|
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
|
|
|
HC ANTIMICROSOMAL AB EA
|
Facility
|
IP
|
$88.34
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$82.16 |
| Rate for Payer: Aetna Commercial |
$76.33
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna All Commercial |
$76.24
|
| Rate for Payer: CORVEL All Commercial |
$82.16
|
| Rate for Payer: Coventry All Commercial |
$77.74
|
| Rate for Payer: Encore All Commercial |
$81.32
|
| Rate for Payer: Frontpath All Commercial |
$81.27
|
| Rate for Payer: Humana ChoiceCare |
$76.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.51
|
| Rate for Payer: PHCS All Commercial |
$66.25
|
| Rate for Payer: PHP All Commercial |
$67.00
|
| Rate for Payer: Sagamore Health Network All Products |
$68.20
|
| Rate for Payer: Signature Care EPO |
$73.32
|
| Rate for Payer: Signature Care PPO |
$77.74
|
| Rate for Payer: United Healthcare Commercial |
$69.61
|
|
|
HC ANTIMICROSOMAL AB EA
|
Facility
|
OP
|
$88.34
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$82.16 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$28.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$40.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.10
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Centivo All Commercial |
$48.06
|
| Rate for Payer: Cigna All Commercial |
$76.24
|
| Rate for Payer: CORVEL All Commercial |
$82.16
|
| Rate for Payer: Coventry All Commercial |
$77.74
|
| Rate for Payer: Encore All Commercial |
$81.32
|
| Rate for Payer: Frontpath All Commercial |
$81.27
|
| Rate for Payer: Humana ChoiceCare |
$76.30
|
| Rate for Payer: Humana Medicare |
$28.27
|
| Rate for Payer: Lucent All Commercial |
$48.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.51
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: MDWise Medicaid |
$14.55
|
| Rate for Payer: PHCS All Commercial |
$66.25
|
| Rate for Payer: PHP All Commercial |
$67.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.45
|
| Rate for Payer: Sagamore Health Network All Products |
$68.20
|
| Rate for Payer: Signature Care EPO |
$73.32
|
| Rate for Payer: Signature Care PPO |
$77.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75.09
|
| Rate for Payer: United Healthcare Commercial |
$69.61
|
| Rate for Payer: United Healthcare Medicare |
$28.27
|
|
|
HC ANTINUCLEAR ANTIBODY
|
Facility
|
OP
|
$104.35
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
63001858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$97.05 |
| Rate for Payer: Aetna Commercial |
$88.07
|
| Rate for Payer: Aetna Medicare |
$33.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.73
|
| Rate for Payer: Cash Price |
$62.61
|
| Rate for Payer: Cash Price |
$62.61
|
| Rate for Payer: Centivo All Commercial |
$56.77
|
| Rate for Payer: Cigna All Commercial |
$90.05
|
| Rate for Payer: CORVEL All Commercial |
$97.05
|
| Rate for Payer: Coventry All Commercial |
$91.83
|
| Rate for Payer: Encore All Commercial |
$96.05
|
| Rate for Payer: Frontpath All Commercial |
$96.00
|
| Rate for Payer: Humana ChoiceCare |
$90.13
|
| Rate for Payer: Humana Medicare |
$33.39
|
| Rate for Payer: Lucent All Commercial |
$56.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.92
|
| Rate for Payer: Managed Health Services Medicaid |
$12.09
|
| Rate for Payer: MDWise Medicaid |
$12.09
|
| Rate for Payer: PHCS All Commercial |
$78.26
|
| Rate for Payer: PHP All Commercial |
$79.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.70
|
| Rate for Payer: Sagamore Health Network All Products |
$80.56
|
| Rate for Payer: Signature Care EPO |
$86.61
|
| Rate for Payer: Signature Care PPO |
$91.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88.70
|
| Rate for Payer: United Healthcare Commercial |
$82.23
|
| Rate for Payer: United Healthcare Medicare |
$33.39
|
|
|
HC ANTINUCLEAR ANTIBODY
|
Facility
|
IP
|
$104.35
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
63001858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$97.05 |
| Rate for Payer: Aetna Commercial |
$90.16
|
| Rate for Payer: Cash Price |
$62.61
|
| Rate for Payer: Cigna All Commercial |
$90.05
|
| Rate for Payer: CORVEL All Commercial |
$97.05
|
| Rate for Payer: Coventry All Commercial |
$91.83
|
| Rate for Payer: Encore All Commercial |
$96.05
|
