|
HC ACID FAST CULTURE
|
Facility
IP
|
$215.94
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63001063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.96 |
| Max. Negotiated Rate |
$200.83 |
| Rate for Payer: Aetna Commercial |
$186.58
|
| Rate for Payer: Cash Price |
$133.89
|
| Rate for Payer: Cigna All Commercial |
$186.36
|
| Rate for Payer: CORVEL All Commercial |
$200.83
|
| Rate for Payer: Coventry All Commercial |
$190.03
|
| Rate for Payer: Encore All Commercial |
$198.78
|
| Rate for Payer: Frontpath All Commercial |
$198.67
|
| Rate for Payer: Humana ChoiceCare |
$186.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.35
|
| Rate for Payer: PHCS All Commercial |
$161.96
|
| Rate for Payer: PHP All Commercial |
$163.77
|
| Rate for Payer: Sagamore Health Network All Products |
$166.71
|
| Rate for Payer: Signature Care EPO |
$179.23
|
| Rate for Payer: Signature Care PPO |
$190.03
|
| Rate for Payer: United Healthcare Commercial |
$170.16
|
|
|
HC ACID FAST CULTURE-BLOOD & BONE MARROW
|
Facility
IP
|
$143.40
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63002006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.55 |
| Max. Negotiated Rate |
$133.36 |
| Rate for Payer: Aetna Commercial |
$123.90
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Cigna All Commercial |
$123.76
|
| Rate for Payer: CORVEL All Commercial |
$133.36
|
| Rate for Payer: Coventry All Commercial |
$126.19
|
| Rate for Payer: Encore All Commercial |
$132.00
|
| Rate for Payer: Frontpath All Commercial |
$131.93
|
| Rate for Payer: Humana ChoiceCare |
$123.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.06
|
| Rate for Payer: PHCS All Commercial |
$107.55
|
| Rate for Payer: PHP All Commercial |
$108.76
|
| Rate for Payer: Sagamore Health Network All Products |
$110.71
|
| Rate for Payer: Signature Care EPO |
$119.02
|
| Rate for Payer: Signature Care PPO |
$126.19
|
| Rate for Payer: United Healthcare Commercial |
$113.00
|
|
|
HC ACID FAST CULTURE-BLOOD & BONE MARROW
|
Facility
OP
|
$143.40
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63002006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$133.36 |
| Rate for Payer: Aetna Commercial |
$121.03
|
| Rate for Payer: Aetna Medicare |
$47.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.05
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Centivo All Commercial |
$73.13
|
| Rate for Payer: Cigna All Commercial |
$123.76
|
| Rate for Payer: CORVEL All Commercial |
$133.36
|
| Rate for Payer: Coventry All Commercial |
$126.19
|
| Rate for Payer: Encore All Commercial |
$132.00
|
| Rate for Payer: Frontpath All Commercial |
$131.93
|
| Rate for Payer: Humana ChoiceCare |
$123.86
|
| Rate for Payer: Humana Medicare |
$73.13
|
| Rate for Payer: Lucent All Commercial |
$73.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.06
|
| Rate for Payer: Managed Health Services Medicaid |
$10.80
|
| Rate for Payer: MDWise Medicaid |
$10.80
|
| Rate for Payer: PHCS All Commercial |
$107.55
|
| Rate for Payer: PHP All Commercial |
$108.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.93
|
| Rate for Payer: Sagamore Health Network All Products |
$110.71
|
| Rate for Payer: Signature Care EPO |
$119.02
|
| Rate for Payer: Signature Care PPO |
$126.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.89
|
| Rate for Payer: United Healthcare Commercial |
$113.00
|
| Rate for Payer: United Healthcare Medicare |
$47.32
|
|
|
HC ACID FAST CULTURE-FECES
|
Facility
OP
|
$143.40
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63002007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$133.36 |
| Rate for Payer: Aetna Commercial |
$121.03
|
| Rate for Payer: Aetna Medicare |
