|
HC 24 HR SODIUM
|
Facility
OP
|
$97.90
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
63001678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$90.12 |
| Rate for Payer: Aetna Commercial |
$82.63
|
| Rate for Payer: Aetna Medicare |
$32.31
|
| Rate for Payer: Anthem Exchange |
$44.99
|
| Rate for Payer: Anthem Medicaid |
$4.70
|
| Rate for Payer: Anthem Medicare |
$32.31
|
| Rate for Payer: Anthem PPO |
$44.99
|
| Rate for Payer: Anthem Traditional |
$44.99
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$4.70
|
| Rate for Payer: Caresource Just 4 Me |
$37.15
|
| Rate for Payer: Caresource Medicare |
$35.54
|
| Rate for Payer: Centivo/Paragon All Products |
$49.93
|
| Rate for Payer: Cigna All Products |
$84.49
|
| Rate for Payer: Coventry/First Health All Products |
$86.15
|
| Rate for Payer: Encore All Products |
$90.12
|
| Rate for Payer: Frontpath All Products |
$90.07
|
| Rate for Payer: Humana ChoiceCare |
$84.56
|
| Rate for Payer: Humana Medicare |
$49.93
|
| Rate for Payer: Lucent/Coldwater Veneers |
$49.93
|
| Rate for Payer: Lutheran Preferred All Products |
$88.11
|
| Rate for Payer: Managed Health Services All Products |
$4.70
|
| Rate for Payer: MDWise All Products |
$4.70
|
| Rate for Payer: PHCS/Multiplan All Products |
$73.43
|
| Rate for Payer: PHP All Products |
$74.25
|
| Rate for Payer: Plain Church Group Ministry All Products |
$38.18
|
| Rate for Payer: Sagamore All Products |
$75.58
|
| Rate for Payer: Self Pay/Cash Rate |
$60.70
|
| Rate for Payer: Signature Care EPO |
$81.26
|
| Rate for Payer: Signature Care PPO |
$86.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$83.22
|
| Rate for Payer: United Healthcare Commercial |
$77.15
|
| Rate for Payer: United Healthcare Medicare |
$32.31
|
|
|
HC 2D&M-MODE W/SPCTRL & CF DPLR
|
Facility
IP
|
$3,261.41
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
863306
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,022.07 |
| Max. Negotiated Rate |
$3,002.13 |
| Rate for Payer: Aetna Commercial |
$2,817.86
|
| Rate for Payer: Cigna All Products |
$2,814.60
|
| Rate for Payer: Coventry/First Health All Products |
$2,870.04
|
| Rate for Payer: Encore All Products |
$3,002.13
|
| Rate for Payer: Frontpath All Products |
$3,000.50
|
| Rate for Payer: Humana ChoiceCare |
$2,816.88
|
| Rate for Payer: Lutheran Preferred All Products |
$2,935.27
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,446.06
|
| Rate for Payer: PHP All Products |
$2,473.45
|
| Rate for Payer: Sagamore All Products |
$2,517.81
|
| Rate for Payer: Self Pay/Cash Rate |
$2,022.07
|
| Rate for Payer: Signature Care EPO |
$2,706.97
|
| Rate for Payer: Signature Care PPO |
$2,870.04
|
| Rate for Payer: United Healthcare Commercial |
$2,569.99
|
|
|
HC 2D&M-MODE W/SPCTRL & CF DPLR
|
Facility
OP
|
$3,261.41
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
863306
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,076.27 |
| Max. Negotiated Rate |
$3,002.13 |
| Rate for Payer: Aetna Commercial |
$2,752.63
|
| Rate for Payer: Aetna Medicare |
$1,076.27
|
| Rate for Payer: Anthem Exchange |
$1,873.03
|
| Rate for Payer: Anthem Medicare |
$1,076.27
|
| Rate for Payer: Anthem PPO |
$1,873.03
|
| Rate for Payer: Anthem Traditional |
$2,038.71
|
| Rate for Payer: Caresource Just 4 Me |
$1,237.71
|
| Rate for Payer: Caresource Medicare |
$1,183.89
|
| Rate for Payer: Centivo/Paragon All Products |
$1,663.32
|
| Rate for Payer: Cigna All Products |
$2,814.60
|
| Rate for Payer: Coventry/First Health All Products |
$2,870.04
|
| Rate for Payer: Encore All Products |
$3,002.13
|
| Rate for Payer: Frontpath All Products |
$3,000.50
|
| Rate for Payer: Humana ChoiceCare |
$2,816.88
|
| Rate for Payer: Humana Medicare |
$1,663.32
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,663.32
|
| Rate for Payer: Lutheran Preferred All Products |
$2,935.27
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,446.06
|
| Rate for Payer: PHP All Products |
$2,473.45
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,271.95
|
| Rate for Payer: Sagamore All Products |
$2,517.81
|
| Rate for Payer: Self Pay/Cash Rate |
$2,022.07
|
| Rate for Payer: Signature Care EPO |
$2,706.97
|
| Rate for Payer: Signature Care PPO |
$2,870.04
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,772.20
