|
HC BEDDED OUTPATIENT EACH ADDITIONAL HOUR
|
Facility
OP
|
$19.27
|
|
| Hospital Charge Code |
01681007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$757.73 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.99
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Centivo All Commercial |
$9.83
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$9.83
|
| Rate for Payer: Lucent All Commercial |
$9.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.51
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
|
|
HC BEDDED OUTPATIENT INITIAL HOUR
|
Facility
IP
|
$1,201.14
|
|
| Hospital Charge Code |
01681006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$900.86 |
| Max. Negotiated Rate |
$1,117.06 |
| Rate for Payer: Aetna Commercial |
$1,037.79
|
| Rate for Payer: Cash Price |
$744.71
|
| Rate for Payer: Cigna All Commercial |
$1,036.59
|
| Rate for Payer: CORVEL All Commercial |
$1,117.06
|
| Rate for Payer: Coventry All Commercial |
$1,057.00
|
| Rate for Payer: Encore All Commercial |
$1,105.65
|
| Rate for Payer: Frontpath All Commercial |
$1,105.05
|
| Rate for Payer: Humana ChoiceCare |
$1,037.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.03
|
| Rate for Payer: PHCS All Commercial |
$900.86
|
| Rate for Payer: PHP All Commercial |
$910.95
|
| Rate for Payer: Sagamore Health Network All Products |
$927.28
|
| Rate for Payer: Signature Care EPO |
$996.95
|
| Rate for Payer: Signature Care PPO |
$1,057.00
|
| Rate for Payer: United Healthcare Commercial |
$946.50
|
|
|
HC BEDDED OUTPATIENT INITIAL HOUR
|
Facility
OP
|
$1,201.14
|
|
| Hospital Charge Code |
01681006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$396.38 |
| Max. Negotiated Rate |
$1,117.06 |
| Rate for Payer: Aetna Commercial |
$1,013.76
|
| Rate for Payer: Aetna Medicare |
$396.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$396.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$689.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$750.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$757.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$455.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$436.01
|
| Rate for Payer: Cash Price |
$744.71
|
| Rate for Payer: Cash Price |
$744.71
|
| Rate for Payer: Centivo All Commercial |
$612.58
|
| Rate for Payer: Cigna All Commercial |
$1,036.59
|
| Rate for Payer: CORVEL All Commercial |
$1,117.06
|
| Rate for Payer: Coventry All Commercial |
$1,057.00
|
| Rate for Payer: Encore All Commercial |
$1,105.65
|
| Rate for Payer: Frontpath All Commercial |
$1,105.05
|
| Rate for Payer: Humana ChoiceCare |
$1,037.43
|
| Rate for Payer: Humana Medicare |
$612.58
|
| Rate for Payer: Lucent All Commercial |
$612.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.03
|
| Rate for Payer: Managed Health Services Medicaid |
$757.73
|
| Rate for Payer: MDWise Medicaid |
$757.73
|
| Rate for Payer: PHCS All Commercial |
$900.86
|
| Rate for Payer: PHP All Commercial |
$910.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$468.45
|
| Rate for Payer: Sagamore Health Network All Products |
$927.28
|
| Rate for Payer: Signature Care EPO |
$996.95
|
| Rate for Payer: Signature Care PPO |
$1,057.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,020.97
|
| Rate for Payer: United Healthcare Commercial |
$946.50
|
| Rate for Payer: United Healthcare Medicare |
$396.38
|
|
|
HC BEHAVIOR COUNSEL OBESITY /15 MIN
|
Facility
OP
|
$53.04
|
|
|
Service Code
|
CPT G0447
|
| Hospital Charge Code |
72001005
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$49.33 |
| Rate for Payer: Aetna Commercial |
$44.77
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.25
|
| Rate for Payer: Cash Price |
$32.89
|
| Rate for Payer: Centivo All Commercial |
$27.05
|
| Rate for Payer: Cigna All Commercial |
$45.77
|
| Rate for Payer: CORVEL All Commercial |
$49.33
|
| Rate for Payer: Coventry All Commercial |
