|
HC BLOOD BANK REF LAB REPORT
|
Facility
OP
|
$648.72
|
|
| Hospital Charge Code |
63002253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.08 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Aetna Commercial |
$547.52
|
| Rate for Payer: Aetna Medicare |
$214.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$372.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$405.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$246.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.49
|
| Rate for Payer: Cash Price |
$402.21
|
| Rate for Payer: Centivo All Commercial |
$330.85
|
| Rate for Payer: Cigna All Commercial |
$559.85
|
| Rate for Payer: CORVEL All Commercial |
$603.31
|
| Rate for Payer: Coventry All Commercial |
$570.87
|
| Rate for Payer: Encore All Commercial |
$597.15
|
| Rate for Payer: Frontpath All Commercial |
$596.82
|
| Rate for Payer: Humana ChoiceCare |
$560.30
|
| Rate for Payer: Humana Medicare |
$330.85
|
| Rate for Payer: Lucent All Commercial |
$330.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$583.85
|
| Rate for Payer: PHCS All Commercial |
$486.54
|
| Rate for Payer: PHP All Commercial |
$491.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.00
|
| Rate for Payer: Sagamore Health Network All Products |
$500.81
|
| Rate for Payer: Signature Care EPO |
$538.44
|
| Rate for Payer: Signature Care PPO |
$570.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$551.41
|
| Rate for Payer: United Healthcare Commercial |
$511.19
|
| Rate for Payer: United Healthcare Medicare |
$214.08
|
|
|
HC BLOOD CULTURE
|
Facility
IP
|
$268.16
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
63001067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$201.12 |
| Max. Negotiated Rate |
$249.39 |
| Rate for Payer: Aetna Commercial |
$231.69
|
| Rate for Payer: Cash Price |
$166.26
|
| Rate for Payer: Cigna All Commercial |
$231.42
|
| Rate for Payer: CORVEL All Commercial |
$249.39
|
| Rate for Payer: Coventry All Commercial |
$235.98
|
| Rate for Payer: Encore All Commercial |
$246.84
|
| Rate for Payer: Frontpath All Commercial |
$246.71
|
| Rate for Payer: Humana ChoiceCare |
$231.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.34
|
| Rate for Payer: PHCS All Commercial |
$201.12
|
| Rate for Payer: PHP All Commercial |
$203.37
|
| Rate for Payer: Sagamore Health Network All Products |
$207.02
|
| Rate for Payer: Signature Care EPO |
$222.57
|
| Rate for Payer: Signature Care PPO |
$235.98
|
| Rate for Payer: United Healthcare Commercial |
$211.31
|
|
|
HC BLOOD CULTURE
|
Facility
OP
|
$268.16
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
63001067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$249.39 |
| Rate for Payer: Aetna Commercial |
$226.33
|
| Rate for Payer: Aetna Medicare |
$88.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$123.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.34
|
| Rate for Payer: Cash Price |
$166.26
|
| Rate for Payer: Cash Price |
$166.26
|
| Rate for Payer: Centivo All Commercial |
$136.76
|
| Rate for Payer: Cigna All Commercial |
$231.42
|
| Rate for Payer: CORVEL All Commercial |
$249.39
|
| Rate for Payer: Coventry All Commercial |
$235.98
|
| Rate for Payer: Encore All Commercial |
$246.84
|
| Rate for Payer: Frontpath All Commercial |
$246.71
|
| Rate for Payer: Humana ChoiceCare |
$231.61
|
| Rate for Payer: Humana Medicare |
$136.76
|
| Rate for Payer: Lucent All Commercial |
$136.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.34
|
| Rate for Payer: Managed Health Services Medicaid |
$10.32
|
| Rate for Payer: MDWise Medicaid |
$10.32
|
| Rate for Payer: PHCS All Commercial |
$201.12
|
| Rate for Payer: PHP All Commercial |
$203.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.58
|
| Rate for Payer: Sagamore Health Network All Products |
$207.02
|
| Rate for Payer: Signature Care EPO |
$222.57
|
| Rate for Payer: Signature Care PPO |
$235.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$227.93
