|
HC ANCHOR QUATTRO LINK 4.5
|
Facility
OP
|
$1,845.00
|
|
| Hospital Charge Code |
41603095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,715.85 |
| Rate for Payer: Aetna Commercial |
$1,557.18
|
| Rate for Payer: Aetna Medicare |
$608.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$608.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,059.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,153.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$700.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$669.74
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Centivo All Commercial |
$940.95
|
| Rate for Payer: Cigna All Commercial |
$1,592.24
|
| Rate for Payer: CORVEL All Commercial |
$1,715.85
|
| Rate for Payer: Coventry All Commercial |
$1,623.60
|
| Rate for Payer: Encore All Commercial |
$1,698.32
|
| Rate for Payer: Frontpath All Commercial |
$1,697.40
|
| Rate for Payer: Humana ChoiceCare |
$1,593.53
|
| Rate for Payer: Humana Medicare |
$940.95
|
| Rate for Payer: Lucent All Commercial |
$940.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,660.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,383.75
|
| Rate for Payer: PHP All Commercial |
$1,399.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$719.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,424.34
|
| Rate for Payer: Signature Care EPO |
$1,531.35
|
| Rate for Payer: Signature Care PPO |
$1,623.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,568.25
|
| Rate for Payer: United Healthcare Commercial |
$1,453.86
|
| Rate for Payer: United Healthcare Medicare |
$608.85
|
|
|
HC ANCHOR QUATTRO LINK 4.5
|
Facility
IP
|
$1,845.00
|
|
| Hospital Charge Code |
41603095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.75 |
| Max. Negotiated Rate |
$1,715.85 |
| Rate for Payer: Aetna Commercial |
$1,594.08
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cigna All Commercial |
$1,592.24
|
| Rate for Payer: CORVEL All Commercial |
$1,715.85
|
| Rate for Payer: Coventry All Commercial |
$1,623.60
|
| Rate for Payer: Encore All Commercial |
$1,698.32
|
| Rate for Payer: Frontpath All Commercial |
$1,697.40
|
| Rate for Payer: Humana ChoiceCare |
$1,593.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,660.50
|
| Rate for Payer: PHCS All Commercial |
$1,383.75
|
| Rate for Payer: PHP All Commercial |
$1,399.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,424.34
|
| Rate for Payer: Signature Care EPO |
$1,531.35
|
| Rate for Payer: Signature Care PPO |
$1,623.60
|
| Rate for Payer: United Healthcare Commercial |
$1,453.86
|
|
|
HC ANCHOR QUATTRO LINK 5.5
|
Facility
OP
|
$1,845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,715.85 |
| Rate for Payer: Aetna Commercial |
$1,557.18
|
| Rate for Payer: Aetna Medicare |
$608.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$608.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,059.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,153.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$700.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$669.74
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Centivo All Commercial |
$940.95
|
| Rate for Payer: Cigna All Commercial |
$1,592.24
|
| Rate for Payer: CORVEL All Commercial |
$1,715.85
|
| Rate for Payer: Coventry All Commercial |
$1,623.60
|
| Rate for Payer: Encore All Commercial |
$1,698.32
|
| Rate for Payer: Frontpath All Commercial |
$1,697.40
|
| Rate for Payer: Humana ChoiceCare |
$1,593.53
|
| Rate for Payer: Humana Medicare |
$940.95
|
| Rate for Payer: Lucent All Commercial |
$940.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,660.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,383.75
|
| Rate for Payer: PHP All Commercial |
$1,399.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$719.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,424.34
|
| Rate for Payer: Signature Care EPO |
$1,531.35
|
| Rate for Payer: Signature Care PPO |
$1,623.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,568.25
|
| Rate for Payer: United Healthcare Commercial |
$1,453.86
|
| Rate for Payer: United Healthcare Medicare |
$608.85
|
|
|
HC ANCHOR QUATTRO LINK 5.5
|
Facility
IP
|
$1,845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.75 |
