|
HC ALCOHOL ETHYL-SERUM/PLASMA
|
Facility
IP
|
$206.04
|
|
|
Service Code
|
CPT 82077
|
| Hospital Charge Code |
63001387
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.53 |
| Max. Negotiated Rate |
$191.62 |
| Rate for Payer: Aetna Commercial |
$178.02
|
| Rate for Payer: Cash Price |
$127.75
|
| Rate for Payer: Cigna All Commercial |
$177.81
|
| Rate for Payer: CORVEL All Commercial |
$191.62
|
| Rate for Payer: Coventry All Commercial |
$181.32
|
| Rate for Payer: Encore All Commercial |
$189.66
|
| Rate for Payer: Frontpath All Commercial |
$189.56
|
| Rate for Payer: Humana ChoiceCare |
$177.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.44
|
| Rate for Payer: PHCS All Commercial |
$154.53
|
| Rate for Payer: PHP All Commercial |
$156.26
|
| Rate for Payer: Sagamore Health Network All Products |
$159.06
|
| Rate for Payer: Signature Care EPO |
$171.01
|
| Rate for Payer: Signature Care PPO |
$181.32
|
| Rate for Payer: United Healthcare Commercial |
$162.36
|
|
|
HC ALCOHOL ETHYL, URINE
|
Facility
IP
|
$196.72
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001386
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.54 |
| Max. Negotiated Rate |
$182.95 |
| Rate for Payer: Aetna Commercial |
$169.96
|
| Rate for Payer: Cash Price |
$121.97
|
| Rate for Payer: Cigna All Commercial |
$169.77
|
| Rate for Payer: CORVEL All Commercial |
$182.95
|
| Rate for Payer: Coventry All Commercial |
$173.11
|
| Rate for Payer: Encore All Commercial |
$181.08
|
| Rate for Payer: Frontpath All Commercial |
$180.98
|
| Rate for Payer: Humana ChoiceCare |
$169.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.05
|
| Rate for Payer: PHCS All Commercial |
$147.54
|
| Rate for Payer: PHP All Commercial |
$149.19
|
| Rate for Payer: Sagamore Health Network All Products |
$151.87
|
| Rate for Payer: Signature Care EPO |
$163.28
|
| Rate for Payer: Signature Care PPO |
$173.11
|
| Rate for Payer: United Healthcare Commercial |
$155.01
|
|
|
HC ALCOHOL ETHYL, URINE
|
Facility
OP
|
$196.72
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001386
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$182.95 |
| Rate for Payer: Aetna Commercial |
$166.03
|
| Rate for Payer: Aetna Medicare |
$64.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.41
|
| Rate for Payer: Cash Price |
$121.97
|
| Rate for Payer: Cash Price |
$121.97
|
| Rate for Payer: Centivo All Commercial |
$100.33
|
| Rate for Payer: Cigna All Commercial |
$169.77
|
| Rate for Payer: CORVEL All Commercial |
$182.95
|
| Rate for Payer: Coventry All Commercial |
$173.11
|
| Rate for Payer: Encore All Commercial |
$181.08
|
| Rate for Payer: Frontpath All Commercial |
$180.98
|
| Rate for Payer: Humana ChoiceCare |
$169.90
|
| Rate for Payer: Humana Medicare |
$100.33
|
| Rate for Payer: Lucent All Commercial |
$100.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.05
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$147.54
|
| Rate for Payer: PHP All Commercial |
$149.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.72
|
| Rate for Payer: Sagamore Health Network All Products |
$151.87
|
| Rate for Payer: Signature Care EPO |
$163.28
|
| Rate for Payer: Signature Care PPO |
$173.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$167.21
|
| Rate for Payer: United Healthcare Commercial |
$155.01
|
| Rate for Payer: United Healthcare Medicare |
$64.92
|
|
|
HC ALCOHOL ETHYL, URINE COMPANY
|
Facility
IP
|
$206.04
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63002260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$154.53 |
| Max. Negotiated Rate |
$191.62 |
| Rate for Payer: Aetna Commercial |
$178.02
|
| Rate for Payer: Cash Price |
$127.75
|
| Rate for Payer: Cigna All Commercial |
$177.81
|
| Rate for Payer: CORVEL All Commercial |
$191.62
|
| Rate for Payer: Coventry All Commercial |
$181.32
|
| Rate for Payer: Encore All Commercial |
$189.66
|
| Rate for Payer: Frontpath All Commercial |
$189.56
|
| Rate for Payer: Humana ChoiceCare |
$177.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.44
|
| Rate for Payer: PHCS All Commercial |
$154.53
|
| Rate for Payer: PHP All Commercial |
$156.26
|
| Rate for Payer: Sagamore Health Network All Products |
$159.06
|
| Rate for Payer: Signature Care EPO |
$171.01
|
| Rate for Payer: Signature Care PPO |
$181.32
|
| Rate for Payer: United Healthcare Commercial |