$47.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.05
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Centivo All Commercial |
$73.13
|
| Rate for Payer: Cigna All Commercial |
$123.76
|
| Rate for Payer: CORVEL All Commercial |
$133.36
|
| Rate for Payer: Coventry All Commercial |
$126.19
|
| Rate for Payer: Encore All Commercial |
$132.00
|
| Rate for Payer: Frontpath All Commercial |
$131.93
|
| Rate for Payer: Humana ChoiceCare |
$123.86
|
| Rate for Payer: Humana Medicare |
$73.13
|
| Rate for Payer: Lucent All Commercial |
$73.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.06
|
| Rate for Payer: Managed Health Services Medicaid |
$10.80
|
| Rate for Payer: MDWise Medicaid |
$10.80
|
| Rate for Payer: PHCS All Commercial |
$107.55
|
| Rate for Payer: PHP All Commercial |
$108.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.93
|
| Rate for Payer: Sagamore Health Network All Products |
$110.71
|
| Rate for Payer: Signature Care EPO |
$119.02
|
| Rate for Payer: Signature Care PPO |
$126.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.89
|
| Rate for Payer: United Healthcare Commercial |
$113.00
|
| Rate for Payer: United Healthcare Medicare |
$47.32
|
|
|
HC ACID FAST CULTURE-FECES
|
Facility
IP
|
$143.40
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63002007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.55 |
| Max. Negotiated Rate |
$133.36 |
| Rate for Payer: Aetna Commercial |
$123.90
|
| Rate for Payer: Cash Price |
$88.91
|
| Rate for Payer: Cigna All Commercial |
$123.76
|
| Rate for Payer: CORVEL All Commercial |
$133.36
|
| Rate for Payer: Coventry All Commercial |
$126.19
|
| Rate for Payer: Encore All Commercial |
$132.00
|
| Rate for Payer: Frontpath All Commercial |
$131.93
|
| Rate for Payer: Humana ChoiceCare |
$123.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.06
|
| Rate for Payer: PHCS All Commercial |
$107.55
|
| Rate for Payer: PHP All Commercial |
$108.76
|
| Rate for Payer: Sagamore Health Network All Products |
$110.71
|
| Rate for Payer: Signature Care EPO |
$119.02
|
| Rate for Payer: Signature Care PPO |
$126.19
|
| Rate for Payer: United Healthcare Commercial |
$113.00
|
|
|
HC ACID FAST ID-DNA SEQUENCE
|
Facility
OP
|
$64.23
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
63002008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$59.73 |
| Rate for Payer: Aetna Commercial |
$54.21
|
| Rate for Payer: Aetna Medicare |
$21.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.32
|
| Rate for Payer: Cash Price |
$39.82
|
| Rate for Payer: Cash Price |
$39.82
|
| Rate for Payer: Centivo All Commercial |
$32.76
|
| Rate for Payer: Cigna All Commercial |
$55.43
|
| Rate for Payer: CORVEL All Commercial |
$59.73
|
| Rate for Payer: Coventry All Commercial |
$56.52
|
| Rate for Payer: Encore All Commercial |
$59.12
|
| Rate for Payer: Frontpath All Commercial |
$59.09
|
| Rate for Payer: Humana ChoiceCare |
$55.47
|
| Rate for Payer: Humana Medicare |
$32.76
|
| Rate for Payer: Lucent All Commercial |
$32.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.81
|
| Rate for Payer: Managed Health Services Medicaid |
$14.61
|
| Rate for Payer: MDWise Medicaid |
$14.61
|
| Rate for Payer: PHCS All Commercial |
$48.17
|
| Rate for Payer: PHP All Commercial |
$48.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.05
|
| Rate for Payer: Sagamore Health Network All Products |
$49.59
|
| Rate for Payer: Signature Care EPO |
$53.31
|
| Rate for Payer: Signature Care PPO |
$56.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.59
|
| Rate for Payer: United Healthcare Commercial |
$50.61
|
| Rate for Payer: United Healthcare Medicare |
$21.20
|
|
|
HC ACID FAST ID-DNA SEQUENCE
|
Facility
IP
|
$64.23
