|
HC ACID FAST CULTURE
|
Facility
IP
|
$211.71
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63001063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.26 |
| Max. Negotiated Rate |
$194.88 |
| Rate for Payer: Aetna Commercial |
$182.92
|
| 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: Lutheran Preferred All Products |
$190.54
|
| Rate for Payer: PHCS/Multiplan All Products |
$158.78
|
| Rate for Payer: PHP All Products |
$160.56
|
| 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: United Healthcare Commercial |
$166.83
|
|
|
HC ACID FAST CULTURE-BLOOD & BONE MARROW
|
Facility
OP
|
$140.59
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63002006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$129.41 |
| Rate for Payer: Aetna Commercial |
$118.66
|
| Rate for Payer: Aetna Medicare |
$46.39
|
| Rate for Payer: Anthem Exchange |
$80.74
|
| Rate for Payer: Anthem Medicaid |
$10.80
|
| Rate for Payer: Anthem Medicare |
$46.39
|
| Rate for Payer: Anthem PPO |
$80.74
|
| Rate for Payer: Anthem Traditional |
$87.88
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$10.80
|
| Rate for Payer: Caresource Just 4 Me |
$53.35
|
| Rate for Payer: Caresource Medicare |
$51.03
|
| Rate for Payer: Centivo/Paragon All Products |
$71.70
|
| Rate for Payer: Cigna All Products |
$121.33
|
| Rate for Payer: Coventry/First Health All Products |
$123.72
|
| Rate for Payer: Encore All Products |
$129.41
|
| Rate for Payer: Frontpath All Products |
$129.34
|
| Rate for Payer: Humana ChoiceCare |
$121.43
|
| Rate for Payer: Humana Medicare |
$71.70
|
| Rate for Payer: Lucent/Coldwater Veneers |
$71.70
|
| Rate for Payer: Lutheran Preferred All Products |
$126.53
|
| 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 |
$105.44
|
| Rate for Payer: PHP All Products |
$106.62
|
| Rate for Payer: Plain Church Group Ministry All Products |
$54.83
|
| Rate for Payer: Sagamore All Products |
$108.54
|
| Rate for Payer: Self Pay/Cash Rate |
$87.17
|
| Rate for Payer: Signature Care EPO |
$116.69
|
| Rate for Payer: Signature Care PPO |
$123.72
|
| Rate for Payer: Three Rivers Preferred All Products |
$119.50
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$46.39
|
|
|
HC ACID FAST CULTURE-BLOOD & BONE MARROW
|
Facility
IP
|
$140.59
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63002006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.17 |
| Max. Negotiated Rate |
$129.41 |
| Rate for Payer: Aetna Commercial |
$121.47
|
| Rate for Payer: Cigna All Products |
$121.33
|
| Rate for Payer: Coventry/First Health All Products |
$123.72
|
| Rate for Payer: Encore All Products |
$129.41
|
| Rate for Payer: Frontpath All Products |
$129.34
|
| Rate for Payer: Humana ChoiceCare |
$121.43
|
| Rate for Payer: Lutheran Preferred All Products |
$126.53
|
| Rate for Payer: PHCS/Multiplan All Products |
$105.44
|
| Rate for Payer: PHP All Products |
$106.62
|
| Rate for Payer: Sagamore All Products |
$108.54
|
| Rate for Payer: Self Pay/Cash Rate |
$87.17
|
| Rate for Payer: Signature Care EPO |
$116.69
|
| Rate for Payer: Signature Care PPO |
$123.72
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
|
|
HC ACID FAST CULTURE-FECES
|
Facility
OP
|
$140.59
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63002007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$129.41 |
| Rate for Payer: Aetna Commercial |
$118.66
|
| Rate for Payer: Aetna Medicare |
$46.39
|
| Rate for Payer: Anthem Exchange |
$80.74
|
| Rate for Payer: Anthem Medicaid |
$10.80
|
| Rate for Payer: Anthem Medicare |
$46.39
|
| Rate for Payer: Anthem PPO |
$80.74
|
| Rate for Payer: Anthem Traditional |
$87.88
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$10.80
|
| Rate for Payer: Caresource Just 4 Me |
$53.35
|
| Rate for Payer: Caresource Medicare |
$51.03
|
| Rate for Payer: Centivo/Paragon All Products |
$71.70
|
| Rate for Payer: Cigna All Products |
$121.33
|
| Rate for Payer: Coventry/First Health All Products |