|
| Rate for Payer: United Healthcare Commercial |
$2,569.99
|
| Rate for Payer: United Healthcare Medicare |
$1,076.27
|
|
|
HC 3D RENDER W/INTRP POSTPROCES ECHOCARDIOGRAPHY
|
Facility
IP
|
$759.35
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
866376
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$470.80 |
| Max. Negotiated Rate |
$698.98 |
| Rate for Payer: Aetna Commercial |
$656.08
|
| Rate for Payer: Cigna All Products |
$655.32
|
| Rate for Payer: Coventry/First Health All Products |
$668.23
|
| Rate for Payer: Encore All Products |
$698.98
|
| Rate for Payer: Frontpath All Products |
$698.60
|
| Rate for Payer: Humana ChoiceCare |
$655.85
|
| Rate for Payer: Lutheran Preferred All Products |
$683.42
|
| Rate for Payer: PHCS/Multiplan All Products |
$569.51
|
| Rate for Payer: PHP All Products |
$575.89
|
| Rate for Payer: Sagamore All Products |
$586.22
|
| Rate for Payer: Self Pay/Cash Rate |
$470.80
|
| Rate for Payer: Signature Care EPO |
$630.26
|
| Rate for Payer: Signature Care PPO |
$668.23
|
| Rate for Payer: United Healthcare Commercial |
$598.37
|
|
|
HC 3D RENDER W/INTRP POSTPROCES ECHOCARDIOGRAPHY
|
Facility
OP
|
$759.35
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
866376
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$698.98 |
| Rate for Payer: Aetna Commercial |
$640.89
|
| Rate for Payer: Aetna Medicare |
$250.59
|
| Rate for Payer: Anthem Exchange |
$436.09
|
| Rate for Payer: Anthem Medicaid |
$50.90
|
| Rate for Payer: Anthem Medicare |
$250.59
|
| Rate for Payer: Anthem PPO |
$436.09
|
| Rate for Payer: Anthem Traditional |
$474.67
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$50.90
|
| Rate for Payer: Caresource Just 4 Me |
$288.17
|
| Rate for Payer: Caresource Medicare |
$275.64
|
| Rate for Payer: Centivo/Paragon All Products |
$387.27
|
| Rate for Payer: Cigna All Products |
$655.32
|
| Rate for Payer: Coventry/First Health All Products |
$668.23
|
| Rate for Payer: Encore All Products |
$698.98
|
| Rate for Payer: Frontpath All Products |
$698.60
|
| Rate for Payer: Humana ChoiceCare |
$655.85
|
| Rate for Payer: Humana Medicare |
$387.27
|
| Rate for Payer: Lucent/Coldwater Veneers |
$387.27
|
| Rate for Payer: Lutheran Preferred All Products |
$683.42
|
| Rate for Payer: Managed Health Services All Products |
$50.90
|
| Rate for Payer: MDWise All Products |
$50.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$569.51
|
| Rate for Payer: PHP All Products |
$575.89
|
| Rate for Payer: Plain Church Group Ministry All Products |
$296.15
|
| Rate for Payer: Sagamore All Products |
$586.22
|
| Rate for Payer: Self Pay/Cash Rate |
$470.80
|
| Rate for Payer: Signature Care EPO |
$630.26
|
| Rate for Payer: Signature Care PPO |
$668.23
|
| Rate for Payer: Three Rivers Preferred All Products |
$645.45
|
| Rate for Payer: United Healthcare Commercial |
$598.37
|
| Rate for Payer: United Healthcare Medicare |
$250.59
|
|
|
HC 5 A DIHYDROTESTOSTERONE
|
Facility
IP
|
$284.55
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.42 |
| Max. Negotiated Rate |
$261.93 |
| Rate for Payer: Aetna Commercial |
$245.85
|
| Rate for Payer: Cigna All Products |
$245.57
|
| Rate for Payer: Coventry/First Health All Products |
$250.40
|
| Rate for Payer: Encore All Products |
$261.93
|
| Rate for Payer: Frontpath All Products |
$261.79
|
| Rate for Payer: Humana ChoiceCare |
$245.77
|
| Rate for Payer: Lutheran Preferred All Products |
$256.10
|
| Rate for Payer: PHCS/Multiplan All Products |
$213.41
|
| Rate for Payer: PHP All Products |
$215.80
|
| Rate for Payer: Sagamore All Products |
$219.67
|
| Rate for Payer: Self Pay/Cash Rate |
$176.42
|
| Rate for Payer: Signature Care EPO |
$236.18
|
| Rate for Payer: Signature Care PPO |
$250.40
|
| Rate for Payer: United Healthcare Commercial |
$224.23
|
|
|
HC 5 A DIHYDROTESTOSTERONE
|
Facility
OP
|
$284.55
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$261.93 |
| Rate for Payer: Aetna Commercial |
$240.16
|
| Rate for Payer: Aetna Medicare |
$93.90
|
| Rate for Payer: Anthem Exchange |
$163.42
|
| Rate for Payer: Anthem Medicaid |
$23.71
|
| Rate for Payer: Anthem Medicare |
$93.90
|
| Rate for Payer: Anthem PPO |
$163.42
|
| Rate for Payer: Anthem Traditional |
$177.87
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$23.71