$46.68
|
| Rate for Payer: Encore All Commercial |
$48.82
|
| Rate for Payer: Frontpath All Commercial |
$48.80
|
| Rate for Payer: Humana ChoiceCare |
$45.81
|
| Rate for Payer: Humana Medicare |
$27.05
|
| Rate for Payer: Lucent All Commercial |
$27.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.74
|
| Rate for Payer: PHCS All Commercial |
$39.78
|
| Rate for Payer: PHP All Commercial |
$40.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.69
|
| Rate for Payer: Sagamore Health Network All Products |
$40.95
|
| Rate for Payer: Signature Care EPO |
$44.02
|
| Rate for Payer: Signature Care PPO |
$46.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.08
|
| Rate for Payer: United Healthcare Commercial |
$41.80
|
| Rate for Payer: United Healthcare Medicare |
$17.50
|
|
|
HC BEHAVIOR COUNSEL OBESITY /15 MIN
|
Facility
IP
|
$53.04
|
|
|
Service Code
|
CPT G0447
|
| Hospital Charge Code |
72001005
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$49.33 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Cash Price |
$32.89
|
| Rate for Payer: Cigna All Commercial |
$45.77
|
| Rate for Payer: CORVEL All Commercial |
$49.33
|
| Rate for Payer: Coventry All Commercial |
$46.68
|
| Rate for Payer: Encore All Commercial |
$48.82
|
| Rate for Payer: Frontpath All Commercial |
$48.80
|
| Rate for Payer: Humana ChoiceCare |
$45.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.74
|
| Rate for Payer: PHCS All Commercial |
$39.78
|
| Rate for Payer: PHP All Commercial |
$40.23
|
| Rate for Payer: Sagamore Health Network All Products |
$40.95
|
| Rate for Payer: Signature Care EPO |
$44.02
|
| Rate for Payer: Signature Care PPO |
$46.68
|
| Rate for Payer: United Healthcare Commercial |
$41.80
|
|
|
HC BENDER FINGER KNUCKLE
|
Facility
OP
|
$94.71
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
41605132
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.25 |
| Max. Negotiated Rate |
$88.08 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna Medicare |
$31.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$51.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.38
|
| Rate for Payer: Cash Price |
$58.72
|
| Rate for Payer: Cash Price |
$58.72
|
| Rate for Payer: Centivo All Commercial |
$48.30
|
| Rate for Payer: Cigna All Commercial |
$81.73
|
| Rate for Payer: CORVEL All Commercial |
$88.08
|
| Rate for Payer: Coventry All Commercial |
$83.34
|
| Rate for Payer: Encore All Commercial |
$87.18
|
| Rate for Payer: Frontpath All Commercial |
$87.13
|
| Rate for Payer: Humana ChoiceCare |
$81.80
|
| Rate for Payer: Humana Medicare |
$48.30
|
| Rate for Payer: Lucent All Commercial |
$48.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.24
|
| Rate for Payer: Managed Health Services Medicaid |
$51.55
|
| Rate for Payer: MDWise Medicaid |
$51.55
|
| Rate for Payer: PHCS All Commercial |
$71.03
|
| Rate for Payer: PHP All Commercial |
$71.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.94
|
| Rate for Payer: Sagamore Health Network All Products |
$73.12
|
| Rate for Payer: Signature Care EPO |
$78.61
|
| Rate for Payer: Signature Care PPO |
$83.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.50
|
| Rate for Payer: United Healthcare Commercial |
$74.63
|
| Rate for Payer: United Healthcare Medicare |
$31.25
|
|
|
HC BENDER FINGER KNUCKLE
|
Facility
IP
|
$94.71
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
41605132
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.03 |
| Max. Negotiated Rate |
$88.08 |
| Rate for Payer: Aetna Commercial |
$81.83
|
| Rate for Payer: Cash Price |
$58.72
|
| Rate for Payer: Cigna All Commercial |
$81.73
|
| Rate for Payer: CORVEL All Commercial |
$88.08
|
| Rate for Payer: Coventry All Commercial |
$83.34
|
| Rate for Payer: Encore All Commercial |
$87.18
|
| Rate for Payer: Frontpath All Commercial |
$87.13
|
| Rate for Payer: Humana ChoiceCare |
