|
HC ABO BLOOD GROUP
|
Facility
IP
|
$82.91
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
63001351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$76.32 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Cigna All Products |
$71.55
|
| Rate for Payer: Coventry/First Health All Products |
$72.96
|
| Rate for Payer: Encore All Products |
$76.32
|
| Rate for Payer: Frontpath All Products |
$76.28
|
| Rate for Payer: Humana ChoiceCare |
$71.61
|
| Rate for Payer: Lutheran Preferred All Products |
$74.62
|
| Rate for Payer: PHCS/Multiplan All Products |
$62.18
|
| Rate for Payer: PHP All Products |
$62.88
|
| Rate for Payer: Sagamore All Products |
$64.01
|
| Rate for Payer: Self Pay/Cash Rate |
$51.40
|
| Rate for Payer: Signature Care EPO |
$68.82
|
| Rate for Payer: Signature Care PPO |
$72.96
|
| Rate for Payer: United Healthcare Commercial |
$65.33
|
|
|
HC ABO BLOOD GROUP
|
Facility
OP
|
$82.91
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
63001351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$76.32 |
| Rate for Payer: Aetna Commercial |
$69.98
|
| Rate for Payer: Aetna Medicare |
$27.36
|
| Rate for Payer: Anthem Exchange |
$38.11
|
| Rate for Payer: Anthem Medicaid |
$2.99
|
| Rate for Payer: Anthem Medicare |
$27.36
|
| Rate for Payer: Anthem PPO |
$38.11
|
| Rate for Payer: Anthem Traditional |
$38.11
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$2.99
|
| Rate for Payer: Caresource Just 4 Me |
$31.46
|
| Rate for Payer: Caresource Medicare |
$30.10
|
| Rate for Payer: Centivo/Paragon All Products |
$42.28
|
| Rate for Payer: Cigna All Products |
$71.55
|
| Rate for Payer: Coventry/First Health All Products |
$72.96
|
| Rate for Payer: Encore All Products |
$76.32
|
| Rate for Payer: Frontpath All Products |
$76.28
|
| Rate for Payer: Humana ChoiceCare |
$71.61
|
| Rate for Payer: Humana Medicare |
$42.28
|
| Rate for Payer: Lucent/Coldwater Veneers |
$42.28
|
| Rate for Payer: Lutheran Preferred All Products |
$74.62
|
| Rate for Payer: Managed Health Services All Products |
$2.99
|
| Rate for Payer: MDWise All Products |
$2.99
|
| Rate for Payer: PHCS/Multiplan All Products |
$62.18
|
| Rate for Payer: PHP All Products |
$62.88
|
| Rate for Payer: Plain Church Group Ministry All Products |
$32.33
|
| Rate for Payer: Sagamore All Products |
$64.01
|
| Rate for Payer: Self Pay/Cash Rate |
$51.40
|
| Rate for Payer: Signature Care EPO |
$68.82
|
| Rate for Payer: Signature Care PPO |
$72.96
|
| Rate for Payer: Three Rivers Preferred All Products |
$70.47
|
| Rate for Payer: United Healthcare Commercial |
$65.33
|
| Rate for Payer: United Healthcare Medicare |
$27.36
|
|
|
HC ABSOLUTE EOSINOPHIL COUNT
|
Facility
IP
|
$55.83
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
63001241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna Commercial |
$48.24
|
| Rate for Payer: Cigna All Products |
$48.18
|
| Rate for Payer: Coventry/First Health All Products |
$49.13
|
| Rate for Payer: Encore All Products |
$51.39
|
| Rate for Payer: Frontpath All Products |
$51.36
|
| Rate for Payer: Humana ChoiceCare |
$48.22
|
| Rate for Payer: Lutheran Preferred All Products |
$50.25
|
| Rate for Payer: PHCS/Multiplan All Products |
$41.87
|
| Rate for Payer: PHP All Products |
$42.34
|
| Rate for Payer: Sagamore All Products |
$43.10
|
| Rate for Payer: Self Pay/Cash Rate |
$34.61
|
| Rate for Payer: Signature Care EPO |
$46.34
|
| Rate for Payer: Signature Care PPO |
$49.13
|
| Rate for Payer: United Healthcare Commercial |
$43.99
|
|
|
HC ABSOLUTE EOSINOPHIL COUNT
|
Facility
OP
|
$55.83
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
63001241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna Commercial |
$47.12
|
| Rate for Payer: Aetna Medicare |
$18.42
|
| Rate for Payer: Anthem Exchange |
$32.06
|
| Rate for Payer: Anthem Medicaid |
$2.54
|
| Rate for Payer: Anthem Medicare |
$18.42
|
| Rate for Payer: Anthem PPO |
$32.06
|
| Rate for Payer: Anthem Traditional |
$34.90
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$2.54
|
| Rate for Payer: Caresource Just 4 Me |
$21.19
|