|
| Rate for Payer: United Healthcare Commercial |
$211.31
|
| Rate for Payer: United Healthcare Medicare |
$88.49
|
|
|
HC BLOOD PRODUCT IRRAD
|
Facility
IP
|
$138.60
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
63001985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$128.90 |
| Rate for Payer: Aetna Commercial |
$119.75
|
| Rate for Payer: Cash Price |
$85.93
|
| Rate for Payer: Cigna All Commercial |
$119.61
|
| Rate for Payer: CORVEL All Commercial |
$128.90
|
| Rate for Payer: Coventry All Commercial |
$121.97
|
| Rate for Payer: Encore All Commercial |
$127.58
|
| Rate for Payer: Frontpath All Commercial |
$127.51
|
| Rate for Payer: Humana ChoiceCare |
$119.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.74
|
| Rate for Payer: PHCS All Commercial |
$103.95
|
| Rate for Payer: PHP All Commercial |
$105.11
|
| Rate for Payer: Sagamore Health Network All Products |
$107.00
|
| Rate for Payer: Signature Care EPO |
$115.04
|
| Rate for Payer: Signature Care PPO |
$121.97
|
| Rate for Payer: United Healthcare Commercial |
$109.21
|
|
|
HC BLOOD PRODUCT IRRAD
|
Facility
OP
|
$138.60
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
63001985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$238.33 |
| Rate for Payer: Aetna Commercial |
$116.98
|
| Rate for Payer: Aetna Medicare |
$45.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$238.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.31
|
| Rate for Payer: Cash Price |
$85.93
|
| Rate for Payer: Cash Price |
$85.93
|
| Rate for Payer: Centivo All Commercial |
$70.68
|
| Rate for Payer: Cigna All Commercial |
$119.61
|
| Rate for Payer: CORVEL All Commercial |
$128.90
|
| Rate for Payer: Coventry All Commercial |
$121.97
|
| Rate for Payer: Encore All Commercial |
$127.58
|
| Rate for Payer: Frontpath All Commercial |
$127.51
|
| Rate for Payer: Humana ChoiceCare |
$119.71
|
| Rate for Payer: Humana Medicare |
$70.68
|
| Rate for Payer: Lucent All Commercial |
$70.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.74
|
| Rate for Payer: Managed Health Services Medicaid |
$238.33
|
| Rate for Payer: MDWise Medicaid |
$238.33
|
| Rate for Payer: PHCS All Commercial |
$103.95
|
| Rate for Payer: PHP All Commercial |
$105.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.05
|
| Rate for Payer: Sagamore Health Network All Products |
$107.00
|
| Rate for Payer: Signature Care EPO |
$115.04
|
| Rate for Payer: Signature Care PPO |
$121.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.81
|
| Rate for Payer: United Healthcare Commercial |
$109.21
|
| Rate for Payer: United Healthcare Medicare |
$45.74
|
|
|
HC BLOOD SMEAR INTERP&REPORT
|
Facility
IP
|
$78.54
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
63001730
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$73.04 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cigna All Commercial |
$67.78
|
| Rate for Payer: CORVEL All Commercial |
$73.04
|
| Rate for Payer: Coventry All Commercial |
$69.12
|
| Rate for Payer: Encore All Commercial |
$72.30
|
| Rate for Payer: Frontpath All Commercial |
$72.26
|
| Rate for Payer: Humana ChoiceCare |
$67.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.69
|
| Rate for Payer: PHCS All Commercial |
$58.90
|
| Rate for Payer: PHP All Commercial |
$59.56
|
| Rate for Payer: Sagamore Health Network All Products |
$60.63
|
| Rate for Payer: Signature Care EPO |
$65.19
|
| Rate for Payer: Signature Care PPO |
$69.12
|
| Rate for Payer: United Healthcare Commercial |
$61.89
|
|
|
HC BLOOD SMEAR INTERP&REPORT
|
Facility
OP
|
$78.54
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
63001730
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.92 |
| Max. Negotiated Rate |
$73.04 |
| Rate for Payer: Aetna Commercial |
$66.29
|
| Rate for Payer: Aetna Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$40.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.51
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Centivo All Commercial |
