|
HC 24 HR SODIUM
|
Facility
IP
|
$99.86
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
63001678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.89 |
| Max. Negotiated Rate |
$92.87 |
| Rate for Payer: Aetna Commercial |
$86.28
|
| Rate for Payer: Cash Price |
$61.91
|
| Rate for Payer: Cigna All Commercial |
$86.18
|
| Rate for Payer: CORVEL All Commercial |
$92.87
|
| Rate for Payer: Coventry All Commercial |
$87.88
|
| Rate for Payer: Encore All Commercial |
$91.92
|
| Rate for Payer: Frontpath All Commercial |
$91.87
|
| Rate for Payer: Humana ChoiceCare |
$86.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.87
|
| Rate for Payer: PHCS All Commercial |
$74.89
|
| Rate for Payer: PHP All Commercial |
$75.73
|
| Rate for Payer: Sagamore Health Network All Products |
$77.09
|
| Rate for Payer: Signature Care EPO |
$82.88
|
| Rate for Payer: Signature Care PPO |
$87.88
|
| Rate for Payer: United Healthcare Commercial |
$78.69
|
|
|
HC 2D&M-MODE W/SPCTRL & CF DPLR
|
Facility
OP
|
$3,326.64
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
00863306
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$788.70 |
| Max. Negotiated Rate |
$3,093.77 |
| Rate for Payer: Aetna Commercial |
$2,807.68
|
| Rate for Payer: Aetna Medicare |
$1,097.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,097.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,910.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,079.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,262.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,207.57
|
| Rate for Payer: Cash Price |
$2,062.52
|
| Rate for Payer: Cash Price |
$2,062.52
|
| Rate for Payer: Centivo All Commercial |
$1,696.59
|
| Rate for Payer: Cigna All Commercial |
$2,870.89
|
| Rate for Payer: CORVEL All Commercial |
$3,093.77
|
| Rate for Payer: Coventry All Commercial |
$2,927.44
|
| Rate for Payer: Encore All Commercial |
$3,062.17
|
| Rate for Payer: Frontpath All Commercial |
$3,060.51
|
| Rate for Payer: Humana ChoiceCare |
$2,873.22
|
| Rate for Payer: Humana Medicare |
$1,696.59
|
| Rate for Payer: Lucent All Commercial |
$1,696.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,993.97
|
| Rate for Payer: Managed Health Services Medicaid |
$788.70
|
| Rate for Payer: MDWise Medicaid |
$788.70
|
| Rate for Payer: PHCS All Commercial |
$2,494.98
|
| Rate for Payer: PHP All Commercial |
$2,522.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,297.39
|
| Rate for Payer: Sagamore Health Network All Products |
$2,568.16
|
| Rate for Payer: Signature Care EPO |
$2,761.11
|
| Rate for Payer: Signature Care PPO |
$2,927.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,827.64
|
| Rate for Payer: United Healthcare Commercial |
$2,621.39
|
| Rate for Payer: United Healthcare Medicare |
$1,097.79
|
|
|
HC 2D&M-MODE W/SPCTRL & CF DPLR
|
Facility
IP
|
$3,326.64
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
00863306
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,494.98 |
| Max. Negotiated Rate |
$3,093.77 |
| Rate for Payer: Aetna Commercial |
$2,874.22
|
| Rate for Payer: Cash Price |
$2,062.52
|
| Rate for Payer: Cigna All Commercial |
$2,870.89
|
| Rate for Payer: CORVEL All Commercial |
$3,093.77
|
| Rate for Payer: Coventry All Commercial |
$2,927.44
|
| Rate for Payer: Encore All Commercial |
$3,062.17
|
| Rate for Payer: Frontpath All Commercial |
$3,060.51
|
| Rate for Payer: Humana ChoiceCare |
$2,873.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,993.97
|
| Rate for Payer: PHCS All Commercial |
$2,494.98
|
| Rate for Payer: PHP All Commercial |
$2,522.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,568.16
|
| Rate for Payer: Signature Care EPO |
$2,761.11
|
| Rate for Payer: Signature Care PPO |
$2,927.44
|
| Rate for Payer: United Healthcare Commercial |
$2,621.39
|
|
|
HC 3D RENDER W/INTRP POSTPROCES ECHOCARDIOGRAPHY