| Max. Negotiated Rate |
$1,715.85 |
| Rate for Payer: Aetna Commercial |
$1,594.08
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cigna All Commercial |
$1,592.24
|
| Rate for Payer: CORVEL All Commercial |
$1,715.85
|
| Rate for Payer: Coventry All Commercial |
$1,623.60
|
| Rate for Payer: Encore All Commercial |
$1,698.32
|
| Rate for Payer: Frontpath All Commercial |
$1,697.40
|
| Rate for Payer: Humana ChoiceCare |
$1,593.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,660.50
|
| Rate for Payer: PHCS All Commercial |
$1,383.75
|
| Rate for Payer: PHP All Commercial |
$1,399.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,424.34
|
| Rate for Payer: Signature Care EPO |
$1,531.35
|
| Rate for Payer: Signature Care PPO |
$1,623.60
|
| Rate for Payer: United Healthcare Commercial |
$1,453.86
|
|
|
HC ANCHOR TWINFIX SUTURE
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$698.78
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Centivo All Commercial |
$981.75
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Humana Medicare |
$981.75
|
| Rate for Payer: Lucent All Commercial |
$981.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$750.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,636.25
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
| Rate for Payer: United Healthcare Medicare |
$635.25
|
|
|
HC ANCHOR TWINFIX SUTURE
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC ANDROSTENEDIONE
|
Facility
IP
|
$207.57
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
63001466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$193.04 |
| Rate for Payer: Cigna All Commercial |
$179.13
|
| Rate for Payer: Aetna Commercial |
$179.34
|
| Rate for Payer: Cash Price |
$128.69
|
| Rate for Payer: CORVEL All Commercial |
$193.04
|
| Rate for Payer: Coventry All Commercial |
$182.66
|
| Rate for Payer: Encore All Commercial |
$191.07
|
| Rate for Payer: Frontpath All Commercial |
$190.96
|
| Rate for Payer: Humana ChoiceCare |
$179.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.81
|
| Rate for Payer: PHCS All Commercial |
$155.68
|
| Rate for Payer: PHP All Commercial |
$157.42
|
| Rate for Payer: Sagamore Health Network All Products |
$160.24
|
| Rate for Payer: Signature Care EPO |
$172.28
|
| Rate for Payer: Signature Care PPO |
$182.66
|
| Rate for Payer: United Healthcare Commercial |
$163.57
|
|
|
HC ANDROSTENEDIONE
|
Facility
OP
|
$207.57
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
63001466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$193.04 |
| Rate for Payer: Aetna Commercial |
$175.19
|
| Rate for Payer: Aetna Medicare |
$68.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$119.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$29.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.35
|
| Rate for Payer: Cash Price |
$128.69
|
| Rate for Payer: Cash Price |
$128.69
|
| Rate for Payer: Centivo All Commercial |
$105.86
|
| Rate for Payer: Cigna All Commercial |
$179.13
|
| Rate for Payer: CORVEL All Commercial |
$193.04
|
| Rate for Payer: Coventry All Commercial |
$182.66
|
| Rate for Payer: Encore All Commercial |
$191.07
|
| Rate for Payer: Frontpath All Commercial |
$190.96
|
| Rate for Payer: Humana ChoiceCare |
$179.28
|
| Rate for Payer: Humana Medicare |
$105.86
|
| Rate for Payer: Lucent All Commercial |
$105.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.81
|
| Rate for Payer: Managed Health Services Medicaid |
$29.28
|
| Rate for Payer: MDWise Medicaid |
$29.28
|
| Rate for Payer: PHCS All Commercial |
$155.68
|
| Rate for Payer: PHP All Commercial |
$157.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.95
|
| Rate for Payer: Sagamore Health Network All Products |
$160.24
|
| Rate for Payer: Signature Care EPO |
$172.28
|
| Rate for Payer: Signature Care PPO |
$182.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$176.43
|
| Rate for Payer: United Healthcare Commercial |
$163.57
|
| Rate for Payer: United Healthcare Medicare |
$68.50
|
|
|
HC ANGIOTENSIN-1
|
Facility
IP
|
$204.28
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
63001467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.21 |
| Max. Negotiated Rate |