$123.72
|
| Rate for Payer: Encore All Products |
$129.41
|
| Rate for Payer: Frontpath All Products |
$129.34
|
| Rate for Payer: Humana ChoiceCare |
$121.43
|
| Rate for Payer: Humana Medicare |
$71.70
|
| Rate for Payer: Lucent/Coldwater Veneers |
$71.70
|
| Rate for Payer: Lutheran Preferred All Products |
$126.53
|
| 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 |
$105.44
|
| Rate for Payer: PHP All Products |
$106.62
|
| Rate for Payer: Plain Church Group Ministry All Products |
$54.83
|
| Rate for Payer: Sagamore All Products |
$108.54
|
| Rate for Payer: Self Pay/Cash Rate |
$87.17
|
| Rate for Payer: Signature Care EPO |
$116.69
|
| Rate for Payer: Signature Care PPO |
$123.72
|
| Rate for Payer: Three Rivers Preferred All Products |
$119.50
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$46.39
|
|
|
HC ACID FAST CULTURE-FECES
|
Facility
IP
|
$140.59
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63002007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.17 |
| Max. Negotiated Rate |
$129.41 |
| Rate for Payer: Aetna Commercial |
$121.47
|
| Rate for Payer: Cigna All Products |
$121.33
|
| Rate for Payer: Coventry/First Health All Products |
$123.72
|
| Rate for Payer: Encore All Products |
$129.41
|
| Rate for Payer: Frontpath All Products |
$129.34
|
| Rate for Payer: Humana ChoiceCare |
$121.43
|
| Rate for Payer: Lutheran Preferred All Products |
$126.53
|
| Rate for Payer: PHCS/Multiplan All Products |
$105.44
|
| Rate for Payer: PHP All Products |
$106.62
|
| Rate for Payer: Sagamore All Products |
$108.54
|
| Rate for Payer: Self Pay/Cash Rate |
$87.17
|
| Rate for Payer: Signature Care EPO |
$116.69
|
| Rate for Payer: Signature Care PPO |
$123.72
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
|
|
HC ACID FAST ID-DNA SEQUENCE
|
Facility
IP
|
$62.97
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
63002008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$54.41
|
| Rate for Payer: Cigna All Products |
$54.34
|
| Rate for Payer: Coventry/First Health All Products |
$55.41
|
| Rate for Payer: Encore All Products |
$57.96
|
| Rate for Payer: Frontpath All Products |
$57.93
|
| Rate for Payer: Humana ChoiceCare |
$54.39
|
| Rate for Payer: Lutheran Preferred All Products |
$56.67
|
| Rate for Payer: PHCS/Multiplan All Products |
$47.23
|
| Rate for Payer: PHP All Products |
$47.76
|
| Rate for Payer: Sagamore All Products |
$48.61
|
| Rate for Payer: Self Pay/Cash Rate |
$39.04
|
| Rate for Payer: Signature Care EPO |
$52.27
|
| Rate for Payer: Signature Care PPO |
$55.41
|
| Rate for Payer: United Healthcare Commercial |
$49.62
|
|
|
HC ACID FAST ID-DNA SEQUENCE
|
Facility
OP
|
$62.97
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
63002008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$53.15
|
| Rate for Payer: Aetna Medicare |
$20.78
|
| Rate for Payer: Anthem Exchange |
$36.16
|
| Rate for Payer: Anthem Medicaid |
$14.61
|
| Rate for Payer: Anthem Medicare |
$20.78
|
| Rate for Payer: Anthem PPO |
$36.16
|
| Rate for Payer: Anthem Traditional |
$39.36
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$14.61
|
| Rate for Payer: Caresource Just 4 Me |
$23.90
|
| Rate for Payer: Caresource Medicare |
$22.86
|
| Rate for Payer: Centivo/Paragon All Products |
$32.11
|
| Rate for Payer: Cigna All Products |
$54.34
|
| Rate for Payer: Coventry/First Health All Products |
$55.41
|
| Rate for Payer: Encore All Products |
$57.96
|
| Rate for Payer: Frontpath All Products |
$57.93
|
| Rate for Payer: Humana ChoiceCare |
$54.39
|
| Rate for Payer: Humana Medicare |
$32.11
|
| Rate for Payer: Lucent/Coldwater Veneers |
$32.11
|
| Rate for Payer: Lutheran Preferred All Products |
$56.67
|
| Rate for Payer: Managed Health Services All Products |
$14.61
|
| Rate for Payer: MDWise All Products |
$14.61
|
| Rate for Payer: PHCS/Multiplan All Products |
$47.23
|
| Rate for Payer: PHP All Products |
$47.76
