|
HC ANA CENTROMERE TITER
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$308.45
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna All Commercial |
$308.09
|
| Rate for Payer: CORVEL All Commercial |
$332.01
|
| Rate for Payer: Coventry All Commercial |
$314.16
|
| Rate for Payer: Encore All Commercial |
$328.62
|
| Rate for Payer: Frontpath All Commercial |
$328.44
|
| Rate for Payer: Humana ChoiceCare |
$308.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.30
|
| Rate for Payer: PHCS All Commercial |
$267.75
|
| Rate for Payer: PHP All Commercial |
$270.75
|
| Rate for Payer: Sagamore Health Network All Products |
$275.60
|
| Rate for Payer: Signature Care EPO |
$296.31
|
| Rate for Payer: Signature Care PPO |
$314.16
|
| Rate for Payer: United Healthcare Commercial |
$281.32
|
|
|
HC ANA CENTROMERE TITER
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$301.31
|
| Rate for Payer: Aetna Medicare |
$114.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$164.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.66
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Centivo All Commercial |
$194.21
|
| Rate for Payer: Cigna All Commercial |
$308.09
|
| Rate for Payer: CORVEL All Commercial |
$332.01
|
| Rate for Payer: Coventry All Commercial |
$314.16
|
| Rate for Payer: Encore All Commercial |
$328.62
|
| Rate for Payer: Frontpath All Commercial |
$328.44
|
| Rate for Payer: Humana ChoiceCare |
$308.34
|
| Rate for Payer: Humana Medicare |
$114.24
|
| Rate for Payer: Lucent All Commercial |
$194.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.30
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$267.75
|
| Rate for Payer: PHP All Commercial |
$270.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.23
|
| Rate for Payer: Sagamore Health Network All Products |
$275.60
|
| Rate for Payer: Signature Care EPO |
$296.31
|
| Rate for Payer: Signature Care PPO |
$314.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$303.45
|
| Rate for Payer: United Healthcare Commercial |
$281.32
|
| Rate for Payer: United Healthcare Medicare |
$114.24
|
|
|
HC ANAEROBIC CULTURE
|
Facility
|
OP
|
$250.67
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
63001073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$233.12 |
| Rate for Payer: Aetna Commercial |
$211.57
|
| Rate for Payer: Aetna Medicare |
$80.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$115.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.24
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Centivo All Commercial |
$136.36
|
| Rate for Payer: Cigna All Commercial |
$216.33
|
| Rate for Payer: CORVEL All Commercial |
$233.12
|
| Rate for Payer: Coventry All Commercial |
$220.59
|
| Rate for Payer: Encore All Commercial |
$230.74
|
| Rate for Payer: Frontpath All Commercial |
$230.62
|
| Rate for Payer: Humana ChoiceCare |
$216.50
|
| Rate for Payer: Humana Medicare |
$80.21
|
| Rate for Payer: Lucent All Commercial |
$136.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$225.60
|
| Rate for Payer: Managed Health Services Medicaid |
$9.47
|
| Rate for Payer: MDWise Medicaid |
$9.47
|
| Rate for Payer: PHCS All Commercial |
$188.00
|
| Rate for Payer: PHP All Commercial |
$190.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.76
|
| Rate for Payer: Sagamore Health Network All Products |
$193.52
|
| Rate for Payer: Signature Care EPO |
$208.06
|
| Rate for Payer: Signature Care PPO |
$220.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$213.07
|
| Rate for Payer: United Healthcare Commercial |
$197.53
|
| Rate for Payer: United Healthcare Medicare |
$80.21
|
|
|
HC ANAEROBIC CULTURE
|
Facility
|
IP
|
$250.67
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
63001073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$233.12 |
| Rate for Payer: Aetna Commercial |
$216.58
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cigna All Commercial |
