|
HC ABG DRAW RT
|
Facility
|
OP
|
$98.47
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
1706010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$83.11
|
| Rate for Payer: Aetna Medicare |
$31.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.66
|
| Rate for Payer: Cash Price |
$59.08
|
| Rate for Payer: Centivo All Commercial |
$53.57
|
| Rate for Payer: Cigna All Commercial |
$84.98
|
| Rate for Payer: CORVEL All Commercial |
$91.58
|
| Rate for Payer: Coventry All Commercial |
$86.65
|
| Rate for Payer: Encore All Commercial |
$90.64
|
| Rate for Payer: Frontpath All Commercial |
$90.59
|
| Rate for Payer: Humana ChoiceCare |
$85.05
|
| Rate for Payer: Humana Medicare |
$31.51
|
| Rate for Payer: Lucent All Commercial |
$53.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$73.85
|
| Rate for Payer: PHP All Commercial |
$74.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.40
|
| Rate for Payer: Sagamore Health Network All Products |
$76.02
|
| Rate for Payer: Signature Care EPO |
$81.73
|
| Rate for Payer: Signature Care PPO |
$86.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$77.59
|
| Rate for Payer: United Healthcare Medicare |
$31.51
|
|
|
HC ABG DRAW RT
|
Facility
|
IP
|
$98.47
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
1706010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Cash Price |
$59.08
|
| Rate for Payer: Cigna All Commercial |
$84.98
|
| Rate for Payer: CORVEL All Commercial |
$91.58
|
| Rate for Payer: Coventry All Commercial |
$86.65
|
| Rate for Payer: Encore All Commercial |
$90.64
|
| Rate for Payer: Frontpath All Commercial |
$90.59
|
| Rate for Payer: Humana ChoiceCare |
$85.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$73.85
|
| Rate for Payer: PHP All Commercial |
$74.68
|
| Rate for Payer: Sagamore Health Network All Products |
$76.02
|
| Rate for Payer: Signature Care EPO |
$81.73
|
| Rate for Payer: Signature Care PPO |
$86.65
|
| Rate for Payer: United Healthcare Commercial |
$77.59
|
|
|
HC AB ID
|
Facility
|
OP
|
$310.79
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
63001344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$289.03 |
| Rate for Payer: Aetna Commercial |
$262.31
|
| Rate for Payer: Aetna Medicare |
$99.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$142.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$65.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.40
|
| Rate for Payer: Cash Price |
$186.47
|
| Rate for Payer: Cash Price |
$186.47
|
| Rate for Payer: Centivo All Commercial |
$169.07
|
| Rate for Payer: Cigna All Commercial |
$268.21
|
| Rate for Payer: CORVEL All Commercial |
$289.03
|
| Rate for Payer: Coventry All Commercial |
$273.50
|
| Rate for Payer: Encore All Commercial |
$286.08
|
| Rate for Payer: Frontpath All Commercial |
$285.93
|
| Rate for Payer: Humana ChoiceCare |
$268.43
|
| Rate for Payer: Humana Medicare |
$99.45
|
| Rate for Payer: Lucent All Commercial |
$169.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.71
|
| Rate for Payer: Managed Health Services Medicaid |
$65.00
|
| Rate for Payer: MDWise Medicaid |
$65.00
|
| Rate for Payer: PHCS All Commercial |
$233.09
|
| Rate for Payer: PHP All Commercial |
$235.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.21
|
| Rate for Payer: Sagamore Health Network All Products |
$239.93
|
| Rate for Payer: Signature Care EPO |
$257.96
|
| Rate for Payer: Signature Care PPO |
$273.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$264.17
|
| Rate for Payer: United Healthcare Commercial |
$244.90
|
| Rate for Payer: United Healthcare Medicare |
$99.45
|
|
|
HC AB ID
|
Facility
|
IP
|
$310.79
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
63001344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$289.03 |
| Rate for Payer: Aetna Commercial |
$268.52
|
| Rate for Payer: Cash Price |
$186.47
|
| Rate for Payer: Cigna All Commercial |
$268.21
|
| Rate for Payer: CORVEL All Commercial |
$289.03
|