|
| Rate for Payer: Plain Church Group Ministry All Products |
$24.56
|
| Rate for Payer: Sagamore All Products |
$48.61
|
| Rate for Payer: Self Pay/Cash Rate |
$39.04
|
| Rate for Payer: Signature Care EPO |
$52.27
|
| Rate for Payer: Signature Care PPO |
$55.41
|
| Rate for Payer: Three Rivers Preferred All Products |
$53.52
|
| Rate for Payer: United Healthcare Commercial |
$49.62
|
| Rate for Payer: United Healthcare Medicare |
$20.78
|
|
|
HC ACID FAST MIC-BROTH DILUT
|
Facility
IP
|
$86.69
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
63002013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$74.90
|
| Rate for Payer: Cigna All Products |
$74.81
|
| Rate for Payer: Coventry/First Health All Products |
$76.29
|
| Rate for Payer: Encore All Products |
$79.80
|
| Rate for Payer: Frontpath All Products |
$79.75
|
| Rate for Payer: Humana ChoiceCare |
$74.87
|
| Rate for Payer: Lutheran Preferred All Products |
$78.02
|
| Rate for Payer: PHCS/Multiplan All Products |
$65.02
|
| Rate for Payer: PHP All Products |
$65.75
|
| Rate for Payer: Sagamore All Products |
$66.92
|
| Rate for Payer: Self Pay/Cash Rate |
$53.75
|
| Rate for Payer: Signature Care EPO |
$71.95
|
| Rate for Payer: Signature Care PPO |
$76.29
|
| Rate for Payer: United Healthcare Commercial |
$68.31
|
|
|
HC ACID FAST MIC-BROTH DILUT
|
Facility
OP
|
$86.69
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
63002013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$73.17
|
| Rate for Payer: Aetna Medicare |
$28.61
|
| Rate for Payer: Anthem Exchange |
$39.84
|
| Rate for Payer: Anthem Medicaid |
$8.65
|
| Rate for Payer: Anthem Medicare |
$28.61
|
| Rate for Payer: Anthem PPO |
$39.84
|
| Rate for Payer: Anthem Traditional |
$39.84
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$8.65
|
| Rate for Payer: Caresource Just 4 Me |
$32.90
|
| Rate for Payer: Caresource Medicare |
$31.47
|
| Rate for Payer: Centivo/Paragon All Products |
$44.21
|
| Rate for Payer: Cigna All Products |
$74.81
|
| Rate for Payer: Coventry/First Health All Products |
$76.29
|
| Rate for Payer: Encore All Products |
$79.80
|
| Rate for Payer: Frontpath All Products |
$79.75
|
| Rate for Payer: Humana ChoiceCare |
$74.87
|
| Rate for Payer: Humana Medicare |
$44.21
|
| Rate for Payer: Lucent/Coldwater Veneers |
$44.21
|
| Rate for Payer: Lutheran Preferred All Products |
$78.02
|
| Rate for Payer: Managed Health Services All Products |
$8.65
|
| Rate for Payer: MDWise All Products |
$8.65
|
| Rate for Payer: PHCS/Multiplan All Products |
$65.02
|
| Rate for Payer: PHP All Products |
$65.75
|
| Rate for Payer: Plain Church Group Ministry All Products |
$33.81
|
| Rate for Payer: Sagamore All Products |
$66.92
|
| Rate for Payer: Self Pay/Cash Rate |
$53.75
|
| Rate for Payer: Signature Care EPO |
$71.95
|
| Rate for Payer: Signature Care PPO |
$76.29
|
| Rate for Payer: Three Rivers Preferred All Products |
$73.69
|
| Rate for Payer: United Healthcare Commercial |
$68.31
|
| Rate for Payer: United Healthcare Medicare |
$28.61
|
|
|
HC ACID FAST SMEAR
|
Facility
IP
|
$71.02
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
63001064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.03 |
| Max. Negotiated Rate |
$65.37 |
| Rate for Payer: Aetna Commercial |
$61.36
|
| Rate for Payer: Cigna All Products |
$61.29
|
| Rate for Payer: Coventry/First Health All Products |
$62.50
|
| Rate for Payer: Encore All Products |
$65.37
|
| Rate for Payer: Frontpath All Products |
$65.34
|
| Rate for Payer: Humana ChoiceCare |
$61.34
|
| Rate for Payer: Lutheran Preferred All Products |
$63.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$53.27
|
| Rate for Payer: PHP All Products |
$53.86
|
| Rate for Payer: Sagamore All Products |
$54.83
|
| Rate for Payer: Self Pay/Cash Rate |
$44.03
|
| Rate for Payer: Signature Care EPO |
$58.95
|
| Rate for Payer: Signature Care PPO |
$62.50
|
| Rate for Payer: United Healthcare Commercial |