$216.33
|
| Rate for Payer: CORVEL All Commercial |
$233.12
|
| Rate for Payer: Coventry All Commercial |
$220.59
|
| Rate for Payer: Encore All Commercial |
$230.74
|
| Rate for Payer: Frontpath All Commercial |
$230.62
|
| Rate for Payer: Humana ChoiceCare |
$216.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$225.60
|
| Rate for Payer: PHCS All Commercial |
$188.00
|
| Rate for Payer: PHP All Commercial |
$190.11
|
| Rate for Payer: Sagamore Health Network All Products |
$193.52
|
| Rate for Payer: Signature Care EPO |
$208.06
|
| Rate for Payer: Signature Care PPO |
$220.59
|
| Rate for Payer: United Healthcare Commercial |
$197.53
|
|
|
HC ANA IGG TITER+PATTERN-IFA
|
Facility
|
OP
|
$160.45
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
63001287
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$135.42
|
| Rate for Payer: Aetna Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.48
|
| Rate for Payer: Cash Price |
$96.27
|
| Rate for Payer: Cash Price |
$96.27
|
| Rate for Payer: Centivo All Commercial |
$87.28
|
| Rate for Payer: Cigna All Commercial |
$138.47
|
| Rate for Payer: CORVEL All Commercial |
$149.22
|
| Rate for Payer: Coventry All Commercial |
$141.20
|
| Rate for Payer: Encore All Commercial |
$147.69
|
| Rate for Payer: Frontpath All Commercial |
$147.61
|
| Rate for Payer: Humana ChoiceCare |
$138.58
|
| Rate for Payer: Humana Medicare |
$51.34
|
| Rate for Payer: Lucent All Commercial |
$87.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.41
|
| Rate for Payer: Managed Health Services Medicaid |
$11.16
|
| Rate for Payer: MDWise Medicaid |
$11.16
|
| Rate for Payer: PHCS All Commercial |
$120.34
|
| Rate for Payer: PHP All Commercial |
$121.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.58
|
| Rate for Payer: Sagamore Health Network All Products |
$123.87
|
| Rate for Payer: Signature Care EPO |
$133.17
|
| Rate for Payer: Signature Care PPO |
$141.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.38
|
| Rate for Payer: United Healthcare Commercial |
$126.43
|
| Rate for Payer: United Healthcare Medicare |
$51.34
|
|
|
HC ANA IGG TITER+PATTERN-IFA
|
Facility
|
IP
|
$160.45
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
63001287
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.34 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$138.63
|
| Rate for Payer: Cash Price |
$96.27
|
| Rate for Payer: Cigna All Commercial |
$138.47
|
| Rate for Payer: CORVEL All Commercial |
$149.22
|
| Rate for Payer: Coventry All Commercial |
$141.20
|
| Rate for Payer: Encore All Commercial |
$147.69
|
| Rate for Payer: Frontpath All Commercial |
$147.61
|
| Rate for Payer: Humana ChoiceCare |
$138.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.41
|
| Rate for Payer: PHCS All Commercial |
$120.34
|
| Rate for Payer: PHP All Commercial |
$121.69
|
| Rate for Payer: Sagamore Health Network All Products |
$123.87
|
| Rate for Payer: Signature Care EPO |
$133.17
|
| Rate for Payer: Signature Care PPO |
$141.20
|
| Rate for Payer: United Healthcare Commercial |
$126.43
|
|
|
HC ANCA-NEUT CYT
|
Facility
|
OP
|
$160.94
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$149.67 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna Medicare |
$51.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.65
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Centivo All Commercial |
$87.55
|
| Rate for Payer: Cigna All Commercial |
$138.89
|
| Rate for Payer: CORVEL All Commercial |
$149.67
|
| Rate for Payer: Coventry All Commercial |
$141.63
|
| Rate for Payer: Encore All Commercial |
$148.15
|
| Rate for Payer: Frontpath All Commercial |
$148.06
|
| Rate for Payer: Humana ChoiceCare |
$139.00
|
| Rate for Payer: Humana Medicare |
$51.50
|
| Rate for Payer: Lucent All Commercial |
$87.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.85