$40.06
|
| Rate for Payer: Cigna All Commercial |
$67.78
|
| Rate for Payer: CORVEL All Commercial |
$73.04
|
| Rate for Payer: Coventry All Commercial |
$69.12
|
| Rate for Payer: Encore All Commercial |
$72.30
|
| Rate for Payer: Frontpath All Commercial |
$72.26
|
| Rate for Payer: Humana ChoiceCare |
$67.83
|
| Rate for Payer: Humana Medicare |
$40.06
|
| Rate for Payer: Lucent All Commercial |
$40.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.69
|
| Rate for Payer: Managed Health Services Medicaid |
$40.87
|
| Rate for Payer: MDWise Medicaid |
$40.87
|
| Rate for Payer: PHCS All Commercial |
$58.90
|
| Rate for Payer: PHP All Commercial |
$59.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.63
|
| Rate for Payer: Sagamore Health Network All Products |
$60.63
|
| Rate for Payer: Signature Care EPO |
$65.19
|
| Rate for Payer: Signature Care PPO |
$69.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.76
|
| Rate for Payer: United Healthcare Commercial |
$61.89
|
| Rate for Payer: United Healthcare Medicare |
$25.92
|
|
|
HC BLOOD TRANSFUSION
|
Facility
IP
|
$1,626.02
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
00526435
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1,219.52 |
| Max. Negotiated Rate |
$1,512.20 |
| Rate for Payer: Aetna Commercial |
$1,404.88
|
| Rate for Payer: Cash Price |
$1,008.13
|
| Rate for Payer: Cigna All Commercial |
$1,403.26
|
| Rate for Payer: CORVEL All Commercial |
$1,512.20
|
| Rate for Payer: Coventry All Commercial |
$1,430.90
|
| Rate for Payer: Encore All Commercial |
$1,496.75
|
| Rate for Payer: Frontpath All Commercial |
$1,495.94
|
| Rate for Payer: Humana ChoiceCare |
$1,404.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,463.42
|
| Rate for Payer: PHCS All Commercial |
$1,219.52
|
| Rate for Payer: PHP All Commercial |
$1,233.18
|
| Rate for Payer: Sagamore Health Network All Products |
$1,255.29
|
| Rate for Payer: Signature Care EPO |
$1,349.60
|
| Rate for Payer: Signature Care PPO |
$1,430.90
|
| Rate for Payer: United Healthcare Commercial |
$1,281.31
|
|
|
HC BLOOD TRANSFUSION
|
Facility
OP
|
$1,626.02
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
00526435
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$383.41 |
| Max. Negotiated Rate |
$1,512.20 |
| Rate for Payer: Aetna Commercial |
$1,372.36
|
| Rate for Payer: Aetna Medicare |
$536.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$536.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$933.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,016.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$383.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$617.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$590.25
|
| Rate for Payer: Cash Price |
$1,008.13
|
| Rate for Payer: Cash Price |
$1,008.13
|
| Rate for Payer: Centivo All Commercial |
$829.27
|
| Rate for Payer: Cigna All Commercial |
$1,403.26
|
| Rate for Payer: CORVEL All Commercial |
$1,512.20
|
| Rate for Payer: Coventry All Commercial |
$1,430.90
|
| Rate for Payer: Encore All Commercial |
$1,496.75
|
| Rate for Payer: Frontpath All Commercial |
$1,495.94
|
| Rate for Payer: Humana ChoiceCare |
$1,404.40
|
| Rate for Payer: Humana Medicare |
$829.27
|
| Rate for Payer: Lucent All Commercial |
$829.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,463.42
|
| Rate for Payer: Managed Health Services Medicaid |
$383.41
|
| Rate for Payer: MDWise Medicaid |
$383.41
|
| Rate for Payer: PHCS All Commercial |
$1,219.52
|
| Rate for Payer: PHP All Commercial |
$1,233.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$634.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,255.29
|
| Rate for Payer: Signature Care EPO |
$1,349.60
|
| Rate for Payer: Signature Care PPO |
$1,430.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,382.12
|
| Rate for Payer: United Healthcare Commercial |
$1,281.31
|
| Rate for Payer: United Healthcare Medicare |
$536.59
|
|
|