| Rate for Payer: Caresource Medicare |
$20.27
|
| Rate for Payer: Centivo/Paragon All Products |
$28.47
|
| Rate for Payer: Cigna All Products |
$48.18
|
| Rate for Payer: Coventry/First Health All Products |
$49.13
|
| Rate for Payer: Encore All Products |
$51.39
|
| Rate for Payer: Frontpath All Products |
$51.36
|
| Rate for Payer: Humana ChoiceCare |
$48.22
|
| Rate for Payer: Humana Medicare |
$28.47
|
| Rate for Payer: Lucent/Coldwater Veneers |
$28.47
|
| Rate for Payer: Lutheran Preferred All Products |
$50.25
|
| Rate for Payer: Managed Health Services All Products |
$2.54
|
| Rate for Payer: MDWise All Products |
$2.54
|
| Rate for Payer: PHCS/Multiplan All Products |
$41.87
|
| Rate for Payer: PHP All Products |
$42.34
|
| Rate for Payer: Plain Church Group Ministry All Products |
$21.77
|
| Rate for Payer: Sagamore All Products |
$43.10
|
| Rate for Payer: Self Pay/Cash Rate |
$34.61
|
| Rate for Payer: Signature Care EPO |
$46.34
|
| Rate for Payer: Signature Care PPO |
$49.13
|
| Rate for Payer: Three Rivers Preferred All Products |
$47.46
|
| Rate for Payer: United Healthcare Commercial |
$43.99
|
| Rate for Payer: United Healthcare Medicare |
$18.42
|
|
|
HC ABSORBA TACK 5MM
|
Facility
OP
|
$359.40
|
|
| Hospital Charge Code |
41602252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.60 |
| Max. Negotiated Rate |
$330.83 |
| Rate for Payer: Aetna Commercial |
$303.33
|
| Rate for Payer: Aetna Medicare |
$118.60
|
| Rate for Payer: Anthem Exchange |
$206.40
|
| Rate for Payer: Anthem Medicare |
$118.60
|
| Rate for Payer: Anthem PPO |
$206.40
|
| Rate for Payer: Anthem Traditional |
$224.66
|
| Rate for Payer: Caresource Just 4 Me |
$136.39
|
| Rate for Payer: Caresource Medicare |
$130.46
|
| Rate for Payer: Centivo/Paragon All Products |
$183.29
|
| Rate for Payer: Cigna All Products |
$310.16
|
| Rate for Payer: Coventry/First Health All Products |
$316.27
|
| Rate for Payer: Encore All Products |
$330.83
|
| Rate for Payer: Frontpath All Products |
$330.65
|
| Rate for Payer: Humana ChoiceCare |
$310.41
|
| Rate for Payer: Humana Medicare |
$183.29
|
| Rate for Payer: Lucent/Coldwater Veneers |
$183.29
|
| Rate for Payer: Lutheran Preferred All Products |
$323.46
|
| Rate for Payer: PHCS/Multiplan All Products |
$269.55
|
| Rate for Payer: PHP All Products |
$272.57
|
| Rate for Payer: Plain Church Group Ministry All Products |
$140.17
|
| Rate for Payer: Sagamore All Products |
$277.46
|
| Rate for Payer: Self Pay/Cash Rate |
$222.83
|
| Rate for Payer: Signature Care EPO |
$298.30
|
| Rate for Payer: Signature Care PPO |
$316.27
|
| Rate for Payer: Three Rivers Preferred All Products |
$305.49
|
| Rate for Payer: United Healthcare Commercial |
$283.21
|
| Rate for Payer: United Healthcare Medicare |
$118.60
|
|
|
HC ABSORBA TACK 5MM
|
Facility
IP
|
$359.40
|
|
| Hospital Charge Code |
41602252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.83 |
| Max. Negotiated Rate |
$330.83 |
| Rate for Payer: Aetna Commercial |
$310.52
|
| Rate for Payer: Cigna All Products |
$310.16
|
| Rate for Payer: Coventry/First Health All Products |
$316.27
|
| Rate for Payer: Encore All Products |
$330.83
|
| Rate for Payer: Frontpath All Products |
$330.65
|
| Rate for Payer: Humana ChoiceCare |
$310.41
|
| Rate for Payer: Lutheran Preferred All Products |
$323.46
|
| Rate for Payer: PHCS/Multiplan All Products |
$269.55
|
| Rate for Payer: PHP All Products |
$272.57
|
| Rate for Payer: Sagamore All Products |
$277.46
|
| Rate for Payer: Self Pay/Cash Rate |
$222.83
|
| Rate for Payer: Signature Care EPO |
$298.30
|
| Rate for Payer: Signature Care PPO |
$316.27
|
| Rate for Payer: United Healthcare Commercial |
$283.21
|
|
|
HC ABTHERA OPEN ABD THER MACH/DAY
|
Facility
IP
|
$300.40
|
|
| Hospital Charge Code |
1895200
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$259.55
|
| Rate for Payer: Cigna All Products |
$259.25
|
| Rate for Payer: Coventry/First Health All Products |
$264.35
|
| Rate for Payer: Encore All Products |
$276.52
|
| Rate for Payer: Frontpath All Products |
$276.37
|
| Rate for Payer: Humana ChoiceCare |
$259.46
|