|
| Rate for Payer: Caresource Just 4 Me |
$107.99
|
| Rate for Payer: Caresource Medicare |
$103.29
|
| Rate for Payer: Centivo/Paragon All Products |
$145.12
|
| Rate for Payer: Cigna All Products |
$245.57
|
| Rate for Payer: Coventry/First Health All Products |
$250.40
|
| Rate for Payer: Encore All Products |
$261.93
|
| Rate for Payer: Frontpath All Products |
$261.79
|
| Rate for Payer: Humana ChoiceCare |
$245.77
|
| Rate for Payer: Humana Medicare |
$145.12
|
| Rate for Payer: Lucent/Coldwater Veneers |
$145.12
|
| Rate for Payer: Lutheran Preferred All Products |
$256.10
|
| Rate for Payer: Managed Health Services All Products |
$23.71
|
| Rate for Payer: MDWise All Products |
$23.71
|
| Rate for Payer: PHCS/Multiplan All Products |
$213.41
|
| Rate for Payer: PHP All Products |
$215.80
|
| Rate for Payer: Plain Church Group Ministry All Products |
$110.97
|
| Rate for Payer: Sagamore All Products |
$219.67
|
| Rate for Payer: Self Pay/Cash Rate |
$176.42
|
| Rate for Payer: Signature Care EPO |
$236.18
|
| Rate for Payer: Signature Care PPO |
$250.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$241.87
|
| Rate for Payer: United Healthcare Commercial |
$224.23
|
| Rate for Payer: United Healthcare Medicare |
$93.90
|
|
|
HC 5-HIAA QL RANDOM UR
|
Facility
IP
|
$139.56
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63001022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.53 |
| Max. Negotiated Rate |
$128.46 |
| Rate for Payer: Aetna Commercial |
$120.58
|
| Rate for Payer: Cigna All Products |
$120.44
|
| Rate for Payer: Coventry/First Health All Products |
$122.81
|
| Rate for Payer: Encore All Products |
$128.46
|
| Rate for Payer: Frontpath All Products |
$128.40
|
| Rate for Payer: Humana ChoiceCare |
$120.54
|
| Rate for Payer: Lutheran Preferred All Products |
$125.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$104.67
|
| Rate for Payer: PHP All Products |
$105.84
|
| Rate for Payer: Sagamore All Products |
$107.74
|
| Rate for Payer: Self Pay/Cash Rate |
$86.53
|
| Rate for Payer: Signature Care EPO |
$115.83
|
| Rate for Payer: Signature Care PPO |
$122.81
|
| Rate for Payer: United Healthcare Commercial |
$109.97
|
|
|
HC 5-HIAA QL RANDOM UR
|
Facility
OP
|
$139.56
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63001022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$128.46 |
| Rate for Payer: Aetna Commercial |
$117.79
|
| Rate for Payer: Aetna Medicare |
$46.05
|
| Rate for Payer: Anthem Exchange |
$80.15
|
| Rate for Payer: Anthem Medicaid |
$12.90
|
| Rate for Payer: Anthem Medicare |
$46.05
|
| Rate for Payer: Anthem PPO |
$80.15
|
| Rate for Payer: Anthem Traditional |
$87.24
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$12.90
|
| Rate for Payer: Caresource Just 4 Me |
$52.96
|
| Rate for Payer: Caresource Medicare |
$50.66
|
| Rate for Payer: Centivo/Paragon All Products |
$71.18
|
| Rate for Payer: Cigna All Products |
$120.44
|
| Rate for Payer: Coventry/First Health All Products |
$122.81
|
| Rate for Payer: Encore All Products |
$128.46
|
| Rate for Payer: Frontpath All Products |
$128.40
|
| Rate for Payer: Humana ChoiceCare |
$120.54
|
| Rate for Payer: Humana Medicare |
$71.18
|
| Rate for Payer: Lucent/Coldwater Veneers |
$71.18
|
| Rate for Payer: Lutheran Preferred All Products |
$125.60
|
| Rate for Payer: Managed Health Services All Products |
$12.90
|
| Rate for Payer: MDWise All Products |
$12.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$104.67
|
| Rate for Payer: PHP All Products |
$105.84
|
| Rate for Payer: Plain Church Group Ministry All Products |
$54.43
|
| Rate for Payer: Sagamore All Products |
$107.74
|
| Rate for Payer: Self Pay/Cash Rate |
$86.53
|
| Rate for Payer: Signature Care EPO |
$115.83
|
| Rate for Payer: Signature Care PPO |
$122.81
|
| Rate for Payer: Three Rivers Preferred All Products |
$118.63
|
| Rate for Payer: United Healthcare Commercial |
$109.97
|
| Rate for Payer: United Healthcare Medicare |
$46.05
|
|
|
HC 5-HIAA QT UR
|
Facility
OP
|
$180.40
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63001573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$166.06 |
| Rate for Payer: Aetna Commercial |
$152.26
|
| Rate for Payer: Aetna Medicare |
$59.53
|
| Rate for Payer: Anthem Exchange |
$103.60
|