|
Facility
OP
|
$774.54
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
00866376
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$720.32 |
| Rate for Payer: Aetna Commercial |
$653.71
|
| Rate for Payer: Aetna Medicare |
$255.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$255.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$444.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$484.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$50.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$293.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$281.16
|
| Rate for Payer: Cash Price |
$480.21
|
| Rate for Payer: Cash Price |
$480.21
|
| Rate for Payer: Centivo All Commercial |
$395.01
|
| Rate for Payer: Cigna All Commercial |
$668.43
|
| Rate for Payer: CORVEL All Commercial |
$720.32
|
| Rate for Payer: Coventry All Commercial |
$681.59
|
| Rate for Payer: Encore All Commercial |
$712.96
|
| Rate for Payer: Frontpath All Commercial |
$712.57
|
| Rate for Payer: Humana ChoiceCare |
$668.97
|
| Rate for Payer: Humana Medicare |
$395.01
|
| Rate for Payer: Lucent All Commercial |
$395.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.08
|
| Rate for Payer: Managed Health Services Medicaid |
$50.90
|
| Rate for Payer: MDWise Medicaid |
$50.90
|
| Rate for Payer: PHCS All Commercial |
$580.90
|
| Rate for Payer: PHP All Commercial |
$587.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$302.07
|
| Rate for Payer: Sagamore Health Network All Products |
$597.94
|
| Rate for Payer: Signature Care EPO |
$642.87
|
| Rate for Payer: Signature Care PPO |
$681.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$658.36
|
| Rate for Payer: United Healthcare Commercial |
$610.34
|
| Rate for Payer: United Healthcare Medicare |
$255.60
|
|
|
HC 3D RENDER W/INTRP POSTPROCES ECHOCARDIOGRAPHY
|
Facility
IP
|
$774.54
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
00866376
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$580.90 |
| Max. Negotiated Rate |
$720.32 |
| Rate for Payer: Aetna Commercial |
$669.20
|
| Rate for Payer: Cash Price |
$480.21
|
| Rate for Payer: Cigna All Commercial |
$668.43
|
| Rate for Payer: CORVEL All Commercial |
$720.32
|
| Rate for Payer: Coventry All Commercial |
$681.59
|
| Rate for Payer: Encore All Commercial |
$712.96
|
| Rate for Payer: Frontpath All Commercial |
$712.57
|
| Rate for Payer: Humana ChoiceCare |
$668.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.08
|
| Rate for Payer: PHCS All Commercial |
$580.90
|
| Rate for Payer: PHP All Commercial |
$587.41
|
| Rate for Payer: Sagamore Health Network All Products |
$597.94
|
| Rate for Payer: Signature Care EPO |
$642.87
|
| Rate for Payer: Signature Care PPO |
$681.59
|
| Rate for Payer: United Healthcare Commercial |
$610.34
|
|
|
HC 5 A DIHYDROTESTOSTERONE
|
Facility
IP
|
$290.24
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.68 |
| Max. Negotiated Rate |
$269.92 |
| Rate for Payer: Aetna Commercial |
$250.77
|
| Rate for Payer: Cash Price |
$179.95
|
| Rate for Payer: Cigna All Commercial |
$250.48
|
| Rate for Payer: CORVEL All Commercial |
$269.92
|
| Rate for Payer: Coventry All Commercial |
$255.41
|
| Rate for Payer: Encore All Commercial |
$267.17
|
| Rate for Payer: Frontpath All Commercial |
$267.02
|
| Rate for Payer: Humana ChoiceCare |
$250.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$261.22
|
| Rate for Payer: PHCS All Commercial |
$217.68
|
| Rate for Payer: PHP All Commercial |
$220.12
|
| Rate for Payer: Sagamore Health Network All Products |
$224.07
|
| Rate for Payer: Signature Care EPO |
$240.90
|
| Rate for Payer: Signature Care PPO |
$255.41
|
| Rate for Payer: United Healthcare Commercial |
$228.71
|
|
|
HC 5 A DIHYDROTESTOSTERONE
|
Facility
OP
|
$290.24
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$269.92 |