$55.96
|
|
|
HC ACID FAST SMEAR
|
Facility
OP
|
$71.02
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
63001064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$65.37 |
| Rate for Payer: Aetna Commercial |
$59.94
|
| Rate for Payer: Aetna Medicare |
$23.44
|
| Rate for Payer: Anthem Exchange |
$40.79
|
| Rate for Payer: Anthem Medicaid |
$5.39
|
| Rate for Payer: Anthem Medicare |
$23.44
|
| Rate for Payer: Anthem PPO |
$40.79
|
| Rate for Payer: Anthem Traditional |
$44.39
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$5.39
|
| Rate for Payer: Caresource Just 4 Me |
$26.95
|
| Rate for Payer: Caresource Medicare |
$25.78
|
| Rate for Payer: Centivo/Paragon All Products |
$36.22
|
| Rate for Payer: Cigna All Products |
$61.29
|
| Rate for Payer: Coventry/First Health All Products |
$62.50
|
| Rate for Payer: Encore All Products |
$65.37
|
| Rate for Payer: Frontpath All Products |
$65.34
|
| Rate for Payer: Humana ChoiceCare |
$61.34
|
| Rate for Payer: Humana Medicare |
$36.22
|
| Rate for Payer: Lucent/Coldwater Veneers |
$36.22
|
| Rate for Payer: Lutheran Preferred All Products |
$63.92
|
| Rate for Payer: Managed Health Services All Products |
$5.39
|
| Rate for Payer: MDWise All Products |
$5.39
|
| Rate for Payer: PHCS/Multiplan All Products |
$53.27
|
| Rate for Payer: PHP All Products |
$53.86
|
| Rate for Payer: Plain Church Group Ministry All Products |
$27.70
|
| Rate for Payer: Sagamore All Products |
$54.83
|
| Rate for Payer: Self Pay/Cash Rate |
$44.03
|
| Rate for Payer: Signature Care EPO |
$58.95
|
| Rate for Payer: Signature Care PPO |
$62.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$60.37
|
| Rate for Payer: United Healthcare Commercial |
$55.96
|
| Rate for Payer: United Healthcare Medicare |
$23.44
|
|
|
HC ACID PHOS
|
Facility
OP
|
$93.86
|
|
|
Service Code
|
CPT 84060
|
| Hospital Charge Code |
63001654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$79.22
|
| Rate for Payer: Aetna Medicare |
$30.97
|
| Rate for Payer: Anthem Exchange |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$7.64
|
| Rate for Payer: Anthem Medicare |
$30.97
|
| Rate for Payer: Anthem PPO |
$53.90
|
| Rate for Payer: Anthem Traditional |
$58.67
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$7.64
|
| Rate for Payer: Caresource Just 4 Me |
$35.62
|
| Rate for Payer: Caresource Medicare |
$34.07
|
| Rate for Payer: Centivo/Paragon All Products |
$47.87
|
| Rate for Payer: Cigna All Products |
$81.00
|
| Rate for Payer: Coventry/First Health All Products |
$82.60
|
| Rate for Payer: Encore All Products |
$86.40
|
| Rate for Payer: Frontpath All Products |
$86.35
|
| Rate for Payer: Humana ChoiceCare |
$81.07
|
| Rate for Payer: Humana Medicare |
$47.87
|
| Rate for Payer: Lucent/Coldwater Veneers |
$47.87
|
| Rate for Payer: Lutheran Preferred All Products |
$84.47
|
| Rate for Payer: Managed Health Services All Products |
$7.64
|
| Rate for Payer: MDWise All Products |
$7.64
|
| Rate for Payer: PHCS/Multiplan All Products |
$70.39
|
| Rate for Payer: PHP All Products |
$71.18
|
| Rate for Payer: Plain Church Group Ministry All Products |
$36.61
|
| Rate for Payer: Sagamore All Products |
$72.46
|
| Rate for Payer: Self Pay/Cash Rate |
$58.19
|
| Rate for Payer: Signature Care EPO |
$77.90
|
| Rate for Payer: Signature Care PPO |
$82.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$79.78
|
| Rate for Payer: United Healthcare Commercial |
$73.96
|
| Rate for Payer: United Healthcare Medicare |
$30.97
|
|
|
HC ACID PHOS
|
Facility
IP
|
$93.86
|
|
|
Service Code
|
CPT 84060
|
| Hospital Charge Code |
63001654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.19 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$81.10
|
| Rate for Payer: Cigna All Products |
$81.00
|
| Rate for Payer: Coventry/First Health All Products |
$82.60
|
| Rate for Payer: Encore All Products |
$86.40
|
| Rate for Payer: Frontpath All Products |
$86.35