| Rate for Payer: Lutheran Preferred All Products |
$270.36
|
| Rate for Payer: PHCS/Multiplan All Products |
$225.30
|
| Rate for Payer: PHP All Products |
$227.82
|
| Rate for Payer: Sagamore All Products |
$231.91
|
| Rate for Payer: Self Pay/Cash Rate |
$186.25
|
| Rate for Payer: Signature Care EPO |
$249.33
|
| Rate for Payer: Signature Care PPO |
$264.35
|
| Rate for Payer: United Healthcare Commercial |
$236.72
|
|
|
HC ABTHERA OPEN ABD THER MACH/DAY
|
Facility
OP
|
$300.40
|
|
| Hospital Charge Code |
1895200
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.13 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$253.54
|
| Rate for Payer: Aetna Medicare |
$99.13
|
| Rate for Payer: Anthem Exchange |
$172.52
|
| Rate for Payer: Anthem Medicare |
$99.13
|
| Rate for Payer: Anthem PPO |
$172.52
|
| Rate for Payer: Anthem Traditional |
$187.78
|
| Rate for Payer: Caresource Just 4 Me |
$114.00
|
| Rate for Payer: Caresource Medicare |
$109.05
|
| Rate for Payer: Centivo/Paragon All Products |
$153.20
|
| Rate for Payer: Cigna All Products |
$259.25
|
| Rate for Payer: Coventry/First Health All Products |
$264.35
|
| Rate for Payer: Encore All Products |
$276.52
|
| Rate for Payer: Frontpath All Products |
$276.37
|
| Rate for Payer: Humana ChoiceCare |
$259.46
|
| Rate for Payer: Humana Medicare |
$153.20
|
| Rate for Payer: Lucent/Coldwater Veneers |
$153.20
|
| Rate for Payer: Lutheran Preferred All Products |
$270.36
|
| Rate for Payer: PHCS/Multiplan All Products |
$225.30
|
| Rate for Payer: PHP All Products |
$227.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$117.16
|
| Rate for Payer: Sagamore All Products |
$231.91
|
| Rate for Payer: Self Pay/Cash Rate |
$186.25
|
| Rate for Payer: Signature Care EPO |
$249.33
|
| Rate for Payer: Signature Care PPO |
$264.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$255.34
|
| Rate for Payer: United Healthcare Commercial |
$236.72
|
| Rate for Payer: United Healthcare Medicare |
$99.13
|
|
|
HC ACCUCATH 20GX2.25IN
|
Facility
OP
|
$163.02
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41605857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$150.06 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Medicare |
$53.80
|
| Rate for Payer: Anthem Exchange |
$93.62
|
| Rate for Payer: Anthem Medicare |
$53.80
|
| Rate for Payer: Anthem PPO |
$93.62
|
| Rate for Payer: Anthem Traditional |
$101.90
|
| Rate for Payer: Caresource Just 4 Me |
$61.87
|
| Rate for Payer: Caresource Medicare |
$59.18
|
| Rate for Payer: Centivo/Paragon All Products |
$83.14
|
| Rate for Payer: Cigna All Products |
$140.69
|
| Rate for Payer: Coventry/First Health All Products |
$143.46
|
| Rate for Payer: Encore All Products |
$150.06
|
| Rate for Payer: Frontpath All Products |
$149.98
|
| Rate for Payer: Humana ChoiceCare |
$140.80
|
| Rate for Payer: Humana Medicare |
$83.14
|
| Rate for Payer: Lucent/Coldwater Veneers |
$83.14
|
| Rate for Payer: Lutheran Preferred All Products |
$146.72
|
| Rate for Payer: PHCS/Multiplan All Products |
$122.27
|
| Rate for Payer: PHP All Products |
$123.63
|
| Rate for Payer: Plain Church Group Ministry All Products |
$63.58
|
| Rate for Payer: Sagamore All Products |
$125.85
|
| Rate for Payer: Self Pay/Cash Rate |
$101.07
|
| Rate for Payer: Signature Care EPO |
$135.31
|
| Rate for Payer: Signature Care PPO |
$143.46
|
| Rate for Payer: Three Rivers Preferred All Products |
$138.57
|
| Rate for Payer: United Healthcare Commercial |
$128.46
|
| Rate for Payer: United Healthcare Medicare |
$53.80
|
|
|
HC ACCUCATH 20GX2.25IN
|
Facility
IP
|
$163.02
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41605857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.07 |
| Max. Negotiated Rate |
$150.06 |
| Rate for Payer: Aetna Commercial |
$140.85
|
| Rate for Payer: Cigna All Products |
$140.69
|
| Rate for Payer: Coventry/First Health All Products |
$143.46
|
| Rate for Payer: Encore All Products |
$150.06
|
| Rate for Payer: Frontpath All Products |
$149.98
|
| Rate for Payer: Humana ChoiceCare |
$140.80
|
| Rate for Payer: Lutheran Preferred All Products |
