
|
| Rate for Payer: Sagamore Health Network All Products |
$217.41
|
| Rate for Payer: Signature Care EPO |
$233.75
|
| Rate for Payer: Signature Care PPO |
$247.83
|
| Rate for Payer: United Healthcare Commercial |
$221.92
|
|
|
HC VON WILLEBRAND FACTOR AG
|
Facility
|
OP
|
$281.62
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
63001737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$261.91 |
| Rate for Payer: Aetna Commercial |
$237.69
|
| Rate for Payer: Aetna Medicare |
$92.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$161.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$176.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.23
|
| Rate for Payer: Cash Price |
$174.61
|
| Rate for Payer: Cash Price |
$174.61
|
| Rate for Payer: Centivo All Commercial |
$143.63
|
| Rate for Payer: Cigna All Commercial |
$243.04
|
| Rate for Payer: CORVEL All Commercial |
$261.91
|
| Rate for Payer: Coventry All Commercial |
$247.83
|
| Rate for Payer: Encore All Commercial |
$259.23
|
| Rate for Payer: Frontpath All Commercial |
$259.09
|
| Rate for Payer: Humana ChoiceCare |
$243.24
|
| Rate for Payer: Humana Medicare |
$143.63
|
| Rate for Payer: Lucent All Commercial |
$143.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.46
|
| Rate for Payer: Managed Health Services Medicaid |
$22.94
|
| Rate for Payer: MDWise Medicaid |
$22.94
|
| Rate for Payer: PHCS All Commercial |
$211.22
|
| Rate for Payer: PHP All Commercial |
$213.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.83
|
| Rate for Payer: Sagamore Health Network All Products |
$217.41
|
| Rate for Payer: Signature Care EPO |
$233.75
|
| Rate for Payer: Signature Care PPO |
$247.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.38
|
| Rate for Payer: United Healthcare Commercial |
$221.92
|
| Rate for Payer: United Healthcare Medicare |
$92.94
|
|
|
HC VP CANDIDA DNA DIR PROBE
|
Facility
|
IP
|
$46.72
|
|
|
Service Code
|
CPT 87480
|
| Hospital Charge Code |
63087804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$43.45 |
| Rate for Payer: Aetna Commercial |
$40.36
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cigna All Commercial |
$40.32
|
| Rate for Payer: CORVEL All Commercial |
$43.45
|
| Rate for Payer: Coventry All Commercial |
$41.11
|
| Rate for Payer: Encore All Commercial |
$43.00
|
| Rate for Payer: Frontpath All Commercial |
$42.98
|
| Rate for Payer: Humana ChoiceCare |
$40.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.04
|
| Rate for Payer: PHCS All Commercial |
$35.04
|
| Rate for Payer: PHP All Commercial |
$35.43
|
| Rate for Payer: Sagamore Health Network All Products |
$36.06
|
| Rate for Payer: Signature Care EPO |
$38.77
|
| Rate for Payer: Signature Care PPO |
$41.11
|
| Rate for Payer: United Healthcare Commercial |
$36.81
|
|
|
HC VP CANDIDA DNA DIR PROBE
|
Facility
|
OP
|
$46.72
|
|
|
Service Code
|
CPT 87480
|
| Hospital Charge Code |
63087804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$43.45 |
| Rate for Payer: Aetna Commercial |
$39.43
|
| Rate for Payer: Aetna Medicare |
$15.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.96
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Centivo All Commercial |
$23.83
|
| Rate for Payer: Cigna All Commercial |
$40.32
|
| Rate for Payer: CORVEL All Commercial |
$43.45
|
| Rate for Payer: Coventry All Commercial |
$41.11
|
| Rate for Payer: Encore All Commercial |
$43.00
|
| Rate for Payer: Frontpath All Commercial |
$42.98
|
| Rate for Payer: Humana ChoiceCare |
$40.35
|
| Rate for Payer: Humana Medicare |
$23.83
|
| Rate for Payer: Lucent All Commercial |
$23.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.04
|
| Rate for Payer: Managed Health Services Medicaid |
$20.05
|
| Rate for Payer: MDWise Medicaid |
$20.05
|
| Rate for Payer: PHCS All Commercial |
$35.04
|
| Rate for Payer: PHP All Commercial |
$35.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.22
|
| Rate for Payer: Sagamore Health Network All Products |
$36.06
|
| Rate for Payer: Signature Care EPO |
$38.77
|
| Rate for Payer: Signature Care PPO |