|
| Rate for Payer: Humana ChoiceCare |
$81.07
|
| Rate for Payer: Lutheran Preferred All Products |
$84.47
|
| Rate for Payer: PHCS/Multiplan All Products |
$70.39
|
| Rate for Payer: PHP All Products |
$71.18
|
| Rate for Payer: Sagamore All Products |
$72.46
|
| Rate for Payer: Self Pay/Cash Rate |
$58.19
|
| Rate for Payer: Signature Care EPO |
$77.90
|
| Rate for Payer: Signature Care PPO |
$82.60
|
| Rate for Payer: United Healthcare Commercial |
$73.96
|
|
|
HC ACID PHOS PROS
|
Facility
OP
|
$54.46
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
63001656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$50.13 |
| Rate for Payer: Aetna Commercial |
$45.96
|
| Rate for Payer: Aetna Medicare |
$17.97
|
| Rate for Payer: Anthem Exchange |
$31.28
|
| Rate for Payer: Anthem Medicaid |
$9.66
|
| Rate for Payer: Anthem Medicare |
$17.97
|
| Rate for Payer: Anthem PPO |
$31.28
|
| Rate for Payer: Anthem Traditional |
$34.04
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$9.66
|
| Rate for Payer: Caresource Just 4 Me |
$20.67
|
| Rate for Payer: Caresource Medicare |
$19.77
|
| Rate for Payer: Centivo/Paragon All Products |
$27.77
|
| Rate for Payer: Cigna All Products |
$47.00
|
| Rate for Payer: Coventry/First Health All Products |
$47.92
|
| Rate for Payer: Encore All Products |
$50.13
|
| Rate for Payer: Frontpath All Products |
$50.10
|
| Rate for Payer: Humana ChoiceCare |
$47.04
|
| Rate for Payer: Humana Medicare |
$27.77
|
| Rate for Payer: Lucent/Coldwater Veneers |
$27.77
|
| Rate for Payer: Lutheran Preferred All Products |
$49.01
|
| Rate for Payer: Managed Health Services All Products |
$9.66
|
| Rate for Payer: MDWise All Products |
$9.66
|
| Rate for Payer: PHCS/Multiplan All Products |
$40.84
|
| Rate for Payer: PHP All Products |
$41.30
|
| Rate for Payer: Plain Church Group Ministry All Products |
$21.24
|
| Rate for Payer: Sagamore All Products |
$42.04
|
| Rate for Payer: Self Pay/Cash Rate |
$33.77
|
| Rate for Payer: Signature Care EPO |
$45.20
|
| Rate for Payer: Signature Care PPO |
$47.92
|
| Rate for Payer: Three Rivers Preferred All Products |
$46.29
|
| Rate for Payer: United Healthcare Commercial |
$42.91
|
| Rate for Payer: United Healthcare Medicare |
$17.97
|
|
|
HC ACID PHOS PROS
|
Facility
IP
|
$54.46
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
63001656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.77 |
| Max. Negotiated Rate |
$50.13 |
| Rate for Payer: Aetna Commercial |
$47.05
|
| Rate for Payer: Cigna All Products |
$47.00
|
| Rate for Payer: Coventry/First Health All Products |
$47.92
|
| Rate for Payer: Encore All Products |
$50.13
|
| Rate for Payer: Frontpath All Products |
$50.10
|
| Rate for Payer: Humana ChoiceCare |
$47.04
|
| Rate for Payer: Lutheran Preferred All Products |
$49.01
|
| Rate for Payer: PHCS/Multiplan All Products |
$40.84
|
| Rate for Payer: PHP All Products |
$41.30
|
| Rate for Payer: Sagamore All Products |
$42.04
|
| Rate for Payer: Self Pay/Cash Rate |
$33.77
|
| Rate for Payer: Signature Care EPO |
$45.20
|
| Rate for Payer: Signature Care PPO |
$47.92
|
| Rate for Payer: United Healthcare Commercial |
$42.91
|
|
|
HC ACTH
|
Facility
OP
|
$392.88
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
63001448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$361.65 |
| Rate for Payer: Aetna Commercial |
$331.59
|
| Rate for Payer: Aetna Medicare |
$129.65
|
| Rate for Payer: Anthem Exchange |
$225.63
|
| Rate for Payer: Anthem Medicaid |
$38.62
|
| Rate for Payer: Anthem Medicare |
$129.65
|
| Rate for Payer: Anthem PPO |
$225.63
|
| Rate for Payer: Anthem Traditional |
$245.59
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$38.62
|
| Rate for Payer: Caresource Just 4 Me |
$149.10
|
| Rate for Payer: Caresource Medicare |
$142.62
|
| Rate for Payer: Centivo/Paragon All Products |
$200.37
|
| Rate for Payer: Cigna All Products |
$339.06
|
| Rate for Payer: Coventry/First Health All Products |