$146.72
|
| Rate for Payer: PHCS/Multiplan All Products |
$122.27
|
| Rate for Payer: PHP All Products |
$123.63
|
| Rate for Payer: Sagamore All Products |
$125.85
|
| Rate for Payer: Self Pay/Cash Rate |
$101.07
|
| Rate for Payer: Signature Care EPO |
$135.31
|
| Rate for Payer: Signature Care PPO |
$143.46
|
| Rate for Payer: United Healthcare Commercial |
$128.46
|
|
|
HC ACCUCHECK BEDSIDE
|
Facility
OP
|
$26.08
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
1239001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$24.01 |
| Rate for Payer: Aetna Commercial |
$22.01
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Anthem Exchange |
$11.99
|
| Rate for Payer: Anthem Medicaid |
$4.31
|
| Rate for Payer: Anthem Medicare |
$8.61
|
| Rate for Payer: Anthem PPO |
$11.99
|
| Rate for Payer: Anthem Traditional |
$11.99
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$4.31
|
| Rate for Payer: Caresource Just 4 Me |
$9.90
|
| Rate for Payer: Caresource Medicare |
$9.47
|
| Rate for Payer: Centivo/Paragon All Products |
$13.30
|
| Rate for Payer: Cigna All Products |
$22.51
|
| Rate for Payer: Coventry/First Health All Products |
$22.95
|
| Rate for Payer: Encore All Products |
$24.01
|
| Rate for Payer: Frontpath All Products |
$23.99
|
| Rate for Payer: Humana ChoiceCare |
$22.53
|
| Rate for Payer: Humana Medicare |
$13.30
|
| Rate for Payer: Lucent/Coldwater Veneers |
$13.30
|
| Rate for Payer: Lutheran Preferred All Products |
$23.47
|
| Rate for Payer: Managed Health Services All Products |
$4.31
|
| Rate for Payer: MDWise All Products |
$4.31
|
| Rate for Payer: PHCS/Multiplan All Products |
$19.56
|
| Rate for Payer: PHP All Products |
$19.78
|
| Rate for Payer: Plain Church Group Ministry All Products |
$10.17
|
| Rate for Payer: Sagamore All Products |
$20.13
|
| Rate for Payer: Self Pay/Cash Rate |
$16.17
|
| Rate for Payer: Signature Care EPO |
$21.65
|
| Rate for Payer: Signature Care PPO |
$22.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$22.17
|
| Rate for Payer: United Healthcare Commercial |
$20.55
|
| Rate for Payer: United Healthcare Medicare |
$8.61
|
|
|
HC ACCUCHECK BEDSIDE
|
Facility
IP
|
$26.08
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
1239001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$24.01 |
| Rate for Payer: Aetna Commercial |
$22.53
|
| Rate for Payer: Cigna All Products |
$22.51
|
| Rate for Payer: Coventry/First Health All Products |
$22.95
|
| Rate for Payer: Encore All Products |
$24.01
|
| Rate for Payer: Frontpath All Products |
$23.99
|
| Rate for Payer: Humana ChoiceCare |
$22.53
|
| Rate for Payer: Lutheran Preferred All Products |
$23.47
|
| Rate for Payer: PHCS/Multiplan All Products |
$19.56
|
| Rate for Payer: PHP All Products |
$19.78
|
| Rate for Payer: Sagamore All Products |
$20.13
|
| Rate for Payer: Self Pay/Cash Rate |
$16.17
|
| Rate for Payer: Signature Care EPO |
$21.65
|
| Rate for Payer: Signature Care PPO |
$22.95
|
| Rate for Payer: United Healthcare Commercial |
$20.55
|
|
|
HC ACCUMAX (ENCOMPASS) INFLATOR /DAY
|
Facility
IP
|
$153.50
|
|
| Hospital Charge Code |
1890110
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$95.17 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna Commercial |
$132.62
|
| Rate for Payer: Cigna All Products |
$132.47
|
| Rate for Payer: Coventry/First Health All Products |
$135.08
|
| Rate for Payer: Encore All Products |
$141.30
|
| Rate for Payer: Frontpath All Products |
$141.22
|
| Rate for Payer: Humana ChoiceCare |
$132.58
|
| Rate for Payer: Lutheran Preferred All Products |
$138.15
|
| Rate for Payer: PHCS/Multiplan All Products |
$115.12
|
| Rate for Payer: PHP All Products |
$116.41
|
| Rate for Payer: Sagamore All Products |
$118.50
|
| Rate for Payer: Self Pay/Cash Rate |
$95.17
|
| Rate for Payer: Signature Care EPO |
$127.40
|
| Rate for Payer: Signature Care PPO |
$135.08
|
| Rate for Payer: United Healthcare Commercial |
$120.96
|
|
|
HC ACCUMAX (ENCOMPASS) INFLATOR /DAY
|
Facility
OP
|
$153.50
|
|
| Hospital Charge Code |
1890110
