|
HC FC DRAWING FEE
|
Facility
IP
|
$5.56
|
|
| Hospital Charge Code |
63002256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cigna All Commercial |
$4.80
|
| Rate for Payer: CORVEL All Commercial |
$5.17
|
| Rate for Payer: Coventry All Commercial |
$4.89
|
| Rate for Payer: Encore All Commercial |
$5.12
|
| Rate for Payer: Frontpath All Commercial |
$5.11
|
| Rate for Payer: Humana ChoiceCare |
$4.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.00
|
| Rate for Payer: PHCS All Commercial |
$4.17
|
| Rate for Payer: PHP All Commercial |
$4.22
|
| Rate for Payer: Sagamore Health Network All Products |
$4.29
|
| Rate for Payer: Signature Care EPO |
$4.61
|
| Rate for Payer: Signature Care PPO |
$4.89
|
| Rate for Payer: United Healthcare Commercial |
$4.38
|
|
|
HC FC FERRITIN
|
Facility
IP
|
$22.80
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
63001540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Cigna All Commercial |
$19.67
|
| Rate for Payer: CORVEL All Commercial |
$21.20
|
| Rate for Payer: Coventry All Commercial |
$20.06
|
| Rate for Payer: Encore All Commercial |
$20.98
|
| Rate for Payer: Frontpath All Commercial |
$20.97
|
| Rate for Payer: Humana ChoiceCare |
$19.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.52
|
| Rate for Payer: PHCS All Commercial |
$17.10
|
| Rate for Payer: PHP All Commercial |
$17.29
|
| Rate for Payer: Sagamore Health Network All Products |
$17.60
|
| Rate for Payer: Signature Care EPO |
$18.92
|
| Rate for Payer: Signature Care PPO |
$20.06
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
|
|
HC FC FERRITIN
|
Facility
OP
|
$22.80
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
63001540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: Aetna Medicare |
$7.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.28
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Centivo All Commercial |
$11.63
|
| Rate for Payer: Cigna All Commercial |
$19.67
|
| Rate for Payer: CORVEL All Commercial |
$21.20
|
| Rate for Payer: Coventry All Commercial |
$20.06
|
| Rate for Payer: Encore All Commercial |
$20.98
|
| Rate for Payer: Frontpath All Commercial |
$20.97
|
| Rate for Payer: Humana ChoiceCare |
$19.69
|
| Rate for Payer: Humana Medicare |
$11.63
|
| Rate for Payer: Lucent All Commercial |
$11.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.52
|
| Rate for Payer: Managed Health Services Medicaid |
$13.63
|
| Rate for Payer: MDWise Medicaid |
$13.63
|
| Rate for Payer: PHCS All Commercial |
$17.10
|
| Rate for Payer: PHP All Commercial |
$17.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.89
|
| Rate for Payer: Sagamore Health Network All Products |
$17.60
|
| Rate for Payer: Signature Care EPO |
$18.92
|
| Rate for Payer: Signature Care PPO |
$20.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.38
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
| Rate for Payer: United Healthcare Medicare |
$7.52
|
|
|
HC FC FREE T4
|
Facility
OP
|
$22.80
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
63001688
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: Aetna Medicare |
$7.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.28
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Centivo All Commercial |
$11.63
|
| Rate for Payer: Cigna All Commercial |
$19.67
|
| Rate for Payer: CORVEL All Commercial |
$21.20
|
| Rate for Payer: Coventry All Commercial |
$20.06
|
| Rate for Payer: Encore All Commercial |
$20.98
|
| Rate for Payer: Frontpath All Commercial |
$20.97
|
| Rate for Payer: Humana ChoiceCare |
$19.69
|
| Rate for Payer: Humana Medicare |
$11.63
|
| Rate for Payer: Lucent All Commercial |
$11.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.52
|
| Rate for Payer: Managed Health Services Medicaid |
$9.02
|
| Rate for Payer: MDWise Medicaid |
$9.02