| Rate for Payer: Frontpath All Commercial |
$96.00
|
| Rate for Payer: Humana ChoiceCare |
$90.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.92
|
| Rate for Payer: PHCS All Commercial |
$78.26
|
| Rate for Payer: PHP All Commercial |
$79.14
|
| Rate for Payer: Sagamore Health Network All Products |
$80.56
|
| Rate for Payer: Signature Care EPO |
$86.61
|
| Rate for Payer: Signature Care PPO |
$91.83
|
| Rate for Payer: United Healthcare Commercial |
$82.23
|
|
|
HC ANTI-PARIETAL AB
|
Facility
|
OP
|
$105.57
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| 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 Medicaid |
$11.53
|
| 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 Hoosier Healthwise/HIP |
$11.53
|
| 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: 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: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| 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 ANTI-PARIETAL AB
|
Facility
|
IP
|
$105.57
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001580
|
|
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 ANTIPARIETAL CELL ANTIBODY (APCA)
|
Facility
|
OP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63044047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| 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 |
$11.53
|
| 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 |
$11.53
|
| 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 |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| 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 ANTIPARIETAL CELL ANTIBODY (APCA)
|
Facility
|
IP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63044047
|
|
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-STR-MUSC AB
|
Facility
|
OP
|
$138.51
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$128.81 |
| Rate for Payer: Aetna Commercial |
$116.90
|
| Rate for Payer: Aetna Medicare |
$44.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.76
|
| Rate for Payer: Cash Price |
$83.11
|
| Rate for Payer: Cash Price |
$83.11
|
| Rate for Payer: Centivo All Commercial |
$75.35
|
| Rate for Payer: Cigna All Commercial |
$119.53
|
| Rate for Payer: CORVEL All Commercial |
$128.81
|
| Rate for Payer: Coventry All Commercial |
$121.89
|
| Rate for Payer: Encore All Commercial |
$127.50
|
| Rate for Payer: Frontpath All Commercial |
$127.43
|
| Rate for Payer: Humana ChoiceCare |
$119.63
|
| Rate for Payer: Humana Medicare |
$44.32
|
| Rate for Payer: Lucent All Commercial |
$75.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.66
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$103.88
|
| Rate for Payer: PHP All Commercial |
$105.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.02
|
| Rate for Payer: Sagamore Health Network All Products |
$106.93
|
| Rate for Payer: Signature Care EPO |
$114.96
|
| Rate for Payer: Signature Care PPO |
$121.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.73
|
| Rate for Payer: United Healthcare Commercial |
$109.15
|
| Rate for Payer: United Healthcare Medicare |
$44.32
|
|
|
HC ANTI-STR-MUSC AB
|
Facility
|
IP
|
$138.51
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$128.81 |
| Rate for Payer: Aetna Commercial |
$119.67
|
| Rate for Payer: Cash Price |
$83.11
|
| Rate for Payer: Cigna All Commercial |
$119.53
|
| Rate for Payer: CORVEL All Commercial |
$128.81
|
| Rate for Payer: Coventry All Commercial |
$121.89
|
| Rate for Payer: Encore All Commercial |
$127.50
|
| Rate for Payer: Frontpath All Commercial |
$127.43
|
| Rate for Payer: Humana ChoiceCare |
$119.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.66
|
| Rate for Payer: PHCS All Commercial |
$103.88
|
| Rate for Payer: PHP All Commercial |
$105.05
|
| Rate for Payer: Sagamore Health Network All Products |
$106.93
|
| Rate for Payer: Signature Care EPO |
$114.96
|
| Rate for Payer: Signature Care PPO |
$121.89
|
| Rate for Payer: United Healthcare Commercial |
$109.15
|
|
|
HC ANTITHROMBIN III
|
Facility
|
OP
|
$279.94
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
63001740
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$260.34 |
| Rate for Payer: Aetna Commercial |
$236.27
|
| Rate for Payer: Aetna Medicare |