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.66 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna Commercial |
$129.55
|
| Rate for Payer: Aetna Medicare |
$50.66
|
| Rate for Payer: Anthem Exchange |
$88.16
|
| Rate for Payer: Anthem Medicare |
$50.66
|
| Rate for Payer: Anthem PPO |
$88.16
|
| Rate for Payer: Anthem Traditional |
$95.95
|
| Rate for Payer: Caresource Just 4 Me |
$58.25
|
| Rate for Payer: Caresource Medicare |
$55.72
|
| Rate for Payer: Centivo/Paragon All Products |
$78.28
|
| Rate for Payer: Cigna All Products |
$132.47
|
| Rate for Payer: Coventry/First Health All Products |
$135.08
|
| Rate for Payer: Encore All Products |
$141.30
|
| Rate for Payer: Frontpath All Products |
$141.22
|
| Rate for Payer: Humana ChoiceCare |
$132.58
|
| Rate for Payer: Humana Medicare |
$78.28
|
| Rate for Payer: Lucent/Coldwater Veneers |
$78.28
|
| Rate for Payer: Lutheran Preferred All Products |
$138.15
|
| Rate for Payer: PHCS/Multiplan All Products |
$115.12
|
| Rate for Payer: PHP All Products |
$116.41
|
| Rate for Payer: Plain Church Group Ministry All Products |
$59.87
|
| Rate for Payer: Sagamore All Products |
$118.50
|
| Rate for Payer: Self Pay/Cash Rate |
$95.17
|
| Rate for Payer: Signature Care EPO |
$127.40
|
| Rate for Payer: Signature Care PPO |
$135.08
|
| Rate for Payer: Three Rivers Preferred All Products |
$130.47
|
| Rate for Payer: United Healthcare Commercial |
$120.96
|
| Rate for Payer: United Healthcare Medicare |
$50.66
|
|
|
HC ACETAMINOPHEN
|
Facility
OP
|
$183.23
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.47 |
| Max. Negotiated Rate |
$168.66 |
| Rate for Payer: Aetna Commercial |
$154.65
|
| Rate for Payer: Aetna Medicare |
$60.47
|
| Rate for Payer: Anthem Exchange |
$84.21
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare |
$60.47
|
| Rate for Payer: Anthem PPO |
$84.21
|
| Rate for Payer: Anthem Traditional |
$84.21
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$62.14
|
| Rate for Payer: Caresource Just 4 Me |
$69.54
|
| Rate for Payer: Caresource Medicare |
$66.51
|
| Rate for Payer: Centivo/Paragon All Products |
$93.45
|
| Rate for Payer: Cigna All Products |
$158.13
|
| Rate for Payer: Coventry/First Health All Products |
$161.24
|
| Rate for Payer: Encore All Products |
$168.66
|
| Rate for Payer: Frontpath All Products |
$168.57
|
| Rate for Payer: Humana ChoiceCare |
$158.26
|
| Rate for Payer: Humana Medicare |
$93.45
|
| Rate for Payer: Lucent/Coldwater Veneers |
$93.45
|
| Rate for Payer: Lutheran Preferred All Products |
$164.91
|
| Rate for Payer: Managed Health Services All Products |
$62.14
|
| Rate for Payer: MDWise All Products |
$62.14
|
| Rate for Payer: PHCS/Multiplan All Products |
$137.42
|
| Rate for Payer: PHP All Products |
$138.96
|
| Rate for Payer: Plain Church Group Ministry All Products |
$71.46
|
| Rate for Payer: Sagamore All Products |
$141.45
|
| Rate for Payer: Self Pay/Cash Rate |
$113.60
|
| Rate for Payer: Signature Care EPO |
$152.08
|
| Rate for Payer: Signature Care PPO |
$161.24
|
| Rate for Payer: Three Rivers Preferred All Products |
$155.75
|
| Rate for Payer: United Healthcare Commercial |
$144.39
|
| Rate for Payer: United Healthcare Medicare |
$60.47
|
|
|
HC ACETAMINOPHEN
|
Facility
IP
|
$183.23
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$168.66 |
| Rate for Payer: Aetna Commercial |
$158.31
|
| Rate for Payer: Cigna All Products |
$158.13
|
| Rate for Payer: Coventry/First Health All Products |
$161.24
|
| Rate for Payer: Encore All Products |
$168.66
|
| Rate for Payer: Frontpath All Products |
$168.57
|
| Rate for Payer: Humana ChoiceCare |
$158.26
|
| Rate for Payer: Lutheran Preferred All Products |
$164.91
|
| Rate for Payer: PHCS/Multiplan All Products |
$137.42
|
| Rate for Payer: PHP All Products |
$138.96
|
| Rate for Payer: Sagamore All Products |
$141.45
|
| Rate for Payer: Self Pay/Cash Rate |
$113.60
|
| Rate for Payer: Signature Care EPO |
$152.08
|
| Rate for Payer: Signature Care PPO |
$161.24
|
| Rate for Payer: United Healthcare Commercial |
$144.39
|
|
|
HC ACETONE
|
Facility
OP
|
$107.80
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