$81.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.24
|
| Rate for Payer: PHCS All Commercial |
$71.03
|
| Rate for Payer: PHP All Commercial |
$71.83
|
| Rate for Payer: Sagamore Health Network All Products |
$73.12
|
| Rate for Payer: Signature Care EPO |
$78.61
|
| Rate for Payer: Signature Care PPO |
$83.34
|
| Rate for Payer: United Healthcare Commercial |
$74.63
|
|
|
HC BENZODIAZEPINE QTMS
|
Facility
IP
|
$127.31
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$109.99
|
| Rate for Payer: Cash Price |
$78.93
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.39
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.12
|
| Rate for Payer: Humana ChoiceCare |
$109.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.66
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
|
|
HC BENZODIAZEPINE QTMS
|
Facility
OP
|
$127.31
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$107.45
|
| Rate for Payer: Aetna Medicare |
$42.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.21
|
| Rate for Payer: Cash Price |
$78.93
|
| Rate for Payer: Cash Price |
$78.93
|
| Rate for Payer: Centivo All Commercial |
$64.93
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.39
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.12
|
| Rate for Payer: Humana ChoiceCare |
$109.95
|
| Rate for Payer: Humana Medicare |
$64.93
|
| Rate for Payer: Lucent All Commercial |
$64.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.65
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.66
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.21
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
| Rate for Payer: United Healthcare Medicare |
$42.01
|
|
|
HC BENZODIAZEPINES CONFIRMATION, QUANTITATIVE, SERUM OR PLASMA
|
Facility
IP
|
$122.40
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$105.75
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
|
|
HC BENZODIAZEPINES CONFIRMATION, QUANTITATIVE, SERUM OR PLASMA
|
Facility
OP
|
$122.40
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$103.31
|
| Rate for Payer: Aetna Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.43
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Centivo All Commercial |
$62.42
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Humana Medicare |
$62.42
|
| Rate for Payer: Lucent All Commercial |
$62.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.74
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.04
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
| Rate for Payer: United Healthcare Medicare |
$40.39
|
|
|
HC BENZODIAZEPINES SCREEN WITH REFLEX CONFIRMATION, WHOLE BLOOD
|
Facility
OP
|
$160.65
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63044022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.01 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna Commercial |
$135.59
|
| Rate for Payer: Aetna Medicare |
$53.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.32
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Centivo All Commercial |
$81.93
|
| Rate for Payer: Cigna All Commercial |
$138.64
|
| Rate for Payer: CORVEL All Commercial |
$149.40
|
| Rate for Payer: Coventry All Commercial |
$141.37
|
| Rate for Payer: Encore All Commercial |
$147.88
|
| Rate for Payer: Frontpath All Commercial |
$147.80
|
| Rate for Payer: Humana ChoiceCare |
$138.75
|
| Rate for Payer: Humana Medicare |
$81.93
|
| Rate for Payer: Lucent All Commercial |
$81.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.58
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$120.49
|
| Rate for Payer: PHP All Commercial |
$121.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.65
|
| Rate for Payer: Sagamore Health Network All Products |
$124.02
|
| Rate for Payer: Signature Care EPO |
$133.34
|
| Rate for Payer: Signature Care PPO |
$141.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.55
|