$89.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$86.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$128.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$128.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.54
|
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Centivo All Commercial |
$152.29
|
| Rate for Payer: Cigna All Commercial |
$241.59
|
| Rate for Payer: CORVEL All Commercial |
$260.34
|
| Rate for Payer: Coventry All Commercial |
$246.35
|
| Rate for Payer: Encore All Commercial |
$257.68
|
| Rate for Payer: Frontpath All Commercial |
$257.54
|
| Rate for Payer: Humana ChoiceCare |
$241.78
|
| Rate for Payer: Humana Medicare |
$89.58
|
| Rate for Payer: Lucent All Commercial |
$152.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$251.95
|
| Rate for Payer: Managed Health Services Medicaid |
$11.85
|
| Rate for Payer: MDWise Medicaid |
$11.85
|
| Rate for Payer: PHCS All Commercial |
$209.96
|
| Rate for Payer: PHP All Commercial |
$212.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.18
|
| Rate for Payer: Sagamore Health Network All Products |
$216.11
|
| Rate for Payer: Signature Care EPO |
$232.35
|
| Rate for Payer: Signature Care PPO |
$246.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$237.95
|
| Rate for Payer: United Healthcare Commercial |
$220.59
|
| Rate for Payer: United Healthcare Medicare |
$89.58
|
|
|
HC ANTITHROMBIN III
|
Facility
|
IP
|
$279.94
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
63001740
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$260.34 |
| Rate for Payer: Aetna Commercial |
$241.87
|
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Cigna All Commercial |
$241.59
|
| Rate for Payer: CORVEL All Commercial |
$260.34
|
| Rate for Payer: Coventry All Commercial |
$246.35
|
| Rate for Payer: Encore All Commercial |
$257.68
|
| Rate for Payer: Frontpath All Commercial |
$257.54
|
| Rate for Payer: Humana ChoiceCare |
$241.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$251.95
|
| Rate for Payer: PHCS All Commercial |
$209.96
|
| Rate for Payer: PHP All Commercial |
$212.31
|
| Rate for Payer: Sagamore Health Network All Products |
$216.11
|
| Rate for Payer: Signature Care EPO |
$232.35
|
| Rate for Payer: Signature Care PPO |
$246.35
|
| Rate for Payer: United Healthcare Commercial |
$220.59
|
|
|
HC APHASIA TEST W/RPT/60 MIN-SP
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 96105 GN
|
| Hospital Charge Code |
1748007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$375.72 |
| Rate for Payer: Aetna Commercial |
$340.98
|
| Rate for Payer: Aetna Medicare |
$129.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$232.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.21
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Centivo All Commercial |
$219.78
|
| Rate for Payer: Cigna All Commercial |
$348.65
|
| Rate for Payer: CORVEL All Commercial |
$375.72
|
| Rate for Payer: Coventry All Commercial |
$355.52
|
| Rate for Payer: Encore All Commercial |
$371.88
|
| Rate for Payer: Frontpath All Commercial |
$371.68
|
| Rate for Payer: Humana ChoiceCare |
$348.93
|
| Rate for Payer: Humana Medicare |
$129.28
|
| Rate for Payer: Lucent All Commercial |
$219.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$363.60
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$303.00
|
| Rate for Payer: PHP All Commercial |
$306.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$157.56
|
| Rate for Payer: Sagamore Health Network All Products |
$311.89
|
| Rate for Payer: Signature Care EPO |
$335.32
|
| Rate for Payer: Signature Care PPO |
$355.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$343.40
|
| Rate for Payer: United Healthcare Commercial |
$318.35
|
| Rate for Payer: United Healthcare Medicare |
$129.28
|
|
|
HC APHASIA TEST W/RPT/60 MIN-SP
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 96105 GN
|
| Hospital Charge Code |
1748007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$303.00 |
| Max. Negotiated Rate |
$375.72 |
| Rate for Payer: Aetna Commercial |
$349.06
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna All Commercial |
$348.65
|
| Rate for Payer: CORVEL All Commercial |
$375.72
|
| Rate for Payer: Coventry All Commercial |
$355.52
|
| Rate for Payer: Encore All Commercial |
$371.88
|
| Rate for Payer: Frontpath All Commercial |
$371.68