| Rate for Payer: Coventry All Commercial |
$273.50
|
| Rate for Payer: Encore All Commercial |
$286.08
|
| Rate for Payer: Frontpath All Commercial |
$285.93
|
| Rate for Payer: Humana ChoiceCare |
$268.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.71
|
| Rate for Payer: PHCS All Commercial |
$233.09
|
| Rate for Payer: PHP All Commercial |
$235.70
|
| Rate for Payer: Sagamore Health Network All Products |
$239.93
|
| Rate for Payer: Signature Care EPO |
$257.96
|
| Rate for Payer: Signature Care PPO |
$273.50
|
| Rate for Payer: United Healthcare Commercial |
$244.90
|
|
|
HC ABSOLUTE EOSINOPHIL COUNT
|
Facility
|
IP
|
$56.95
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
63001241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$34.17
|
| Rate for Payer: Cigna All Commercial |
$49.15
|
| Rate for Payer: CORVEL All Commercial |
$52.96
|
| Rate for Payer: Coventry All Commercial |
$50.12
|
| Rate for Payer: Encore All Commercial |
$52.42
|
| Rate for Payer: Frontpath All Commercial |
$52.39
|
| Rate for Payer: Humana ChoiceCare |
$49.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.26
|
| Rate for Payer: PHCS All Commercial |
$42.71
|
| Rate for Payer: PHP All Commercial |
$43.19
|
| Rate for Payer: Sagamore Health Network All Products |
$43.97
|
| Rate for Payer: Signature Care EPO |
$47.27
|
| Rate for Payer: Signature Care PPO |
$50.12
|
| Rate for Payer: United Healthcare Commercial |
$44.88
|
|
|
HC ABSOLUTE EOSINOPHIL COUNT
|
Facility
|
OP
|
$56.95
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
63001241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$48.07
|
| Rate for Payer: Aetna Medicare |
$18.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$34.17
|
| Rate for Payer: Cash Price |
$34.17
|
| Rate for Payer: Centivo All Commercial |
$30.98
|
| Rate for Payer: Cigna All Commercial |
$49.15
|
| Rate for Payer: CORVEL All Commercial |
$52.96
|
| Rate for Payer: Coventry All Commercial |
$50.12
|
| Rate for Payer: Encore All Commercial |
$52.42
|
| Rate for Payer: Frontpath All Commercial |
$52.39
|
| Rate for Payer: Humana ChoiceCare |
$49.19
|
| Rate for Payer: Humana Medicare |
$18.22
|
| Rate for Payer: Lucent All Commercial |
$30.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.26
|
| Rate for Payer: Managed Health Services Medicaid |
$2.54
|
| Rate for Payer: MDWise Medicaid |
$2.54
|
| Rate for Payer: PHCS All Commercial |
$42.71
|
| Rate for Payer: PHP All Commercial |
$43.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.21
|
| Rate for Payer: Sagamore Health Network All Products |
$43.97
|
| Rate for Payer: Signature Care EPO |
$47.27
|
| Rate for Payer: Signature Care PPO |
$50.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.41
|
| Rate for Payer: United Healthcare Commercial |
$44.88
|
| Rate for Payer: United Healthcare Medicare |
$18.22
|
|
|
HC ACCUCHECK BEDSIDE
|
Facility
|
OP
|
$26.60
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
1239001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$24.74 |
| Rate for Payer: Aetna Commercial |
$22.45
|
| Rate for Payer: Aetna Medicare |
$8.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.36
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Centivo All Commercial |
$14.47
|
| Rate for Payer: Cigna All Commercial |
$22.96
|
| Rate for Payer: CORVEL All Commercial |
$24.74
|
| Rate for Payer: Coventry All Commercial |
$23.41
|
| Rate for Payer: Encore All Commercial |
$24.49
|
| Rate for Payer: Frontpath All Commercial |
$24.47
|
| Rate for Payer: Humana ChoiceCare |
$22.97
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Lucent All Commercial |
$14.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.94
|
| Rate for Payer: Managed Health Services Medicaid |
$5.04
|
| Rate for Payer: MDWise Medicaid |
$5.04
|
| Rate for Payer: PHCS All Commercial |
$19.95
|
| Rate for Payer: PHP All Commercial |
$20.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.37
|