$162.36
|
|
|
HC ALCOHOL ETHYL, URINE COMPANY
|
Facility
OP
|
$206.04
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63002260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.99 |
| Max. Negotiated Rate |
$191.62 |
| Rate for Payer: Aetna Commercial |
$173.90
|
| Rate for Payer: Aetna Medicare |
$67.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.79
|
| Rate for Payer: Cash Price |
$127.75
|
| Rate for Payer: Cash Price |
$127.75
|
| Rate for Payer: Centivo All Commercial |
$105.08
|
| Rate for Payer: Cigna All Commercial |
$177.81
|
| Rate for Payer: CORVEL All Commercial |
$191.62
|
| Rate for Payer: Coventry All Commercial |
$181.32
|
| Rate for Payer: Encore All Commercial |
$189.66
|
| Rate for Payer: Frontpath All Commercial |
$189.56
|
| Rate for Payer: Humana ChoiceCare |
$177.96
|
| Rate for Payer: Humana Medicare |
$105.08
|
| Rate for Payer: Lucent All Commercial |
$105.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.44
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$154.53
|
| Rate for Payer: PHP All Commercial |
$156.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.36
|
| Rate for Payer: Sagamore Health Network All Products |
$159.06
|
| Rate for Payer: Signature Care EPO |
$171.01
|
| Rate for Payer: Signature Care PPO |
$181.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.13
|
| Rate for Payer: United Healthcare Commercial |
$162.36
|
| Rate for Payer: United Healthcare Medicare |
$67.99
|
|
|
HC ALDOLASE
|
Facility
OP
|
$132.40
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
63001449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$123.13 |
| Rate for Payer: Aetna Commercial |
$111.74
|
| Rate for Payer: Aetna Medicare |
$43.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.06
|
| Rate for Payer: Cash Price |
$82.09
|
| Rate for Payer: Cash Price |
$82.09
|
| Rate for Payer: Centivo All Commercial |
$67.52
|
| Rate for Payer: Cigna All Commercial |
$114.26
|
| Rate for Payer: CORVEL All Commercial |
$123.13
|
| Rate for Payer: Coventry All Commercial |
$116.51
|
| Rate for Payer: Encore All Commercial |
$121.87
|
| Rate for Payer: Frontpath All Commercial |
$121.80
|
| Rate for Payer: Humana ChoiceCare |
$114.35
|
| Rate for Payer: Humana Medicare |
$67.52
|
| Rate for Payer: Lucent All Commercial |
$67.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.16
|
| Rate for Payer: Managed Health Services Medicaid |
$9.71
|
| Rate for Payer: MDWise Medicaid |
$9.71
|
| Rate for Payer: PHCS All Commercial |
$99.30
|
| Rate for Payer: PHP All Commercial |
$100.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.63
|
| Rate for Payer: Sagamore Health Network All Products |
$102.21
|
| Rate for Payer: Signature Care EPO |
$109.89
|
| Rate for Payer: Signature Care PPO |
$116.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.54
|
| Rate for Payer: United Healthcare Commercial |
$104.33
|
| Rate for Payer: United Healthcare Medicare |
$43.69
|
|
|
HC ALDOLASE
|
Facility
IP
|
$132.40
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
63001449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$123.13 |
| Rate for Payer: Aetna Commercial |
$114.39
|
| Rate for Payer: Cash Price |
$82.09
|
| Rate for Payer: Cigna All Commercial |
$114.26
|
| Rate for Payer: CORVEL All Commercial |
$123.13
|
| Rate for Payer: Coventry All Commercial |
$116.51
|
| Rate for Payer: Encore All Commercial |
$121.87
|
| Rate for Payer: Frontpath All Commercial |
$121.80
|
| Rate for Payer: Humana ChoiceCare |
$114.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.16
|
| Rate for Payer: PHCS All Commercial |
$99.30
|
| Rate for Payer: PHP All Commercial |
$100.41
|
| Rate for Payer: Sagamore Health Network All Products |
$102.21
|
| Rate for Payer: Signature Care EPO |
$109.89
|
| Rate for Payer: Signature Care PPO |
$116.51
|
| Rate for Payer: United Healthcare Commercial |
$104.33
|
|
|
HC ALDOSTERONE
|
Facility
IP
|
$380.36
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
63001450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$285.27 |
| Max. Negotiated Rate |
$353.73 |
| Rate for Payer: Aetna Commercial |
$328.63
|
| Rate for Payer: Cash Price |
$235.82
|
| Rate for Payer: Cigna All Commercial |
$328.25
|
| Rate for Payer: CORVEL All Commercial |
$353.73
|
| Rate for Payer: Coventry All Commercial |
$334.72