|
| Rate for Payer: Humana ChoiceCare |
$348.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$363.60
|
| Rate for Payer: PHCS All Commercial |
$303.00
|
| Rate for Payer: PHP All Commercial |
$306.39
|
| Rate for Payer: Sagamore Health Network All Products |
$311.89
|
| Rate for Payer: Signature Care EPO |
$335.32
|
| Rate for Payer: Signature Care PPO |
$355.52
|
| Rate for Payer: United Healthcare Commercial |
$318.35
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
63001468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.69 |
| Max. Negotiated Rate |
$87.65 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cigna All Commercial |
$81.34
|
| Rate for Payer: CORVEL All Commercial |
$87.65
|
| Rate for Payer: Coventry All Commercial |
$82.94
|
| Rate for Payer: Encore All Commercial |
$86.76
|
| Rate for Payer: Frontpath All Commercial |
$86.71
|
| Rate for Payer: Humana ChoiceCare |
$81.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.83
|
| Rate for Payer: PHCS All Commercial |
$70.69
|
| Rate for Payer: PHP All Commercial |
$71.48
|
| Rate for Payer: Sagamore Health Network All Products |
$72.76
|
| Rate for Payer: Signature Care EPO |
$78.23
|
| Rate for Payer: Signature Care PPO |
$82.94
|
| Rate for Payer: United Healthcare Commercial |
$74.27
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
OP
|
$94.25
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
63001468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$87.65 |
| Rate for Payer: Aetna Commercial |
$79.55
|
| Rate for Payer: Aetna Medicare |
$30.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$43.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.18
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Centivo All Commercial |
$51.27
|
| Rate for Payer: Cigna All Commercial |
$81.34
|
| Rate for Payer: CORVEL All Commercial |
$87.65
|
| Rate for Payer: Coventry All Commercial |
$82.94
|
| Rate for Payer: Encore All Commercial |
$86.76
|
| Rate for Payer: Frontpath All Commercial |
$86.71
|
| Rate for Payer: Humana ChoiceCare |
$81.40
|
| Rate for Payer: Humana Medicare |
$30.16
|
| Rate for Payer: Lucent All Commercial |
$51.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.83
|
| Rate for Payer: Managed Health Services Medicaid |
$21.09
|
| Rate for Payer: MDWise Medicaid |
$21.09
|
| Rate for Payer: PHCS All Commercial |
$70.69
|
| Rate for Payer: PHP All Commercial |
$71.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.76
|
| Rate for Payer: Sagamore Health Network All Products |
$72.76
|
| Rate for Payer: Signature Care EPO |
$78.23
|
| Rate for Payer: Signature Care PPO |
$82.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.11
|
| Rate for Payer: United Healthcare Commercial |
$74.27
|
| Rate for Payer: United Healthcare Medicare |
$30.16
|
|
|
HC APTT W/MIXING STUDIES IF INDICATED
|
Facility
|
OP
|
$136.85
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
63001275
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$127.27 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Aetna Medicare |
$43.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$62.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.17
|
| Rate for Payer: Cash Price |
$82.11
|
| Rate for Payer: Cash Price |
$82.11
|
| Rate for Payer: Centivo All Commercial |
$74.45
|
| Rate for Payer: Cigna All Commercial |
$118.10
|
| Rate for Payer: CORVEL All Commercial |
$127.27
|
| Rate for Payer: Coventry All Commercial |
$120.43
|
| Rate for Payer: Encore All Commercial |
$125.97
|
| Rate for Payer: Frontpath All Commercial |
$125.90
|
| Rate for Payer: Humana ChoiceCare |
$118.20
|
| Rate for Payer: Humana Medicare |
$43.79
|
| Rate for Payer: Lucent All Commercial |
$74.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.17
|
| Rate for Payer: Managed Health Services Medicaid |
$6.01
|
| Rate for Payer: MDWise Medicaid |
$6.01
|
| Rate for Payer: PHCS All Commercial |
$102.64
|
| Rate for Payer: PHP All Commercial |
$103.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.37
|
| Rate for Payer: Sagamore Health Network All Products |
$105.65
|
| Rate for Payer: Signature Care EPO |
$113.59
|
| Rate for Payer: Signature Care PPO |
$120.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.32
|
| Rate for Payer: United Healthcare Commercial |