$189.98 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: Cash Price |
$126.65
|
| Rate for Payer: Cigna All Commercial |
$176.29
|
| Rate for Payer: CORVEL All Commercial |
$189.98
|
| Rate for Payer: Coventry All Commercial |
$179.76
|
| Rate for Payer: Encore All Commercial |
$188.04
|
| Rate for Payer: Frontpath All Commercial |
$187.93
|
| Rate for Payer: Humana ChoiceCare |
$176.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.85
|
| Rate for Payer: PHCS All Commercial |
$153.21
|
| Rate for Payer: PHP All Commercial |
$154.92
|
| Rate for Payer: Sagamore Health Network All Products |
$157.70
|
| Rate for Payer: Signature Care EPO |
$169.55
|
| Rate for Payer: Signature Care PPO |
$179.76
|
| Rate for Payer: United Healthcare Commercial |
$160.97
|
|
|
HC ANGIOTENSIN-1
|
Facility
OP
|
$204.28
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
63001467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$189.98 |
| Rate for Payer: Aetna Commercial |
$172.41
|
| Rate for Payer: Aetna Medicare |
$67.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.15
|
| Rate for Payer: Cash Price |
$126.65
|
| Rate for Payer: Cash Price |
$126.65
|
| Rate for Payer: Centivo All Commercial |
$104.18
|
| Rate for Payer: Cigna All Commercial |
$176.29
|
| Rate for Payer: CORVEL All Commercial |
$189.98
|
| Rate for Payer: Coventry All Commercial |
$179.76
|
| Rate for Payer: Encore All Commercial |
$188.04
|
| Rate for Payer: Frontpath All Commercial |
$187.93
|
| Rate for Payer: Humana ChoiceCare |
$176.43
|
| Rate for Payer: Humana Medicare |
$104.18
|
| Rate for Payer: Lucent All Commercial |
$104.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.85
|
| Rate for Payer: Managed Health Services Medicaid |
$14.60
|
| Rate for Payer: MDWise Medicaid |
$14.60
|
| Rate for Payer: PHCS All Commercial |
$153.21
|
| Rate for Payer: PHP All Commercial |
$154.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.67
|
| Rate for Payer: Sagamore Health Network All Products |
$157.70
|
| Rate for Payer: Signature Care EPO |
$169.55
|
| Rate for Payer: Signature Care PPO |
$179.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.63
|
| Rate for Payer: United Healthcare Commercial |
$160.97
|
| Rate for Payer: United Healthcare Medicare |
$67.41
|
|
|
HC ANKLE DISTRACTOR STRAP
|
Facility
OP
|
$346.50
|
|
| Hospital Charge Code |
41603432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.34 |
| Max. Negotiated Rate |
$322.24 |
| Rate for Payer: Aetna Commercial |
$292.45
|
| Rate for Payer: Aetna Medicare |
$114.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$198.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$216.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.78
|
| Rate for Payer: Cash Price |
$214.83
|
| Rate for Payer: Cash Price |
$214.83
|
| Rate for Payer: Centivo All Commercial |
$176.72
|
| Rate for Payer: Cigna All Commercial |
$299.03
|
| Rate for Payer: CORVEL All Commercial |
$322.24
|
| Rate for Payer: Coventry All Commercial |
$304.92
|
| Rate for Payer: Encore All Commercial |
$318.95
|
| Rate for Payer: Frontpath All Commercial |
$318.78
|
| Rate for Payer: Humana ChoiceCare |
$299.27
|
| Rate for Payer: Humana Medicare |
$176.72
|
| Rate for Payer: Lucent All Commercial |
$176.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$311.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$259.88
|
| Rate for Payer: PHP All Commercial |
$262.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.14
|
| Rate for Payer: Sagamore Health Network All Products |
$267.50
|
| Rate for Payer: Signature Care EPO |
$287.60
|
| Rate for Payer: Signature Care PPO |
$304.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$294.52
|
| Rate for Payer: United Healthcare Commercial |
$273.04
|
| Rate for Payer: United Healthcare Medicare |
$114.34
|
|
|
HC ANKLE DISTRACTOR STRAP
|
Facility
IP
|
$346.50
|
|
| Hospital Charge Code |
41603432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.88 |
| Max. Negotiated Rate |
$322.24 |
| Rate for Payer: Aetna Commercial |
$299.38
|
| Rate for Payer: Cash Price |
$214.83
|
| Rate for Payer: Cigna All Commercial |
$299.03
|
| Rate for Payer: CORVEL All Commercial |
$322.24
|
| Rate for Payer: Coventry All Commercial |