$41.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.71
|
| Rate for Payer: United Healthcare Commercial |
$36.81
|
| Rate for Payer: United Healthcare Medicare |
$15.42
|
|
|
HC VP GARDNER VAG DNA DIR PROBE
|
Facility
|
OP
|
$46.72
|
|
|
Service Code
|
CPT 87510
|
| Hospital Charge Code |
63087805
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$43.45 |
| Rate for Payer: Aetna Commercial |
$39.43
|
| Rate for Payer: Aetna Medicare |
$15.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.96
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Centivo All Commercial |
$23.83
|
| Rate for Payer: Cigna All Commercial |
$40.32
|
| Rate for Payer: CORVEL All Commercial |
$43.45
|
| Rate for Payer: Coventry All Commercial |
$41.11
|
| Rate for Payer: Encore All Commercial |
$43.00
|
| Rate for Payer: Frontpath All Commercial |
$42.98
|
| Rate for Payer: Humana ChoiceCare |
$40.35
|
| Rate for Payer: Humana Medicare |
$23.83
|
| Rate for Payer: Lucent All Commercial |
$23.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.04
|
| Rate for Payer: Managed Health Services Medicaid |
$20.05
|
| Rate for Payer: MDWise Medicaid |
$20.05
|
| Rate for Payer: PHCS All Commercial |
$35.04
|
| Rate for Payer: PHP All Commercial |
$35.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.22
|
| Rate for Payer: Sagamore Health Network All Products |
$36.06
|
| Rate for Payer: Signature Care EPO |
$38.77
|
| Rate for Payer: Signature Care PPO |
$41.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.71
|
| Rate for Payer: United Healthcare Commercial |
$36.81
|
| Rate for Payer: United Healthcare Medicare |
$15.42
|
|
|
HC VP GARDNER VAG DNA DIR PROBE
|
Facility
|
IP
|
$46.72
|
|
|
Service Code
|
CPT 87510
|
| Hospital Charge Code |
63087805
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$43.45 |
| Rate for Payer: Aetna Commercial |
$40.36
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cigna All Commercial |
$40.32
|
| Rate for Payer: CORVEL All Commercial |
$43.45
|
| Rate for Payer: Coventry All Commercial |
$41.11
|
| Rate for Payer: Encore All Commercial |
$43.00
|
| Rate for Payer: Frontpath All Commercial |
$42.98
|
| Rate for Payer: Humana ChoiceCare |
$40.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.04
|
| Rate for Payer: PHCS All Commercial |
$35.04
|
| Rate for Payer: PHP All Commercial |
$35.43
|
| Rate for Payer: Sagamore Health Network All Products |
$36.06
|
| Rate for Payer: Signature Care EPO |
$38.77
|
| Rate for Payer: Signature Care PPO |
$41.11
|
| Rate for Payer: United Healthcare Commercial |
$36.81
|
|
|
HC VP TRICHOMONAS VAGIN DIR PROBE
|
Facility
|
OP
|
$46.72
|
|
|
Service Code
|
CPT 87660
|
| Hospital Charge Code |
63087806
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$43.45 |
| Rate for Payer: Aetna Commercial |
$39.43
|
| Rate for Payer: Aetna Medicare |
$15.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.96
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Centivo All Commercial |
$23.83
|
| Rate for Payer: Cigna All Commercial |
$40.32
|
| Rate for Payer: CORVEL All Commercial |
$43.45
|
| Rate for Payer: Coventry All Commercial |
$41.11
|
| Rate for Payer: Encore All Commercial |
$43.00
|
| Rate for Payer: Frontpath All Commercial |
$42.98
|
| Rate for Payer: Humana ChoiceCare |
$40.35
|
| Rate for Payer: Humana Medicare |
$23.83
|
| Rate for Payer: Lucent All Commercial |
$23.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.04
|
| Rate for Payer: Managed Health Services Medicaid |
$20.05
|
| Rate for Payer: MDWise Medicaid |
$20.05
|
| Rate for Payer: PHCS All Commercial |
$35.04
|
| Rate for Payer: PHP All Commercial |
$35.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.22
|
| Rate for Payer: Sagamore Health Network All Products |
$36.06
|
| Rate for Payer: Signature Care EPO |
$38.77
|
| Rate for Payer: Signature Care PPO |
$41.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.71
|
| Rate for Payer: United Healthcare Commercial |
$36.81
|
| Rate for Payer: United Healthcare Medicare |
$15.42
|
|
|
HC VP TRICHOMONAS VAGIN DIR PROBE