|
| Rate for Payer: PHCS All Commercial |
$17.10
|
| Rate for Payer: PHP All Commercial |
$17.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.89
|
| Rate for Payer: Sagamore Health Network All Products |
$17.60
|
| Rate for Payer: Signature Care EPO |
$18.92
|
| Rate for Payer: Signature Care PPO |
$20.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.38
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
| Rate for Payer: United Healthcare Medicare |
$7.52
|
|
|
HC FC FREE T4
|
Facility
IP
|
$22.80
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
63001688
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Cigna All Commercial |
$19.67
|
| Rate for Payer: CORVEL All Commercial |
$21.20
|
| Rate for Payer: Coventry All Commercial |
$20.06
|
| Rate for Payer: Encore All Commercial |
$20.98
|
| Rate for Payer: Frontpath All Commercial |
$20.97
|
| Rate for Payer: Humana ChoiceCare |
$19.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.52
|
| Rate for Payer: PHCS All Commercial |
$17.10
|
| Rate for Payer: PHP All Commercial |
$17.29
|
| Rate for Payer: Sagamore Health Network All Products |
$17.60
|
| Rate for Payer: Signature Care EPO |
$18.92
|
| Rate for Payer: Signature Care PPO |
$20.06
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
|
|
HC FC HIV-1 & 2 SCREEN
|
Facility
OP
|
$25.57
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
63002031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$24.08 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.28
|
| Rate for Payer: Cash Price |
$15.85
|
| Rate for Payer: Cash Price |
$15.85
|
| Rate for Payer: Centivo All Commercial |
$13.04
|
| Rate for Payer: Cigna All Commercial |
$22.07
|
| Rate for Payer: CORVEL All Commercial |
$23.78
|
| Rate for Payer: Coventry All Commercial |
$22.50
|
| Rate for Payer: Encore All Commercial |
$23.54
|
| Rate for Payer: Frontpath All Commercial |
$23.53
|
| Rate for Payer: Humana ChoiceCare |
$22.09
|
| Rate for Payer: Humana Medicare |
$13.04
|
| Rate for Payer: Lucent All Commercial |
$13.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.01
|
| Rate for Payer: Managed Health Services Medicaid |
$24.08
|
| Rate for Payer: MDWise Medicaid |
$24.08
|
| Rate for Payer: PHCS All Commercial |
$19.18
|
| Rate for Payer: PHP All Commercial |
$19.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.97
|
| Rate for Payer: Sagamore Health Network All Products |
$19.74
|
| Rate for Payer: Signature Care EPO |
$21.22
|
| Rate for Payer: Signature Care PPO |
$22.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.74
|
| Rate for Payer: United Healthcare Commercial |
$20.15
|
| Rate for Payer: United Healthcare Medicare |
$8.44
|
|
|
HC FC HIV-1 & 2 SCREEN
|
Facility
IP
|
$25.57
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
63002031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$23.78 |
| Rate for Payer: Aetna Commercial |
$22.09
|
| Rate for Payer: Cash Price |
$15.85
|
| Rate for Payer: Cigna All Commercial |
$22.07
|
| Rate for Payer: CORVEL All Commercial |
$23.78
|
| Rate for Payer: Coventry All Commercial |
$22.50
|
| Rate for Payer: Encore All Commercial |
$23.54
|
| Rate for Payer: Frontpath All Commercial |
$23.53
|
| Rate for Payer: Humana ChoiceCare |
$22.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.01
|
| Rate for Payer: PHCS All Commercial |
$19.18
|
| Rate for Payer: PHP All Commercial |
$19.39
|
| Rate for Payer: Sagamore Health Network All Products |
$19.74
|
| Rate for Payer: Signature Care EPO |
$21.22
|
| Rate for Payer: Signature Care PPO |
$22.50
|
| Rate for Payer: United Healthcare Commercial |
$20.15
|
|
|
HC FC IRON
|
Facility
OP
|
$10.57
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
63001614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.84
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Centivo All Commercial |