| Rate for Payer: Anthem Medicaid |
$12.90
|
| Rate for Payer: Anthem Medicare |
$59.53
|
| Rate for Payer: Anthem PPO |
$103.60
|
| Rate for Payer: Anthem Traditional |
$112.77
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$12.90
|
| Rate for Payer: Caresource Just 4 Me |
$68.46
|
| Rate for Payer: Caresource Medicare |
$65.49
|
| Rate for Payer: Centivo/Paragon All Products |
$92.00
|
| Rate for Payer: Cigna All Products |
$155.69
|
| Rate for Payer: Coventry/First Health All Products |
$158.75
|
| Rate for Payer: Encore All Products |
$166.06
|
| Rate for Payer: Frontpath All Products |
$165.97
|
| Rate for Payer: Humana ChoiceCare |
$155.81
|
| Rate for Payer: Humana Medicare |
$92.00
|
| Rate for Payer: Lucent/Coldwater Veneers |
$92.00
|
| Rate for Payer: Lutheran Preferred All Products |
$162.36
|
| Rate for Payer: Managed Health Services All Products |
$12.90
|
| Rate for Payer: MDWise All Products |
$12.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$135.30
|
| Rate for Payer: PHP All Products |
$136.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$70.36
|
| Rate for Payer: Sagamore All Products |
$139.27
|
| Rate for Payer: Self Pay/Cash Rate |
$111.85
|
| Rate for Payer: Signature Care EPO |
$149.73
|
| Rate for Payer: Signature Care PPO |
$158.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$153.34
|
| Rate for Payer: United Healthcare Commercial |
$142.16
|
| Rate for Payer: United Healthcare Medicare |
$59.53
|
|
|
HC 5-HIAA QT UR
|
Facility
IP
|
$180.40
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63001573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.85 |
| Max. Negotiated Rate |
$166.06 |
| Rate for Payer: Aetna Commercial |
$155.87
|
| Rate for Payer: Cigna All Products |
$155.69
|
| Rate for Payer: Coventry/First Health All Products |
$158.75
|
| Rate for Payer: Encore All Products |
$166.06
|
| Rate for Payer: Frontpath All Products |
$165.97
|
| Rate for Payer: Humana ChoiceCare |
$155.81
|
| Rate for Payer: Lutheran Preferred All Products |
$162.36
|
| Rate for Payer: PHCS/Multiplan All Products |
$135.30
|
| Rate for Payer: PHP All Products |
$136.82
|
| Rate for Payer: Sagamore All Products |
$139.27
|
| Rate for Payer: Self Pay/Cash Rate |
$111.85
|
| Rate for Payer: Signature Care EPO |
$149.73
|
| Rate for Payer: Signature Care PPO |
$158.75
|
| Rate for Payer: United Healthcare Commercial |
$142.16
|
|
|
HC 5-HYDROXYINDOLEACETIC ACID (HIAA), QUANTITATIVE, RANDOM URINE (PEDIATRIC)
|
Facility
IP
|
$31.13
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.30 |
| Max. Negotiated Rate |
$28.66 |
| Rate for Payer: Aetna Commercial |
$26.90
|
| Rate for Payer: Cigna All Products |
$26.87
|
| Rate for Payer: Coventry/First Health All Products |
$27.39
|
| Rate for Payer: Encore All Products |
$28.66
|
| Rate for Payer: Frontpath All Products |
$28.64
|
| Rate for Payer: Humana ChoiceCare |
$26.89
|
| Rate for Payer: Lutheran Preferred All Products |
$28.02
|
| Rate for Payer: PHCS/Multiplan All Products |
$23.35
|
| Rate for Payer: PHP All Products |
$23.61
|
| Rate for Payer: Sagamore All Products |
$24.03
|
| Rate for Payer: Self Pay/Cash Rate |
$19.30
|
| Rate for Payer: Signature Care EPO |
$25.84
|
| Rate for Payer: Signature Care PPO |
$27.39
|
| Rate for Payer: United Healthcare Commercial |
$24.53
|
|
|
HC 5-HYDROXYINDOLEACETIC ACID (HIAA), QUANTITATIVE, RANDOM URINE (PEDIATRIC)
|
Facility
OP
|
$31.13
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$28.66 |
| Rate for Payer: Aetna Commercial |
$26.27
|
| Rate for Payer: Aetna Medicare |
$10.27
|
| Rate for Payer: Anthem Exchange |
$14.31
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare |
$10.27
|
| Rate for Payer: Anthem PPO |
$14.31
|
| Rate for Payer: Anthem Traditional |
$14.31
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$5.18
|
| Rate for Payer: Caresource Just 4 Me |
$11.81
|
| Rate for Payer: Caresource Medicare |
$11.30
|
| Rate for Payer: Centivo/Paragon All Products |
$15.88
|
| Rate for Payer: Cigna All Products |
$26.87
|
| Rate for Payer: Coventry/First Health All Products |
$27.39
|
| Rate for Payer: Encore All Products |
$28.66
|
| Rate for Payer: Frontpath All Products |
$28.64
|
| Rate for Payer: Humana ChoiceCare |
$26.89
|
| Rate for Payer: Humana Medicare |
$15.88
|