| Rate for Payer: Sagamore Health Network All Products |
$20.54
|
| Rate for Payer: Signature Care EPO |
$22.08
|
| Rate for Payer: Signature Care PPO |
$23.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.61
|
| Rate for Payer: United Healthcare Commercial |
$20.96
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
|
|
HC ACCUCHECK BEDSIDE
|
Facility
|
IP
|
$26.60
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
1239001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$24.74 |
| Rate for Payer: Aetna Commercial |
$22.98
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cigna All Commercial |
$22.96
|
| Rate for Payer: CORVEL All Commercial |
$24.74
|
| Rate for Payer: Coventry All Commercial |
$23.41
|
| Rate for Payer: Encore All Commercial |
$24.49
|
| Rate for Payer: Frontpath All Commercial |
$24.47
|
| Rate for Payer: Humana ChoiceCare |
$22.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.94
|
| Rate for Payer: PHCS All Commercial |
$19.95
|
| Rate for Payer: PHP All Commercial |
$20.17
|
| Rate for Payer: Sagamore Health Network All Products |
$20.54
|
| Rate for Payer: Signature Care EPO |
$22.08
|
| Rate for Payer: Signature Care PPO |
$23.41
|
| Rate for Payer: United Healthcare Commercial |
$20.96
|
|
|
HC ACCUMAX (ENCOMPASS) INFLATOR /DAY
|
Facility
|
OP
|
$156.57
|
|
| Hospital Charge Code |
1890110
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$145.61 |
| Rate for Payer: Aetna Commercial |
$132.15
|
| Rate for Payer: Aetna Medicare |
$50.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$89.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.11
|
| Rate for Payer: Cash Price |
$93.94
|
| Rate for Payer: Cash Price |
$93.94
|
| Rate for Payer: Centivo All Commercial |
$85.17
|
| Rate for Payer: Cigna All Commercial |
$135.12
|
| Rate for Payer: CORVEL All Commercial |
$145.61
|
| Rate for Payer: Coventry All Commercial |
$137.78
|
| Rate for Payer: Encore All Commercial |
$144.12
|
| Rate for Payer: Frontpath All Commercial |
$144.04
|
| Rate for Payer: Humana ChoiceCare |
$135.23
|
| Rate for Payer: Humana Medicare |
$50.10
|
| Rate for Payer: Lucent All Commercial |
$85.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.91
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$117.43
|
| Rate for Payer: PHP All Commercial |
$118.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.06
|
| Rate for Payer: Sagamore Health Network All Products |
$120.87
|
| Rate for Payer: Signature Care EPO |
$129.95
|
| Rate for Payer: Signature Care PPO |
$137.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.08
|
| Rate for Payer: United Healthcare Commercial |
$123.38
|
| Rate for Payer: United Healthcare Medicare |
$50.10
|
|
|
HC ACCUMAX (ENCOMPASS) INFLATOR /DAY
|
Facility
|
IP
|
$156.57
|
|
| Hospital Charge Code |
1890110
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$117.43 |
| Max. Negotiated Rate |
$145.61 |
| Rate for Payer: Aetna Commercial |
$135.28
|
| Rate for Payer: Cash Price |
$93.94
|
| Rate for Payer: Cigna All Commercial |
$135.12
|
| Rate for Payer: CORVEL All Commercial |
$145.61
|
| Rate for Payer: Coventry All Commercial |
$137.78
|
| Rate for Payer: Encore All Commercial |
$144.12
|
| Rate for Payer: Frontpath All Commercial |
$144.04
|
| Rate for Payer: Humana ChoiceCare |
$135.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.91
|
| Rate for Payer: PHCS All Commercial |
$117.43
|
| Rate for Payer: PHP All Commercial |
$118.74
|
| Rate for Payer: Sagamore Health Network All Products |
$120.87
|
| Rate for Payer: Signature Care EPO |
$129.95
|
| Rate for Payer: Signature Care PPO |
$137.78
|
| Rate for Payer: United Healthcare Commercial |
$123.38
|
|
|
HC ACETAMINOPHEN
|
Facility
|
IP
|
$186.89
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
63001403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Aetna Commercial |
$161.47
|
| Rate for Payer: Cash Price |
$112.13
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.46
|
| Rate for Payer: Encore All Commercial |