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
63002008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.17 |
| Max. Negotiated Rate |
$59.73 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Cash Price |
$39.82
|
| Rate for Payer: Cigna All Commercial |
$55.43
|
| Rate for Payer: CORVEL All Commercial |
$59.73
|
| Rate for Payer: Coventry All Commercial |
$56.52
|
| Rate for Payer: Encore All Commercial |
$59.12
|
| Rate for Payer: Frontpath All Commercial |
$59.09
|
| Rate for Payer: Humana ChoiceCare |
$55.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.81
|
| Rate for Payer: PHCS All Commercial |
$48.17
|
| Rate for Payer: PHP All Commercial |
$48.71
|
| Rate for Payer: Sagamore Health Network All Products |
$49.59
|
| Rate for Payer: Signature Care EPO |
$53.31
|
| Rate for Payer: Signature Care PPO |
$56.52
|
| Rate for Payer: United Healthcare Commercial |
$50.61
|
|
|
HC ACID FAST MIC-BROTH DILUT
|
Facility
OP
|
$88.42
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
63002013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$82.23 |
| Rate for Payer: Aetna Commercial |
$74.63
|
| Rate for Payer: Aetna Medicare |
$29.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.10
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Centivo All Commercial |
$45.10
|
| Rate for Payer: Cigna All Commercial |
$76.31
|
| Rate for Payer: CORVEL All Commercial |
$82.23
|
| Rate for Payer: Coventry All Commercial |
$77.81
|
| Rate for Payer: Encore All Commercial |
$81.39
|
| Rate for Payer: Frontpath All Commercial |
$81.35
|
| Rate for Payer: Humana ChoiceCare |
$76.37
|
| Rate for Payer: Humana Medicare |
$45.10
|
| Rate for Payer: Lucent All Commercial |
$45.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.58
|
| Rate for Payer: Managed Health Services Medicaid |
$8.65
|
| Rate for Payer: MDWise Medicaid |
$8.65
|
| Rate for Payer: PHCS All Commercial |
$66.32
|
| Rate for Payer: PHP All Commercial |
$67.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.49
|
| Rate for Payer: Sagamore Health Network All Products |
$68.26
|
| Rate for Payer: Signature Care EPO |
$73.39
|
| Rate for Payer: Signature Care PPO |
$77.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75.16
|
| Rate for Payer: United Healthcare Commercial |
$69.68
|
| Rate for Payer: United Healthcare Medicare |
$29.18
|
|
|
HC ACID FAST MIC-BROTH DILUT
|
Facility
IP
|
$88.42
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
63002013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.32 |
| Max. Negotiated Rate |
$82.23 |
| Rate for Payer: Aetna Commercial |
$76.40
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cigna All Commercial |
$76.31
|
| Rate for Payer: CORVEL All Commercial |
$82.23
|
| Rate for Payer: Coventry All Commercial |
$77.81
|
| Rate for Payer: Encore All Commercial |
$81.39
|
| Rate for Payer: Frontpath All Commercial |
$81.35
|
| Rate for Payer: Humana ChoiceCare |
$76.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.58
|
| Rate for Payer: PHCS All Commercial |
$66.32
|
| Rate for Payer: PHP All Commercial |
$67.06
|
| Rate for Payer: Sagamore Health Network All Products |
$68.26
|
| Rate for Payer: Signature Care EPO |
$73.39
|
| Rate for Payer: Signature Care PPO |
$77.81
|
| Rate for Payer: United Healthcare Commercial |
$69.68
|
|
|
HC ACID FAST SMEAR
|
Facility
OP
|
$72.44
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
63001064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$67.37 |
| Rate for Payer: Aetna Commercial |
$61.14
|
| Rate for Payer: Aetna Medicare |
$23.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.30
|
| Rate for Payer: Cash Price |
$44.91
|
| Rate for Payer: Cash Price |
$44.91
|