| Rate for Payer: Lucent/Coldwater Veneers |
$15.88
|
| Rate for Payer: Lutheran Preferred All Products |
$28.02
|
| Rate for Payer: Managed Health Services All Products |
$5.18
|
| Rate for Payer: MDWise All Products |
$5.18
|
| Rate for Payer: PHCS/Multiplan All Products |
$23.35
|
| Rate for Payer: PHP All Products |
$23.61
|
| Rate for Payer: Plain Church Group Ministry All Products |
$12.14
|
| Rate for Payer: Sagamore All Products |
$24.03
|
| Rate for Payer: Self Pay/Cash Rate |
$19.30
|
| Rate for Payer: Signature Care EPO |
$25.84
|
| Rate for Payer: Signature Care PPO |
$27.39
|
| Rate for Payer: Three Rivers Preferred All Products |
$26.46
|
| Rate for Payer: United Healthcare Commercial |
$24.53
|
| Rate for Payer: United Healthcare Medicare |
$10.27
|
|
|
HC 5-HYDROXYINDOLEACETIC ACID (HIAA), QUANTITATIVE, RANDOM URINE (PEDIATRIC)-B
|
Facility
IP
|
$31.12
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63044019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Cigna All Products |
$26.86
|
| Rate for Payer: Coventry/First Health All Products |
$27.39
|
| Rate for Payer: Encore All Products |
$28.65
|
| Rate for Payer: Frontpath All Products |
$28.63
|
| Rate for Payer: Humana ChoiceCare |
$26.88
|
| Rate for Payer: Lutheran Preferred All Products |
$28.01
|
| Rate for Payer: PHCS/Multiplan All Products |
$23.34
|
| Rate for Payer: PHP All Products |
$23.60
|
| Rate for Payer: Sagamore All Products |
$24.02
|
| Rate for Payer: Self Pay/Cash Rate |
$19.29
|
| Rate for Payer: Signature Care EPO |
$25.83
|
| Rate for Payer: Signature Care PPO |
$27.39
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
HC 5-HYDROXYINDOLEACETIC ACID (HIAA), QUANTITATIVE, RANDOM URINE (PEDIATRIC)-B
|
Facility
OP
|
$31.12
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
63044019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$26.27
|
| Rate for Payer: Aetna Medicare |
$10.27
|
| Rate for Payer: Anthem Exchange |
$17.87
|
| Rate for Payer: Anthem Medicaid |
$12.90
|
| Rate for Payer: Anthem Medicare |
$10.27
|
| Rate for Payer: Anthem PPO |
$17.87
|
| Rate for Payer: Anthem Traditional |
$19.45
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$12.90
|
| Rate for Payer: Caresource Just 4 Me |
$11.81
|
| Rate for Payer: Caresource Medicare |
$11.30
|
| Rate for Payer: Centivo/Paragon All Products |
$15.87
|
| Rate for Payer: Cigna All Products |
$26.86
|
| Rate for Payer: Coventry/First Health All Products |
$27.39
|
| Rate for Payer: Encore All Products |
$28.65
|
| Rate for Payer: Frontpath All Products |
$28.63
|
| Rate for Payer: Humana ChoiceCare |
$26.88
|
| Rate for Payer: Humana Medicare |
$15.87
|
| Rate for Payer: Lucent/Coldwater Veneers |
$15.87
|
| Rate for Payer: Lutheran Preferred All Products |
$28.01
|
| Rate for Payer: Managed Health Services All Products |
$12.90
|
| Rate for Payer: MDWise All Products |
$12.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$23.34
|
| Rate for Payer: PHP All Products |
$23.60
|
| Rate for Payer: Plain Church Group Ministry All Products |
$12.14
|
| Rate for Payer: Sagamore All Products |
$24.02
|
| Rate for Payer: Self Pay/Cash Rate |
$19.29
|
| Rate for Payer: Signature Care EPO |
$25.83
|
| Rate for Payer: Signature Care PPO |
$27.39
|
| Rate for Payer: Three Rivers Preferred All Products |
$26.45
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
| Rate for Payer: United Healthcare Medicare |
$10.27
|
|
|
HC ABD PARACENTESIS W/IMAGING
|
Facility
OP
|
$1,531.42
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
1649083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$505.37 |
| Max. Negotiated Rate |
$1,409.67 |
| Rate for Payer: Aetna Commercial |
$1,292.52
|
| Rate for Payer: Aetna Medicare |
$505.37
|
| Rate for Payer: Anthem Exchange |
$879.49
|
| Rate for Payer: Anthem Medicaid |
$1,283.57
|
| Rate for Payer: Anthem Medicare |
$505.37
|
| Rate for Payer: Anthem PPO |
$879.49
|
| Rate for Payer: Anthem Traditional |
$957.29
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$1,283.57
|
| Rate for Payer: Caresource Just 4 Me |
$581.17
|
| Rate for Payer: Caresource Medicare |
$555.91
|
| Rate for Payer: Centivo/Paragon All Products |
$781.02
|
| Rate for Payer: Cigna All Products |
$1,321.62
|
| Rate for Payer: Coventry/First Health All Products |
$1,347.65