63001207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$99.23 |
| Rate for Payer: Aetna Commercial |
$90.98
|
| Rate for Payer: Aetna Medicare |
$35.57
|
| Rate for Payer: Anthem Exchange |
$49.54
|
| Rate for Payer: Anthem Medicaid |
$4.52
|
| Rate for Payer: Anthem Medicare |
$35.57
|
| Rate for Payer: Anthem PPO |
$49.54
|
| Rate for Payer: Anthem Traditional |
$49.54
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$4.52
|
| Rate for Payer: Caresource Just 4 Me |
$40.91
|
| Rate for Payer: Caresource Medicare |
$39.13
|
| Rate for Payer: Centivo/Paragon All Products |
$54.98
|
| Rate for Payer: Cigna All Products |
$93.03
|
| Rate for Payer: Coventry/First Health All Products |
$94.86
|
| Rate for Payer: Encore All Products |
$99.23
|
| Rate for Payer: Frontpath All Products |
$99.18
|
| Rate for Payer: Humana ChoiceCare |
$93.11
|
| Rate for Payer: Humana Medicare |
$54.98
|
| Rate for Payer: Lucent/Coldwater Veneers |
$54.98
|
| Rate for Payer: Lutheran Preferred All Products |
$97.02
|
| Rate for Payer: Managed Health Services All Products |
$4.52
|
| Rate for Payer: MDWise All Products |
$4.52
|
| Rate for Payer: PHCS/Multiplan All Products |
$80.85
|
| Rate for Payer: PHP All Products |
$81.76
|
| Rate for Payer: Plain Church Group Ministry All Products |
$42.04
|
| Rate for Payer: Sagamore All Products |
$83.22
|
| Rate for Payer: Self Pay/Cash Rate |
$66.84
|
| Rate for Payer: Signature Care EPO |
$89.47
|
| Rate for Payer: Signature Care PPO |
$94.86
|
| Rate for Payer: Three Rivers Preferred All Products |
$91.63
|
| Rate for Payer: United Healthcare Commercial |
$84.95
|
| Rate for Payer: United Healthcare Medicare |
$35.57
|
|
|
HC ACETONE
|
Facility
IP
|
$107.80
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
63001207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.84 |
| Max. Negotiated Rate |
$99.23 |
| Rate for Payer: Aetna Commercial |
$93.14
|
| Rate for Payer: Cigna All Products |
$93.03
|
| Rate for Payer: Coventry/First Health All Products |
$94.86
|
| Rate for Payer: Encore All Products |
$99.23
|
| Rate for Payer: Frontpath All Products |
$99.18
|
| Rate for Payer: Humana ChoiceCare |
$93.11
|
| Rate for Payer: Lutheran Preferred All Products |
$97.02
|
| Rate for Payer: PHCS/Multiplan All Products |
$80.85
|
| Rate for Payer: PHP All Products |
$81.76
|
| Rate for Payer: Sagamore All Products |
$83.22
|
| Rate for Payer: Self Pay/Cash Rate |
$66.84
|
| Rate for Payer: Signature Care EPO |
$89.47
|
| Rate for Payer: Signature Care PPO |
$94.86
|
| Rate for Payer: United Healthcare Commercial |
$84.95
|
|
|
HC ACETYLCHOLINE BINDING ANTBY
|
Facility
IP
|
$328.90
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
63001049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$203.92 |
| Max. Negotiated Rate |
$302.75 |
| Rate for Payer: Aetna Commercial |
$284.17
|
| Rate for Payer: Cigna All Products |
$283.84
|
| Rate for Payer: Coventry/First Health All Products |
$289.43
|
| Rate for Payer: Encore All Products |
$302.75
|
| Rate for Payer: Frontpath All Products |
$302.59
|
| Rate for Payer: Humana ChoiceCare |
$284.07
|
| Rate for Payer: Lutheran Preferred All Products |
$296.01
|
| Rate for Payer: PHCS/Multiplan All Products |
$246.67
|
| Rate for Payer: PHP All Products |
$249.44
|
| Rate for Payer: Sagamore All Products |
$253.91
|
| Rate for Payer: Self Pay/Cash Rate |
$203.92
|
| Rate for Payer: Signature Care EPO |
$272.99
|
| Rate for Payer: Signature Care PPO |
$289.43
|
| Rate for Payer: United Healthcare Commercial |
$259.17
|
|
|
HC ACETYLCHOLINE BINDING ANTBY
|
Facility
OP
|
$328.90
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
63001049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$302.75 |
| Rate for Payer: Aetna Commercial |
$277.59
|
| Rate for Payer: Aetna Medicare |
$108.54
|
| Rate for Payer: Anthem Exchange |
$188.89
|
| Rate for Payer: Anthem Medicaid |
$18.39
|
| Rate for Payer: Anthem Medicare |
$108.54
|
| Rate for Payer: Anthem PPO |
$188.89
|
| Rate for Payer: Anthem Traditional |
$205.60
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$18.39
|