$172.03
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.20
|
| Rate for Payer: PHCS All Commercial |
$140.17
|
| Rate for Payer: PHP All Commercial |
$141.74
|
| Rate for Payer: Sagamore Health Network All Products |
$144.28
|
| Rate for Payer: Signature Care EPO |
$155.12
|
| Rate for Payer: Signature Care PPO |
$164.46
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
|
|
HC ACETAMINOPHEN
|
Facility
|
OP
|
$186.89
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
63001403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Aetna Commercial |
$157.74
|
| Rate for Payer: Aetna Medicare |
$59.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.79
|
| Rate for Payer: Cash Price |
$112.13
|
| Rate for Payer: Cash Price |
$112.13
|
| Rate for Payer: Centivo All Commercial |
$101.67
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.46
|
| Rate for Payer: Encore All Commercial |
$172.03
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Humana Medicare |
$59.80
|
| Rate for Payer: Lucent All Commercial |
$101.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.20
|
| Rate for Payer: Managed Health Services Medicaid |
$18.64
|
| Rate for Payer: MDWise Medicaid |
$18.64
|
| Rate for Payer: PHCS All Commercial |
$140.17
|
| Rate for Payer: PHP All Commercial |
$141.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.89
|
| Rate for Payer: Sagamore Health Network All Products |
$144.28
|
| Rate for Payer: Signature Care EPO |
$155.12
|
| Rate for Payer: Signature Care PPO |
$164.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158.86
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
| Rate for Payer: United Healthcare Medicare |
$59.80
|
|
|
HC ACETONE
|
Facility
|
IP
|
$109.96
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
63001207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.47 |
| Max. Negotiated Rate |
$102.26 |
| Rate for Payer: Aetna Commercial |
$95.01
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cigna All Commercial |
$94.90
|
| Rate for Payer: CORVEL All Commercial |
$102.26
|
| Rate for Payer: Coventry All Commercial |
$96.76
|
| Rate for Payer: Encore All Commercial |
$101.22
|
| Rate for Payer: Frontpath All Commercial |
$101.16
|
| Rate for Payer: Humana ChoiceCare |
$94.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.96
|
| Rate for Payer: PHCS All Commercial |
$82.47
|
| Rate for Payer: PHP All Commercial |
$83.39
|
| Rate for Payer: Sagamore Health Network All Products |
$84.89
|
| Rate for Payer: Signature Care EPO |
$91.27
|
| Rate for Payer: Signature Care PPO |
$96.76
|
| Rate for Payer: United Healthcare Commercial |
$86.65
|
|
|
HC ACETONE
|
Facility
|
OP
|
$109.96
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
63001207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$102.26 |
| Rate for Payer: Aetna Commercial |
$92.81
|
| Rate for Payer: Aetna Medicare |
$35.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$50.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.71
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Centivo All Commercial |
$59.82
|
| Rate for Payer: Cigna All Commercial |
$94.90
|
| Rate for Payer: CORVEL All Commercial |
$102.26
|
| Rate for Payer: Coventry All Commercial |
$96.76
|
| Rate for Payer: Encore All Commercial |
$101.22
|
| Rate for Payer: Frontpath All Commercial |
$101.16
|
| Rate for Payer: Humana ChoiceCare |
$94.97
|
| Rate for Payer: Humana Medicare |
$35.19
|
| Rate for Payer: Lucent All Commercial |
$59.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.96
|
| Rate for Payer: Managed Health Services Medicaid |
$4.52
|
| Rate for Payer: MDWise Medicaid |
$4.52
|
| Rate for Payer: PHCS All Commercial |
$82.47
|
| Rate for Payer: PHP All Commercial |
$83.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.88
|
| Rate for Payer: Sagamore Health Network All Products |
$84.89
|
| Rate for Payer: Signature Care EPO |
$91.27
|
| Rate for Payer: Signature Care PPO |