|
| Rate for Payer: Encore All Commercial |
$350.12
|
| Rate for Payer: Frontpath All Commercial |
$349.93
|
| Rate for Payer: Humana ChoiceCare |
$328.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$342.32
|
| Rate for Payer: PHCS All Commercial |
$285.27
|
| Rate for Payer: PHP All Commercial |
$288.46
|
| Rate for Payer: Sagamore Health Network All Products |
$293.64
|
| Rate for Payer: Signature Care EPO |
$315.70
|
| Rate for Payer: Signature Care PPO |
$334.72
|
| Rate for Payer: United Healthcare Commercial |
$299.72
|
|
|
HC ALDOSTERONE
|
Facility
OP
|
$380.36
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
63001450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$353.73 |
| Rate for Payer: Aetna Commercial |
$321.02
|
| Rate for Payer: Aetna Medicare |
$125.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$218.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$237.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$40.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.07
|
| Rate for Payer: Cash Price |
$235.82
|
| Rate for Payer: Cash Price |
$235.82
|
| Rate for Payer: Centivo All Commercial |
$193.98
|
| Rate for Payer: Cigna All Commercial |
$328.25
|
| Rate for Payer: CORVEL All Commercial |
$353.73
|
| Rate for Payer: Coventry All Commercial |
$334.72
|
| Rate for Payer: Encore All Commercial |
$350.12
|
| Rate for Payer: Frontpath All Commercial |
$349.93
|
| Rate for Payer: Humana ChoiceCare |
$328.52
|
| Rate for Payer: Humana Medicare |
$193.98
|
| Rate for Payer: Lucent All Commercial |
$193.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$342.32
|
| Rate for Payer: Managed Health Services Medicaid |
$40.75
|
| Rate for Payer: MDWise Medicaid |
$40.75
|
| Rate for Payer: PHCS All Commercial |
$285.27
|
| Rate for Payer: PHP All Commercial |
$288.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.34
|
| Rate for Payer: Sagamore Health Network All Products |
$293.64
|
| Rate for Payer: Signature Care EPO |
$315.70
|
| Rate for Payer: Signature Care PPO |
$334.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$323.30
|
| Rate for Payer: United Healthcare Commercial |
$299.72
|
| Rate for Payer: United Healthcare Medicare |
$125.52
|
|
|
HC ALDOSTERONE U
|
Facility
IP
|
$279.16
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
63001451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$209.37 |
| Max. Negotiated Rate |
$259.62 |
| Rate for Payer: Aetna Commercial |
$241.20
|
| Rate for Payer: Cash Price |
$173.08
|
| Rate for Payer: Cigna All Commercial |
$240.92
|
| Rate for Payer: CORVEL All Commercial |
$259.62
|
| Rate for Payer: Coventry All Commercial |
$245.66
|
| Rate for Payer: Encore All Commercial |
$256.97
|
| Rate for Payer: Frontpath All Commercial |
$256.83
|
| Rate for Payer: Humana ChoiceCare |
$241.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$251.25
|
| Rate for Payer: PHCS All Commercial |
$209.37
|
| Rate for Payer: PHP All Commercial |
$211.72
|
| Rate for Payer: Sagamore Health Network All Products |
$215.51
|
| Rate for Payer: Signature Care EPO |
$231.71
|
| Rate for Payer: Signature Care PPO |
$245.66
|
| Rate for Payer: United Healthcare Commercial |
$219.98
|
|
|
HC ALDOSTERONE U
|
Facility
OP
|
$279.16
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
63001451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$259.62 |
| Rate for Payer: Aetna Commercial |
$235.61
|
| Rate for Payer: Aetna Medicare |
$92.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$160.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$174.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$40.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$105.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.34
|
| Rate for Payer: Cash Price |
$173.08
|
| Rate for Payer: Cash Price |
$173.08
|
| Rate for Payer: Centivo All Commercial |
$142.37
|
| Rate for Payer: Cigna All Commercial |
$240.92
|
| Rate for Payer: CORVEL All Commercial |
$259.62
|
| Rate for Payer: Coventry All Commercial |
$245.66
|
| Rate for Payer: Encore All Commercial |
$256.97
|
| Rate for Payer: Frontpath All Commercial |
$256.83
|
| Rate for Payer: Humana ChoiceCare |
$241.11
|
| Rate for Payer: Humana Medicare |
$142.37
|
| Rate for Payer: Lucent All Commercial |
$142.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$251.25
|