| Rate for Payer: Aetna Commercial |
$244.96
|
| Rate for Payer: Aetna Medicare |
$95.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$166.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$181.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.36
|
| Rate for Payer: Cash Price |
$179.95
|
| Rate for Payer: Cash Price |
$179.95
|
| Rate for Payer: Centivo All Commercial |
$148.02
|
| Rate for Payer: Cigna All Commercial |
$250.48
|
| Rate for Payer: CORVEL All Commercial |
$269.92
|
| Rate for Payer: Coventry All Commercial |
$255.41
|
| Rate for Payer: Encore All Commercial |
$267.17
|
| Rate for Payer: Frontpath All Commercial |
$267.02
|
| Rate for Payer: Humana ChoiceCare |
$250.68
|
| Rate for Payer: Humana Medicare |
$148.02
|
| Rate for Payer: Lucent All Commercial |
$148.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$261.22
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$217.68
|
| Rate for Payer: PHP All Commercial |
$220.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.19
|
| Rate for Payer: Sagamore Health Network All Products |
$224.07
|
| Rate for Payer: Signature Care EPO |
$240.90
|
| Rate for Payer: Signature Care PPO |
$255.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$246.70
|
| Rate for Payer: United Healthcare Commercial |
$228.71
|
| Rate for Payer: United Healthcare Medicare |
$95.78
|
|
|
HC 5-HIAA QL RANDOM UR
|
Facility
OP
|
$142.35
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63001022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Aetna Commercial |
$120.14
|
| Rate for Payer: Aetna Medicare |
$46.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$81.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.67
|
| Rate for Payer: Cash Price |
$88.26
|
| Rate for Payer: Cash Price |
$88.26
|
| Rate for Payer: Centivo All Commercial |
$72.60
|
| Rate for Payer: Cigna All Commercial |
$122.85
|
| Rate for Payer: CORVEL All Commercial |
$132.39
|
| Rate for Payer: Coventry All Commercial |
$125.27
|
| Rate for Payer: Encore All Commercial |
$131.03
|
| Rate for Payer: Frontpath All Commercial |
$130.96
|
| Rate for Payer: Humana ChoiceCare |
$122.95
|
| Rate for Payer: Humana Medicare |
$72.60
|
| Rate for Payer: Lucent All Commercial |
$72.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.12
|
| Rate for Payer: Managed Health Services Medicaid |
$12.90
|
| Rate for Payer: MDWise Medicaid |
$12.90
|
| Rate for Payer: PHCS All Commercial |
$106.76
|
| Rate for Payer: PHP All Commercial |
$107.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.52
|
| Rate for Payer: Sagamore Health Network All Products |
$109.90
|
| Rate for Payer: Signature Care EPO |
$118.15
|
| Rate for Payer: Signature Care PPO |
$125.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.00
|
| Rate for Payer: United Healthcare Commercial |
$112.17
|
| Rate for Payer: United Healthcare Medicare |
$46.98
|
|
|
HC 5-HIAA QL RANDOM UR
|
Facility
IP
|
$142.35
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63001022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.76 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Aetna Commercial |
$122.99
|
| Rate for Payer: Cash Price |
$88.26
|
| Rate for Payer: Cigna All Commercial |
$122.85
|
| Rate for Payer: CORVEL All Commercial |
$132.39
|
| Rate for Payer: Coventry All Commercial |
$125.27
|
| Rate for Payer: Encore All Commercial |
$131.03
|
| Rate for Payer: Frontpath All Commercial |
$130.96
|
| Rate for Payer: Humana ChoiceCare |
$122.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.12
|
| Rate for Payer: PHCS All Commercial |
$106.76
|
| Rate for Payer: PHP All Commercial |
$107.96
|
| Rate for Payer: Sagamore Health Network All Products |
$109.90
|
| Rate for Payer: Signature Care EPO |
$118.15
|
| Rate for Payer: Signature Care PPO |
$125.27
|
| Rate for Payer: United Healthcare Commercial |
$112.17