|
Facility
|
IP
|
$46.72
|
|
|
Service Code
|
CPT 87660
|
| Hospital Charge Code |
63087806
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$43.45 |
| Rate for Payer: Aetna Commercial |
$40.36
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cigna All Commercial |
$40.32
|
| Rate for Payer: CORVEL All Commercial |
$43.45
|
| Rate for Payer: Coventry All Commercial |
$41.11
|
| Rate for Payer: Encore All Commercial |
$43.00
|
| Rate for Payer: Frontpath All Commercial |
$42.98
|
| Rate for Payer: Humana ChoiceCare |
$40.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.04
|
| Rate for Payer: PHCS All Commercial |
$35.04
|
| Rate for Payer: PHP All Commercial |
$35.43
|
| Rate for Payer: Sagamore Health Network All Products |
$36.06
|
| Rate for Payer: Signature Care EPO |
$38.77
|
| Rate for Payer: Signature Care PPO |
$41.11
|
| Rate for Payer: United Healthcare Commercial |
$36.81
|
|
|
HC W 10MM INST SET
|
Facility
|
IP
|
$1,375.00
|
|
| Hospital Charge Code |
41606543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.25 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$1,188.00
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna All Commercial |
$1,186.62
|
| Rate for Payer: CORVEL All Commercial |
$1,278.75
|
| Rate for Payer: Coventry All Commercial |
$1,210.00
|
| Rate for Payer: Encore All Commercial |
$1,265.69
|
| Rate for Payer: Frontpath All Commercial |
$1,265.00
|
| Rate for Payer: Humana ChoiceCare |
$1,187.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,237.50
|
| Rate for Payer: PHCS All Commercial |
$1,031.25
|
| Rate for Payer: PHP All Commercial |
$1,042.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,061.50
|
| Rate for Payer: Signature Care EPO |
$1,141.25
|
| Rate for Payer: Signature Care PPO |
$1,210.00
|
| Rate for Payer: United Healthcare Commercial |
$1,083.50
|
|
|
HC W 10MM INST SET
|
Facility
|
OP
|
$1,375.00
|
|
| Hospital Charge Code |
41606543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$1,160.50
|
| Rate for Payer: Aetna Medicare |
$453.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$453.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$789.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$859.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$521.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$499.12
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Centivo All Commercial |
$701.25
|
| Rate for Payer: Cigna All Commercial |
$1,186.62
|
| Rate for Payer: CORVEL All Commercial |
$1,278.75
|
| Rate for Payer: Coventry All Commercial |
$1,210.00
|
| Rate for Payer: Encore All Commercial |
$1,265.69
|
| Rate for Payer: Frontpath All Commercial |
$1,265.00
|
| Rate for Payer: Humana ChoiceCare |
$1,187.59
|
| Rate for Payer: Humana Medicare |
$701.25
|
| Rate for Payer: Lucent All Commercial |
$701.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,237.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,031.25
|
| Rate for Payer: PHP All Commercial |
$1,042.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$536.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,061.50
|
| Rate for Payer: Signature Care EPO |
$1,141.25
|
| Rate for Payer: Signature Care PPO |
$1,210.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,168.75
|
| Rate for Payer: United Healthcare Commercial |
$1,083.50
|
| Rate for Payer: United Healthcare Medicare |
$453.75
|
|
|
HC W ACSHLD AMNION 2X4 200UM
|
Facility
|
OP
|
$7,992.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,432.56 |
| Rate for Payer: Aetna Commercial |
$6,745.25
|
| Rate for Payer: Aetna Medicare |
$2,637.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,637.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,589.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,995.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,032.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,901.10
|
| Rate for Payer: Cash Price |
$4,955.04
|
| Rate for Payer: Cash Price |
$4,955.04
|
| Rate for Payer: Centivo All Commercial |
$4,075.92
|
| Rate for Payer: Cigna All Commercial |