$5.39
|
| Rate for Payer: Cigna All Commercial |
$9.12
|
| Rate for Payer: CORVEL All Commercial |
$9.83
|
| Rate for Payer: Coventry All Commercial |
$9.30
|
| Rate for Payer: Encore All Commercial |
$9.73
|
| Rate for Payer: Frontpath All Commercial |
$9.72
|
| Rate for Payer: Humana ChoiceCare |
$9.13
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: Lucent All Commercial |
$5.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.51
|
| Rate for Payer: Managed Health Services Medicaid |
$6.47
|
| Rate for Payer: MDWise Medicaid |
$6.47
|
| Rate for Payer: PHCS All Commercial |
$7.93
|
| Rate for Payer: PHP All Commercial |
$8.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.12
|
| Rate for Payer: Sagamore Health Network All Products |
$8.16
|
| Rate for Payer: Signature Care EPO |
$8.77
|
| Rate for Payer: Signature Care PPO |
$9.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$8.33
|
| Rate for Payer: United Healthcare Medicare |
$3.49
|
|
|
HC FC IRON
|
Facility
IP
|
$10.57
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
63001614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Cigna All Commercial |
$9.12
|
| Rate for Payer: Aetna Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: CORVEL All Commercial |
$9.83
|
| Rate for Payer: Coventry All Commercial |
$9.30
|
| Rate for Payer: Encore All Commercial |
$9.73
|
| Rate for Payer: Frontpath All Commercial |
$9.72
|
| Rate for Payer: Humana ChoiceCare |
$9.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.51
|
| Rate for Payer: PHCS All Commercial |
$7.93
|
| Rate for Payer: PHP All Commercial |
$8.01
|
| Rate for Payer: Sagamore Health Network All Products |
$8.16
|
| Rate for Payer: Signature Care EPO |
$8.77
|
| Rate for Payer: Signature Care PPO |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$8.33
|
|
|
HC FC LIPASE
|
Facility
IP
|
$12.24
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
63001621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Aetna Commercial |
$10.58
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cigna All Commercial |
$10.56
|
| Rate for Payer: CORVEL All Commercial |
$11.38
|
| Rate for Payer: Coventry All Commercial |
$10.77
|
| Rate for Payer: Encore All Commercial |
$11.27
|
| Rate for Payer: Frontpath All Commercial |
$11.26
|
| Rate for Payer: Humana ChoiceCare |
$10.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.02
|
| Rate for Payer: PHCS All Commercial |
$9.18
|
| Rate for Payer: PHP All Commercial |
$9.28
|
| Rate for Payer: Sagamore Health Network All Products |
$9.45
|
| Rate for Payer: Signature Care EPO |
$10.16
|
| Rate for Payer: Signature Care PPO |
$10.77
|
| Rate for Payer: United Healthcare Commercial |
$9.65
|
|
|
HC FC LIPASE
|
Facility
OP
|
$12.24
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
63001621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Aetna Commercial |
$10.33
|
| Rate for Payer: Aetna Medicare |
$4.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.44
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Centivo All Commercial |
$6.24
|
| Rate for Payer: Cigna All Commercial |
$10.56
|
| Rate for Payer: CORVEL All Commercial |
$11.38
|
| Rate for Payer: Coventry All Commercial |
$10.77
|
| Rate for Payer: Encore All Commercial |
$11.27
|
| Rate for Payer: Frontpath All Commercial |
$11.26
|
| Rate for Payer: Humana ChoiceCare |
$10.57
|
| Rate for Payer: Humana Medicare |
$6.24
|
| Rate for Payer: Lucent All Commercial |
$6.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.02
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$9.18
|
| Rate for Payer: PHP All Commercial |
$9.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.77
|
| Rate for Payer: Sagamore Health Network All Products |
$9.45
|
| Rate for Payer: Signature Care EPO |