|
|
|
HC 5-HIAA QT UR
|
Facility
OP
|
$184.01
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63001573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$171.13 |
| Rate for Payer: Aetna Commercial |
$155.30
|
| Rate for Payer: Aetna Medicare |
$60.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.79
|
| Rate for Payer: Cash Price |
$114.09
|
| Rate for Payer: Cash Price |
$114.09
|
| Rate for Payer: Centivo All Commercial |
$93.84
|
| Rate for Payer: Cigna All Commercial |
$158.80
|
| Rate for Payer: CORVEL All Commercial |
$171.13
|
| Rate for Payer: Coventry All Commercial |
$161.93
|
| Rate for Payer: Encore All Commercial |
$169.38
|
| Rate for Payer: Frontpath All Commercial |
$169.29
|
| Rate for Payer: Humana ChoiceCare |
$158.93
|
| Rate for Payer: Humana Medicare |
$93.84
|
| Rate for Payer: Lucent All Commercial |
$93.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.61
|
| Rate for Payer: Managed Health Services Medicaid |
$12.90
|
| Rate for Payer: MDWise Medicaid |
$12.90
|
| Rate for Payer: PHCS All Commercial |
$138.01
|
| Rate for Payer: PHP All Commercial |
$139.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.76
|
| Rate for Payer: Sagamore Health Network All Products |
$142.05
|
| Rate for Payer: Signature Care EPO |
$152.73
|
| Rate for Payer: Signature Care PPO |
$161.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$156.41
|
| Rate for Payer: United Healthcare Commercial |
$145.00
|
| Rate for Payer: United Healthcare Medicare |
$60.72
|
|
|
HC 5-HIAA QT UR
|
Facility
IP
|
$184.01
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63001573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.01 |
| Max. Negotiated Rate |
$171.13 |
| Rate for Payer: Aetna Commercial |
$158.98
|
| Rate for Payer: Cash Price |
$114.09
|
| Rate for Payer: Cigna All Commercial |
$158.80
|
| Rate for Payer: CORVEL All Commercial |
$171.13
|
| Rate for Payer: Coventry All Commercial |
$161.93
|
| Rate for Payer: Encore All Commercial |
$169.38
|
| Rate for Payer: Frontpath All Commercial |
$169.29
|
| Rate for Payer: Humana ChoiceCare |
$158.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.61
|
| Rate for Payer: PHCS All Commercial |
$138.01
|
| Rate for Payer: PHP All Commercial |
$139.55
|
| Rate for Payer: Sagamore Health Network All Products |
$142.05
|
| Rate for Payer: Signature Care EPO |
$152.73
|
| Rate for Payer: Signature Care PPO |
$161.93
|
| Rate for Payer: United Healthcare Commercial |
$145.00
|
|
|
HC 5-HYDROXYINDOLEACETIC ACID (HIAA), QUANTITATIVE, RANDOM URINE (PEDIATRIC)
|
Facility
OP
|
$31.75
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$29.53 |
| Rate for Payer: Aetna Commercial |
$26.80
|
| Rate for Payer: Aetna Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Centivo All Commercial |
$16.19
|
| Rate for Payer: Cigna All Commercial |
$27.40
|
| Rate for Payer: CORVEL All Commercial |
$29.53
|
| Rate for Payer: Coventry All Commercial |
$27.94
|
| Rate for Payer: Encore All Commercial |
$29.23
|
| Rate for Payer: Frontpath All Commercial |
$29.21
|
| Rate for Payer: Humana ChoiceCare |
$27.42
|
| Rate for Payer: Humana Medicare |
$16.19
|
| Rate for Payer: Lucent All Commercial |
$16.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.58
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$23.81
|
| Rate for Payer: PHP All Commercial |
$24.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.38
|
| Rate for Payer: Sagamore Health Network All Products |
$24.51
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$27.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.99
|
| Rate for Payer: United Healthcare Commercial |
$25.02
|
| Rate for Payer: United Healthcare Medicare |
$10.48
|
|
|
HC 5-HYDROXYINDOLEACETIC ACID (HIAA), QUANTITATIVE, RANDOM URINE (PEDIATRIC)
|
Facility
IP
|
$31.75
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$29.53 |