HC BLOOD TYPING ABO
|
Facility
IP
|
$84.57
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
63001353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.43 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Cash Price |
$52.43
|
| Rate for Payer: Cigna All Commercial |
$72.98
|
| Rate for Payer: CORVEL All Commercial |
$78.65
|
| Rate for Payer: Coventry All Commercial |
$74.42
|
| Rate for Payer: Encore All Commercial |
$77.85
|
| Rate for Payer: Frontpath All Commercial |
$77.80
|
| Rate for Payer: Humana ChoiceCare |
$73.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.11
|
| Rate for Payer: PHCS All Commercial |
$63.43
|
| Rate for Payer: PHP All Commercial |
$64.14
|
| Rate for Payer: Sagamore Health Network All Products |
$65.29
|
| Rate for Payer: Signature Care EPO |
$70.19
|
| Rate for Payer: Signature Care PPO |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$66.64
|
|
|
HC BLOOD TYPING ABO
|
Facility
OP
|
$84.57
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
63001353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$71.38
|
| Rate for Payer: Aetna Medicare |
$27.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.70
|
| Rate for Payer: Cash Price |
$52.43
|
| Rate for Payer: Cash Price |
$52.43
|
| Rate for Payer: Centivo All Commercial |
$43.13
|
| Rate for Payer: Cigna All Commercial |
$72.98
|
| Rate for Payer: CORVEL All Commercial |
$78.65
|
| Rate for Payer: Coventry All Commercial |
$74.42
|
| Rate for Payer: Encore All Commercial |
$77.85
|
| Rate for Payer: Frontpath All Commercial |
$77.80
|
| Rate for Payer: Humana ChoiceCare |
$73.04
|
| Rate for Payer: Humana Medicare |
$43.13
|
| Rate for Payer: Lucent All Commercial |
$43.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.11
|
| Rate for Payer: Managed Health Services Medicaid |
$2.99
|
| Rate for Payer: MDWise Medicaid |
$2.99
|
| Rate for Payer: PHCS All Commercial |
$63.43
|
| Rate for Payer: PHP All Commercial |
$64.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.98
|
| Rate for Payer: Sagamore Health Network All Products |
$65.29
|
| Rate for Payer: Signature Care EPO |
$70.19
|
| Rate for Payer: Signature Care PPO |
$74.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.88
|
| Rate for Payer: United Healthcare Commercial |
$66.64
|
| Rate for Payer: United Healthcare Medicare |
$27.91
|
|
|
HC B NATRIURETIC PEPTIDE
|
Facility
IP
|
$326.70
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
63001147
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$245.02 |
| Max. Negotiated Rate |
$303.83 |
| Rate for Payer: Aetna Commercial |
$282.27
|
| Rate for Payer: Cash Price |
$202.55
|
| Rate for Payer: Cigna All Commercial |
$281.94
|
| Rate for Payer: CORVEL All Commercial |
$303.83
|
| Rate for Payer: Coventry All Commercial |
$287.49
|
| Rate for Payer: Encore All Commercial |
$300.72
|
| Rate for Payer: Frontpath All Commercial |
$300.56
|
| Rate for Payer: Humana ChoiceCare |
$282.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.03
|
| Rate for Payer: PHCS All Commercial |
$245.02
|
| Rate for Payer: PHP All Commercial |
$247.77
|
| Rate for Payer: Sagamore Health Network All Products |
$252.21
|
| Rate for Payer: Signature Care EPO |
$271.16
|
| Rate for Payer: Signature Care PPO |
$287.49
|
| Rate for Payer: United Healthcare Commercial |
$257.44
|
|
|
HC B NATRIURETIC PEPTIDE
|
Facility
OP
|
$326.70
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
63001147
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$303.83 |
| Rate for Payer: Aetna Commercial |
$275.73
|
| Rate for Payer: Aetna Medicare |
$107.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$150.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$39.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.59
|
| Rate for Payer: Cash Price |
$202.55
|
| Rate for Payer: Cash Price |
$202.55
|
| Rate for Payer: Centivo All Commercial |
$166.61
|
| Rate for Payer: Cigna All Commercial |
$281.94
|