| Rate for Payer: Caresource Just 4 Me |
$124.82
|
| Rate for Payer: Caresource Medicare |
$119.39
|
| Rate for Payer: Centivo/Paragon All Products |
$167.74
|
| Rate for Payer: Cigna All Products |
$283.84
|
| Rate for Payer: Coventry/First Health All Products |
$289.43
|
| Rate for Payer: Encore All Products |
$302.75
|
| Rate for Payer: Frontpath All Products |
$302.59
|
| Rate for Payer: Humana ChoiceCare |
$284.07
|
| Rate for Payer: Humana Medicare |
$167.74
|
| Rate for Payer: Lucent/Coldwater Veneers |
$167.74
|
| Rate for Payer: Lutheran Preferred All Products |
$296.01
|
| Rate for Payer: Managed Health Services All Products |
$18.39
|
| Rate for Payer: MDWise All Products |
$18.39
|
| Rate for Payer: PHCS/Multiplan All Products |
$246.67
|
| Rate for Payer: PHP All Products |
$249.44
|
| Rate for Payer: Plain Church Group Ministry All Products |
$128.27
|
| Rate for Payer: Sagamore All Products |
$253.91
|
| Rate for Payer: Self Pay/Cash Rate |
$203.92
|
| Rate for Payer: Signature Care EPO |
$272.99
|
| Rate for Payer: Signature Care PPO |
$289.43
|
| Rate for Payer: Three Rivers Preferred All Products |
$279.56
|
| Rate for Payer: United Healthcare Commercial |
$259.17
|
| Rate for Payer: United Healthcare Medicare |
$108.54
|
|
|
HC ACETYLCHOLINE BLOCKING ANTBY
|
Facility
OP
|
$128.29
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$118.09 |
| Rate for Payer: Aetna Commercial |
$108.28
|
| Rate for Payer: Aetna Medicare |
$42.34
|
| Rate for Payer: Anthem Exchange |
$58.96
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare |
$42.34
|
| Rate for Payer: Anthem PPO |
$58.96
|
| Rate for Payer: Anthem Traditional |
$58.96
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$11.53
|
| Rate for Payer: Caresource Just 4 Me |
$48.69
|
| Rate for Payer: Caresource Medicare |
$46.57
|
| Rate for Payer: Centivo/Paragon All Products |
$65.43
|
| Rate for Payer: Cigna All Products |
$110.71
|
| Rate for Payer: Coventry/First Health All Products |
$112.90
|
| Rate for Payer: Encore All Products |
$118.09
|
| Rate for Payer: Frontpath All Products |
$118.03
|
| Rate for Payer: Humana ChoiceCare |
$110.80
|
| Rate for Payer: Humana Medicare |
$65.43
|
| Rate for Payer: Lucent/Coldwater Veneers |
$65.43
|
| Rate for Payer: Lutheran Preferred All Products |
$115.46
|
| Rate for Payer: Managed Health Services All Products |
$11.53
|
| Rate for Payer: MDWise All Products |
$11.53
|
| Rate for Payer: PHCS/Multiplan All Products |
$96.22
|
| Rate for Payer: PHP All Products |
$97.30
|
| Rate for Payer: Plain Church Group Ministry All Products |
$50.03
|
| Rate for Payer: Sagamore All Products |
$99.04
|
| Rate for Payer: Self Pay/Cash Rate |
$79.54
|
| Rate for Payer: Signature Care EPO |
$106.48
|
| Rate for Payer: Signature Care PPO |
$112.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$109.05
|
| Rate for Payer: United Healthcare Commercial |
$101.09
|
| Rate for Payer: United Healthcare Medicare |
$42.34
|
|
|
HC ACETYLCHOLINE BLOCKING ANTBY
|
Facility
IP
|
$128.29
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.54 |
| Max. Negotiated Rate |
$118.09 |
| Rate for Payer: Aetna Commercial |
$110.84
|
| Rate for Payer: Cigna All Products |
$110.71
|
| Rate for Payer: Coventry/First Health All Products |
$112.90
|
| Rate for Payer: Encore All Products |
$118.09
|
| Rate for Payer: Frontpath All Products |
$118.03
|
| Rate for Payer: Humana ChoiceCare |
$110.80
|
| Rate for Payer: Lutheran Preferred All Products |
$115.46
|
| Rate for Payer: PHCS/Multiplan All Products |
$96.22
|
| Rate for Payer: PHP All Products |
$97.30
|
| Rate for Payer: Sagamore All Products |
$99.04
|
| Rate for Payer: Self Pay/Cash Rate |
$79.54
|
| Rate for Payer: Signature Care EPO |
$106.48
|
| Rate for Payer: Signature Care PPO |
$112.90
|
| Rate for Payer: United Healthcare Commercial |
$101.09
|
|
|
HC ACETYLCHOLINE MODULATING ANTBY
|
Facility
OP
|
$103.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$95.27 |
| Rate for Payer: Aetna Commercial |
$87.35
|
| Rate for Payer: Aetna Medicare |
$34.16
|
| Rate for Payer: Anthem Exchange |
$47.57