| Rate for Payer: Aetna Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cigna All Commercial |
$27.40
|
| Rate for Payer: CORVEL All Commercial |
$29.53
|
| Rate for Payer: Coventry All Commercial |
$27.94
|
| Rate for Payer: Encore All Commercial |
$29.23
|
| Rate for Payer: Frontpath All Commercial |
$29.21
|
| Rate for Payer: Humana ChoiceCare |
$27.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.58
|
| Rate for Payer: PHCS All Commercial |
$23.81
|
| Rate for Payer: PHP All Commercial |
$24.08
|
| Rate for Payer: Sagamore Health Network All Products |
$24.51
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$27.94
|
| Rate for Payer: United Healthcare Commercial |
$25.02
|
|
|
HC 5-HYDROXYINDOLEACETIC ACID (HIAA), QUANTITATIVE, RANDOM URINE (PEDIATRIC)-B
|
Facility
OP
|
$31.74
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63044019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$29.52 |
| Rate for Payer: Aetna Commercial |
$26.79
|
| Rate for Payer: Aetna Medicare |
$10.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.52
|
| Rate for Payer: Cash Price |
$19.68
|
| Rate for Payer: Cash Price |
$19.68
|
| Rate for Payer: Centivo All Commercial |
$16.19
|
| Rate for Payer: Cigna All Commercial |
$27.39
|
| Rate for Payer: CORVEL All Commercial |
$29.52
|
| Rate for Payer: Coventry All Commercial |
$27.93
|
| Rate for Payer: Encore All Commercial |
$29.22
|
| Rate for Payer: Frontpath All Commercial |
$29.20
|
| Rate for Payer: Humana ChoiceCare |
$27.42
|
| Rate for Payer: Humana Medicare |
$16.19
|
| Rate for Payer: Lucent All Commercial |
$16.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.57
|
| Rate for Payer: Managed Health Services Medicaid |
$12.90
|
| Rate for Payer: MDWise Medicaid |
$12.90
|
| Rate for Payer: PHCS All Commercial |
$23.81
|
| Rate for Payer: PHP All Commercial |
$24.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.38
|
| Rate for Payer: Sagamore Health Network All Products |
$24.51
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$27.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.98
|
| Rate for Payer: United Healthcare Commercial |
$25.01
|
| Rate for Payer: United Healthcare Medicare |
$10.47
|
|
|
HC 5-HYDROXYINDOLEACETIC ACID (HIAA), QUANTITATIVE, RANDOM URINE (PEDIATRIC)-B
|
Facility
IP
|
$31.74
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63044019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$29.52 |
| Rate for Payer: Aetna Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$19.68
|
| Rate for Payer: Cigna All Commercial |
$27.39
|
| Rate for Payer: CORVEL All Commercial |
$29.52
|
| Rate for Payer: Coventry All Commercial |
$27.93
|
| Rate for Payer: Encore All Commercial |
$29.22
|
| Rate for Payer: Frontpath All Commercial |
$29.20
|
| Rate for Payer: Humana ChoiceCare |
$27.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.57
|
| Rate for Payer: PHCS All Commercial |
$23.81
|
| Rate for Payer: PHP All Commercial |
$24.07
|
| Rate for Payer: Sagamore Health Network All Products |
$24.51
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$27.93
|
| Rate for Payer: United Healthcare Commercial |
$25.01
|
|
|
HC ABD PARACENTESIS W/IMAGING
|
Facility
OP
|
$1,562.05
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
01599083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.48 |
| Max. Negotiated Rate |
$1,452.71 |
| Rate for Payer: Aetna Commercial |
$1,318.37
|
| Rate for Payer: Aetna Medicare |
$515.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$515.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$897.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$976.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,283.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$592.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$567.02
|
| Rate for Payer: Cash Price |