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$120.70
|
| Rate for Payer: PHP All Commercial |
$122.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.77
|
| Rate for Payer: Sagamore Health Network All Products |
$124.25
|
| Rate for Payer: Signature Care EPO |
$133.58
|
| Rate for Payer: Signature Care PPO |
$141.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.80
|
| Rate for Payer: United Healthcare Commercial |
$126.82
|
| Rate for Payer: United Healthcare Medicare |
$51.50
|
|
|
HC ANCA-NEUT CYT
|
Facility
|
IP
|
$160.94
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$149.67 |
| Rate for Payer: Aetna Commercial |
$139.05
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Cigna All Commercial |
$138.89
|
| Rate for Payer: CORVEL All Commercial |
$149.67
|
| Rate for Payer: Coventry All Commercial |
$141.63
|
| Rate for Payer: Encore All Commercial |
$148.15
|
| Rate for Payer: Frontpath All Commercial |
$148.06
|
| Rate for Payer: Humana ChoiceCare |
$139.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.85
|
| Rate for Payer: PHCS All Commercial |
$120.70
|
| Rate for Payer: PHP All Commercial |
$122.06
|
| Rate for Payer: Sagamore Health Network All Products |
$124.25
|
| Rate for Payer: Signature Care EPO |
$133.58
|
| Rate for Payer: Signature Care PPO |
$141.63
|
| Rate for Payer: United Healthcare Commercial |
$126.82
|
|
|
HC ANDROSTENEDIONE
|
Facility
|
IP
|
$207.57
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
63001466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$193.04 |
| Rate for Payer: Aetna Commercial |
$179.34
|
| Rate for Payer: Cash Price |
$124.54
|
| Rate for Payer: Cigna All Commercial |
$179.13
|
| Rate for Payer: CORVEL All Commercial |
$193.04
|
| Rate for Payer: Coventry All Commercial |
$182.66
|
| Rate for Payer: Encore All Commercial |
$191.07
|
| Rate for Payer: Frontpath All Commercial |
$190.96
|
| Rate for Payer: Humana ChoiceCare |
$179.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.81
|
| Rate for Payer: PHCS All Commercial |
$155.68
|
| Rate for Payer: PHP All Commercial |
$157.42
|
| Rate for Payer: Sagamore Health Network All Products |
$160.24
|
| Rate for Payer: Signature Care EPO |
$172.28
|
| Rate for Payer: Signature Care PPO |
$182.66
|
| Rate for Payer: United Healthcare Commercial |
$163.57
|
|
|
HC ANDROSTENEDIONE
|
Facility
|
OP
|
$207.57
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
63001466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$193.04 |
| Rate for Payer: Aetna Commercial |
$175.19
|
| Rate for Payer: Aetna Medicare |
$66.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$29.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$95.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$29.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.06
|
| Rate for Payer: Cash Price |
$124.54
|
| Rate for Payer: Cash Price |
$124.54
|
| Rate for Payer: Centivo All Commercial |
$112.92
|
| Rate for Payer: Cigna All Commercial |
$179.13
|
| Rate for Payer: CORVEL All Commercial |
$193.04
|
| Rate for Payer: Coventry All Commercial |
$182.66
|
| Rate for Payer: Encore All Commercial |
$191.07
|
| Rate for Payer: Frontpath All Commercial |
$190.96
|
| Rate for Payer: Humana ChoiceCare |
$179.28
|
| Rate for Payer: Humana Medicare |
$66.42
|
| Rate for Payer: Lucent All Commercial |
$112.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.81
|
| Rate for Payer: Managed Health Services Medicaid |
$29.28
|
| Rate for Payer: MDWise Medicaid |
$29.28
|
| Rate for Payer: PHCS All Commercial |
$155.68
|
| Rate for Payer: PHP All Commercial |
$157.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.95
|
| Rate for Payer: Sagamore Health Network All Products |
$160.24
|
| Rate for Payer: Signature Care EPO |
$172.28
|
| Rate for Payer: Signature Care PPO |
$182.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$176.43
|
| Rate for Payer: United Healthcare Commercial |