$96.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.47
|
| Rate for Payer: United Healthcare Commercial |
$86.65
|
| Rate for Payer: United Healthcare Medicare |
$35.19
|
|
|
HC ACETYLCHOLINE BINDING ANTBY
|
Facility
|
IP
|
$335.48
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
63001049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$251.61 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$289.85
|
| Rate for Payer: Cash Price |
$201.29
|
| Rate for Payer: Cigna All Commercial |
$289.52
|
| Rate for Payer: CORVEL All Commercial |
$312.00
|
| Rate for Payer: Coventry All Commercial |
$295.22
|
| Rate for Payer: Encore All Commercial |
$308.81
|
| Rate for Payer: Frontpath All Commercial |
$308.64
|
| Rate for Payer: Humana ChoiceCare |
$289.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.93
|
| Rate for Payer: PHCS All Commercial |
$251.61
|
| Rate for Payer: PHP All Commercial |
$254.43
|
| Rate for Payer: Sagamore Health Network All Products |
$258.99
|
| Rate for Payer: Signature Care EPO |
$278.45
|
| Rate for Payer: Signature Care PPO |
$295.22
|
| Rate for Payer: United Healthcare Commercial |
$264.36
|
|
|
HC ACETYLCHOLINE BINDING ANTBY
|
Facility
|
OP
|
$335.48
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
63001049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$283.15
|
| Rate for Payer: Aetna Medicare |
$107.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$154.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.09
|
| Rate for Payer: Cash Price |
$201.29
|
| Rate for Payer: Centivo All Commercial |
$182.50
|
| Rate for Payer: Cigna All Commercial |
$289.52
|
| Rate for Payer: CORVEL All Commercial |
$312.00
|
| Rate for Payer: Coventry All Commercial |
$295.22
|
| Rate for Payer: Encore All Commercial |
$308.81
|
| Rate for Payer: Frontpath All Commercial |
$308.64
|
| Rate for Payer: Humana ChoiceCare |
$289.75
|
| Rate for Payer: Humana Medicare |
$107.35
|
| Rate for Payer: Lucent All Commercial |
$182.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.93
|
| Rate for Payer: PHCS All Commercial |
$251.61
|
| Rate for Payer: PHP All Commercial |
$254.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.84
|
| Rate for Payer: Sagamore Health Network All Products |
$258.99
|
| Rate for Payer: Signature Care EPO |
$278.45
|
| Rate for Payer: Signature Care PPO |
$295.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$285.16
|
| Rate for Payer: United Healthcare Commercial |
$264.36
|
| Rate for Payer: United Healthcare Medicare |
$107.35
|
|
|
HC ACETYLCHOLINE BLOCKING ANTBY
|
Facility
|
IP
|
$130.86
|
|
|
Service Code
|
CPT 86042
|
| Hospital Charge Code |
63001576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.16
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
|
|
HC ACETYLCHOLINE BLOCKING ANTBY
|
Facility
|
OP
|
$130.86
|
|
|
Service Code
|
CPT 86042
|
| Hospital Charge Code |
63001576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Medicare |
$41.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.06
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Centivo All Commercial |
$71.19
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$41.88
|
| Rate for Payer: Lucent All Commercial |
$71.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.04
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
| Rate for Payer: United Healthcare Medicare |
$41.88
|
|
|
HC ACETYLCHOLINE MODULATING ANTBY
|
Facility
|
IP
|
$105.57
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
63001577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.18 |
| Max. Negotiated Rate |
$98.18 |
| Rate for Payer: Aetna Commercial |
$91.21
|
| Rate for Payer: Cash Price |
$63.34
|
| Rate for Payer: Cigna All Commercial |
$91.11
|
| Rate for Payer: CORVEL All Commercial |
$98.18
|
| Rate for Payer: Coventry All Commercial |
$92.90
|
| Rate for Payer: Encore All Commercial |
$97.18
|
| Rate for Payer: Frontpath All Commercial |
$97.12
|