| Rate for Payer: Managed Health Services Medicaid |
$40.75
|
| Rate for Payer: MDWise Medicaid |
$40.75
|
| Rate for Payer: PHCS All Commercial |
$209.37
|
| Rate for Payer: PHP All Commercial |
$211.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.87
|
| Rate for Payer: Sagamore Health Network All Products |
$215.51
|
| Rate for Payer: Signature Care EPO |
$231.71
|
| Rate for Payer: Signature Care PPO |
$245.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$237.29
|
| Rate for Payer: United Healthcare Commercial |
$219.98
|
| Rate for Payer: United Healthcare Medicare |
$92.12
|
|
|
HC ALK PHOS
|
Facility
IP
|
$91.59
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
63001099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$85.17 |
| Rate for Payer: Aetna Commercial |
$79.13
|
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Cigna All Commercial |
$79.04
|
| Rate for Payer: CORVEL All Commercial |
$85.17
|
| Rate for Payer: Coventry All Commercial |
$80.60
|
| Rate for Payer: Encore All Commercial |
$84.30
|
| Rate for Payer: Frontpath All Commercial |
$84.26
|
| Rate for Payer: Humana ChoiceCare |
$79.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.43
|
| Rate for Payer: PHCS All Commercial |
$68.69
|
| Rate for Payer: PHP All Commercial |
$69.46
|
| Rate for Payer: Sagamore Health Network All Products |
$70.70
|
| Rate for Payer: Signature Care EPO |
$76.02
|
| Rate for Payer: Signature Care PPO |
$80.60
|
| Rate for Payer: United Healthcare Commercial |
$72.17
|
|
|
HC ALK PHOS
|
Facility
OP
|
$91.59
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
63001099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$85.17 |
| Rate for Payer: Aetna Commercial |
$77.30
|
| Rate for Payer: Aetna Medicare |
$30.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.25
|
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Centivo All Commercial |
$46.71
|
| Rate for Payer: Cigna All Commercial |
$79.04
|
| Rate for Payer: CORVEL All Commercial |
$85.17
|
| Rate for Payer: Coventry All Commercial |
$80.60
|
| Rate for Payer: Encore All Commercial |
$84.30
|
| Rate for Payer: Frontpath All Commercial |
$84.26
|
| Rate for Payer: Humana ChoiceCare |
$79.10
|
| Rate for Payer: Humana Medicare |
$46.71
|
| Rate for Payer: Lucent All Commercial |
$46.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.43
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$68.69
|
| Rate for Payer: PHP All Commercial |
$69.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.72
|
| Rate for Payer: Sagamore Health Network All Products |
$70.70
|
| Rate for Payer: Signature Care EPO |
$76.02
|
| Rate for Payer: Signature Care PPO |
$80.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.85
|
| Rate for Payer: United Healthcare Commercial |
$72.17
|
| Rate for Payer: United Healthcare Medicare |
$30.22
|
|
|
HC ALK PHOS BONE SPECIF
|
Facility
IP
|
$163.81
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
63001023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.86 |
| Max. Negotiated Rate |
$152.35 |
| Rate for Payer: Aetna Commercial |
$141.53
|
| Rate for Payer: Cash Price |
$101.56
|
| Rate for Payer: Cigna All Commercial |
$141.37
|
| Rate for Payer: CORVEL All Commercial |
$152.35
|
| Rate for Payer: Coventry All Commercial |
$144.15
|
| Rate for Payer: Encore All Commercial |
$150.79
|
| Rate for Payer: Frontpath All Commercial |
$150.71
|
| Rate for Payer: Humana ChoiceCare |
$141.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.43
|
| Rate for Payer: PHCS All Commercial |
$122.86
|
| Rate for Payer: PHP All Commercial |
$124.24
|
| Rate for Payer: Sagamore Health Network All Products |
$126.46
|
| Rate for Payer: Signature Care EPO |
$135.96
|
| Rate for Payer: Signature Care PPO |
$144.15
|
| Rate for Payer: United Healthcare Commercial |
$129.08
|
|
|
HC ALK PHOS BONE SPECIF
|
Facility
OP
|
$163.81
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
63001023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$152.35 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Aetna Medicare |
$54.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.46
|
| Rate for Payer: Cash Price |
$101.56
|
| Rate for Payer: Cash Price |
$101.56
|
| Rate for Payer: Centivo All Commercial |
$83.54
|
| Rate for Payer: Cigna All Commercial |
$141.37
|
| Rate for Payer: CORVEL All Commercial |