$968.47
|
| Rate for Payer: Cash Price |
$968.47
|
| Rate for Payer: Centivo All Commercial |
$796.64
|
| Rate for Payer: Cigna All Commercial |
$1,348.05
|
| Rate for Payer: CORVEL All Commercial |
$1,452.71
|
| Rate for Payer: Coventry All Commercial |
$1,374.60
|
| Rate for Payer: Encore All Commercial |
$1,437.87
|
| Rate for Payer: Frontpath All Commercial |
$1,437.08
|
| Rate for Payer: Humana ChoiceCare |
$1,349.14
|
| Rate for Payer: Humana Medicare |
$796.64
|
| Rate for Payer: Lucent All Commercial |
$796.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,405.84
|
| Rate for Payer: Managed Health Services Medicaid |
$1,283.57
|
| Rate for Payer: MDWise Medicaid |
$1,283.57
|
| Rate for Payer: PHCS All Commercial |
$1,171.54
|
| Rate for Payer: PHP All Commercial |
$1,184.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$609.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,205.90
|
| Rate for Payer: Signature Care EPO |
$1,296.50
|
| Rate for Payer: Signature Care PPO |
$1,374.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,327.74
|
| Rate for Payer: United Healthcare Commercial |
$1,230.89
|
| Rate for Payer: United Healthcare Medicare |
$515.48
|
|
|
HC ABD PARACENTESIS W/IMAGING
|
Facility
IP
|
$1,562.05
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
01599083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,171.54 |
| Max. Negotiated Rate |
$1,452.71 |
| Rate for Payer: Aetna Commercial |
$1,349.61
|
| Rate for Payer: Cash Price |
$968.47
|
| Rate for Payer: Cigna All Commercial |
$1,348.05
|
| Rate for Payer: CORVEL All Commercial |
$1,452.71
|
| Rate for Payer: Coventry All Commercial |
$1,374.60
|
| Rate for Payer: Encore All Commercial |
$1,437.87
|
| Rate for Payer: Frontpath All Commercial |
$1,437.08
|
| Rate for Payer: Humana ChoiceCare |
$1,349.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,405.84
|
| Rate for Payer: PHCS All Commercial |
$1,171.54
|
| Rate for Payer: PHP All Commercial |
$1,184.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,205.90
|
| Rate for Payer: Signature Care EPO |
$1,296.50
|
| Rate for Payer: Signature Care PPO |
$1,374.60
|
| Rate for Payer: United Healthcare Commercial |
$1,230.89
|
|
|
HC ABD PARACENTESIS W/IMAGING
|
Facility
OP
|
$1,562.05
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
01649083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.48 |
| Max. Negotiated Rate |
$1,452.71 |
| Rate for Payer: Aetna Commercial |
$1,318.37
|
| Rate for Payer: Aetna Medicare |
$515.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$515.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$897.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$976.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,283.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$592.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$567.02
|
| Rate for Payer: Cash Price |
$968.47
|
| Rate for Payer: Cash Price |
$968.47
|
| Rate for Payer: Centivo All Commercial |
$796.64
|
| Rate for Payer: Cigna All Commercial |
$1,348.05
|
| Rate for Payer: CORVEL All Commercial |
$1,452.71
|
| Rate for Payer: Coventry All Commercial |
$1,374.60
|
| Rate for Payer: Encore All Commercial |
$1,437.87
|
| Rate for Payer: Frontpath All Commercial |
$1,437.08
|
| Rate for Payer: Humana ChoiceCare |
$1,349.14
|
| Rate for Payer: Humana Medicare |
$796.64
|
| Rate for Payer: Lucent All Commercial |
$796.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,405.84
|
| Rate for Payer: Managed Health Services Medicaid |
$1,283.57
|
| Rate for Payer: MDWise Medicaid |
$1,283.57
|
| Rate for Payer: PHCS All Commercial |
$1,171.54
|
| Rate for Payer: PHP All Commercial |
$1,184.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$609.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,205.90
|
| Rate for Payer: Signature Care EPO |
$1,296.50
|