| Rate for Payer: Humana ChoiceCare |
$91.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.01
|
| Rate for Payer: PHCS All Commercial |
$79.18
|
| Rate for Payer: PHP All Commercial |
$80.06
|
| Rate for Payer: Sagamore Health Network All Products |
$81.50
|
| Rate for Payer: Signature Care EPO |
$87.62
|
| Rate for Payer: Signature Care PPO |
$92.90
|
| Rate for Payer: United Healthcare Commercial |
$83.19
|
|
|
HC ACETYLCHOLINE MODULATING ANTBY
|
Facility
|
OP
|
$105.57
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
63001577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$98.18 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: Aetna Medicare |
$33.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.16
|
| Rate for Payer: Cash Price |
$63.34
|
| Rate for Payer: Centivo All Commercial |
$57.43
|
| Rate for Payer: Cigna All Commercial |
$91.11
|
| Rate for Payer: CORVEL All Commercial |
$98.18
|
| Rate for Payer: Coventry All Commercial |
$92.90
|
| Rate for Payer: Encore All Commercial |
$97.18
|
| Rate for Payer: Frontpath All Commercial |
$97.12
|
| Rate for Payer: Humana ChoiceCare |
$91.18
|
| Rate for Payer: Humana Medicare |
$33.78
|
| Rate for Payer: Lucent All Commercial |
$57.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.01
|
| Rate for Payer: PHCS All Commercial |
$79.18
|
| Rate for Payer: PHP All Commercial |
$80.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.17
|
| Rate for Payer: Sagamore Health Network All Products |
$81.50
|
| Rate for Payer: Signature Care EPO |
$87.62
|
| Rate for Payer: Signature Care PPO |
$92.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.73
|
| Rate for Payer: United Healthcare Commercial |
$83.19
|
| Rate for Payer: United Healthcare Medicare |
$33.78
|
|
|
HC ACID FAST CULTURE
|
Facility
|
OP
|
$215.94
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63001063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$200.82 |
| Rate for Payer: Aetna Commercial |
$182.25
|
| Rate for Payer: Aetna Medicare |
$69.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$99.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.01
|
| Rate for Payer: Cash Price |
$129.56
|
| Rate for Payer: Cash Price |
$129.56
|
| Rate for Payer: Centivo All Commercial |
$117.47
|
| Rate for Payer: Cigna All Commercial |
$186.36
|
| Rate for Payer: CORVEL All Commercial |
$200.82
|
| Rate for Payer: Coventry All Commercial |
$190.03
|
| Rate for Payer: Encore All Commercial |
$198.77
|
| Rate for Payer: Frontpath All Commercial |
$198.66
|
| Rate for Payer: Humana ChoiceCare |
$186.51
|
| Rate for Payer: Humana Medicare |
$69.10
|
| Rate for Payer: Lucent All Commercial |
$117.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.35
|
| Rate for Payer: Managed Health Services Medicaid |
$10.80
|
| Rate for Payer: MDWise Medicaid |
$10.80
|
| Rate for Payer: PHCS All Commercial |
$161.96
|
| Rate for Payer: PHP All Commercial |
$163.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.22
|
| Rate for Payer: Sagamore Health Network All Products |
$166.71
|
| Rate for Payer: Signature Care EPO |
$179.23
|
| Rate for Payer: Signature Care PPO |
$190.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$183.55
|
| Rate for Payer: United Healthcare Commercial |
$170.16
|
| Rate for Payer: United Healthcare Medicare |
$69.10
|
|
|
HC ACID FAST CULTURE
|
Facility
|
IP
|
$215.94
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63001063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.96 |
| Max. Negotiated Rate |
$200.82 |
| Rate for Payer: Aetna Commercial |
$186.57
|
| Rate for Payer: Cash Price |
$129.56
|
| Rate for Payer: Cigna All Commercial |
$186.36
|
| Rate for Payer: CORVEL All Commercial |
$200.82
|
| Rate for Payer: Coventry All Commercial |
$190.03
|
| Rate for Payer: Encore All Commercial |
$198.77
|
| Rate for Payer: Frontpath All Commercial |
$198.66
|
| Rate for Payer: Humana ChoiceCare |
$186.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.35