$163.57
|
| Rate for Payer: United Healthcare Medicare |
$66.42
|
|
|
HC ANGIOTENSIN-1
|
Facility
|
OP
|
$204.28
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
63001467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$189.98 |
| Rate for Payer: Aetna Commercial |
$172.41
|
| Rate for Payer: Aetna Medicare |
$65.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$93.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.91
|
| Rate for Payer: Cash Price |
$122.57
|
| Rate for Payer: Cash Price |
$122.57
|
| Rate for Payer: Centivo All Commercial |
$111.13
|
| Rate for Payer: Cigna All Commercial |
$176.29
|
| Rate for Payer: CORVEL All Commercial |
$189.98
|
| Rate for Payer: Coventry All Commercial |
$179.77
|
| Rate for Payer: Encore All Commercial |
$188.04
|
| Rate for Payer: Frontpath All Commercial |
$187.94
|
| Rate for Payer: Humana ChoiceCare |
$176.44
|
| Rate for Payer: Humana Medicare |
$65.37
|
| Rate for Payer: Lucent All Commercial |
$111.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.85
|
| Rate for Payer: Managed Health Services Medicaid |
$14.60
|
| Rate for Payer: MDWise Medicaid |
$14.60
|
| Rate for Payer: PHCS All Commercial |
$153.21
|
| Rate for Payer: PHP All Commercial |
$154.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.67
|
| Rate for Payer: Sagamore Health Network All Products |
$157.70
|
| Rate for Payer: Signature Care EPO |
$169.55
|
| Rate for Payer: Signature Care PPO |
$179.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.64
|
| Rate for Payer: United Healthcare Commercial |
$160.97
|
| Rate for Payer: United Healthcare Medicare |
$65.37
|
|
|
HC ANGIOTENSIN-1
|
Facility
|
IP
|
$204.28
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
63001467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.21 |
| Max. Negotiated Rate |
$189.98 |
| Rate for Payer: Aetna Commercial |
$176.50
|
| Rate for Payer: Cash Price |
$122.57
|
| Rate for Payer: Cigna All Commercial |
$176.29
|
| Rate for Payer: CORVEL All Commercial |
$189.98
|
| Rate for Payer: Coventry All Commercial |
$179.77
|
| Rate for Payer: Encore All Commercial |
$188.04
|
| Rate for Payer: Frontpath All Commercial |
$187.94
|
| Rate for Payer: Humana ChoiceCare |
$176.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.85
|
| Rate for Payer: PHCS All Commercial |
$153.21
|
| Rate for Payer: PHP All Commercial |
$154.93
|
| Rate for Payer: Sagamore Health Network All Products |
$157.70
|
| Rate for Payer: Signature Care EPO |
$169.55
|
| Rate for Payer: Signature Care PPO |
$179.77
|
| Rate for Payer: United Healthcare Commercial |
$160.97
|
|
|
HC ANTIBACTERIAL ENVELOPE LG
|
Facility
|
OP
|
$4,662.00
|
|
| Hospital Charge Code |
41607378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$4,335.66 |
| Rate for Payer: Aetna Commercial |
$3,934.73
|
| Rate for Payer: Aetna Medicare |
$1,491.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,445.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,677.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,914.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,715.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,641.02
|
| Rate for Payer: Cash Price |
$2,797.20
|
| Rate for Payer: Cash Price |
$2,797.20
|
| Rate for Payer: Centivo All Commercial |
$2,536.13
|
| Rate for Payer: Cigna All Commercial |
$4,023.31
|
| Rate for Payer: CORVEL All Commercial |
$4,335.66
|
| Rate for Payer: Coventry All Commercial |
$4,102.56
|
| Rate for Payer: Encore All Commercial |
$4,291.37
|
| Rate for Payer: Frontpath All Commercial |
$4,289.04
|
| Rate for Payer: Humana ChoiceCare |
$4,026.57
|
| Rate for Payer: Humana Medicare |
$1,491.84
|
| Rate for Payer: Lucent All Commercial |
$2,536.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,195.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3,496.50
|
| Rate for Payer: PHP All Commercial |