| Rate for Payer: United Healthcare Commercial |
$126.59
|
| Rate for Payer: United Healthcare Medicare |
$53.01
|
|
|
HC BENZODIAZEPINES SCREEN WITH REFLEX CONFIRMATION, WHOLE BLOOD
|
Facility
IP
|
$160.65
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63044022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.49 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna Commercial |
$138.80
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna All Commercial |
$138.64
|
| Rate for Payer: CORVEL All Commercial |
$149.40
|
| Rate for Payer: Coventry All Commercial |
$141.37
|
| Rate for Payer: Encore All Commercial |
$147.88
|
| Rate for Payer: Frontpath All Commercial |
$147.80
|
| Rate for Payer: Humana ChoiceCare |
$138.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.58
|
| Rate for Payer: PHCS All Commercial |
$120.49
|
| Rate for Payer: PHP All Commercial |
$121.84
|
| Rate for Payer: Sagamore Health Network All Products |
$124.02
|
| Rate for Payer: Signature Care EPO |
$133.34
|
| Rate for Payer: Signature Care PPO |
$141.37
|
| Rate for Payer: United Healthcare Commercial |
$126.59
|
|
|
HC BETA-2 GLYCOPROTEIN 1 ANTIBODY CHARGE
|
Facility
IP
|
$69.46
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63001860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.10 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna Commercial |
$60.02
|
| Rate for Payer: Cash Price |
$43.07
|
| Rate for Payer: Cigna All Commercial |
$59.95
|
| Rate for Payer: CORVEL All Commercial |
$64.60
|
| Rate for Payer: Coventry All Commercial |
$61.13
|
| Rate for Payer: Encore All Commercial |
$63.94
|
| Rate for Payer: Frontpath All Commercial |
$63.91
|
| Rate for Payer: Humana ChoiceCare |
$59.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.52
|
| Rate for Payer: PHCS All Commercial |
$52.10
|
| Rate for Payer: PHP All Commercial |
$52.68
|
| Rate for Payer: Sagamore Health Network All Products |
$53.62
|
| Rate for Payer: Signature Care EPO |
$57.65
|
| Rate for Payer: Signature Care PPO |
$61.13
|
| Rate for Payer: United Healthcare Commercial |
$54.74
|
|
|
HC BETA-2 GLYCOPROTEIN 1 ANTIBODY CHARGE
|
Facility
OP
|
$69.46
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63001860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna Medicare |
$22.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.21
|
| Rate for Payer: Cash Price |
$43.07
|
| Rate for Payer: Cash Price |
$43.07
|
| Rate for Payer: Centivo All Commercial |
$35.43
|
| Rate for Payer: Cigna All Commercial |
$59.95
|
| Rate for Payer: CORVEL All Commercial |
$64.60
|
| Rate for Payer: Coventry All Commercial |
$61.13
|
| Rate for Payer: Encore All Commercial |
$63.94
|
| Rate for Payer: Frontpath All Commercial |
$63.91
|
| Rate for Payer: Humana ChoiceCare |
$59.99
|
| Rate for Payer: Humana Medicare |
$35.43
|
| Rate for Payer: Lucent All Commercial |
$35.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.52
|
| Rate for Payer: Managed Health Services Medicaid |
$8.88
|
| Rate for Payer: MDWise Medicaid |
$8.88
|
| Rate for Payer: PHCS All Commercial |
$52.10
|
| Rate for Payer: PHP All Commercial |
$52.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.09
|
| Rate for Payer: Sagamore Health Network All Products |
$53.62
|
| Rate for Payer: Signature Care EPO |
$57.65
|
| Rate for Payer: Signature Care PPO |
$61.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.04
|
| Rate for Payer: United Healthcare Commercial |
$54.74
|
| Rate for Payer: United Healthcare Medicare |
$22.92
|
|
|
HC BETA-2 GLYCOPROTEIN 1 IGA ANTIBODY
|
Facility
IP
|
$130.64
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63001861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna Commercial |
$112.87
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna All Commercial |
$112.74
|
| Rate for Payer: CORVEL All Commercial |
$121.50
|