|
| Rate for Payer: PHCS All Commercial |
$161.96
|
| Rate for Payer: PHP All Commercial |
$163.77
|
| Rate for Payer: Sagamore Health Network All Products |
$166.71
|
| Rate for Payer: Signature Care EPO |
$179.23
|
| Rate for Payer: Signature Care PPO |
$190.03
|
| Rate for Payer: United Healthcare Commercial |
$170.16
|
|
|
HC ACTH
|
Facility
|
IP
|
$400.74
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
63001448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$300.56 |
| Max. Negotiated Rate |
$372.69 |
| Rate for Payer: Aetna Commercial |
$346.24
|
| Rate for Payer: Cash Price |
$240.44
|
| Rate for Payer: Cigna All Commercial |
$345.84
|
| Rate for Payer: CORVEL All Commercial |
$372.69
|
| Rate for Payer: Coventry All Commercial |
$352.65
|
| Rate for Payer: Encore All Commercial |
$368.88
|
| Rate for Payer: Frontpath All Commercial |
$368.68
|
| Rate for Payer: Humana ChoiceCare |
$346.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$360.67
|
| Rate for Payer: PHCS All Commercial |
$300.56
|
| Rate for Payer: PHP All Commercial |
$303.92
|
| Rate for Payer: Sagamore Health Network All Products |
$309.37
|
| Rate for Payer: Signature Care EPO |
$332.61
|
| Rate for Payer: Signature Care PPO |
$352.65
|
| Rate for Payer: United Healthcare Commercial |
$315.78
|
|
|
HC ACTH
|
Facility
|
OP
|
$400.74
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
63001448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$372.69 |
| Rate for Payer: Aetna Commercial |
$338.22
|
| Rate for Payer: Aetna Medicare |
$128.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$38.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$184.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$184.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$38.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.06
|
| Rate for Payer: Cash Price |
$240.44
|
| Rate for Payer: Cash Price |
$240.44
|
| Rate for Payer: Centivo All Commercial |
$218.00
|
| Rate for Payer: Cigna All Commercial |
$345.84
|
| Rate for Payer: CORVEL All Commercial |
$372.69
|
| Rate for Payer: Coventry All Commercial |
$352.65
|
| Rate for Payer: Encore All Commercial |
$368.88
|
| Rate for Payer: Frontpath All Commercial |
$368.68
|
| Rate for Payer: Humana ChoiceCare |
$346.12
|
| Rate for Payer: Humana Medicare |
$128.24
|
| Rate for Payer: Lucent All Commercial |
$218.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$360.67
|
| Rate for Payer: Managed Health Services Medicaid |
$38.62
|
| Rate for Payer: MDWise Medicaid |
$38.62
|
| Rate for Payer: PHCS All Commercial |
$300.56
|
| Rate for Payer: PHP All Commercial |
$303.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.29
|
| Rate for Payer: Sagamore Health Network All Products |
$309.37
|
| Rate for Payer: Signature Care EPO |
$332.61
|
| Rate for Payer: Signature Care PPO |
$352.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$340.63
|
| Rate for Payer: United Healthcare Commercial |
$315.78
|
| Rate for Payer: United Healthcare Medicare |
$128.24
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
IP
|
$309.87
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
63001734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna Commercial |
$267.73
|
| Rate for Payer: Cash Price |
$185.92
|
| Rate for Payer: Cigna All Commercial |
$267.42
|
| Rate for Payer: CORVEL All Commercial |
$288.18
|
| Rate for Payer: Coventry All Commercial |
$272.69
|
| Rate for Payer: Encore All Commercial |
$285.24
|
| Rate for Payer: Frontpath All Commercial |
$285.08
|
| Rate for Payer: Humana ChoiceCare |
$267.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.88
|
| Rate for Payer: PHCS All Commercial |
$232.40
|
| Rate for Payer: PHP All Commercial |
$235.01
|
| Rate for Payer: Sagamore Health Network All Products |
$239.22
|
| Rate for Payer: Signature Care EPO |
$257.19
|
| Rate for Payer: Signature Care PPO |
$272.69
|
| Rate for Payer: United Healthcare Commercial |
$244.18
|
|