$10.16
|
| Rate for Payer: Signature Care PPO |
$10.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.40
|
| Rate for Payer: United Healthcare Commercial |
$9.65
|
| Rate for Payer: United Healthcare Medicare |
$4.04
|
|
|
HC FC LIPID PANEL
|
Facility
OP
|
$15.30
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63001366
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$14.23 |
| Rate for Payer: Aetna Commercial |
$12.91
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.55
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Centivo All Commercial |
$7.80
|
| Rate for Payer: Cigna All Commercial |
$13.20
|
| Rate for Payer: CORVEL All Commercial |
$14.23
|
| Rate for Payer: Coventry All Commercial |
$13.46
|
| Rate for Payer: Encore All Commercial |
$14.08
|
| Rate for Payer: Frontpath All Commercial |
$14.08
|
| Rate for Payer: Humana ChoiceCare |
$13.21
|
| Rate for Payer: Humana Medicare |
$7.80
|
| Rate for Payer: Lucent All Commercial |
$7.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.77
|
| Rate for Payer: Managed Health Services Medicaid |
$13.39
|
| Rate for Payer: MDWise Medicaid |
$13.39
|
| Rate for Payer: PHCS All Commercial |
$11.48
|
| Rate for Payer: PHP All Commercial |
$11.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.97
|
| Rate for Payer: Sagamore Health Network All Products |
$11.81
|
| Rate for Payer: Signature Care EPO |
$12.70
|
| Rate for Payer: Signature Care PPO |
$13.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.00
|
| Rate for Payer: United Healthcare Commercial |
$12.06
|
| Rate for Payer: United Healthcare Medicare |
$5.05
|
|
|
HC FC LIPID PANEL
|
Facility
IP
|
$15.30
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63001366
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$14.23 |
| Rate for Payer: Aetna Commercial |
$13.22
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cigna All Commercial |
$13.20
|
| Rate for Payer: CORVEL All Commercial |
$14.23
|
| Rate for Payer: Coventry All Commercial |
$13.46
|
| Rate for Payer: Encore All Commercial |
$14.08
|
| Rate for Payer: Frontpath All Commercial |
$14.08
|
| Rate for Payer: Humana ChoiceCare |
$13.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.77
|
| Rate for Payer: PHCS All Commercial |
$11.48
|
| Rate for Payer: PHP All Commercial |
$11.60
|
| Rate for Payer: Sagamore Health Network All Products |
$11.81
|
| Rate for Payer: Signature Care EPO |
$12.70
|
| Rate for Payer: Signature Care PPO |
$13.46
|
| Rate for Payer: United Healthcare Commercial |
$12.06
|
|
|
HC FC LIVER FUNCTION PANEL
|
Facility
OP
|
$9.69
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
63001368
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Aetna Commercial |
$8.18
|
| Rate for Payer: Aetna Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.52
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Centivo All Commercial |
$4.94
|
| Rate for Payer: Cigna All Commercial |
$8.36
|
| Rate for Payer: CORVEL All Commercial |
$9.01
|
| Rate for Payer: Coventry All Commercial |
$8.53
|
| Rate for Payer: Encore All Commercial |
$8.92
|
| Rate for Payer: Frontpath All Commercial |
$8.91
|
| Rate for Payer: Humana ChoiceCare |
$8.37
|
| Rate for Payer: Humana Medicare |
$4.94
|
| Rate for Payer: Lucent All Commercial |
$4.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.72
|
| Rate for Payer: Managed Health Services Medicaid |
$8.17
|
| Rate for Payer: MDWise Medicaid |
$8.17
|
| Rate for Payer: PHCS All Commercial |
$7.27
|
| Rate for Payer: PHP All Commercial |
$7.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.78
|
| Rate for Payer: Sagamore Health Network All Products |
$7.48
|
| Rate for Payer: Signature Care EPO |
$8.04
|
| Rate for Payer: Signature Care PPO |
$8.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