$345.73
|
| Rate for Payer: Encore All Products |
$361.65
|
| Rate for Payer: Frontpath All Products |
$361.45
|
| Rate for Payer: Humana ChoiceCare |
$339.33
|
| Rate for Payer: Humana Medicare |
$200.37
|
| Rate for Payer: Lucent/Coldwater Veneers |
$200.37
|
| Rate for Payer: Lutheran Preferred All Products |
$353.59
|
| Rate for Payer: Managed Health Services All Products |
$38.62
|
| Rate for Payer: MDWise All Products |
$38.62
|
| Rate for Payer: PHCS/Multiplan All Products |
$294.66
|
| Rate for Payer: PHP All Products |
$297.96
|
| Rate for Payer: Plain Church Group Ministry All Products |
$153.22
|
| Rate for Payer: Sagamore All Products |
$303.30
|
| Rate for Payer: Self Pay/Cash Rate |
$243.59
|
| Rate for Payer: Signature Care EPO |
$326.09
|
| Rate for Payer: Signature Care PPO |
$345.73
|
| Rate for Payer: Three Rivers Preferred All Products |
$333.95
|
| Rate for Payer: United Healthcare Commercial |
$309.59
|
| Rate for Payer: United Healthcare Medicare |
$129.65
|
|
|
HC ACTH
|
Facility
IP
|
$392.88
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
63001448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.59 |
| Max. Negotiated Rate |
$361.65 |
| Rate for Payer: Aetna Commercial |
$339.45
|
| Rate for Payer: Cigna All Products |
$339.06
|
| Rate for Payer: Coventry/First Health All Products |
$345.73
|
| Rate for Payer: Encore All Products |
$361.65
|
| Rate for Payer: Frontpath All Products |
$361.45
|
| Rate for Payer: Humana ChoiceCare |
$339.33
|
| Rate for Payer: Lutheran Preferred All Products |
$353.59
|
| Rate for Payer: PHCS/Multiplan All Products |
$294.66
|
| Rate for Payer: PHP All Products |
$297.96
|
| Rate for Payer: Sagamore All Products |
$303.30
|
| Rate for Payer: Self Pay/Cash Rate |
$243.59
|
| Rate for Payer: Signature Care EPO |
$326.09
|
| Rate for Payer: Signature Care PPO |
$345.73
|
| Rate for Payer: United Healthcare Commercial |
$309.59
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
IP
|
$303.79
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
63001734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.35 |
| Max. Negotiated Rate |
$279.64 |
| Rate for Payer: Aetna Commercial |
$262.47
|
| Rate for Payer: Cigna All Products |
$262.17
|
| Rate for Payer: Coventry/First Health All Products |
$267.34
|
| Rate for Payer: Encore All Products |
$279.64
|
| Rate for Payer: Frontpath All Products |
$279.49
|
| Rate for Payer: Humana ChoiceCare |
$262.38
|
| Rate for Payer: Lutheran Preferred All Products |
$273.41
|
| Rate for Payer: PHCS/Multiplan All Products |
$227.84
|
| Rate for Payer: PHP All Products |
$230.39
|
| Rate for Payer: Sagamore All Products |
$234.53
|
| Rate for Payer: Self Pay/Cash Rate |
$188.35
|
| Rate for Payer: Signature Care EPO |
$252.15
|
| Rate for Payer: Signature Care PPO |
$267.34
|
| Rate for Payer: United Healthcare Commercial |
$239.39
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
OP
|
$303.79
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
63001734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$279.64 |
| Rate for Payer: Aetna Commercial |
$256.40
|
| Rate for Payer: Aetna Medicare |
$100.25
|
| Rate for Payer: Anthem Exchange |
$174.47
|
| Rate for Payer: Anthem Medicaid |
$17.90
|
| Rate for Payer: Anthem Medicare |
$100.25
|
| Rate for Payer: Anthem PPO |
$174.47
|
| Rate for Payer: Anthem Traditional |
$189.90
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$17.90
|
| Rate for Payer: Caresource Just 4 Me |
$115.29
|
| Rate for Payer: Caresource Medicare |
$110.28
|
| Rate for Payer: Centivo/Paragon All Products |
$154.93
|
| Rate for Payer: Cigna All Products |
$262.17
|
| Rate for Payer: Coventry/First Health All Products |
$267.34
|
| Rate for Payer: Encore All Products |
$279.64
|
| Rate for Payer: Frontpath All Products |
$279.49
|
| Rate for Payer: Humana ChoiceCare |
$262.38
|
| Rate for Payer: Humana Medicare |
$154.93
|