|
| Rate for Payer: Encore All Products |
$1,409.67
|
| Rate for Payer: Frontpath All Products |
$1,408.91
|
| Rate for Payer: Humana ChoiceCare |
$1,322.69
|
| Rate for Payer: Humana Medicare |
$781.02
|
| Rate for Payer: Lucent/Coldwater Veneers |
$781.02
|
| Rate for Payer: Lutheran Preferred All Products |
$1,378.28
|
| Rate for Payer: Managed Health Services All Products |
$1,283.57
|
| Rate for Payer: MDWise All Products |
$1,283.57
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,148.57
|
| Rate for Payer: PHP All Products |
$1,161.43
|
| Rate for Payer: Plain Church Group Ministry All Products |
$597.25
|
| Rate for Payer: Sagamore All Products |
$1,182.26
|
| Rate for Payer: Self Pay/Cash Rate |
$949.48
|
| Rate for Payer: Signature Care EPO |
$1,271.08
|
| Rate for Payer: Signature Care PPO |
$1,347.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,301.71
|
| Rate for Payer: United Healthcare Commercial |
$1,206.76
|
| Rate for Payer: United Healthcare Medicare |
$505.37
|
|
|
HC ABD PARACENTESIS W/IMAGING
|
Facility
IP
|
$1,531.42
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
1599083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$949.48 |
| Max. Negotiated Rate |
$1,409.67 |
| Rate for Payer: Aetna Commercial |
$1,323.15
|
| Rate for Payer: Cigna All Products |
$1,321.62
|
| Rate for Payer: Coventry/First Health All Products |
$1,347.65
|
| Rate for Payer: Encore All Products |
$1,409.67
|
| Rate for Payer: Frontpath All Products |
$1,408.91
|
| Rate for Payer: Humana ChoiceCare |
$1,322.69
|
| Rate for Payer: Lutheran Preferred All Products |
$1,378.28
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,148.57
|
| Rate for Payer: PHP All Products |
$1,161.43
|
| Rate for Payer: Sagamore All Products |
$1,182.26
|
| Rate for Payer: Self Pay/Cash Rate |
$949.48
|
| Rate for Payer: Signature Care EPO |
$1,271.08
|
| Rate for Payer: Signature Care PPO |
$1,347.65
|
| Rate for Payer: United Healthcare Commercial |
$1,206.76
|
|
|
HC ABD PARACENTESIS W/IMAGING
|
Facility
IP
|
$1,531.42
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
1649083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$949.48 |
| Max. Negotiated Rate |
$1,409.67 |
| Rate for Payer: Aetna Commercial |
$1,323.15
|
| Rate for Payer: Cigna All Products |
$1,321.62
|
| Rate for Payer: Coventry/First Health All Products |
$1,347.65
|
| Rate for Payer: Encore All Products |
$1,409.67
|
| Rate for Payer: Frontpath All Products |
$1,408.91
|
| Rate for Payer: Humana ChoiceCare |
$1,322.69
|
| Rate for Payer: Lutheran Preferred All Products |
$1,378.28
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,148.57
|
| Rate for Payer: PHP All Products |
$1,161.43
|
| Rate for Payer: Sagamore All Products |
$1,182.26
|
| Rate for Payer: Self Pay/Cash Rate |
$949.48
|
| Rate for Payer: Signature Care EPO |
$1,271.08
|
| Rate for Payer: Signature Care PPO |
$1,347.65
|
| Rate for Payer: United Healthcare Commercial |
$1,206.76
|
|
|
HC ABD PARACENTESIS W/IMAGING
|
Facility
OP
|
$1,531.42
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
1599083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$505.37 |
| Max. Negotiated Rate |
$1,409.67 |
| Rate for Payer: Aetna Commercial |
$1,292.52
|
| Rate for Payer: Aetna Medicare |
$505.37
|
| Rate for Payer: Anthem Exchange |
$879.49
|
| Rate for Payer: Anthem Medicaid |
$1,283.57
|
| Rate for Payer: Anthem Medicare |
$505.37
|
| Rate for Payer: Anthem PPO |
$879.49
|
| Rate for Payer: Anthem Traditional |
$957.29
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$1,283.57
|
| Rate for Payer: Caresource Just 4 Me |
$581.17
|
| Rate for Payer: Caresource Medicare |
$555.91
|
| Rate for Payer: Centivo/Paragon All Products |
$781.02
|
| Rate for Payer: Cigna All Products |
$1,321.62
|
| Rate for Payer: Coventry/First Health All Products |
$1,347.65
|
| Rate for Payer: Encore All Products |
$1,409.67
|
| Rate for Payer: Frontpath All Products |
$1,408.91
|
| Rate for Payer: Humana ChoiceCare |
$1,322.69
|
| Rate for Payer: Humana Medicare |
$781.02
|
| Rate for Payer: Lucent/Coldwater Veneers |
$781.02
|
| Rate for Payer: Lutheran Preferred All Products |
$1,378.28
|
| Rate for Payer: Managed Health Services All Products |
$1,283.57
|
| Rate for Payer: MDWise All Products |
$1,283.57