| Rate for Payer: Signature Care PPO |
$1,374.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,327.74
|
| Rate for Payer: United Healthcare Commercial |
$1,230.89
|
| Rate for Payer: United Healthcare Medicare |
$515.48
|
|
|
HC ABD PARACENTESIS W/IMAGING
|
Facility
IP
|
$1,562.05
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
01649083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,171.54 |
| Max. Negotiated Rate |
$1,452.71 |
| Rate for Payer: Aetna Commercial |
$1,349.61
|
| Rate for Payer: Cash Price |
$968.47
|
| Rate for Payer: Cigna All Commercial |
$1,348.05
|
| Rate for Payer: CORVEL All Commercial |
$1,452.71
|
| Rate for Payer: Coventry All Commercial |
$1,374.60
|
| Rate for Payer: Encore All Commercial |
$1,437.87
|
| Rate for Payer: Frontpath All Commercial |
$1,437.08
|
| Rate for Payer: Humana ChoiceCare |
$1,349.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,405.84
|
| Rate for Payer: PHCS All Commercial |
$1,171.54
|
| Rate for Payer: PHP All Commercial |
$1,184.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,205.90
|
| Rate for Payer: Signature Care EPO |
$1,296.50
|
| Rate for Payer: Signature Care PPO |
$1,374.60
|
| Rate for Payer: United Healthcare Commercial |
$1,230.89
|
|
|
HC ABG DRAW
|
Facility
IP
|
$98.47
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
01706485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Cash Price |
$61.05
|
| Rate for Payer: Cigna All Commercial |
$84.98
|
| Rate for Payer: CORVEL All Commercial |
$91.58
|
| Rate for Payer: Coventry All Commercial |
$86.65
|
| Rate for Payer: Encore All Commercial |
$90.64
|
| Rate for Payer: Frontpath All Commercial |
$90.59
|
| Rate for Payer: Humana ChoiceCare |
$85.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$73.85
|
| Rate for Payer: PHP All Commercial |
$74.68
|
| Rate for Payer: Sagamore Health Network All Products |
$76.02
|
| Rate for Payer: Signature Care EPO |
$81.73
|
| Rate for Payer: Signature Care PPO |
$86.65
|
| Rate for Payer: United Healthcare Commercial |
$77.59
|
|
|
HC ABG DRAW
|
Facility
OP
|
$98.47
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
01706485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$83.11
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.74
|
| Rate for Payer: Cash Price |
$61.05
|
| Rate for Payer: Centivo All Commercial |
$50.22
|
| Rate for Payer: Cigna All Commercial |
$84.98
|
| Rate for Payer: CORVEL All Commercial |
$91.58
|
| Rate for Payer: Coventry All Commercial |
$86.65
|
| Rate for Payer: Encore All Commercial |
$90.64
|
| Rate for Payer: Frontpath All Commercial |
$90.59
|
| Rate for Payer: Humana ChoiceCare |
$85.05
|
| Rate for Payer: Humana Medicare |
$50.22
|
| Rate for Payer: Lucent All Commercial |
$50.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$73.85
|
| Rate for Payer: PHP All Commercial |
$74.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.40
|
| Rate for Payer: Sagamore Health Network All Products |
$76.02
|
| Rate for Payer: Signature Care EPO |
$81.73
|
| Rate for Payer: Signature Care PPO |
$86.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$77.59
|
| Rate for Payer: United Healthcare Medicare |
$32.50
|
|
|
HC ABG DRAW RT
|
Facility
IP
|
$98.47
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
01706010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Cash Price |
$61.05
|
| Rate for Payer: Cigna All Commercial |
$84.98
|
| Rate for Payer: CORVEL All Commercial |
$91.58
|
| Rate for Payer: Coventry All Commercial |
$86.65
|
| Rate for Payer: Encore All Commercial |
$90.64
|
| Rate for Payer: Frontpath All Commercial |
$90.59
|
| Rate for Payer: Humana ChoiceCare |
$85.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$73.85
|
| Rate for Payer: PHP All Commercial |
$74.68
|
| Rate for Payer: Sagamore Health Network All Products |
$76.02
|
| Rate for Payer: Signature Care EPO |