$107.84
|
| Rate for Payer: United Healthcare Medicare |
$43.79
|
|
|
HC APTT W/MIXING STUDIES IF INDICATED
|
Facility
|
IP
|
$136.85
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
63001275
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.64 |
| Max. Negotiated Rate |
$127.27 |
| Rate for Payer: Aetna Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$82.11
|
| Rate for Payer: Cigna All Commercial |
$118.10
|
| Rate for Payer: CORVEL All Commercial |
$127.27
|
| Rate for Payer: Coventry All Commercial |
$120.43
|
| Rate for Payer: Encore All Commercial |
$125.97
|
| Rate for Payer: Frontpath All Commercial |
$125.90
|
| Rate for Payer: Humana ChoiceCare |
$118.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.17
|
| Rate for Payer: PHCS All Commercial |
$102.64
|
| Rate for Payer: PHP All Commercial |
$103.79
|
| Rate for Payer: Sagamore Health Network All Products |
$105.65
|
| Rate for Payer: Signature Care EPO |
$113.59
|
| Rate for Payer: Signature Care PPO |
$120.43
|
| Rate for Payer: United Healthcare Commercial |
$107.84
|
|
|
HC AQUAMANTYS BIPOLAR SEAL
|
Facility
|
IP
|
$2,530.80
|
|
| Hospital Charge Code |
41602820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,898.10 |
| Max. Negotiated Rate |
$2,353.64 |
| Rate for Payer: Aetna Commercial |
$2,186.61
|
| Rate for Payer: Cash Price |
$1,518.48
|
| Rate for Payer: Cigna All Commercial |
$2,184.08
|
| Rate for Payer: CORVEL All Commercial |
$2,353.64
|
| Rate for Payer: Coventry All Commercial |
$2,227.10
|
| Rate for Payer: Encore All Commercial |
$2,329.60
|
| Rate for Payer: Frontpath All Commercial |
$2,328.34
|
| Rate for Payer: Humana ChoiceCare |
$2,185.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,277.72
|
| Rate for Payer: PHCS All Commercial |
$1,898.10
|
| Rate for Payer: PHP All Commercial |
$1,919.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,953.78
|
| Rate for Payer: Signature Care EPO |
$2,100.56
|
| Rate for Payer: Signature Care PPO |
$2,227.10
|
| Rate for Payer: United Healthcare Commercial |
$1,994.27
|
|
|
HC AQUAMANTYS BIPOLAR SEAL
|
Facility
|
OP
|
$2,530.80
|
|
| Hospital Charge Code |
41602820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$2,353.64 |
| Rate for Payer: Aetna Commercial |
$2,136.00
|
| Rate for Payer: Aetna Medicare |
$809.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$784.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,453.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,582.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$931.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$890.84
|
| Rate for Payer: Cash Price |
$1,518.48
|
| Rate for Payer: Cash Price |
$1,518.48
|
| Rate for Payer: Centivo All Commercial |
$1,376.76
|
| Rate for Payer: Cigna All Commercial |
$2,184.08
|
| Rate for Payer: CORVEL All Commercial |
$2,353.64
|
| Rate for Payer: Coventry All Commercial |
$2,227.10
|
| Rate for Payer: Encore All Commercial |
$2,329.60
|
| Rate for Payer: Frontpath All Commercial |
$2,328.34
|
| Rate for Payer: Humana ChoiceCare |
$2,185.85
|
| Rate for Payer: Humana Medicare |
$809.86
|
| Rate for Payer: Lucent All Commercial |
$1,376.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,277.72
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,898.10
|
| Rate for Payer: PHP All Commercial |
$1,919.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$987.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,953.78
|
| Rate for Payer: Signature Care EPO |
$2,100.56
|
| Rate for Payer: Signature Care PPO |
$2,227.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,151.18
|
| Rate for Payer: United Healthcare Commercial |
$1,994.27
|
| Rate for Payer: United Healthcare Medicare |
$809.86
|
|
|
HC AQUA PAD 15X22 DISP
|
Facility
|
IP
|
$125.51
|
|
| Hospital Charge Code |
41601085
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$94.13 |
| Max. Negotiated Rate |
$116.72 |
| Rate for Payer: Aetna Commercial |
$108.44
|
| Rate for Payer: Cash Price |
$75.31
|
| Rate for Payer: Cigna All Commercial |
$108.32
|
| Rate for Payer: CORVEL All Commercial |
$116.72
|
| Rate for Payer: Coventry All Commercial |
$110.45
|
| Rate for Payer: Encore All Commercial |
$115.53
|
| Rate for Payer: Frontpath All Commercial |
$115.47
|