$6,897.10
|
| Rate for Payer: CORVEL All Commercial |
$7,432.56
|
| Rate for Payer: Coventry All Commercial |
$7,032.96
|
| Rate for Payer: Encore All Commercial |
$7,356.64
|
| Rate for Payer: Frontpath All Commercial |
$7,352.64
|
| Rate for Payer: Humana ChoiceCare |
$6,902.69
|
| Rate for Payer: Humana Medicare |
$4,075.92
|
| Rate for Payer: Lucent All Commercial |
$4,075.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,192.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,994.00
|
| Rate for Payer: PHP All Commercial |
$6,061.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,116.88
|
| Rate for Payer: Sagamore Health Network All Products |
$6,169.82
|
| Rate for Payer: Signature Care EPO |
$6,633.36
|
| Rate for Payer: Signature Care PPO |
$7,032.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,793.20
|
| Rate for Payer: United Healthcare Commercial |
$6,297.70
|
| Rate for Payer: United Healthcare Medicare |
$2,637.36
|
|
|
HC W ACSHLD AMNION 2X4 200UM
|
Facility
|
IP
|
$7,992.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,994.00 |
| Max. Negotiated Rate |
$7,432.56 |
| Rate for Payer: Aetna Commercial |
$6,905.09
|
| Rate for Payer: Cash Price |
$4,955.04
|
| Rate for Payer: Cigna All Commercial |
$6,897.10
|
| Rate for Payer: CORVEL All Commercial |
$7,432.56
|
| Rate for Payer: Coventry All Commercial |
$7,032.96
|
| Rate for Payer: Encore All Commercial |
$7,356.64
|
| Rate for Payer: Frontpath All Commercial |
$7,352.64
|
| Rate for Payer: Humana ChoiceCare |
$6,902.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,192.80
|
| Rate for Payer: PHCS All Commercial |
$5,994.00
|
| Rate for Payer: PHP All Commercial |
$6,061.13
|
| Rate for Payer: Sagamore Health Network All Products |
$6,169.82
|
| Rate for Payer: Signature Care EPO |
$6,633.36
|
| Rate for Payer: Signature Care PPO |
$7,032.96
|
| Rate for Payer: United Healthcare Commercial |
$6,297.70
|
|
|
HC W ACSHLD AMNION 4X4 200UM
|
Facility
|
IP
|
$9,777.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,333.20 |
| Max. Negotiated Rate |
$9,093.17 |
| Rate for Payer: Aetna Commercial |
$8,447.85
|
| Rate for Payer: Cash Price |
$6,062.11
|
| Rate for Payer: Cigna All Commercial |
$8,438.07
|
| Rate for Payer: CORVEL All Commercial |
$9,093.17
|
| Rate for Payer: Coventry All Commercial |
$8,604.29
|
| Rate for Payer: Encore All Commercial |
$9,000.28
|
| Rate for Payer: Frontpath All Commercial |
$8,995.39
|
| Rate for Payer: Humana ChoiceCare |
$8,444.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,799.84
|
| Rate for Payer: PHCS All Commercial |
$7,333.20
|
| Rate for Payer: PHP All Commercial |
$7,415.33
|
| Rate for Payer: Sagamore Health Network All Products |
$7,548.31
|
| Rate for Payer: Signature Care EPO |
$8,115.41
|
| Rate for Payer: Signature Care PPO |
$8,604.29
|
| Rate for Payer: United Healthcare Commercial |
$7,704.75
|
|
|
HC W ACSHLD AMNION 4X4 200UM
|
Facility
|
OP
|
$9,777.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,093.17 |
| Rate for Payer: Aetna Commercial |
$8,252.29
|
| Rate for Payer: Aetna Medicare |
$3,226.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,226.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,615.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,111.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,710.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,549.27
|
| Rate for Payer: Cash Price |
$6,062.11
|
| Rate for Payer: Cash Price |
$6,062.11
|
| Rate for Payer: Centivo All Commercial |
$4,986.58
|
| Rate for Payer: Cigna All Commercial |
$8,438.07
|
| Rate for Payer: CORVEL All Commercial |
$9,093.17
|
| Rate for Payer: Coventry All Commercial |
$8,604.29
|
| Rate for Payer: Encore All Commercial |
$9,000.28
|
| Rate for Payer: Frontpath All Commercial |
$8,995.39
|
| Rate for Payer: Humana ChoiceCare |
$8,444.91
|
| Rate for Payer: Humana Medicare |
$4,986.58
|
| Rate for Payer: Lucent All Commercial |
$4,986.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,799.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,333.20