$304.92
|
| Rate for Payer: Encore All Commercial |
$318.95
|
| Rate for Payer: Frontpath All Commercial |
$318.78
|
| Rate for Payer: Humana ChoiceCare |
$299.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$311.85
|
| Rate for Payer: PHCS All Commercial |
$259.88
|
| Rate for Payer: PHP All Commercial |
$262.79
|
| Rate for Payer: Sagamore Health Network All Products |
$267.50
|
| Rate for Payer: Signature Care EPO |
$287.60
|
| Rate for Payer: Signature Care PPO |
$304.92
|
| Rate for Payer: United Healthcare Commercial |
$273.04
|
|
|
HC ANTGLIADIN AB IGA
|
Facility
IP
|
$111.68
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
63001578
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.76 |
| Max. Negotiated Rate |
$103.86 |
| Rate for Payer: Aetna Commercial |
$96.49
|
| Rate for Payer: Cash Price |
$69.24
|
| Rate for Payer: Cigna All Commercial |
$96.38
|
| Rate for Payer: CORVEL All Commercial |
$103.86
|
| Rate for Payer: Coventry All Commercial |
$98.28
|
| Rate for Payer: Encore All Commercial |
$102.80
|
| Rate for Payer: Frontpath All Commercial |
$102.75
|
| Rate for Payer: Humana ChoiceCare |
$96.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.51
|
| Rate for Payer: PHCS All Commercial |
$83.76
|
| Rate for Payer: PHP All Commercial |
$84.70
|
| Rate for Payer: Sagamore Health Network All Products |
$86.22
|
| Rate for Payer: Signature Care EPO |
$92.69
|
| Rate for Payer: Signature Care PPO |
$98.28
|
| Rate for Payer: United Healthcare Commercial |
$88.00
|
|
|
HC ANTGLIADIN AB IGA
|
Facility
OP
|
$111.68
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
63001578
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$103.86 |
| Rate for Payer: Aetna Commercial |
$94.26
|
| Rate for Payer: Aetna Medicare |
$36.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.54
|
| Rate for Payer: Cash Price |
$69.24
|
| Rate for Payer: Cash Price |
$69.24
|
| Rate for Payer: Centivo All Commercial |
$56.96
|
| Rate for Payer: Cigna All Commercial |
$96.38
|
| Rate for Payer: CORVEL All Commercial |
$103.86
|
| Rate for Payer: Coventry All Commercial |
$98.28
|
| Rate for Payer: Encore All Commercial |
$102.80
|
| Rate for Payer: Frontpath All Commercial |
$102.75
|
| Rate for Payer: Humana ChoiceCare |
$96.46
|
| Rate for Payer: Humana Medicare |
$56.96
|
| Rate for Payer: Lucent All Commercial |
$56.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.51
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$83.76
|
| Rate for Payer: PHP All Commercial |
$84.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.56
|
| Rate for Payer: Sagamore Health Network All Products |
$86.22
|
| Rate for Payer: Signature Care EPO |
$92.69
|
| Rate for Payer: Signature Care PPO |
$98.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.93
|
| Rate for Payer: United Healthcare Commercial |
$88.00
|
| Rate for Payer: United Healthcare Medicare |
$36.85
|
|
|
HC ANTIBACTERIAL ENVELOPE LG
|
Facility
OP
|
$4,856.25
|
|
| Hospital Charge Code |
41607378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,516.31 |
| Rate for Payer: Aetna Commercial |
$4,098.68
|
| Rate for Payer: Aetna Medicare |
$1,602.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,602.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,788.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,035.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,842.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,762.82
|
| Rate for Payer: Cash Price |
$3,010.88
|
| Rate for Payer: Cash Price |
$3,010.88
|
| Rate for Payer: Centivo All Commercial |
$2,476.69
|
| Rate for Payer: Cigna All Commercial |
$4,190.94
|
| Rate for Payer: CORVEL All Commercial |
$4,516.31
|
| Rate for Payer: Coventry All Commercial |
$4,273.50
|
| Rate for Payer: Encore All Commercial |
$4,470.18
|
| Rate for Payer: Frontpath All Commercial |
$4,467.75
|
| Rate for Payer: Humana ChoiceCare |
$4,194.34
|
| Rate for Payer: Humana Medicare |
$2,476.69
|
| Rate for Payer: Lucent All Commercial |
$2,476.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,370.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,642.19
|
| Rate for Payer: PHP All Commercial |