$3,535.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,818.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,599.06
|
| Rate for Payer: Signature Care EPO |
$3,869.46
|
| Rate for Payer: Signature Care PPO |
$4,102.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,962.70
|
| Rate for Payer: United Healthcare Commercial |
$3,673.66
|
| Rate for Payer: United Healthcare Medicare |
$1,491.84
|
|
|
HC ANTIBACTERIAL ENVELOPE LG
|
Facility
|
IP
|
$4,662.00
|
|
| Hospital Charge Code |
41607378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,496.50 |
| Max. Negotiated Rate |
$4,335.66 |
| Rate for Payer: Aetna Commercial |
$4,027.97
|
| Rate for Payer: Cash Price |
$2,797.20
|
| Rate for Payer: Cigna All Commercial |
$4,023.31
|
| Rate for Payer: CORVEL All Commercial |
$4,335.66
|
| Rate for Payer: Coventry All Commercial |
$4,102.56
|
| Rate for Payer: Encore All Commercial |
$4,291.37
|
| Rate for Payer: Frontpath All Commercial |
$4,289.04
|
| Rate for Payer: Humana ChoiceCare |
$4,026.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,195.80
|
| Rate for Payer: PHCS All Commercial |
$3,496.50
|
| Rate for Payer: PHP All Commercial |
$3,535.66
|
| Rate for Payer: Sagamore Health Network All Products |
$3,599.06
|
| Rate for Payer: Signature Care EPO |
$3,869.46
|
| Rate for Payer: Signature Care PPO |
$4,102.56
|
| Rate for Payer: United Healthcare Commercial |
$3,673.66
|
|
|
HC ANTIBODY SCREEN
|
Facility
|
OP
|
$133.90
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
63001346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$124.53 |
| Rate for Payer: Aetna Commercial |
$113.01
|
| Rate for Payer: Aetna Medicare |
$42.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$61.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.13
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Centivo All Commercial |
$72.84
|
| Rate for Payer: Cigna All Commercial |
$115.56
|
| Rate for Payer: CORVEL All Commercial |
$124.53
|
| Rate for Payer: Coventry All Commercial |
$117.83
|
| Rate for Payer: Encore All Commercial |
$123.25
|
| Rate for Payer: Frontpath All Commercial |
$123.19
|
| Rate for Payer: Humana ChoiceCare |
$115.65
|
| Rate for Payer: Humana Medicare |
$42.85
|
| Rate for Payer: Lucent All Commercial |
$72.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$120.51
|
| Rate for Payer: Managed Health Services Medicaid |
$9.77
|
| Rate for Payer: MDWise Medicaid |
$9.77
|
| Rate for Payer: PHCS All Commercial |
$100.42
|
| Rate for Payer: PHP All Commercial |
$101.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.22
|
| Rate for Payer: Sagamore Health Network All Products |
$103.37
|
| Rate for Payer: Signature Care EPO |
$111.14
|
| Rate for Payer: Signature Care PPO |
$117.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$113.81
|
| Rate for Payer: United Healthcare Commercial |
$105.51
|
| Rate for Payer: United Healthcare Medicare |
$42.85
|
|
|
HC ANTIBODY SCREEN
|
Facility
|
IP
|
$133.90
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
63001346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.42 |
| Max. Negotiated Rate |
$124.53 |
| Rate for Payer: Aetna Commercial |
$115.69
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cigna All Commercial |
$115.56
|
| Rate for Payer: CORVEL All Commercial |
$124.53
|
| Rate for Payer: Coventry All Commercial |
$117.83
|
| Rate for Payer: Encore All Commercial |
$123.25
|
| Rate for Payer: Frontpath All Commercial |
$123.19
|
| Rate for Payer: Humana ChoiceCare |
$115.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$120.51
|
| Rate for Payer: PHCS All Commercial |
$100.42
|
| Rate for Payer: PHP All Commercial |
$101.55
|
| Rate for Payer: Sagamore Health Network All Products |
$103.37
|
| Rate for Payer: Signature Care EPO |
$111.14
|
| Rate for Payer: Signature Care PPO |
$117.83
|
| Rate for Payer: United Healthcare Commercial |
$105.51
|
|
|