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,148.57
|
| Rate for Payer: PHP All Products |
$1,161.43
|
| Rate for Payer: Plain Church Group Ministry All Products |
$597.25
|
| Rate for Payer: Sagamore All Products |
$1,182.26
|
| Rate for Payer: Self Pay/Cash Rate |
$949.48
|
| Rate for Payer: Signature Care EPO |
$1,271.08
|
| Rate for Payer: Signature Care PPO |
$1,347.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,301.71
|
| Rate for Payer: United Healthcare Commercial |
$1,206.76
|
| Rate for Payer: United Healthcare Medicare |
$505.37
|
|
|
HC ABG DRAW
|
Facility
IP
|
$96.54
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
1706485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$88.87 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: Cigna All Products |
$83.31
|
| Rate for Payer: Coventry/First Health All Products |
$84.96
|
| Rate for Payer: Encore All Products |
$88.87
|
| Rate for Payer: Frontpath All Products |
$88.82
|
| Rate for Payer: Humana ChoiceCare |
$83.38
|
| Rate for Payer: Lutheran Preferred All Products |
$86.89
|
| Rate for Payer: PHCS/Multiplan All Products |
$72.41
|
| Rate for Payer: PHP All Products |
$73.22
|
| Rate for Payer: Sagamore All Products |
$74.53
|
| Rate for Payer: Self Pay/Cash Rate |
$59.85
|
| Rate for Payer: Signature Care EPO |
$80.13
|
| Rate for Payer: Signature Care PPO |
$84.96
|
| Rate for Payer: United Healthcare Commercial |
$76.07
|
|
|
HC ABG DRAW
|
Facility
OP
|
$96.54
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
1706485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$190.59 |
| Rate for Payer: Aetna Commercial |
$81.48
|
| Rate for Payer: Aetna Medicare |
$31.86
|
| Rate for Payer: Anthem Exchange |
$44.37
|
| Rate for Payer: Anthem Medicaid |
$190.59
|
| Rate for Payer: Anthem Medicare |
$31.86
|
| Rate for Payer: Anthem PPO |
$44.37
|
| Rate for Payer: Anthem Traditional |
$44.37
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$190.59
|
| Rate for Payer: Caresource Just 4 Me |
$36.64
|
| Rate for Payer: Caresource Medicare |
$35.04
|
| Rate for Payer: Centivo/Paragon All Products |
$49.24
|
| Rate for Payer: Cigna All Products |
$83.31
|
| Rate for Payer: Coventry/First Health All Products |
$84.96
|
| Rate for Payer: Encore All Products |
$88.87
|
| Rate for Payer: Frontpath All Products |
$88.82
|
| Rate for Payer: Humana ChoiceCare |
$83.38
|
| Rate for Payer: Humana Medicare |
$49.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$49.24
|
| Rate for Payer: Lutheran Preferred All Products |
$86.89
|
| Rate for Payer: Managed Health Services All Products |
$190.59
|
| Rate for Payer: MDWise All Products |
$190.59
|
| Rate for Payer: PHCS/Multiplan All Products |
$72.41
|
| Rate for Payer: PHP All Products |
$73.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$37.65
|
| Rate for Payer: Sagamore All Products |
$74.53
|
| Rate for Payer: Self Pay/Cash Rate |
$59.85
|
| Rate for Payer: Signature Care EPO |
$80.13
|
| Rate for Payer: Signature Care PPO |
$84.96
|
| Rate for Payer: Three Rivers Preferred All Products |
$82.06
|
| Rate for Payer: United Healthcare Commercial |
$76.07
|
| Rate for Payer: United Healthcare Medicare |
$31.86
|
|
|
HC ABG DRAW RT
|
Facility
IP
|
$96.54
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
1706010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$88.87 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: Cigna All Products |
$83.31
|
| Rate for Payer: Coventry/First Health All Products |
$84.96
|
| Rate for Payer: Encore All Products |
$88.87
|
| Rate for Payer: Frontpath All Products |
$88.82
|
| Rate for Payer: Humana ChoiceCare |
$83.38
|
| Rate for Payer: Lutheran Preferred All Products |
$86.89
|
| Rate for Payer: PHCS/Multiplan All Products |
$72.41
|
| Rate for Payer: PHP All Products |
$73.22
|
| Rate for Payer: Sagamore All Products |
$74.53
|
| Rate for Payer: Self Pay/Cash Rate |
$59.85
|
| Rate for Payer: Signature Care EPO |
$80.13
|
| Rate for Payer: Signature Care PPO |
$84.96
|
| Rate for Payer: United Healthcare Commercial |
$76.07
|
|
|
HC ABG DRAW RT
|
Facility
OP
|
$96.54
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
1706010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$190.59 |
| Rate for Payer: Aetna Commercial |
$81.48
|
| Rate for Payer: Aetna Medicare |