| Rate for Payer: United Healthcare Medicare |
$3.20
|
|
|
HC FC LIVER FUNCTION PANEL
|
Facility
IP
|
$9.69
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
63001368
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cigna All Commercial |
$8.36
|
| Rate for Payer: CORVEL All Commercial |
$9.01
|
| Rate for Payer: Coventry All Commercial |
$8.53
|
| Rate for Payer: Encore All Commercial |
$8.92
|
| Rate for Payer: Frontpath All Commercial |
$8.91
|
| Rate for Payer: Humana ChoiceCare |
$8.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.72
|
| Rate for Payer: PHCS All Commercial |
$7.27
|
| Rate for Payer: PHP All Commercial |
$7.35
|
| Rate for Payer: Sagamore Health Network All Products |
$7.48
|
| Rate for Payer: Signature Care EPO |
$8.04
|
| Rate for Payer: Signature Care PPO |
$8.53
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
|
|
HC FC PHENYTOIN
|
Facility
OP
|
$24.74
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
63001378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.98
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Centivo All Commercial |
$12.61
|
| Rate for Payer: Cigna All Commercial |
$21.35
|
| Rate for Payer: CORVEL All Commercial |
$23.00
|
| Rate for Payer: Coventry All Commercial |
$21.77
|
| Rate for Payer: Encore All Commercial |
$22.77
|
| Rate for Payer: Frontpath All Commercial |
$22.76
|
| Rate for Payer: Humana ChoiceCare |
$21.36
|
| Rate for Payer: Humana Medicare |
$12.61
|
| Rate for Payer: Lucent All Commercial |
$12.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.26
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$18.55
|
| Rate for Payer: PHP All Commercial |
$18.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.65
|
| Rate for Payer: Sagamore Health Network All Products |
$19.10
|
| Rate for Payer: Signature Care EPO |
$20.53
|
| Rate for Payer: Signature Care PPO |
$21.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.02
|
| Rate for Payer: United Healthcare Commercial |
$19.49
|
| Rate for Payer: United Healthcare Medicare |
$8.16
|
|
|
HC FC PHENYTOIN
|
Facility
IP
|
$24.74
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
63001378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$21.37
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cigna All Commercial |
$21.35
|
| Rate for Payer: CORVEL All Commercial |
$23.00
|
| Rate for Payer: Coventry All Commercial |
$21.77
|
| Rate for Payer: Encore All Commercial |
$22.77
|
| Rate for Payer: Frontpath All Commercial |
$22.76
|
| Rate for Payer: Humana ChoiceCare |
$21.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.26
|
| Rate for Payer: PHCS All Commercial |
$18.55
|
| Rate for Payer: PHP All Commercial |
$18.76
|
| Rate for Payer: Sagamore Health Network All Products |
$19.10
|
| Rate for Payer: Signature Care EPO |
$20.53
|
| Rate for Payer: Signature Care PPO |
$21.77
|
| Rate for Payer: United Healthcare Commercial |
$19.49
|
|
|
HC FC PROTIME
|
Facility
OP
|
$10.01
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
63001750
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.45
|
| Rate for Payer: Aetna Medicare |
$3.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.63
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Centivo All Commercial |
$5.10
|
| Rate for Payer: Cigna All Commercial |
$8.64
|
| Rate for Payer: CORVEL All Commercial |
$9.31
|
| Rate for Payer: Coventry All Commercial |
$8.81
|
| Rate for Payer: Encore All Commercial |
$9.21
|
| Rate for Payer: Frontpath All Commercial |
$9.21
|
| Rate for Payer: Humana ChoiceCare |
$8.64
|
| Rate for Payer: Humana Medicare |
$5.10
|
| Rate for Payer: Lucent All Commercial |
$5.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.01
|
| Rate for Payer: Managed Health Services Medicaid |
$4.29
|
| Rate for Payer: MDWise Medicaid |
$4.29
|