HC ANTI-CYCLIC CIT PEPT
|
Facility
|
OP
|
$155.86
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
63001146
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$144.95 |
| Rate for Payer: Aetna Commercial |
$131.55
|
| Rate for Payer: Aetna Medicare |
$49.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.86
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Centivo All Commercial |
$84.79
|
| Rate for Payer: Cigna All Commercial |
$134.51
|
| Rate for Payer: CORVEL All Commercial |
$144.95
|
| Rate for Payer: Coventry All Commercial |
$137.16
|
| Rate for Payer: Encore All Commercial |
$143.47
|
| Rate for Payer: Frontpath All Commercial |
$143.39
|
| Rate for Payer: Humana ChoiceCare |
$134.62
|
| Rate for Payer: Humana Medicare |
$49.88
|
| Rate for Payer: Lucent All Commercial |
$84.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.27
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: MDWise Medicaid |
$12.95
|
| Rate for Payer: PHCS All Commercial |
$116.89
|
| Rate for Payer: PHP All Commercial |
$118.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.79
|
| Rate for Payer: Sagamore Health Network All Products |
$120.32
|
| Rate for Payer: Signature Care EPO |
$129.36
|
| Rate for Payer: Signature Care PPO |
$137.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.48
|
| Rate for Payer: United Healthcare Commercial |
$122.82
|
| Rate for Payer: United Healthcare Medicare |
$49.88
|
|
|
HC ANTI-CYCLIC CIT PEPT
|
Facility
|
IP
|
$155.86
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
63001146
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.89 |
| Max. Negotiated Rate |
$144.95 |
| Rate for Payer: Aetna Commercial |
$134.66
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cigna All Commercial |
$134.51
|
| Rate for Payer: CORVEL All Commercial |
$144.95
|
| Rate for Payer: Coventry All Commercial |
$137.16
|
| Rate for Payer: Encore All Commercial |
$143.47
|
| Rate for Payer: Frontpath All Commercial |
$143.39
|
| Rate for Payer: Humana ChoiceCare |
$134.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.27
|
| Rate for Payer: PHCS All Commercial |
$116.89
|
| Rate for Payer: PHP All Commercial |
$118.20
|
| Rate for Payer: Sagamore Health Network All Products |
$120.32
|
| Rate for Payer: Signature Care EPO |
$129.36
|
| Rate for Payer: Signature Care PPO |
$137.16
|
| Rate for Payer: United Healthcare Commercial |
$122.82
|
|
|
HC ANTI-ENA ANTI
|
Facility
|
IP
|
$95.83
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna All Commercial |
$82.70
|
| Rate for Payer: CORVEL All Commercial |
$89.12
|
| Rate for Payer: Coventry All Commercial |
$84.33
|
| Rate for Payer: Encore All Commercial |
$88.21
|
| Rate for Payer: Frontpath All Commercial |
$88.16
|
| Rate for Payer: Humana ChoiceCare |
$82.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.25
|
| Rate for Payer: PHCS All Commercial |
$71.87
|
| Rate for Payer: PHP All Commercial |
$72.68
|
| Rate for Payer: Sagamore Health Network All Products |
$73.98
|
| Rate for Payer: Signature Care EPO |
$79.54
|
| Rate for Payer: Signature Care PPO |
$84.33
|
| Rate for Payer: United Healthcare Commercial |
$75.51
|
|
|
HC ANTI-ENA ANTI
|
Facility
|
OP
|
$95.83
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$80.88
|
| Rate for Payer: Aetna Medicare |
$30.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$44.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.73
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Centivo All Commercial |
$52.13
|
| Rate for Payer: Cigna All Commercial |
$82.70
|
| Rate for Payer: CORVEL All Commercial |
$89.12
|
| Rate for Payer: Coventry All Commercial |
$84.33
|
| Rate for Payer: Encore All Commercial |
$88.21
|
| Rate for Payer: Frontpath All Commercial |
$88.16
|
| Rate for Payer: Humana ChoiceCare |
$82.77
|
| Rate for Payer: Humana Medicare |
$30.67
|
| Rate for Payer: Lucent All Commercial |