$152.35
|
| Rate for Payer: Coventry All Commercial |
$144.15
|
| Rate for Payer: Encore All Commercial |
$150.79
|
| Rate for Payer: Frontpath All Commercial |
$150.71
|
| Rate for Payer: Humana ChoiceCare |
$141.48
|
| Rate for Payer: Humana Medicare |
$83.54
|
| Rate for Payer: Lucent All Commercial |
$83.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.43
|
| Rate for Payer: Managed Health Services Medicaid |
$14.78
|
| Rate for Payer: MDWise Medicaid |
$14.78
|
| Rate for Payer: PHCS All Commercial |
$122.86
|
| Rate for Payer: PHP All Commercial |
$124.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.89
|
| Rate for Payer: Sagamore Health Network All Products |
$126.46
|
| Rate for Payer: Signature Care EPO |
$135.96
|
| Rate for Payer: Signature Care PPO |
$144.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.24
|
| Rate for Payer: United Healthcare Commercial |
$129.08
|
| Rate for Payer: United Healthcare Medicare |
$54.06
|
|
|
HC ALK PHOS ISOENZYME
|
Facility
IP
|
$163.81
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
63001657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.86 |
| Max. Negotiated Rate |
$152.35 |
| Rate for Payer: Aetna Commercial |
$141.53
|
| Rate for Payer: Cash Price |
$101.56
|
| Rate for Payer: Cigna All Commercial |
$141.37
|
| Rate for Payer: CORVEL All Commercial |
$152.35
|
| Rate for Payer: Coventry All Commercial |
$144.15
|
| Rate for Payer: Encore All Commercial |
$150.79
|
| Rate for Payer: Frontpath All Commercial |
$150.71
|
| Rate for Payer: Humana ChoiceCare |
$141.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.43
|
| Rate for Payer: PHCS All Commercial |
$122.86
|
| Rate for Payer: PHP All Commercial |
$124.24
|
| Rate for Payer: Sagamore Health Network All Products |
$126.46
|
| Rate for Payer: Signature Care EPO |
$135.96
|
| Rate for Payer: Signature Care PPO |
$144.15
|
| Rate for Payer: United Healthcare Commercial |
$129.08
|
|
|
HC ALK PHOS ISOENZYME
|
Facility
OP
|
$163.81
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
63001657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$152.35 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Aetna Medicare |
$54.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.46
|
| Rate for Payer: Cash Price |
$101.56
|
| Rate for Payer: Cash Price |
$101.56
|
| Rate for Payer: Centivo All Commercial |
$83.54
|
| Rate for Payer: Cigna All Commercial |
$141.37
|
| Rate for Payer: CORVEL All Commercial |
$152.35
|
| Rate for Payer: Coventry All Commercial |
$144.15
|
| Rate for Payer: Encore All Commercial |
$150.79
|
| Rate for Payer: Frontpath All Commercial |
$150.71
|
| Rate for Payer: Humana ChoiceCare |
$141.48
|
| Rate for Payer: Humana Medicare |
$83.54
|
| Rate for Payer: Lucent All Commercial |
$83.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.43
|
| Rate for Payer: Managed Health Services Medicaid |
$14.78
|
| Rate for Payer: MDWise Medicaid |
$14.78
|
| Rate for Payer: PHCS All Commercial |
$122.86
|
| Rate for Payer: PHP All Commercial |
$124.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.89
|
| Rate for Payer: Sagamore Health Network All Products |
$126.46
|
| Rate for Payer: Signature Care EPO |
$135.96
|
| Rate for Payer: Signature Care PPO |
$144.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.24
|
| Rate for Payer: United Healthcare Commercial |
$129.08
|
| Rate for Payer: United Healthcare Medicare |
$54.06
|
|
|
HC ALLERGEN ACREMONIUM KILIENSE
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001759
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN ACREMONIUM KILIENSE
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001759
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN ALDER TREE
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001760
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN ALDER TREE
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001760
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN ALMOND
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001761
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN ALMOND
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001761
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN ALT TENUIS
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN ALT TENUIS
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