$81.73
|
| Rate for Payer: Signature Care PPO |
$86.65
|
| Rate for Payer: United Healthcare Commercial |
$77.59
|
|
|
HC ABG DRAW RT
|
Facility
OP
|
$98.47
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
01706010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$83.11
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.74
|
| Rate for Payer: Cash Price |
$61.05
|
| Rate for Payer: Centivo All Commercial |
$50.22
|
| Rate for Payer: Cigna All Commercial |
$84.98
|
| Rate for Payer: CORVEL All Commercial |
$91.58
|
| Rate for Payer: Coventry All Commercial |
$86.65
|
| Rate for Payer: Encore All Commercial |
$90.64
|
| Rate for Payer: Frontpath All Commercial |
$90.59
|
| Rate for Payer: Humana ChoiceCare |
$85.05
|
| Rate for Payer: Humana Medicare |
$50.22
|
| Rate for Payer: Lucent All Commercial |
$50.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$73.85
|
| Rate for Payer: PHP All Commercial |
$74.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.40
|
| Rate for Payer: Sagamore Health Network All Products |
$76.02
|
| Rate for Payer: Signature Care EPO |
$81.73
|
| Rate for Payer: Signature Care PPO |
$86.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$77.59
|
| Rate for Payer: United Healthcare Medicare |
$32.50
|
|
|
HC AB ID
|
Facility
IP
|
$310.79
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
63001344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$289.04 |
| Rate for Payer: Aetna Commercial |
$268.53
|
| Rate for Payer: Cash Price |
$192.69
|
| Rate for Payer: Cigna All Commercial |
$268.22
|
| Rate for Payer: CORVEL All Commercial |
$289.04
|
| Rate for Payer: Coventry All Commercial |
$273.50
|
| Rate for Payer: Encore All Commercial |
$286.09
|
| Rate for Payer: Frontpath All Commercial |
$285.93
|
| Rate for Payer: Humana ChoiceCare |
$268.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.71
|
| Rate for Payer: PHCS All Commercial |
$233.10
|
| Rate for Payer: PHP All Commercial |
$235.71
|
| Rate for Payer: Sagamore Health Network All Products |
$239.93
|
| Rate for Payer: Signature Care EPO |
$257.96
|
| Rate for Payer: Signature Care PPO |
$273.50
|
| Rate for Payer: United Healthcare Commercial |
$244.91
|
|
|
HC AB ID
|
Facility
OP
|
$310.79
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
63001344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.56 |
| Max. Negotiated Rate |
$289.04 |
| Rate for Payer: Aetna Commercial |
$262.31
|
| Rate for Payer: Aetna Medicare |
$102.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$142.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$195.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.82
|
| Rate for Payer: Cash Price |
$192.69
|
| Rate for Payer: Cash Price |
$192.69
|
| Rate for Payer: Centivo All Commercial |
$158.50
|
| Rate for Payer: Cigna All Commercial |
$268.22
|
| Rate for Payer: CORVEL All Commercial |
$289.04
|
| Rate for Payer: Coventry All Commercial |
$273.50
|
| Rate for Payer: Encore All Commercial |
$286.09
|
| Rate for Payer: Frontpath All Commercial |
$285.93
|
| Rate for Payer: Humana ChoiceCare |
$268.43
|
| Rate for Payer: Humana Medicare |
$158.50
|
| Rate for Payer: Lucent All Commercial |
$158.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.71
|
| Rate for Payer: Managed Health Services Medicaid |
$195.00
|
| Rate for Payer: MDWise Medicaid |
$195.00
|
| Rate for Payer: PHCS All Commercial |
$233.10
|
| Rate for Payer: PHP All Commercial |
$235.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.21
|
| Rate for Payer: Sagamore Health Network All Products |
$239.93
|
| Rate for Payer: Signature Care EPO |
$257.96
|
| Rate for Payer: Signature Care PPO |
$273.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$264.17
|
| Rate for Payer: United Healthcare Commercial |
$244.91
|
| Rate for Payer: United Healthcare Medicare |
$102.56
|
|