$31.86
|
| Rate for Payer: Anthem Exchange |
$44.37
|
| Rate for Payer: Anthem Medicaid |
$190.59
|
| Rate for Payer: Anthem Medicare |
$31.86
|
| Rate for Payer: Anthem PPO |
$44.37
|
| Rate for Payer: Anthem Traditional |
$44.37
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$190.59
|
| Rate for Payer: Caresource Just 4 Me |
$36.64
|
| Rate for Payer: Caresource Medicare |
$35.04
|
| Rate for Payer: Centivo/Paragon All Products |
$49.24
|
| Rate for Payer: Cigna All Products |
$83.31
|
| Rate for Payer: Coventry/First Health All Products |
$84.96
|
| Rate for Payer: Encore All Products |
$88.87
|
| Rate for Payer: Frontpath All Products |
$88.82
|
| Rate for Payer: Humana ChoiceCare |
$83.38
|
| Rate for Payer: Humana Medicare |
$49.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$49.24
|
| Rate for Payer: Lutheran Preferred All Products |
$86.89
|
| Rate for Payer: Managed Health Services All Products |
$190.59
|
| Rate for Payer: MDWise All Products |
$190.59
|
| Rate for Payer: PHCS/Multiplan All Products |
$72.41
|
| Rate for Payer: PHP All Products |
$73.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$37.65
|
| Rate for Payer: Sagamore All Products |
$74.53
|
| Rate for Payer: Self Pay/Cash Rate |
$59.85
|
| Rate for Payer: Signature Care EPO |
$80.13
|
| Rate for Payer: Signature Care PPO |
$84.96
|
| Rate for Payer: Three Rivers Preferred All Products |
$82.06
|
| Rate for Payer: United Healthcare Commercial |
$76.07
|
| Rate for Payer: United Healthcare Medicare |
$31.86
|
|
|
HC AB ID
|
Facility
OP
|
$304.70
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
63001344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.55 |
| Max. Negotiated Rate |
$280.48 |
| Rate for Payer: Aetna Commercial |
$257.17
|
| Rate for Payer: Aetna Medicare |
$100.55
|
| Rate for Payer: Anthem Exchange |
$140.04
|
| Rate for Payer: Anthem Medicaid |
$195.00
|
| Rate for Payer: Anthem Medicare |
$100.55
|
| Rate for Payer: Anthem PPO |
$140.04
|
| Rate for Payer: Anthem Traditional |
$140.04
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$195.00
|
| Rate for Payer: Caresource Just 4 Me |
$115.63
|
| Rate for Payer: Caresource Medicare |
$110.61
|
| Rate for Payer: Centivo/Paragon All Products |
$155.40
|
| Rate for Payer: Cigna All Products |
$262.96
|
| Rate for Payer: Coventry/First Health All Products |
$268.14
|
| Rate for Payer: Encore All Products |
$280.48
|
| Rate for Payer: Frontpath All Products |
$280.32
|
| Rate for Payer: Humana ChoiceCare |
$263.17
|
| Rate for Payer: Humana Medicare |
$155.40
|
| Rate for Payer: Lucent/Coldwater Veneers |
$155.40
|
| Rate for Payer: Lutheran Preferred All Products |
$274.23
|
| Rate for Payer: Managed Health Services All Products |
$195.00
|
| Rate for Payer: MDWise All Products |
$195.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$228.52
|
| Rate for Payer: PHP All Products |
$231.08
|
| Rate for Payer: Plain Church Group Ministry All Products |
$118.83
|
| Rate for Payer: Sagamore All Products |
$235.23
|
| Rate for Payer: Self Pay/Cash Rate |
$188.91
|
| Rate for Payer: Signature Care EPO |
$252.90
|
| Rate for Payer: Signature Care PPO |
$268.14
|
| Rate for Payer: Three Rivers Preferred All Products |
$259.00
|
| Rate for Payer: United Healthcare Commercial |
$240.10
|
| Rate for Payer: United Healthcare Medicare |
$100.55
|
|
|
HC AB ID
|
Facility
IP
|
$304.70
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
63001344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.91 |
| Max. Negotiated Rate |
$280.48 |
| Rate for Payer: Aetna Commercial |
$263.26
|
| Rate for Payer: Cigna All Products |
$262.96
|
| Rate for Payer: Coventry/First Health All Products |
$268.14
|
| Rate for Payer: Encore All Products |
$280.48
|
| Rate for Payer: Frontpath All Products |
$280.32
|
| Rate for Payer: Humana ChoiceCare |
$263.17
|
| Rate for Payer: Lutheran Preferred All Products |
$274.23
|
| Rate for Payer: PHCS/Multiplan All Products |
$228.52
|
| Rate for Payer: PHP All Products |
$231.08
|
| Rate for Payer: Sagamore All Products |
$235.23
|
| Rate for Payer: Self Pay/Cash Rate |
$188.91
|
| Rate for Payer: Signature Care EPO |
$252.90
|
| Rate for Payer: Signature Care PPO |
$268.14
|
| Rate for Payer: United Healthcare Commercial |
$240.10
|
|