| Rate for Payer: PHCS All Commercial |
$7.50
|
| Rate for Payer: PHP All Commercial |
$7.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.90
|
| Rate for Payer: Sagamore Health Network All Products |
$7.72
|
| Rate for Payer: Signature Care EPO |
$8.31
|
| Rate for Payer: Signature Care PPO |
$8.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.51
|
| Rate for Payer: United Healthcare Commercial |
$7.88
|
| Rate for Payer: United Healthcare Medicare |
$3.30
|
|
|
HC FC PROTIME
|
Facility
IP
|
$10.01
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
63001750
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.65
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cigna All Commercial |
$8.64
|
| Rate for Payer: CORVEL All Commercial |
$9.31
|
| Rate for Payer: Coventry All Commercial |
$8.81
|
| Rate for Payer: Encore All Commercial |
$9.21
|
| Rate for Payer: Frontpath All Commercial |
$9.21
|
| Rate for Payer: Humana ChoiceCare |
$8.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.01
|
| Rate for Payer: PHCS All Commercial |
$7.50
|
| Rate for Payer: PHP All Commercial |
$7.59
|
| Rate for Payer: Sagamore Health Network All Products |
$7.72
|
| Rate for Payer: Signature Care EPO |
$8.31
|
| Rate for Payer: Signature Care PPO |
$8.81
|
| Rate for Payer: United Healthcare Commercial |
$7.88
|
|
|
HC FC PSA
|
Facility
OP
|
$18.06
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
63001665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$18.39 |
| Rate for Payer: Aetna Commercial |
$15.25
|
| Rate for Payer: Aetna Medicare |
$5.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.56
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Centivo All Commercial |
$9.21
|
| Rate for Payer: Cigna All Commercial |
$15.59
|
| Rate for Payer: CORVEL All Commercial |
$16.80
|
| Rate for Payer: Coventry All Commercial |
$15.90
|
| Rate for Payer: Encore All Commercial |
$16.63
|
| Rate for Payer: Frontpath All Commercial |
$16.62
|
| Rate for Payer: Humana ChoiceCare |
$15.60
|
| Rate for Payer: Humana Medicare |
$9.21
|
| Rate for Payer: Lucent All Commercial |
$9.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.26
|
| Rate for Payer: Managed Health Services Medicaid |
$18.39
|
| Rate for Payer: MDWise Medicaid |
$18.39
|
| Rate for Payer: PHCS All Commercial |
$13.55
|
| Rate for Payer: PHP All Commercial |
$13.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.05
|
| Rate for Payer: Sagamore Health Network All Products |
$13.95
|
| Rate for Payer: Signature Care EPO |
$14.99
|
| Rate for Payer: Signature Care PPO |
$15.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.35
|
| Rate for Payer: United Healthcare Commercial |
$14.23
|
| Rate for Payer: United Healthcare Medicare |
$5.96
|
|
|
HC FC PSA
|
Facility
IP
|
$18.06
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
63001665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cigna All Commercial |
$15.59
|
| Rate for Payer: CORVEL All Commercial |
$16.80
|
| Rate for Payer: Coventry All Commercial |
$15.90
|
| Rate for Payer: Encore All Commercial |
$16.63
|
| Rate for Payer: Frontpath All Commercial |
$16.62
|
| Rate for Payer: Humana ChoiceCare |
$15.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.26
|
| Rate for Payer: PHCS All Commercial |
$13.55
|
| Rate for Payer: PHP All Commercial |
$13.70
|
| Rate for Payer: Sagamore Health Network All Products |
$13.95
|
| Rate for Payer: Signature Care EPO |
$14.99
|
| Rate for Payer: Signature Care PPO |
$15.90
|
| Rate for Payer: United Healthcare Commercial |
$14.23
|
|
|
HC FC SEDRATE
|
Facility
OP
|
$8.06
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
63001753
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna Medicare |
$2.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.93