| Rate for Payer: Coventry All Commercial |
$114.96
|
| Rate for Payer: Encore All Commercial |
$120.26
|
| Rate for Payer: Frontpath All Commercial |
$120.19
|
| Rate for Payer: Humana ChoiceCare |
$112.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.58
|
| Rate for Payer: PHCS All Commercial |
$97.98
|
| Rate for Payer: PHP All Commercial |
$99.08
|
| Rate for Payer: Sagamore Health Network All Products |
$100.86
|
| Rate for Payer: Signature Care EPO |
$108.43
|
| Rate for Payer: Signature Care PPO |
$114.96
|
| Rate for Payer: United Healthcare Commercial |
$102.95
|
|
|
HC BETA-2 GLYCOPROTEIN 1 IGA ANTIBODY
|
Facility
OP
|
$130.64
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63001861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna Commercial |
$110.26
|
| Rate for Payer: Aetna Medicare |
$43.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.42
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Centivo All Commercial |
$66.63
|
| Rate for Payer: Cigna All Commercial |
$112.74
|
| Rate for Payer: CORVEL All Commercial |
$121.50
|
| Rate for Payer: Coventry All Commercial |
$114.96
|
| Rate for Payer: Encore All Commercial |
$120.26
|
| Rate for Payer: Frontpath All Commercial |
$120.19
|
| Rate for Payer: Humana ChoiceCare |
$112.84
|
| Rate for Payer: Humana Medicare |
$66.63
|
| Rate for Payer: Lucent All Commercial |
$66.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.58
|
| Rate for Payer: Managed Health Services Medicaid |
$8.88
|
| Rate for Payer: MDWise Medicaid |
$8.88
|
| Rate for Payer: PHCS All Commercial |
$97.98
|
| Rate for Payer: PHP All Commercial |
$99.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.95
|
| Rate for Payer: Sagamore Health Network All Products |
$100.86
|
| Rate for Payer: Signature Care EPO |
$108.43
|
| Rate for Payer: Signature Care PPO |
$114.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.05
|
| Rate for Payer: United Healthcare Commercial |
$102.95
|
| Rate for Payer: United Healthcare Medicare |
$43.11
|
|
|
HC BETA-2 GLYCOPROTEIN 1 IGG AND IGM ATBY
|
Facility
OP
|
$80.78
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63002194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$68.18
|
| Rate for Payer: Aetna Medicare |
$26.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.32
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Centivo All Commercial |
$41.20
|
| Rate for Payer: Cigna All Commercial |
$69.72
|
| Rate for Payer: CORVEL All Commercial |
$75.13
|
| Rate for Payer: Coventry All Commercial |
$71.09
|
| Rate for Payer: Encore All Commercial |
$74.36
|
| Rate for Payer: Frontpath All Commercial |
$74.32
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Humana Medicare |
$41.20
|
| Rate for Payer: Lucent All Commercial |
$41.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.71
|
| Rate for Payer: Managed Health Services Medicaid |
$8.88
|
| Rate for Payer: MDWise Medicaid |
$8.88
|
| Rate for Payer: PHCS All Commercial |
$60.59
|
| Rate for Payer: PHP All Commercial |
$61.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.51
|
| Rate for Payer: Sagamore Health Network All Products |
$62.37
|
| Rate for Payer: Signature Care EPO |
$67.05
|
| Rate for Payer: Signature Care PPO |
$71.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.67
|
| Rate for Payer: United Healthcare Commercial |
$63.66
|
| Rate for Payer: United Healthcare Medicare |
$26.66
|
|
|
HC BETA-2 GLYCOPROTEIN 1 IGG AND IGM ATBY
|
Facility
IP
|
$80.78
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63002194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.59 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$69.80
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cigna All Commercial |
$69.72
|
| Rate for Payer: CORVEL All Commercial |
$75.13
|
| Rate for Payer: Coventry All Commercial |
$71.09
|
| Rate for Payer: Encore All Commercial |
$74.36