| Rate for Payer: Centivo All Commercial |
$36.94
|
| Rate for Payer: Cigna All Commercial |
$62.52
|
| Rate for Payer: CORVEL All Commercial |
$67.37
|
| Rate for Payer: Coventry All Commercial |
$63.75
|
| Rate for Payer: Encore All Commercial |
$66.68
|
| Rate for Payer: Frontpath All Commercial |
$66.65
|
| Rate for Payer: Humana ChoiceCare |
$62.57
|
| Rate for Payer: Humana Medicare |
$36.94
|
| Rate for Payer: Lucent All Commercial |
$36.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.20
|
| Rate for Payer: Managed Health Services Medicaid |
$5.39
|
| Rate for Payer: MDWise Medicaid |
$5.39
|
| Rate for Payer: PHCS All Commercial |
$54.33
|
| Rate for Payer: PHP All Commercial |
$54.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.25
|
| Rate for Payer: Sagamore Health Network All Products |
$55.92
|
| Rate for Payer: Signature Care EPO |
$60.13
|
| Rate for Payer: Signature Care PPO |
$63.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.57
|
| Rate for Payer: United Healthcare Commercial |
$57.08
|
| Rate for Payer: United Healthcare Medicare |
$23.91
|
|
|
HC ACID FAST SMEAR
|
Facility
IP
|
$72.44
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
63001064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$67.37 |
| Rate for Payer: Aetna Commercial |
$62.59
|
| Rate for Payer: Cash Price |
$44.91
|
| Rate for Payer: Cigna All Commercial |
$62.52
|
| Rate for Payer: CORVEL All Commercial |
$67.37
|
| Rate for Payer: Coventry All Commercial |
$63.75
|
| Rate for Payer: Encore All Commercial |
$66.68
|
| Rate for Payer: Frontpath All Commercial |
$66.65
|
| Rate for Payer: Humana ChoiceCare |
$62.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.20
|
| Rate for Payer: PHCS All Commercial |
$54.33
|
| Rate for Payer: PHP All Commercial |
$54.94
|
| Rate for Payer: Sagamore Health Network All Products |
$55.92
|
| Rate for Payer: Signature Care EPO |
$60.13
|
| Rate for Payer: Signature Care PPO |
$63.75
|
| Rate for Payer: United Healthcare Commercial |
$57.08
|
|
|
HC ACID PHOS
|
Facility
OP
|
$95.74
|
|
|
Service Code
|
CPT 84060
|
| Hospital Charge Code |
63001654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$89.04 |
| Rate for Payer: Aetna Commercial |
$80.80
|
| Rate for Payer: Aetna Medicare |
$31.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.75
|
| Rate for Payer: Cash Price |
$59.36
|
| Rate for Payer: Cash Price |
$59.36
|
| Rate for Payer: Centivo All Commercial |
$48.83
|
| Rate for Payer: Cigna All Commercial |
$82.62
|
| Rate for Payer: CORVEL All Commercial |
$89.04
|
| Rate for Payer: Coventry All Commercial |
$84.25
|
| Rate for Payer: Encore All Commercial |
$88.13
|
| Rate for Payer: Frontpath All Commercial |
$88.08
|
| Rate for Payer: Humana ChoiceCare |
$82.69
|
| Rate for Payer: Humana Medicare |
$48.83
|
| Rate for Payer: Lucent All Commercial |
$48.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.16
|
| Rate for Payer: Managed Health Services Medicaid |
$7.64
|
| Rate for Payer: MDWise Medicaid |
$7.64
|
| Rate for Payer: PHCS All Commercial |
$71.80
|
| Rate for Payer: PHP All Commercial |
$72.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.34
|
| Rate for Payer: Sagamore Health Network All Products |
$73.91
|
| Rate for Payer: Signature Care EPO |
$79.46
|
| Rate for Payer: Signature Care PPO |
$84.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.38
|
| Rate for Payer: United Healthcare Commercial |
$75.44
|
| Rate for Payer: United Healthcare Medicare |
$31.59
|
|
|
HC ACID PHOS
|
Facility
IP
|
$95.74
|
|
|
Service Code
|
CPT 84060
|
| Hospital Charge Code |
63001654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$89.04 |
| Rate for Payer: Aetna Commercial |
$82.72
|