$3,682.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,893.94
|
| Rate for Payer: Sagamore Health Network All Products |
$3,749.02
|
| Rate for Payer: Signature Care EPO |
$4,030.69
|
| Rate for Payer: Signature Care PPO |
$4,273.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,127.81
|
| Rate for Payer: United Healthcare Commercial |
$3,826.72
|
| Rate for Payer: United Healthcare Medicare |
$1,602.56
|
|
|
HC ANTIBACTERIAL ENVELOPE LG
|
Facility
IP
|
$4,856.25
|
|
| Hospital Charge Code |
41607378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,642.19 |
| Max. Negotiated Rate |
$4,516.31 |
| Rate for Payer: Aetna Commercial |
$4,195.80
|
| Rate for Payer: Cash Price |
$3,010.88
|
| Rate for Payer: Cigna All Commercial |
$4,190.94
|
| Rate for Payer: CORVEL All Commercial |
$4,516.31
|
| Rate for Payer: Coventry All Commercial |
$4,273.50
|
| Rate for Payer: Encore All Commercial |
$4,470.18
|
| Rate for Payer: Frontpath All Commercial |
$4,467.75
|
| Rate for Payer: Humana ChoiceCare |
$4,194.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,370.62
|
| Rate for Payer: PHCS All Commercial |
$3,642.19
|
| Rate for Payer: PHP All Commercial |
$3,682.98
|
| Rate for Payer: Sagamore Health Network All Products |
$3,749.02
|
| Rate for Payer: Signature Care EPO |
$4,030.69
|
| Rate for Payer: Signature Care PPO |
$4,273.50
|
| Rate for Payer: United Healthcare Commercial |
$3,826.72
|
|
|
HC ANTIBACTERIAL ENVELOPE MED
|
Facility
OP
|
$4,856.25
|
|
| Hospital Charge Code |
41607377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,516.31 |
| Rate for Payer: Aetna Commercial |
$4,098.68
|
| Rate for Payer: Aetna Medicare |
$1,602.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,602.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,788.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,035.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,842.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,762.82
|
| Rate for Payer: Cash Price |
$3,010.88
|
| Rate for Payer: Cash Price |
$3,010.88
|
| Rate for Payer: Centivo All Commercial |
$2,476.69
|
| Rate for Payer: Cigna All Commercial |
$4,190.94
|
| Rate for Payer: CORVEL All Commercial |
$4,516.31
|
| Rate for Payer: Coventry All Commercial |
$4,273.50
|
| Rate for Payer: Encore All Commercial |
$4,470.18
|
| Rate for Payer: Frontpath All Commercial |
$4,467.75
|
| Rate for Payer: Humana ChoiceCare |
$4,194.34
|
| Rate for Payer: Humana Medicare |
$2,476.69
|
| Rate for Payer: Lucent All Commercial |
$2,476.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,370.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,642.19
|
| Rate for Payer: PHP All Commercial |
$3,682.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,893.94
|
| Rate for Payer: Sagamore Health Network All Products |
$3,749.02
|
| Rate for Payer: Signature Care EPO |
$4,030.69
|
| Rate for Payer: Signature Care PPO |
$4,273.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,127.81
|
| Rate for Payer: United Healthcare Commercial |
$3,826.72
|
| Rate for Payer: United Healthcare Medicare |
$1,602.56
|
|
|
HC ANTIBACTERIAL ENVELOPE MED
|
Facility
IP
|
$4,856.25
|
|
| Hospital Charge Code |
41607377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,642.19 |
| Max. Negotiated Rate |
$4,516.31 |
| Rate for Payer: Aetna Commercial |
$4,195.80
|
| Rate for Payer: Cash Price |
$3,010.88
|
| Rate for Payer: Cigna All Commercial |
$4,190.94
|
| Rate for Payer: CORVEL All Commercial |
$4,516.31
|
| Rate for Payer: Coventry All Commercial |
$4,273.50
|
| Rate for Payer: Encore All Commercial |
$4,470.18
|
| Rate for Payer: Frontpath All Commercial |
$4,467.75
|
| Rate for Payer: Humana ChoiceCare |
$4,194.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,370.62
|
| Rate for Payer: PHCS All Commercial |
$3,642.19
|
| Rate for Payer: PHP All Commercial |
$3,682.98
|
| Rate for Payer: Sagamore Health Network All Products |
$3,749.02
|
| Rate for Payer: Signature Care EPO |
$4,030.69
|
| Rate for Payer: Signature Care PPO |
$4,273.50
|
| Rate for Payer: United Healthcare Commercial |
$3,826.72
|
|
|
HC ANTIBODY SCREEN
|
Facility
IP
|
$133.90
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
63001346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.42 |