$52.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.25
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$71.87
|
| Rate for Payer: PHP All Commercial |
$72.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.37
|
| Rate for Payer: Sagamore Health Network All Products |
$73.98
|
| Rate for Payer: Signature Care EPO |
$79.54
|
| Rate for Payer: Signature Care PPO |
$84.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$75.51
|
| Rate for Payer: United Healthcare Medicare |
$30.67
|
|
|
HC ANTI-ENDOMYSIAL
|
Facility
|
IP
|
$130.86
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001579
|
|
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 ANTI-ENDOMYSIAL
|
Facility
|
OP
|
$130.86
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| 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 Medicaid |
$12.09
|
| 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 Hoosier Healthwise/HIP |
$12.09
|
| 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: 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: Managed Health Services Medicaid |
$12.09
|
| Rate for Payer: MDWise Medicaid |
$12.09
|
| 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 ANTI-ENDOMYSIAL IGA TITER
|
Facility
|
IP
|
$147.40
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.55 |
| Max. Negotiated Rate |
$137.08 |
| Rate for Payer: Aetna Commercial |
$127.35
|
| Rate for Payer: Cash Price |
$88.44
|
| Rate for Payer: Cigna All Commercial |
$127.21
|
| Rate for Payer: CORVEL All Commercial |
$137.08
|
| Rate for Payer: Coventry All Commercial |
$129.71
|
| Rate for Payer: Encore All Commercial |
$135.68
|
| Rate for Payer: Frontpath All Commercial |
$135.61
|
| Rate for Payer: Humana ChoiceCare |
$127.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.66
|
| Rate for Payer: PHCS All Commercial |
$110.55
|
| Rate for Payer: PHP All Commercial |
$111.79
|
| Rate for Payer: Sagamore Health Network All Products |
$113.79
|
| Rate for Payer: Signature Care EPO |
$122.34
|
| Rate for Payer: Signature Care PPO |
$129.71
|
| Rate for Payer: United Healthcare Commercial |
$116.15
|
|
|
HC ANTI-ENDOMYSIAL IGA TITER
|
Facility
|
OP
|
$147.40
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$137.08 |
| Rate for Payer: Aetna Commercial |
$124.41
|
| Rate for Payer: Aetna Medicare |
$47.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.88
|
| Rate for Payer: Cash Price |
$88.44
|
| Rate for Payer: Cash Price |
$88.44
|
| Rate for Payer: Centivo All Commercial |
$80.19
|
| Rate for Payer: Cigna All Commercial |
$127.21
|
| Rate for Payer: CORVEL All Commercial |
$137.08
|
| Rate for Payer: Coventry All Commercial |
$129.71
|
| Rate for Payer: Encore All Commercial |
$135.68
|
| Rate for Payer: Frontpath All Commercial |
$135.61
|
| Rate for Payer: Humana ChoiceCare |
$127.31
|
| Rate for Payer: Humana Medicare |
$47.17
|
| Rate for Payer: Lucent All Commercial |
$80.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.66
|
| Rate for Payer: Managed Health Services Medicaid |
$12.09
|
| Rate for Payer: MDWise Medicaid |
$12.09
|
| Rate for Payer: PHCS All Commercial |
$110.55
|
| Rate for Payer: PHP All Commercial |
$111.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.49
|
| Rate for Payer: Sagamore Health Network All Products |
$113.79
|
| Rate for Payer: Signature Care EPO |
$122.34
|
| Rate for Payer: Signature Care PPO |
$129.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$125.29
|
| Rate for Payer: United Healthcare Commercial |
$116.15
|
| Rate for Payer: United Healthcare Medicare |
$47.17
|
|
|
HC ANTI-ENDOMYSIAL TITE
|
Facility
|
IP
|
$194.36
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.77 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Aetna Commercial |
$167.93
|
| Rate for Payer: Cash Price |
$116.62
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.75
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
|