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Centivo All Commercial |
$4.11
|
| Rate for Payer: Cigna All Commercial |
$6.95
|
| Rate for Payer: CORVEL All Commercial |
$7.49
|
| Rate for Payer: Coventry All Commercial |
$7.09
|
| Rate for Payer: Encore All Commercial |
$7.42
|
| Rate for Payer: Frontpath All Commercial |
$7.41
|
| Rate for Payer: Humana ChoiceCare |
$6.96
|
| Rate for Payer: Humana Medicare |
$4.11
|
| Rate for Payer: Lucent All Commercial |
$4.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.25
|
| Rate for Payer: Managed Health Services Medicaid |
$2.70
|
| Rate for Payer: MDWise Medicaid |
$2.70
|
| Rate for Payer: PHCS All Commercial |
$6.04
|
| Rate for Payer: PHP All Commercial |
$6.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.14
|
| Rate for Payer: Sagamore Health Network All Products |
$6.22
|
| Rate for Payer: Signature Care EPO |
$6.69
|
| Rate for Payer: Signature Care PPO |
$7.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.85
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare |
$2.66
|
|
|
HC FC SEDRATE
|
Facility
IP
|
$8.06
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
63001753
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna All Commercial |
$6.95
|
| Rate for Payer: CORVEL All Commercial |
$7.49
|
| Rate for Payer: Coventry All Commercial |
$7.09
|
| Rate for Payer: Encore All Commercial |
$7.42
|
| Rate for Payer: Frontpath All Commercial |
$7.41
|
| Rate for Payer: Humana ChoiceCare |
$6.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.25
|
| Rate for Payer: PHCS All Commercial |
$6.04
|
| Rate for Payer: PHP All Commercial |
$6.11
|
| Rate for Payer: Sagamore Health Network All Products |
$6.22
|
| Rate for Payer: Signature Care EPO |
$6.69
|
| Rate for Payer: Signature Care PPO |
$7.09
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
|
|
HC FC SGPT
|
Facility
OP
|
$10.57
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
63001697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.84
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Centivo All Commercial |
$5.39
|
| Rate for Payer: Cigna All Commercial |
$9.12
|
| Rate for Payer: CORVEL All Commercial |
$9.83
|
| Rate for Payer: Coventry All Commercial |
$9.30
|
| Rate for Payer: Encore All Commercial |
$9.73
|
| Rate for Payer: Frontpath All Commercial |
$9.72
|
| Rate for Payer: Humana ChoiceCare |
$9.13
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: Lucent All Commercial |
$5.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.51
|
| Rate for Payer: Managed Health Services Medicaid |
$5.30
|
| Rate for Payer: MDWise Medicaid |
$5.30
|
| Rate for Payer: PHCS All Commercial |
$7.93
|
| Rate for Payer: PHP All Commercial |
$8.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.12
|
| Rate for Payer: Sagamore Health Network All Products |
$8.16
|
| Rate for Payer: Signature Care EPO |
$8.77
|
| Rate for Payer: Signature Care PPO |
$9.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$8.33
|
| Rate for Payer: United Healthcare Medicare |
$3.49
|
|
|
HC FC SGPT
|
Facility
IP
|
$10.57
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
63001697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cigna All Commercial |
$9.12
|
| Rate for Payer: CORVEL All Commercial |
$9.83
|
| Rate for Payer: Coventry All Commercial |
$9.30
|
| Rate for Payer: Encore All Commercial |
$9.73
|
| Rate for Payer: Frontpath All Commercial |
$9.72
|
| Rate for Payer: Humana ChoiceCare |
$9.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.51
|
| Rate for Payer: PHCS All Commercial |
$7.93
|
| Rate for Payer: PHP All Commercial |
$8.01
|
| Rate for Payer: Sagamore Health Network All Products |
$8.16
|
| Rate for Payer: Signature Care EPO |
$8.77
|
| Rate for Payer: Signature Care PPO |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$8.33
|
|