| Rate for Payer: Cash Price |
$59.36
|
| Rate for Payer: Cigna All Commercial |
$82.62
|
| Rate for Payer: CORVEL All Commercial |
$89.04
|
| Rate for Payer: Coventry All Commercial |
$84.25
|
| Rate for Payer: Encore All Commercial |
$88.13
|
| Rate for Payer: Frontpath All Commercial |
$88.08
|
| Rate for Payer: Humana ChoiceCare |
$82.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.16
|
| Rate for Payer: PHCS All Commercial |
$71.80
|
| Rate for Payer: PHP All Commercial |
$72.61
|
| Rate for Payer: Sagamore Health Network All Products |
$73.91
|
| Rate for Payer: Signature Care EPO |
$79.46
|
| Rate for Payer: Signature Care PPO |
$84.25
|
| Rate for Payer: United Healthcare Commercial |
$75.44
|
|
|
HC ACID PHOS PROS
|
Facility
OP
|
$55.55
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
63001656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$51.66 |
| Rate for Payer: Aetna Commercial |
$46.88
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.16
|
| Rate for Payer: Cash Price |
$34.44
|
| Rate for Payer: Cash Price |
$34.44
|
| Rate for Payer: Centivo All Commercial |
$28.33
|
| Rate for Payer: Cigna All Commercial |
$47.94
|
| Rate for Payer: CORVEL All Commercial |
$51.66
|
| Rate for Payer: Coventry All Commercial |
$48.88
|
| Rate for Payer: Encore All Commercial |
$51.13
|
| Rate for Payer: Frontpath All Commercial |
$51.11
|
| Rate for Payer: Humana ChoiceCare |
$47.98
|
| Rate for Payer: Humana Medicare |
$28.33
|
| Rate for Payer: Lucent All Commercial |
$28.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.99
|
| Rate for Payer: Managed Health Services Medicaid |
$9.66
|
| Rate for Payer: MDWise Medicaid |
$9.66
|
| Rate for Payer: PHCS All Commercial |
$41.66
|
| Rate for Payer: PHP All Commercial |
$42.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.66
|
| Rate for Payer: Sagamore Health Network All Products |
$42.88
|
| Rate for Payer: Signature Care EPO |
$46.11
|
| Rate for Payer: Signature Care PPO |
$48.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.22
|
| Rate for Payer: United Healthcare Commercial |
$43.77
|
| Rate for Payer: United Healthcare Medicare |
$18.33
|
|
|
HC ACID PHOS PROS
|
Facility
IP
|
$55.55
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
63001656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$51.66 |
| Rate for Payer: Aetna Commercial |
$47.99
|
| Rate for Payer: Cash Price |
$34.44
|
| Rate for Payer: Cigna All Commercial |
$47.94
|
| Rate for Payer: CORVEL All Commercial |
$51.66
|
| Rate for Payer: Coventry All Commercial |
$48.88
|
| Rate for Payer: Encore All Commercial |
$51.13
|
| Rate for Payer: Frontpath All Commercial |
$51.11
|
| Rate for Payer: Humana ChoiceCare |
$47.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.99
|
| Rate for Payer: PHCS All Commercial |
$41.66
|
| Rate for Payer: PHP All Commercial |
$42.13
|
| Rate for Payer: Sagamore Health Network All Products |
$42.88
|
| Rate for Payer: Signature Care EPO |
$46.11
|
| Rate for Payer: Signature Care PPO |
$48.88
|
| Rate for Payer: United Healthcare Commercial |
$43.77
|
|
|
HC ACTH
|
Facility
OP
|
$400.74
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
63001448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$372.69 |
| Rate for Payer: Aetna Commercial |
$338.22
|
| Rate for Payer: Aetna Medicare |
$132.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$230.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$250.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$38.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$145.47
|
| Rate for Payer: Cash Price |
$248.46
|
| Rate for Payer: Cash Price |
$248.46
|
| Rate for Payer: Centivo All Commercial |
$204.38
|
| Rate for Payer: Cigna All Commercial |