| Rate for Payer: Lucent/Coldwater Veneers |
$154.93
|
| Rate for Payer: Lutheran Preferred All Products |
$273.41
|
| Rate for Payer: Managed Health Services All Products |
$17.90
|
| Rate for Payer: MDWise All Products |
$17.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$227.84
|
| Rate for Payer: PHP All Products |
$230.39
|
| Rate for Payer: Plain Church Group Ministry All Products |
$118.48
|
| Rate for Payer: Sagamore All Products |
$234.53
|
| Rate for Payer: Self Pay/Cash Rate |
$188.35
|
| Rate for Payer: Signature Care EPO |
$252.15
|
| Rate for Payer: Signature Care PPO |
$267.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$258.22
|
| Rate for Payer: United Healthcare Commercial |
$239.39
|
| Rate for Payer: United Healthcare Medicare |
$100.25
|
|
|
HC ACU .035 X 5.75 ST GUIDE WIRE
|
Facility
IP
|
$86.40
|
|
| Hospital Charge Code |
41603242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Commercial |
$74.65
|
| Rate for Payer: Cigna All Products |
$74.56
|
| Rate for Payer: Coventry/First Health All Products |
$76.03
|
| Rate for Payer: Encore All Products |
$79.53
|
| Rate for Payer: Frontpath All Products |
$79.49
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Lutheran Preferred All Products |
$77.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$64.80
|
| Rate for Payer: PHP All Products |
$65.53
|
| Rate for Payer: Sagamore All Products |
$66.70
|
| Rate for Payer: Self Pay/Cash Rate |
$53.57
|
| Rate for Payer: Signature Care EPO |
$71.71
|
| Rate for Payer: Signature Care PPO |
$76.03
|
| Rate for Payer: United Healthcare Commercial |
$68.08
|
|
|
HC ACU .035 X 5.75 ST GUIDE WIRE
|
Facility
OP
|
$86.40
|
|
| Hospital Charge Code |
41603242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Commercial |
$72.92
|
| Rate for Payer: Aetna Medicare |
$28.51
|
| Rate for Payer: Anthem Exchange |
$49.62
|
| Rate for Payer: Anthem Medicare |
$28.51
|
| Rate for Payer: Anthem PPO |
$49.62
|
| Rate for Payer: Anthem Traditional |
$54.01
|
| Rate for Payer: Caresource Just 4 Me |
$32.79
|
| Rate for Payer: Caresource Medicare |
$31.36
|
| Rate for Payer: Centivo/Paragon All Products |
$44.06
|
| Rate for Payer: Cigna All Products |
$74.56
|
| Rate for Payer: Coventry/First Health All Products |
$76.03
|
| Rate for Payer: Encore All Products |
$79.53
|
| Rate for Payer: Frontpath All Products |
$79.49
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Humana Medicare |
$44.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$44.06
|
| Rate for Payer: Lutheran Preferred All Products |
$77.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$64.80
|
| Rate for Payer: PHP All Products |
$65.53
|
| Rate for Payer: Plain Church Group Ministry All Products |
$33.70
|
| Rate for Payer: Sagamore All Products |
$66.70
|
| Rate for Payer: Self Pay/Cash Rate |
$53.57
|
| Rate for Payer: Signature Care EPO |
$71.71
|
| Rate for Payer: Signature Care PPO |
$76.03
|
| Rate for Payer: Three Rivers Preferred All Products |
$73.44
|
| Rate for Payer: United Healthcare Commercial |
$68.08
|
| Rate for Payer: United Healthcare Medicare |
$28.51
|
|
|
HC ACU .035X5.75 ST GUIDE WIRE
|
Facility
IP
|
$180.00
|
|
| Hospital Charge Code |
41602632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$165.69 |
| Rate for Payer: Aetna Commercial |
$155.52
|
| Rate for Payer: Cigna All Products |
$155.34
|
| Rate for Payer: Coventry/First Health All Products |
$158.40
|
| Rate for Payer: Encore All Products |
$165.69
|
| Rate for Payer: Frontpath All Products |
$165.60
|
| Rate for Payer: Humana ChoiceCare |
$155.47
|
| Rate for Payer: Lutheran Preferred All Products |
$162.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$135.00
|
| Rate for Payer: PHP All Products |
$136.51
|
| Rate for Payer: Sagamore All Products |
$138.96
|
| Rate for Payer: Self Pay/Cash Rate |
$111.60
|
| Rate for Payer: Signature Care EPO |
$149.40
|
| Rate for Payer: Signature Care PPO |
$158.40
|