| Rate for Payer: CORVEL All Commercial |
$303.83
|
| Rate for Payer: Coventry All Commercial |
$287.49
|
| Rate for Payer: Encore All Commercial |
$300.72
|
| Rate for Payer: Frontpath All Commercial |
$300.56
|
| Rate for Payer: Humana ChoiceCare |
$282.17
|
| Rate for Payer: Humana Medicare |
$166.61
|
| Rate for Payer: Lucent All Commercial |
$166.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.03
|
| Rate for Payer: Managed Health Services Medicaid |
$39.26
|
| Rate for Payer: MDWise Medicaid |
$39.26
|
| Rate for Payer: PHCS All Commercial |
$245.02
|
| Rate for Payer: PHP All Commercial |
$247.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.41
|
| Rate for Payer: Sagamore Health Network All Products |
$252.21
|
| Rate for Payer: Signature Care EPO |
$271.16
|
| Rate for Payer: Signature Care PPO |
$287.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$277.69
|
| Rate for Payer: United Healthcare Commercial |
$257.44
|
| Rate for Payer: United Healthcare Medicare |
$107.81
|
|
|
HC BONE ANCHOR G11
|
Facility
OP
|
$2,335.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601817
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$2,171.55 |
| Rate for Payer: Aetna Commercial |
$1,970.74
|
| Rate for Payer: Aetna Medicare |
$770.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$770.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,340.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,459.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$886.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$847.60
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Centivo All Commercial |
$1,190.85
|
| Rate for Payer: Cigna All Commercial |
$2,015.10
|
| Rate for Payer: CORVEL All Commercial |
$2,171.55
|
| Rate for Payer: Coventry All Commercial |
$2,054.80
|
| Rate for Payer: Encore All Commercial |
$2,149.37
|
| Rate for Payer: Frontpath All Commercial |
$2,148.20
|
| Rate for Payer: Humana ChoiceCare |
$2,016.74
|
| Rate for Payer: Humana Medicare |
$1,190.85
|
| Rate for Payer: Lucent All Commercial |
$1,190.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,101.50
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$1,751.25
|
| Rate for Payer: PHP All Commercial |
$1,770.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$910.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,802.62
|
| Rate for Payer: Signature Care EPO |
$1,938.05
|
| Rate for Payer: Signature Care PPO |
$2,054.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,984.75
|
| Rate for Payer: United Healthcare Commercial |
$1,839.98
|
| Rate for Payer: United Healthcare Medicare |
$770.55
|
|
|
HC BONE ANCHOR G11
|
Facility
IP
|
$2,335.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601817
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,751.25 |
| Max. Negotiated Rate |
$2,171.55 |
| Rate for Payer: Aetna Commercial |
$2,017.44
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Cigna All Commercial |
$2,015.10
|
| Rate for Payer: CORVEL All Commercial |
$2,171.55
|
| Rate for Payer: Coventry All Commercial |
$2,054.80
|
| Rate for Payer: Encore All Commercial |
$2,149.37
|
| Rate for Payer: Frontpath All Commercial |
$2,148.20
|
| Rate for Payer: Humana ChoiceCare |
$2,016.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,101.50
|
| Rate for Payer: PHCS All Commercial |
$1,751.25
|
| Rate for Payer: PHP All Commercial |
$1,770.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,802.62
|
| Rate for Payer: Signature Care EPO |
$1,938.05
|
| Rate for Payer: Signature Care PPO |
$2,054.80
|
| Rate for Payer: United Healthcare Commercial |
$1,839.98
|
|
|
HC BONE BX SYSTEM 13G.6
|
Facility
IP
|
$810.00
|
|
| Hospital Charge Code |
41607940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$607.50 |
| Max. Negotiated Rate |
$753.30 |
| Rate for Payer: Aetna Commercial |
$699.84
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna All Commercial |
$699.03
|
| Rate for Payer: CORVEL All Commercial |
$753.30