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare |
$34.16
|
| Rate for Payer: Anthem PPO |
$47.57
|
| Rate for Payer: Anthem Traditional |
$47.57
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$11.53
|
| Rate for Payer: Caresource Just 4 Me |
$39.28
|
| Rate for Payer: Caresource Medicare |
$37.57
|
| Rate for Payer: Centivo/Paragon All Products |
$52.79
|
| Rate for Payer: Cigna All Products |
$89.32
|
| Rate for Payer: Coventry/First Health All Products |
$91.08
|
| Rate for Payer: Encore All Products |
$95.27
|
| Rate for Payer: Frontpath All Products |
$95.22
|
| Rate for Payer: Humana ChoiceCare |
$89.39
|
| Rate for Payer: Humana Medicare |
$52.79
|
| Rate for Payer: Lucent/Coldwater Veneers |
$52.79
|
| Rate for Payer: Lutheran Preferred All Products |
$93.15
|
| Rate for Payer: Managed Health Services All Products |
$11.53
|
| Rate for Payer: MDWise All Products |
$11.53
|
| Rate for Payer: PHCS/Multiplan All Products |
$77.62
|
| Rate for Payer: PHP All Products |
$78.49
|
| Rate for Payer: Plain Church Group Ministry All Products |
$40.37
|
| Rate for Payer: Sagamore All Products |
$79.90
|
| Rate for Payer: Self Pay/Cash Rate |
$64.17
|
| Rate for Payer: Signature Care EPO |
$85.91
|
| Rate for Payer: Signature Care PPO |
$91.08
|
| Rate for Payer: Three Rivers Preferred All Products |
$87.97
|
| Rate for Payer: United Healthcare Commercial |
$81.56
|
| Rate for Payer: United Healthcare Medicare |
$34.16
|
|
|
HC ACETYLCHOLINE MODULATING ANTBY
|
Facility
IP
|
$103.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.17 |
| Max. Negotiated Rate |
$95.27 |
| Rate for Payer: Aetna Commercial |
$89.42
|
| Rate for Payer: Cigna All Products |
$89.32
|
| Rate for Payer: Coventry/First Health All Products |
$91.08
|
| Rate for Payer: Encore All Products |
$95.27
|
| Rate for Payer: Frontpath All Products |
$95.22
|
| Rate for Payer: Humana ChoiceCare |
$89.39
|
| Rate for Payer: Lutheran Preferred All Products |
$93.15
|
| Rate for Payer: PHCS/Multiplan All Products |
$77.62
|
| Rate for Payer: PHP All Products |
$78.49
|
| Rate for Payer: Sagamore All Products |
$79.90
|
| Rate for Payer: Self Pay/Cash Rate |
$64.17
|
| Rate for Payer: Signature Care EPO |
$85.91
|
| Rate for Payer: Signature Care PPO |
$91.08
|
| Rate for Payer: United Healthcare Commercial |
$81.56
|
|
|
HC ACID FAST CULTURE
|
Facility
OP
|
$211.71
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63001063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$194.88 |
| Rate for Payer: Aetna Commercial |
$178.68
|
| Rate for Payer: Aetna Medicare |
$69.86
|
| Rate for Payer: Anthem Exchange |
$121.59
|
| Rate for Payer: Anthem Medicaid |
$10.80
|
| Rate for Payer: Anthem Medicare |
$69.86
|
| Rate for Payer: Anthem PPO |
$121.59
|
| Rate for Payer: Anthem Traditional |
$132.34
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$10.80
|
| Rate for Payer: Caresource Just 4 Me |
$80.34
|
| Rate for Payer: Caresource Medicare |
$76.85
|
| Rate for Payer: Centivo/Paragon All Products |
$107.97
|
| Rate for Payer: Cigna All Products |
$182.71
|
| Rate for Payer: Coventry/First Health All Products |
$186.30
|
| Rate for Payer: Encore All Products |
$194.88
|
| Rate for Payer: Frontpath All Products |
$194.77
|
| Rate for Payer: Humana ChoiceCare |
$182.85
|
| Rate for Payer: Humana Medicare |
$107.97
|
| Rate for Payer: Lucent/Coldwater Veneers |
$107.97
|
| Rate for Payer: Lutheran Preferred All Products |
$190.54
|
| Rate for Payer: Managed Health Services All Products |
$10.80
|
| Rate for Payer: MDWise All Products |
$10.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$158.78
|
| Rate for Payer: PHP All Products |
$160.56
|
| Rate for Payer: Plain Church Group Ministry All Products |
$82.57
|
| Rate for Payer: Sagamore All Products |
$163.44
|
| Rate for Payer: Self Pay/Cash Rate |
$131.26
|
| Rate for Payer: Signature Care EPO |
$175.72
|
| Rate for Payer: Signature Care PPO |
$186.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$179.95
|
| Rate for Payer: United Healthcare Commercial |
$166.83
|
| Rate for Payer: United Healthcare Medicare |
$69.86
|
|