| Rate for Payer: Humana ChoiceCare |
$108.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.96
|
| Rate for Payer: PHCS All Commercial |
$94.13
|
| Rate for Payer: PHP All Commercial |
$95.19
|
| Rate for Payer: Sagamore Health Network All Products |
$96.89
|
| Rate for Payer: Signature Care EPO |
$104.17
|
| Rate for Payer: Signature Care PPO |
$110.45
|
| Rate for Payer: United Healthcare Commercial |
$98.90
|
|
|
HC AQUA PAD 15X22 DISP
|
Facility
|
OP
|
$125.51
|
|
| Hospital Charge Code |
41601085
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$116.72 |
| Rate for Payer: Aetna Commercial |
$105.93
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$72.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.18
|
| Rate for Payer: Cash Price |
$75.31
|
| Rate for Payer: Cash Price |
$75.31
|
| Rate for Payer: Centivo All Commercial |
$68.28
|
| Rate for Payer: Cigna All Commercial |
$108.32
|
| Rate for Payer: CORVEL All Commercial |
$116.72
|
| Rate for Payer: Coventry All Commercial |
$110.45
|
| Rate for Payer: Encore All Commercial |
$115.53
|
| Rate for Payer: Frontpath All Commercial |
$115.47
|
| Rate for Payer: Humana ChoiceCare |
$108.40
|
| Rate for Payer: Humana Medicare |
$40.16
|
| Rate for Payer: Lucent All Commercial |
$68.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.96
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$94.13
|
| Rate for Payer: PHP All Commercial |
$95.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.95
|
| Rate for Payer: Sagamore Health Network All Products |
$96.89
|
| Rate for Payer: Signature Care EPO |
$104.17
|
| Rate for Payer: Signature Care PPO |
$110.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.68
|
| Rate for Payer: United Healthcare Commercial |
$98.90
|
| Rate for Payer: United Healthcare Medicare |
$40.16
|
|
|
HC AQUATIC THERAPY/15 MIN-OT
|
Facility
|
OP
|
$140.33
|
|
|
Service Code
|
CPT 97113 GO
|
| Hospital Charge Code |
1738202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$130.51 |
| Rate for Payer: Aetna Commercial |
$118.44
|
| Rate for Payer: Aetna Medicare |
$44.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$80.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.40
|
| Rate for Payer: Cash Price |
$84.20
|
| Rate for Payer: Cash Price |
$84.20
|
| Rate for Payer: Centivo All Commercial |
$76.34
|
| Rate for Payer: Cigna All Commercial |
$121.10
|
| Rate for Payer: CORVEL All Commercial |
$130.51
|
| Rate for Payer: Coventry All Commercial |
$123.49
|
| Rate for Payer: Encore All Commercial |
$129.17
|
| Rate for Payer: Frontpath All Commercial |
$129.10
|
| Rate for Payer: Humana ChoiceCare |
$121.20
|
| Rate for Payer: Humana Medicare |
$44.91
|
| Rate for Payer: Lucent All Commercial |
$76.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.30
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$105.25
|
| Rate for Payer: PHP All Commercial |
$106.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.73
|
| Rate for Payer: Sagamore Health Network All Products |
$108.33
|
| Rate for Payer: Signature Care EPO |
$116.47
|
| Rate for Payer: Signature Care PPO |
$123.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.28
|
| Rate for Payer: United Healthcare Commercial |
$110.58
|
| Rate for Payer: United Healthcare Medicare |
$44.91
|
|
|
HC AQUATIC THERAPY/15 MIN-OT
|
Facility
|
IP
|
$140.33
|
|
|
Service Code
|
CPT 97113 GO
|
| Hospital Charge Code |
1738202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$105.25 |
| Max. Negotiated Rate |
$130.51 |
| Rate for Payer: Aetna Commercial |
$121.25
|
| Rate for Payer: Cash Price |
$84.20
|
| Rate for Payer: Cigna All Commercial |
$121.10
|
| Rate for Payer: CORVEL All Commercial |
$130.51
|
| Rate for Payer: Coventry All Commercial |
$123.49
|
| Rate for Payer: Encore All Commercial |
$129.17
|
| Rate for Payer: Frontpath All Commercial |
$129.10
|
| Rate for Payer: Humana ChoiceCare |
$121.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.30
|
| Rate for Payer: PHCS All Commercial |
$105.25
|
| Rate for Payer: PHP All Commercial |
$106.43
|
| Rate for Payer: Sagamore Health Network All Products |
$108.33
|
| Rate for Payer: Signature Care EPO |
$116.47
|
| Rate for Payer: Signature Care PPO |
$123.49
|
| Rate for Payer: United Healthcare Commercial |
$110.58
|
|