|
| Rate for Payer: Coventry All Commercial |
$712.80
|
| Rate for Payer: Encore All Commercial |
$745.60
|
| Rate for Payer: Frontpath All Commercial |
$745.20
|
| Rate for Payer: Humana ChoiceCare |
$699.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$729.00
|
| Rate for Payer: PHCS All Commercial |
$607.50
|
| Rate for Payer: PHP All Commercial |
$614.30
|
| Rate for Payer: Sagamore Health Network All Products |
$625.32
|
| Rate for Payer: Signature Care EPO |
$672.30
|
| Rate for Payer: Signature Care PPO |
$712.80
|
| Rate for Payer: United Healthcare Commercial |
$638.28
|
|
|
HC BONE BX SYSTEM 13G.6
|
Facility
OP
|
$810.00
|
|
| Hospital Charge Code |
41607940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$753.30 |
| Rate for Payer: Aetna Commercial |
$683.64
|
| Rate for Payer: Aetna Medicare |
$267.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$267.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$465.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$506.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$307.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$294.03
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Centivo All Commercial |
$413.10
|
| Rate for Payer: Cigna All Commercial |
$699.03
|
| Rate for Payer: CORVEL All Commercial |
$753.30
|
| Rate for Payer: Coventry All Commercial |
$712.80
|
| Rate for Payer: Encore All Commercial |
$745.60
|
| Rate for Payer: Frontpath All Commercial |
$745.20
|
| Rate for Payer: Humana ChoiceCare |
$699.60
|
| Rate for Payer: Humana Medicare |
$413.10
|
| Rate for Payer: Lucent All Commercial |
$413.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$729.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$607.50
|
| Rate for Payer: PHP All Commercial |
$614.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$315.90
|
| Rate for Payer: Sagamore Health Network All Products |
$625.32
|
| Rate for Payer: Signature Care EPO |
$672.30
|
| Rate for Payer: Signature Care PPO |
$712.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$688.50
|
| Rate for Payer: United Healthcare Commercial |
$638.28
|
| Rate for Payer: United Healthcare Medicare |
$267.30
|
|
|
HC BONE IMAGING (SPECT)
|
Facility
OP
|
$1,786.18
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
01638320
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$589.44 |
| Max. Negotiated Rate |
$1,661.15 |
| Rate for Payer: Aetna Commercial |
$1,507.54
|
| Rate for Payer: Aetna Medicare |
$589.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$589.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,025.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,116.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$792.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$677.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$648.38
|
| Rate for Payer: Cash Price |
$1,107.43
|
| Rate for Payer: Cash Price |
$1,107.43
|
| Rate for Payer: Centivo All Commercial |
$910.95
|
| Rate for Payer: Cigna All Commercial |
$1,541.48
|
| Rate for Payer: CORVEL All Commercial |
$1,661.15
|
| Rate for Payer: Coventry All Commercial |
$1,571.84
|
| Rate for Payer: Encore All Commercial |
$1,644.18
|
| Rate for Payer: Frontpath All Commercial |
$1,643.29
|
| Rate for Payer: Humana ChoiceCare |
$1,542.73
|
| Rate for Payer: Humana Medicare |
$910.95
|
| Rate for Payer: Lucent All Commercial |
$910.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,607.56
|
| Rate for Payer: Managed Health Services Medicaid |
$792.21
|
| Rate for Payer: MDWise Medicaid |
$792.21
|
| Rate for Payer: PHCS All Commercial |
$1,339.64
|
| Rate for Payer: PHP All Commercial |
$1,354.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$696.61
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.93
|
| Rate for Payer: Signature Care EPO |
$1,482.53
|
| Rate for Payer: Signature Care PPO |
$1,571.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,518.26
|
| Rate for Payer: United Healthcare Commercial |