|
| Rate for Payer: Frontpath All Commercial |
$74.32
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.71
|
| Rate for Payer: PHCS All Commercial |
$60.59
|
| Rate for Payer: PHP All Commercial |
$61.27
|
| Rate for Payer: Sagamore Health Network All Products |
$62.37
|
| Rate for Payer: Signature Care EPO |
$67.05
|
| Rate for Payer: Signature Care PPO |
$71.09
|
| Rate for Payer: United Healthcare Commercial |
$63.66
|
|
|
HC BETA-2MICROGLOB
|
Facility
IP
|
$187.94
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
63001470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.95 |
| Max. Negotiated Rate |
$174.78 |
| Rate for Payer: Aetna Commercial |
$162.38
|
| Rate for Payer: Cash Price |
$116.52
|
| Rate for Payer: Cigna All Commercial |
$162.19
|
| Rate for Payer: CORVEL All Commercial |
$174.78
|
| Rate for Payer: Coventry All Commercial |
$165.38
|
| Rate for Payer: Encore All Commercial |
$172.99
|
| Rate for Payer: Frontpath All Commercial |
$172.90
|
| Rate for Payer: Humana ChoiceCare |
$162.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.14
|
| Rate for Payer: PHCS All Commercial |
$140.95
|
| Rate for Payer: PHP All Commercial |
$142.53
|
| Rate for Payer: Sagamore Health Network All Products |
$145.09
|
| Rate for Payer: Signature Care EPO |
$155.99
|
| Rate for Payer: Signature Care PPO |
$165.38
|
| Rate for Payer: United Healthcare Commercial |
$148.09
|
|
|
HC BETA-2MICROGLOB
|
Facility
OP
|
$187.94
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
63001470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$174.78 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Aetna Medicare |
$62.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.22
|
| Rate for Payer: Cash Price |
$116.52
|
| Rate for Payer: Cash Price |
$116.52
|
| Rate for Payer: Centivo All Commercial |
$95.85
|
| Rate for Payer: Cigna All Commercial |
$162.19
|
| Rate for Payer: CORVEL All Commercial |
$174.78
|
| Rate for Payer: Coventry All Commercial |
$165.38
|
| Rate for Payer: Encore All Commercial |
$172.99
|
| Rate for Payer: Frontpath All Commercial |
$172.90
|
| Rate for Payer: Humana ChoiceCare |
$162.32
|
| Rate for Payer: Humana Medicare |
$95.85
|
| Rate for Payer: Lucent All Commercial |
$95.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.14
|
| Rate for Payer: Managed Health Services Medicaid |
$16.18
|
| Rate for Payer: MDWise Medicaid |
$16.18
|
| Rate for Payer: PHCS All Commercial |
$140.95
|
| Rate for Payer: PHP All Commercial |
$142.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.29
|
| Rate for Payer: Sagamore Health Network All Products |
$145.09
|
| Rate for Payer: Signature Care EPO |
$155.99
|
| Rate for Payer: Signature Care PPO |
$165.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.74
|
| Rate for Payer: United Healthcare Commercial |
$148.09
|
| Rate for Payer: United Healthcare Medicare |
$62.02
|
|
|
HC BETA-C TELOPEPTIDE
|
Facility
OP
|
$198.11
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
63001496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$184.25 |
| Rate for Payer: Aetna Commercial |
$167.21
|
| Rate for Payer: Aetna Medicare |
$65.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$113.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.92
|
| Rate for Payer: Cash Price |
$122.83
|
| Rate for Payer: Cash Price |
$122.83
|
| Rate for Payer: Centivo All Commercial |
$101.04
|
| Rate for Payer: Cigna All Commercial |
$170.97
|
| Rate for Payer: CORVEL All Commercial |
$184.25
|
| Rate for Payer: Coventry All Commercial |
$174.34
|
| Rate for Payer: Encore All Commercial |
$182.36
|
| Rate for Payer: Frontpath All Commercial |
$182.27
|
| Rate for Payer: Humana ChoiceCare |
$171.11
|
| Rate for Payer: Humana Medicare |
$101.04
|
| Rate for Payer: Lucent All Commercial |
$101.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.30
|