|
| Rate for Payer: PHP All Commercial |
$7,415.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,813.26
|
| Rate for Payer: Sagamore Health Network All Products |
$7,548.31
|
| Rate for Payer: Signature Care EPO |
$8,115.41
|
| Rate for Payer: Signature Care PPO |
$8,604.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,310.96
|
| Rate for Payer: United Healthcare Commercial |
$7,704.75
|
| Rate for Payer: United Healthcare Medicare |
$3,226.61
|
|
|
HC W ACSHLD AMNION 4X8 200UM
|
Facility
|
OP
|
$17,121.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$15,923.09 |
| Rate for Payer: Aetna Commercial |
$14,450.63
|
| Rate for Payer: Aetna Medicare |
$5,650.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,650.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9,832.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,702.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,497.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,215.14
|
| Rate for Payer: Cash Price |
$10,615.39
|
| Rate for Payer: Cash Price |
$10,615.39
|
| Rate for Payer: Centivo All Commercial |
$8,732.02
|
| Rate for Payer: Cigna All Commercial |
$14,775.94
|
| Rate for Payer: CORVEL All Commercial |
$15,923.09
|
| Rate for Payer: Coventry All Commercial |
$15,067.01
|
| Rate for Payer: Encore All Commercial |
$15,760.43
|
| Rate for Payer: Frontpath All Commercial |
$15,751.87
|
| Rate for Payer: Humana ChoiceCare |
$14,787.93
|
| Rate for Payer: Humana Medicare |
$8,732.02
|
| Rate for Payer: Lucent All Commercial |
$8,732.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15,409.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$12,841.20
|
| Rate for Payer: PHP All Commercial |
$12,985.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,677.42
|
| Rate for Payer: Sagamore Health Network All Products |
$13,217.88
|
| Rate for Payer: Signature Care EPO |
$14,210.93
|
| Rate for Payer: Signature Care PPO |
$15,067.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,553.36
|
| Rate for Payer: United Healthcare Commercial |
$13,491.82
|
| Rate for Payer: United Healthcare Medicare |
$5,650.13
|
|
|
HC W ACSHLD AMNION 4X8 200UM
|
Facility
|
IP
|
$17,121.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,841.20 |
| Max. Negotiated Rate |
$15,923.09 |
| Rate for Payer: Aetna Commercial |
$14,793.06
|
| Rate for Payer: Cash Price |
$10,615.39
|
| Rate for Payer: Cigna All Commercial |
$14,775.94
|
| Rate for Payer: CORVEL All Commercial |
$15,923.09
|
| Rate for Payer: Coventry All Commercial |
$15,067.01
|
| Rate for Payer: Encore All Commercial |
$15,760.43
|
| Rate for Payer: Frontpath All Commercial |
$15,751.87
|
| Rate for Payer: Humana ChoiceCare |
$14,787.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15,409.44
|
| Rate for Payer: PHCS All Commercial |
$12,841.20
|
| Rate for Payer: PHP All Commercial |
$12,985.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13,217.88
|
| Rate for Payer: Signature Care EPO |
$14,210.93
|
| Rate for Payer: Signature Care PPO |
$15,067.01
|
| Rate for Payer: United Healthcare Commercial |
$13,491.82
|
|
|
HC W ACSHLD CF AMNION 2.4 45UM
|
Facility
|
IP
|
$6,192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,644.00 |
| Max. Negotiated Rate |
$5,758.56 |
| Rate for Payer: Aetna Commercial |
$5,349.89
|
| Rate for Payer: Cash Price |
$3,839.04
|
| Rate for Payer: Cigna All Commercial |
$5,343.70
|
| Rate for Payer: CORVEL All Commercial |
$5,758.56
|
| Rate for Payer: Coventry All Commercial |
$5,448.96
|
| Rate for Payer: Encore All Commercial |
$5,699.74
|
| Rate for Payer: Frontpath All Commercial |
$5,696.64
|
| Rate for Payer: Humana ChoiceCare |
$5,348.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,572.80
|
| Rate for Payer: PHCS All Commercial |
$4,644.00
|
| Rate for Payer: PHP All Commercial |
$4,696.01
|
| Rate for Payer: Sagamore Health Network All Products |
$4,780.22
|
| Rate for Payer: Signature Care EPO |
$5,139.36
|
| Rate for Payer: Signature Care PPO |
$5,448.96
|
| Rate for Payer: United Healthcare Commercial |
$4,879.30
|
|