$1,407.51
|
| Rate for Payer: United Healthcare Medicare |
$589.44
|
|
|
HC BONE IMAGING (SPECT)
|
Facility
IP
|
$1,786.18
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
01638320
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,339.64 |
| Max. Negotiated Rate |
$1,661.15 |
| Rate for Payer: Aetna Commercial |
$1,543.26
|
| Rate for Payer: Cash Price |
$1,107.43
|
| Rate for Payer: Cigna All Commercial |
$1,541.48
|
| Rate for Payer: CORVEL All Commercial |
$1,661.15
|
| Rate for Payer: Coventry All Commercial |
$1,571.84
|
| Rate for Payer: Encore All Commercial |
$1,644.18
|
| Rate for Payer: Frontpath All Commercial |
$1,643.29
|
| Rate for Payer: Humana ChoiceCare |
$1,542.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,607.56
|
| Rate for Payer: PHCS All Commercial |
$1,339.64
|
| Rate for Payer: PHP All Commercial |
$1,354.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.93
|
| Rate for Payer: Signature Care EPO |
$1,482.53
|
| Rate for Payer: Signature Care PPO |
$1,571.84
|
| Rate for Payer: United Healthcare Commercial |
$1,407.51
|
|
|
HC BONE MARROW BX INTERP
|
Facility
OP
|
$337.65
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63002097
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.42 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$284.98
|
| Rate for Payer: Aetna Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$277.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.57
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Centivo All Commercial |
$172.20
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Humana Medicare |
$172.20
|
| Rate for Payer: Lucent All Commercial |
$172.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: Managed Health Services Medicaid |
$277.37
|
| Rate for Payer: MDWise Medicaid |
$277.37
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.68
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.00
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
| Rate for Payer: United Healthcare Medicare |
$111.42
|
|
|
HC BONE MARROW BX INTERP
|
Facility
IP
|
$337.65
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63002097
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$253.24 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$291.73
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
|
|
HC BONE MARROW SMEAR INTERP
|
Facility
IP
|
$243.43
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
63001224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.57 |
| Max. Negotiated Rate |
$226.39 |
| Rate for Payer: Aetna Commercial |
$210.33
|
| Rate for Payer: Cash Price |
$150.93
|
| Rate for Payer: Cigna All Commercial |
$210.08
|
| Rate for Payer: CORVEL All Commercial |
$226.39
|
| Rate for Payer: Coventry All Commercial |
$214.22
|
| Rate for Payer: Encore All Commercial |
$224.08
|
| Rate for Payer: Frontpath All Commercial |
$223.96
|
| Rate for Payer: Humana ChoiceCare |
$210.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.09
|
| Rate for Payer: PHCS All Commercial |
$182.57
|
| Rate for Payer: PHP All Commercial |
$184.62
|
| Rate for Payer: Sagamore Health Network All Products |
$187.93
|
| Rate for Payer: Signature Care EPO |
$202.05
|
| Rate for Payer: Signature Care PPO |
$214.22
|
| Rate for Payer: United Healthcare Commercial |
$191.83
|
|
|
HC BONE MARROW SMEAR INTERP
|
Facility
OP
|
$243.43
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
63001224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.33 |
| Max. Negotiated Rate |
$226.39 |
| Rate for Payer: Aetna Commercial |
$205.46
|
| Rate for Payer: Aetna Medicare |
$80.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$139.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$152.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$140.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.37
|
| Rate for Payer: Cash Price |
$150.93
|
| Rate for Payer: Cash Price |
$150.93
|
| Rate for Payer: Centivo All Commercial |