$345.84
|
| Rate for Payer: CORVEL All Commercial |
$372.69
|
| Rate for Payer: Coventry All Commercial |
$352.65
|
| Rate for Payer: Encore All Commercial |
$368.88
|
| Rate for Payer: Frontpath All Commercial |
$368.68
|
| Rate for Payer: Humana ChoiceCare |
$346.12
|
| Rate for Payer: Humana Medicare |
$204.38
|
| Rate for Payer: Lucent All Commercial |
$204.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$360.66
|
| Rate for Payer: Managed Health Services Medicaid |
$38.62
|
| Rate for Payer: MDWise Medicaid |
$38.62
|
| Rate for Payer: PHCS All Commercial |
$300.55
|
| Rate for Payer: PHP All Commercial |
$303.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.29
|
| Rate for Payer: Sagamore Health Network All Products |
$309.37
|
| Rate for Payer: Signature Care EPO |
$332.61
|
| Rate for Payer: Signature Care PPO |
$352.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$340.63
|
| Rate for Payer: United Healthcare Commercial |
$315.78
|
| Rate for Payer: United Healthcare Medicare |
$132.24
|
|
|
HC ACTH
|
Facility
IP
|
$400.74
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
63001448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$300.55 |
| Max. Negotiated Rate |
$372.69 |
| Rate for Payer: Aetna Commercial |
$346.24
|
| Rate for Payer: Cash Price |
$248.46
|
| Rate for Payer: Cigna All Commercial |
$345.84
|
| Rate for Payer: CORVEL All Commercial |
$372.69
|
| Rate for Payer: Coventry All Commercial |
$352.65
|
| Rate for Payer: Encore All Commercial |
$368.88
|
| Rate for Payer: Frontpath All Commercial |
$368.68
|
| Rate for Payer: Humana ChoiceCare |
$346.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$360.66
|
| Rate for Payer: PHCS All Commercial |
$300.55
|
| Rate for Payer: PHP All Commercial |
$303.92
|
| Rate for Payer: Sagamore Health Network All Products |
$309.37
|
| Rate for Payer: Signature Care EPO |
$332.61
|
| Rate for Payer: Signature Care PPO |
$352.65
|
| Rate for Payer: United Healthcare Commercial |
$315.78
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
OP
|
$309.87
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
63001734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna Commercial |
$261.53
|
| Rate for Payer: Aetna Medicare |
$102.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$177.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.48
|
| Rate for Payer: Cash Price |
$192.12
|
| Rate for Payer: Cash Price |
$192.12
|
| Rate for Payer: Centivo All Commercial |
$158.03
|
| Rate for Payer: Cigna All Commercial |
$267.41
|
| Rate for Payer: CORVEL All Commercial |
$288.18
|
| Rate for Payer: Coventry All Commercial |
$272.68
|
| Rate for Payer: Encore All Commercial |
$285.23
|
| Rate for Payer: Frontpath All Commercial |
$285.08
|
| Rate for Payer: Humana ChoiceCare |
$267.63
|
| Rate for Payer: Humana Medicare |
$158.03
|
| Rate for Payer: Lucent All Commercial |
$158.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.88
|
| Rate for Payer: Managed Health Services Medicaid |
$17.90
|
| Rate for Payer: MDWise Medicaid |
$17.90
|
| Rate for Payer: PHCS All Commercial |
$232.40
|
| Rate for Payer: PHP All Commercial |
$235.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$120.85
|
| Rate for Payer: Sagamore Health Network All Products |
$239.22
|
| Rate for Payer: Signature Care EPO |
$257.19
|
| Rate for Payer: Signature Care PPO |
$272.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$263.39
|
| Rate for Payer: United Healthcare Commercial |
$244.17
|
| Rate for Payer: United Healthcare Medicare |
$102.26
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
IP
|
$309.87
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