| Max. Negotiated Rate |
$124.52 |
| Rate for Payer: Aetna Commercial |
$115.69
|
| Rate for Payer: Cash Price |
$83.02
|
| Rate for Payer: Cigna All Commercial |
$115.55
|
| Rate for Payer: CORVEL All Commercial |
$124.52
|
| Rate for Payer: Coventry All Commercial |
$117.83
|
| Rate for Payer: Encore All Commercial |
$123.25
|
| Rate for Payer: Frontpath All Commercial |
$123.18
|
| Rate for Payer: Humana ChoiceCare |
$115.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$120.51
|
| Rate for Payer: PHCS All Commercial |
$100.42
|
| Rate for Payer: PHP All Commercial |
$101.55
|
| Rate for Payer: Sagamore Health Network All Products |
$103.37
|
| Rate for Payer: Signature Care EPO |
$111.13
|
| Rate for Payer: Signature Care PPO |
$117.83
|
| Rate for Payer: United Healthcare Commercial |
$105.51
|
|
|
HC ANTIBODY SCREEN
|
Facility
OP
|
$133.90
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
63001346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$124.52 |
| Rate for Payer: Aetna Commercial |
$113.01
|
| Rate for Payer: Aetna Medicare |
$44.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.60
|
| Rate for Payer: Cash Price |
$83.02
|
| Rate for Payer: Cash Price |
$83.02
|
| Rate for Payer: Centivo All Commercial |
$68.29
|
| Rate for Payer: Cigna All Commercial |
$115.55
|
| Rate for Payer: CORVEL All Commercial |
$124.52
|
| Rate for Payer: Coventry All Commercial |
$117.83
|
| Rate for Payer: Encore All Commercial |
$123.25
|
| Rate for Payer: Frontpath All Commercial |
$123.18
|
| Rate for Payer: Humana ChoiceCare |
$115.65
|
| Rate for Payer: Humana Medicare |
$68.29
|
| Rate for Payer: Lucent All Commercial |
$68.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$120.51
|
| Rate for Payer: Managed Health Services Medicaid |
$5.21
|
| Rate for Payer: MDWise Medicaid |
$5.21
|
| Rate for Payer: PHCS All Commercial |
$100.42
|
| Rate for Payer: PHP All Commercial |
$101.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.22
|
| Rate for Payer: Sagamore Health Network All Products |
$103.37
|
| Rate for Payer: Signature Care EPO |
$111.13
|
| Rate for Payer: Signature Care PPO |
$117.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$113.81
|
| Rate for Payer: United Healthcare Commercial |
$105.51
|
| Rate for Payer: United Healthcare Medicare |
$44.19
|
|
|
HC ANTIBODY SCREEN RBC-EA PANEL
|
Facility
IP
|
$264.77
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
63001129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$198.58 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$228.76
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cigna All Commercial |
$228.50
|
| Rate for Payer: CORVEL All Commercial |
$246.24
|
| Rate for Payer: Coventry All Commercial |
$233.00
|
| Rate for Payer: Encore All Commercial |
$243.72
|
| Rate for Payer: Frontpath All Commercial |
$243.59
|
| Rate for Payer: Humana ChoiceCare |
$228.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$238.29
|
| Rate for Payer: PHCS All Commercial |
$198.58
|
| Rate for Payer: PHP All Commercial |
$200.80
|
| Rate for Payer: Sagamore Health Network All Products |
$204.40
|
| Rate for Payer: Signature Care EPO |
$219.76
|
| Rate for Payer: Signature Care PPO |
$233.00
|
| Rate for Payer: United Healthcare Commercial |
$208.64
|
|
|
HC ANTIBODY SCREEN RBC-EA PANEL
|
Facility
OP
|
$264.77
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
63001129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.37 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$223.47
|
| Rate for Payer: Aetna Medicare |
$87.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$195.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.11
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Centivo All Commercial |
$135.03
|
| Rate for Payer: Cigna All Commercial |
$228.50
|
| Rate for Payer: CORVEL All Commercial |
$246.24
|
| Rate for Payer: Coventry All Commercial |
$233.00
|
| Rate for Payer: Encore All Commercial |
$243.72
|
| Rate for Payer: Frontpath All Commercial |
$243.59
|
| Rate for Payer: Humana ChoiceCare |
$228.68
|
| Rate for Payer: Humana Medicare |
$135.03
|
| Rate for Payer: Lucent All Commercial |