$124.15
|
| Rate for Payer: Cigna All Commercial |
$210.08
|
| Rate for Payer: CORVEL All Commercial |
$226.39
|
| Rate for Payer: Coventry All Commercial |
$214.22
|
| Rate for Payer: Encore All Commercial |
$224.08
|
| Rate for Payer: Frontpath All Commercial |
$223.96
|
| Rate for Payer: Humana ChoiceCare |
$210.25
|
| Rate for Payer: Humana Medicare |
$124.15
|
| Rate for Payer: Lucent All Commercial |
$124.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.09
|
| Rate for Payer: Managed Health Services Medicaid |
$140.79
|
| Rate for Payer: MDWise Medicaid |
$140.79
|
| Rate for Payer: PHCS All Commercial |
$182.57
|
| Rate for Payer: PHP All Commercial |
$184.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.94
|
| Rate for Payer: Sagamore Health Network All Products |
$187.93
|
| Rate for Payer: Signature Care EPO |
$202.05
|
| Rate for Payer: Signature Care PPO |
$214.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$206.92
|
| Rate for Payer: United Healthcare Commercial |
$191.83
|
| Rate for Payer: United Healthcare Medicare |
$80.33
|
|
|
HC BONE SCAN - MULTIPLE AREAS
|
Facility
IP
|
$1,707.27
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
01638305
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,280.45 |
| Max. Negotiated Rate |
$1,587.76 |
| Rate for Payer: Aetna Commercial |
$1,475.08
|
| Rate for Payer: Cash Price |
$1,058.51
|
| Rate for Payer: Cigna All Commercial |
$1,473.37
|
| Rate for Payer: CORVEL All Commercial |
$1,587.76
|
| Rate for Payer: Coventry All Commercial |
$1,502.39
|
| Rate for Payer: Encore All Commercial |
$1,571.54
|
| Rate for Payer: Frontpath All Commercial |
$1,570.68
|
| Rate for Payer: Humana ChoiceCare |
$1,474.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,536.54
|
| Rate for Payer: PHCS All Commercial |
$1,280.45
|
| Rate for Payer: PHP All Commercial |
$1,294.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1,318.01
|
| Rate for Payer: Signature Care EPO |
$1,417.03
|
| Rate for Payer: Signature Care PPO |
$1,502.39
|
| Rate for Payer: United Healthcare Commercial |
$1,345.33
|
|
|
HC BONE SCAN - MULTIPLE AREAS
|
Facility
OP
|
$1,707.27
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
01638305
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.64 |
| Max. Negotiated Rate |
$1,587.76 |
| Rate for Payer: Aetna Commercial |
$1,440.93
|
| Rate for Payer: Aetna Medicare |
$563.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$563.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$980.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,067.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$522.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$647.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$619.74
|
| Rate for Payer: Cash Price |
$1,058.51
|
| Rate for Payer: Cash Price |
$1,058.51
|
| Rate for Payer: Centivo All Commercial |
$870.71
|
| Rate for Payer: Cigna All Commercial |
$1,473.37
|
| Rate for Payer: CORVEL All Commercial |
$1,587.76
|
| Rate for Payer: Coventry All Commercial |
$1,502.39
|
| Rate for Payer: Encore All Commercial |
$1,571.54
|
| Rate for Payer: Frontpath All Commercial |
$1,570.68
|
| Rate for Payer: Humana ChoiceCare |
$1,474.57
|
| Rate for Payer: Humana Medicare |
$870.71
|
| Rate for Payer: Lucent All Commercial |
$870.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,536.54
|
| Rate for Payer: Managed Health Services Medicaid |
$522.64
|
| Rate for Payer: MDWise Medicaid |
$522.64
|
| Rate for Payer: PHCS All Commercial |
$1,280.45
|
| Rate for Payer: PHP All Commercial |
$1,294.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$665.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,318.01
|
| Rate for Payer: Signature Care EPO |
$1,417.03
|
| Rate for Payer: Signature Care PPO |
$1,502.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,451.18
|
| Rate for Payer: United Healthcare Commercial |
$1,345.33
|
| Rate for Payer: United Healthcare Medicare |
$563.40
|
|