63001734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna Commercial |
$267.72
|
| Rate for Payer: Cash Price |
$192.12
|
| Rate for Payer: Cigna All Commercial |
$267.41
|
| Rate for Payer: CORVEL All Commercial |
$288.18
|
| Rate for Payer: Coventry All Commercial |
$272.68
|
| Rate for Payer: Encore All Commercial |
$285.23
|
| Rate for Payer: Frontpath All Commercial |
$285.08
|
| Rate for Payer: Humana ChoiceCare |
$267.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.88
|
| Rate for Payer: PHCS All Commercial |
$232.40
|
| Rate for Payer: PHP All Commercial |
$235.00
|
| Rate for Payer: Sagamore Health Network All Products |
$239.22
|
| Rate for Payer: Signature Care EPO |
$257.19
|
| Rate for Payer: Signature Care PPO |
$272.68
|
| Rate for Payer: United Healthcare Commercial |
$244.17
|
|
|
HC ACU .035 X 5.75 ST GUIDE WIRE
|
Facility
OP
|
$168.00
|
|
| Hospital Charge Code |
41603242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$156.24 |
| Rate for Payer: Aetna Commercial |
$141.79
|
| Rate for Payer: Aetna Medicare |
$55.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.98
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Centivo All Commercial |
$85.68
|
| Rate for Payer: Cigna All Commercial |
$144.98
|
| Rate for Payer: CORVEL All Commercial |
$156.24
|
| Rate for Payer: Coventry All Commercial |
$147.84
|
| Rate for Payer: Encore All Commercial |
$154.64
|
| Rate for Payer: Frontpath All Commercial |
$154.56
|
| Rate for Payer: Humana ChoiceCare |
$145.10
|
| Rate for Payer: Humana Medicare |
$85.68
|
| Rate for Payer: Lucent All Commercial |
$85.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$126.00
|
| Rate for Payer: PHP All Commercial |
$127.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.52
|
| Rate for Payer: Sagamore Health Network All Products |
$129.70
|
| Rate for Payer: Signature Care EPO |
$139.44
|
| Rate for Payer: Signature Care PPO |
$147.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.80
|
| Rate for Payer: United Healthcare Commercial |
$132.38
|
| Rate for Payer: United Healthcare Medicare |
$55.44
|
|
|
HC ACU .035 X 5.75 ST GUIDE WIRE
|
Facility
IP
|
$168.00
|
|
| Hospital Charge Code |
41603242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$156.24 |
| Rate for Payer: Aetna Commercial |
$145.15
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cigna All Commercial |
$144.98
|
| Rate for Payer: CORVEL All Commercial |
$156.24
|
| Rate for Payer: Coventry All Commercial |
$147.84
|
| Rate for Payer: Encore All Commercial |
$154.64
|
| Rate for Payer: Frontpath All Commercial |
$154.56
|
| Rate for Payer: Humana ChoiceCare |
$145.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.20
|
| Rate for Payer: PHCS All Commercial |
$126.00
|
| Rate for Payer: PHP All Commercial |
$127.41
|
| Rate for Payer: Sagamore Health Network All Products |
$129.70
|
| Rate for Payer: Signature Care EPO |
$139.44
|
| Rate for Payer: Signature Care PPO |
$147.84
|
| Rate for Payer: United Healthcare Commercial |
$132.38
|
|
|
HC ACU .035X5.75 ST GUIDE WIRE
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
41602632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$295.40
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.05
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Centivo All Commercial |
$178.50
|
| Rate for Payer: Cigna All Commercial |
$302.05
|
| Rate for Payer: CORVEL All Commercial |
$325.50
|
| Rate for Payer: Coventry All Commercial |
$308.00
|
| Rate for Payer: Encore All Commercial |
$322.18
|
| Rate for Payer: Frontpath All Commercial |
$322.00
|
| Rate for Payer: Humana ChoiceCare |
$302.30
|
| Rate for Payer: Humana Medicare |
$178.50
|
| Rate for Payer: Lucent All Commercial |