$135.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$238.29
|
| Rate for Payer: Managed Health Services Medicaid |
$195.00
|
| Rate for Payer: MDWise Medicaid |
$195.00
|
| Rate for Payer: PHCS All Commercial |
$198.58
|
| Rate for Payer: PHP All Commercial |
$200.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.26
|
| Rate for Payer: Sagamore Health Network All Products |
$204.40
|
| Rate for Payer: Signature Care EPO |
$219.76
|
| Rate for Payer: Signature Care PPO |
$233.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$225.06
|
| Rate for Payer: United Healthcare Commercial |
$208.64
|
| Rate for Payer: United Healthcare Medicare |
$87.37
|
|
|
HC ANTI-CYCLIC CIT PEPT
|
Facility
IP
|
$155.86
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
63001146
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.89 |
| Max. Negotiated Rate |
$144.95 |
| Rate for Payer: Aetna Commercial |
$134.66
|
| Rate for Payer: Cash Price |
$96.63
|
| Rate for Payer: Cigna All Commercial |
$134.50
|
| Rate for Payer: CORVEL All Commercial |
$144.95
|
| Rate for Payer: Coventry All Commercial |
$137.15
|
| Rate for Payer: Encore All Commercial |
$143.47
|
| Rate for Payer: Frontpath All Commercial |
$143.39
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.27
|
| Rate for Payer: PHCS All Commercial |
$116.89
|
| Rate for Payer: PHP All Commercial |
$118.20
|
| Rate for Payer: Sagamore Health Network All Products |
$120.32
|
| Rate for Payer: Signature Care EPO |
$129.36
|
| Rate for Payer: Signature Care PPO |
$137.15
|
| Rate for Payer: United Healthcare Commercial |
$122.81
|
|
|
HC ANTI-CYCLIC CIT PEPT
|
Facility
OP
|
$155.86
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
63001146
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$144.95 |
| Rate for Payer: Aetna Commercial |
$131.54
|
| Rate for Payer: Aetna Medicare |
$51.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.58
|
| Rate for Payer: Cash Price |
$96.63
|
| Rate for Payer: Cash Price |
$96.63
|
| Rate for Payer: Centivo All Commercial |
$79.49
|
| Rate for Payer: Cigna All Commercial |
$134.50
|
| Rate for Payer: CORVEL All Commercial |
$144.95
|
| Rate for Payer: Coventry All Commercial |
$137.15
|
| Rate for Payer: Encore All Commercial |
$143.47
|
| Rate for Payer: Frontpath All Commercial |
$143.39
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare |
$79.49
|
| Rate for Payer: Lucent All Commercial |
$79.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.27
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: MDWise Medicaid |
$12.95
|
| Rate for Payer: PHCS All Commercial |
$116.89
|
| Rate for Payer: PHP All Commercial |
$118.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.78
|
| Rate for Payer: Sagamore Health Network All Products |
$120.32
|
| Rate for Payer: Signature Care EPO |
$129.36
|
| Rate for Payer: Signature Care PPO |
$137.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.48
|
| Rate for Payer: United Healthcare Commercial |
$122.81
|
| Rate for Payer: United Healthcare Medicare |
$51.43
|
|
|
HC ANTI-ENA ANTI
|
Facility
OP
|
$95.83
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$80.88
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.79
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Centivo All Commercial |
$48.87
|
| Rate for Payer: Cigna All Commercial |
$82.70
|
| Rate for Payer: CORVEL All Commercial |
$89.12
|
| Rate for Payer: Coventry All Commercial |
$84.33
|
| Rate for Payer: Encore All Commercial |
$88.21
|
| Rate for Payer: Frontpath All Commercial |
$88.16
|
| Rate for Payer: Humana ChoiceCare |
$82.77
|
| Rate for Payer: Humana Medicare |
$48.87
|
| Rate for Payer: Lucent All Commercial |
$48.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.25
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$71.87
|
| Rate for Payer: PHP All Commercial |
$72.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.37
|
| Rate for Payer: Sagamore Health Network All Products |
$73.98
|
| Rate for Payer: Signature Care EPO |
$79.54
|
| Rate for Payer: Signature Care PPO |
$84.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.45
|
| Rate for Payer: United Healthcare Commercial |
$75.51
|
| Rate for Payer: United Healthcare Medicare |
$31.62
|
|