| Rate for Payer: Managed Health Services Medicaid |
$18.68
|
| Rate for Payer: MDWise Medicaid |
$18.68
|
| Rate for Payer: PHCS All Commercial |
$148.59
|
| Rate for Payer: PHP All Commercial |
$150.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.26
|
| Rate for Payer: Sagamore Health Network All Products |
$152.94
|
| Rate for Payer: Signature Care EPO |
$164.44
|
| Rate for Payer: Signature Care PPO |
$174.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$168.40
|
| Rate for Payer: United Healthcare Commercial |
$156.11
|
| Rate for Payer: United Healthcare Medicare |
$65.38
|
|
|
HC BETA-C TELOPEPTIDE
|
Facility
IP
|
$198.11
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
63001496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.59 |
| Max. Negotiated Rate |
$184.25 |
| Rate for Payer: Aetna Commercial |
$171.17
|
| Rate for Payer: Cash Price |
$122.83
|
| Rate for Payer: Cigna All Commercial |
$170.97
|
| Rate for Payer: CORVEL All Commercial |
$184.25
|
| Rate for Payer: Coventry All Commercial |
$174.34
|
| Rate for Payer: Encore All Commercial |
$182.36
|
| Rate for Payer: Frontpath All Commercial |
$182.27
|
| Rate for Payer: Humana ChoiceCare |
$171.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.30
|
| Rate for Payer: PHCS All Commercial |
$148.59
|
| Rate for Payer: PHP All Commercial |
$150.25
|
| Rate for Payer: Sagamore Health Network All Products |
$152.94
|
| Rate for Payer: Signature Care EPO |
$164.44
|
| Rate for Payer: Signature Care PPO |
$174.34
|
| Rate for Payer: United Healthcare Commercial |
$156.11
|
|
|
HC BETA CULT
|
Facility
IP
|
$138.01
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
63002001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Aetna Commercial |
$119.24
|
| Rate for Payer: Cash Price |
$85.56
|
| Rate for Payer: Cigna All Commercial |
$119.10
|
| Rate for Payer: CORVEL All Commercial |
$128.35
|
| Rate for Payer: Coventry All Commercial |
$121.45
|
| Rate for Payer: Encore All Commercial |
$127.03
|
| Rate for Payer: Frontpath All Commercial |
$126.97
|
| Rate for Payer: Humana ChoiceCare |
$119.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.21
|
| Rate for Payer: PHCS All Commercial |
$103.50
|
| Rate for Payer: PHP All Commercial |
$104.66
|
| Rate for Payer: Sagamore Health Network All Products |
$106.54
|
| Rate for Payer: Signature Care EPO |
$114.54
|
| Rate for Payer: Signature Care PPO |
$121.45
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
|
|
HC BETA CULT
|
Facility
OP
|
$138.01
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
63002001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Aetna Commercial |
$116.48
|
| Rate for Payer: Aetna Medicare |
$45.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.10
|
| Rate for Payer: Cash Price |
$85.56
|
| Rate for Payer: Cash Price |
$85.56
|
| Rate for Payer: Centivo All Commercial |
$70.38
|
| Rate for Payer: Cigna All Commercial |
$119.10
|
| Rate for Payer: CORVEL All Commercial |
$128.35
|
| Rate for Payer: Coventry All Commercial |
$121.45
|
| Rate for Payer: Encore All Commercial |
$127.03
|
| Rate for Payer: Frontpath All Commercial |
$126.97
|
| Rate for Payer: Humana ChoiceCare |
$119.20
|
| Rate for Payer: Humana Medicare |
$70.38
|
| Rate for Payer: Lucent All Commercial |
$70.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.21
|
| Rate for Payer: Managed Health Services Medicaid |
$6.63
|
| Rate for Payer: MDWise Medicaid |
$6.63
|
| Rate for Payer: PHCS All Commercial |
$103.50
|
| Rate for Payer: PHP All Commercial |
$104.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.82
|
| Rate for Payer: Sagamore Health Network All Products |
$106.54
|
| Rate for Payer: Signature Care EPO |
$114.54
|
| Rate for Payer: Signature Care PPO |
$121.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.31
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$45.54
|
|