$178.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: PHP All Commercial |
$265.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.50
|
| Rate for Payer: Sagamore Health Network All Products |
$270.20
|
| Rate for Payer: Signature Care EPO |
$290.50
|
| Rate for Payer: Signature Care PPO |
$308.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.50
|
| Rate for Payer: United Healthcare Commercial |
$275.80
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
|
|
HC ACU .035X5.75 ST GUIDE WIRE
|
Facility
IP
|
$350.00
|
|
| Hospital Charge Code |
41602632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna All Commercial |
$302.05
|
| Rate for Payer: CORVEL All Commercial |
$325.50
|
| Rate for Payer: Coventry All Commercial |
$308.00
|
| Rate for Payer: Encore All Commercial |
$322.18
|
| Rate for Payer: Frontpath All Commercial |
$322.00
|
| Rate for Payer: Humana ChoiceCare |
$302.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: PHP All Commercial |
$265.44
|
| Rate for Payer: Sagamore Health Network All Products |
$270.20
|
| Rate for Payer: Signature Care EPO |
$290.50
|
| Rate for Payer: Signature Care PPO |
$308.00
|
| Rate for Payer: United Healthcare Commercial |
$275.80
|
|
|
HC ACU .040" PLATE TACK
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.13 |
| Max. Negotiated Rate |
$800.73 |
| Rate for Payer: Aetna Commercial |
$726.68
|
| Rate for Payer: Aetna Medicare |
$284.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$284.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$494.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$538.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$326.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$312.54
|
| Rate for Payer: Cash Price |
$533.82
|
| Rate for Payer: Cash Price |
$533.82
|
| Rate for Payer: Centivo All Commercial |
$439.11
|
| Rate for Payer: Cigna All Commercial |
$743.04
|
| Rate for Payer: CORVEL All Commercial |
$800.73
|
| Rate for Payer: Coventry All Commercial |
$757.68
|
| Rate for Payer: Encore All Commercial |
$792.55
|
| Rate for Payer: Frontpath All Commercial |
$792.12
|
| Rate for Payer: Humana ChoiceCare |
$743.65
|
| Rate for Payer: Humana Medicare |
$439.11
|
| Rate for Payer: Lucent All Commercial |
$439.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$774.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$645.75
|
| Rate for Payer: PHP All Commercial |
$652.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$335.79
|
| Rate for Payer: Sagamore Health Network All Products |
$664.69
|
| Rate for Payer: Signature Care EPO |
$714.63
|
| Rate for Payer: Signature Care PPO |
$757.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$731.85
|
| Rate for Payer: United Healthcare Commercial |
$678.47
|
| Rate for Payer: United Healthcare Medicare |
$284.13
|
|
|
HC ACU .040" PLATE TACK
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.75 |
| Max. Negotiated Rate |
$800.73 |
| Rate for Payer: Aetna Commercial |
$743.90
|
| Rate for Payer: Cash Price |
$533.82
|
| Rate for Payer: Cigna All Commercial |
$743.04
|
| Rate for Payer: CORVEL All Commercial |
$800.73
|
| Rate for Payer: Coventry All Commercial |
$757.68
|
| Rate for Payer: Encore All Commercial |
$792.55
|
| Rate for Payer: Frontpath All Commercial |
$792.12
|
| Rate for Payer: Humana ChoiceCare |
$743.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$774.90
|
| Rate for Payer: PHCS All Commercial |
$645.75
|
| Rate for Payer: PHP All Commercial |
$652.98
|
| Rate for Payer: Sagamore Health Network All Products |
$664.69
|
| Rate for Payer: Signature Care EPO |
$714.63
|
| Rate for Payer: Signature Care PPO |
$757.68
|
| Rate for Payer: United Healthcare Commercial |
$678.47
|
|