| Rate for Payer: United Healthcare Commercial |
$141.84
|
|
|
HC ACU .035X5.75 ST GUIDE WIRE
|
Facility
OP
|
$180.00
|
|
| Hospital Charge Code |
41602632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$165.69 |
| Rate for Payer: Signature Care PPO |
$158.40
|
| Rate for Payer: Aetna Commercial |
$151.92
|
| Rate for Payer: Aetna Medicare |
$59.40
|
| Rate for Payer: Anthem Exchange |
$103.37
|
| Rate for Payer: Anthem Medicare |
$59.40
|
| Rate for Payer: Anthem PPO |
$103.37
|
| Rate for Payer: Anthem Traditional |
$112.52
|
| Rate for Payer: Caresource Just 4 Me |
$68.31
|
| Rate for Payer: Caresource Medicare |
$65.34
|
| Rate for Payer: Centivo/Paragon All Products |
$91.80
|
| Rate for Payer: Cigna All Products |
$155.34
|
| Rate for Payer: Coventry/First Health All Products |
$158.40
|
| Rate for Payer: Encore All Products |
$165.69
|
| Rate for Payer: Frontpath All Products |
$165.60
|
| Rate for Payer: Humana ChoiceCare |
$155.47
|
| Rate for Payer: Humana Medicare |
$91.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$91.80
|
| Rate for Payer: Lutheran Preferred All Products |
$162.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$135.00
|
| Rate for Payer: PHP All Products |
$136.51
|
| Rate for Payer: Plain Church Group Ministry All Products |
$70.20
|
| Rate for Payer: Sagamore All Products |
$138.96
|
| Rate for Payer: Self Pay/Cash Rate |
$111.60
|
| Rate for Payer: Signature Care EPO |
$149.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$141.84
|
| Rate for Payer: United Healthcare Medicare |
$59.40
|
|
|
HC ACU .040" PLATE TACK
|
Facility
IP
|
$442.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.54 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$382.58
|
| Rate for Payer: Cigna All Products |
$382.14
|
| Rate for Payer: Coventry/First Health All Products |
$389.66
|
| Rate for Payer: Encore All Products |
$407.60
|
| Rate for Payer: Frontpath All Products |
$407.38
|
| Rate for Payer: Humana ChoiceCare |
$382.45
|
| Rate for Payer: Lutheran Preferred All Products |
$398.52
|
| Rate for Payer: PHCS/Multiplan All Products |
$332.10
|
| Rate for Payer: PHP All Products |
$335.82
|
| Rate for Payer: Sagamore All Products |
$341.84
|
| Rate for Payer: Self Pay/Cash Rate |
$274.54
|
| Rate for Payer: Signature Care EPO |
$367.52
|
| Rate for Payer: Signature Care PPO |
$389.66
|
| Rate for Payer: United Healthcare Commercial |
$348.93
|
|
|
HC ACU .040" PLATE TACK
|
Facility
OP
|
$442.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.12 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$373.72
|
| Rate for Payer: Aetna Medicare |
$146.12
|
| Rate for Payer: Anthem Exchange |
$254.30
|
| Rate for Payer: Anthem Medicare |
$146.12
|
| Rate for Payer: Anthem PPO |
$254.30
|
| Rate for Payer: Anthem Traditional |
$276.79
|
| Rate for Payer: Caresource Just 4 Me |
$168.04
|
| Rate for Payer: Caresource Medicare |
$160.74
|
| Rate for Payer: Centivo/Paragon All Products |
$225.83
|
| Rate for Payer: Cigna All Products |
$382.14
|
| Rate for Payer: Coventry/First Health All Products |
$389.66
|
| Rate for Payer: Encore All Products |
$407.60
|
| Rate for Payer: Frontpath All Products |
$407.38
|
| Rate for Payer: Humana ChoiceCare |
$382.45
|
| Rate for Payer: Humana Medicare |
$225.83
|
| Rate for Payer: Lucent/Coldwater Veneers |
$225.83
|
| Rate for Payer: Lutheran Preferred All Products |
$398.52
|
| Rate for Payer: PHCS/Multiplan All Products |
$332.10
|
| Rate for Payer: PHP All Products |
$335.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$172.69
|
| Rate for Payer: Sagamore All Products |
$341.84
|
| Rate for Payer: Self Pay/Cash Rate |
$274.54
|
| Rate for Payer: Signature Care EPO |
$367.52
|
| Rate for Payer: Signature Care PPO |
$389.66
|
| Rate for Payer: Three Rivers Preferred All Products |
$376.38
|
| Rate for Payer: United Healthcare Commercial |
$348.93
|
| Rate for Payer: United Healthcare Medicare |
$146.12
|
|
