|
HC HDNRBC ANTIBODY TITER
|
Facility
OP
|
$213.01
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
63001343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$198.10 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$70.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$122.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.32
|
| Rate for Payer: Cash Price |
$132.06
|
| Rate for Payer: Cash Price |
$132.06
|
| Rate for Payer: Centivo All Commercial |
$108.63
|
| Rate for Payer: Cigna All Commercial |
$183.82
|
| Rate for Payer: CORVEL All Commercial |
$198.10
|
| Rate for Payer: Coventry All Commercial |
$187.45
|
| Rate for Payer: Encore All Commercial |
$196.07
|
| Rate for Payer: Frontpath All Commercial |
$195.97
|
| Rate for Payer: Humana ChoiceCare |
$183.97
|
| Rate for Payer: Humana Medicare |
$108.63
|
| Rate for Payer: Lucent All Commercial |
$108.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.71
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$159.75
|
| Rate for Payer: PHP All Commercial |
$161.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.07
|
| Rate for Payer: Sagamore Health Network All Products |
$164.44
|
| Rate for Payer: Signature Care EPO |
$176.80
|
| Rate for Payer: Signature Care PPO |
$187.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$181.06
|
| Rate for Payer: United Healthcare Commercial |
$167.85
|
| Rate for Payer: United Healthcare Medicare |
$70.29
|
|
|
HC HDNRBC ANTIBODY TITER
|
Facility
IP
|
$213.01
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
63001343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$198.10 |
| Rate for Payer: Aetna Commercial |
$184.04
|
| Rate for Payer: Cash Price |
$132.06
|
| Rate for Payer: Cigna All Commercial |
$183.82
|
| Rate for Payer: CORVEL All Commercial |
$198.10
|
| Rate for Payer: Coventry All Commercial |
$187.45
|
| Rate for Payer: Encore All Commercial |
$196.07
|
| Rate for Payer: Frontpath All Commercial |
$195.97
|
| Rate for Payer: Humana ChoiceCare |
$183.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.71
|
| Rate for Payer: PHCS All Commercial |
$159.75
|
| Rate for Payer: PHP All Commercial |
$161.54
|
| Rate for Payer: Sagamore Health Network All Products |
$164.44
|
| Rate for Payer: Signature Care EPO |
$176.80
|
| Rate for Payer: Signature Care PPO |
$187.45
|
| Rate for Payer: United Healthcare Commercial |
$167.85
|
|
|
HC HE4, OVARIAN CANCER MONITORING
|
Facility
OP
|
$1,005.38
|
|
|
Service Code
|
CPT 86305
|
| Hospital Charge Code |
63001036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$935.01 |
| Rate for Payer: Aetna Commercial |
$848.54
|
| Rate for Payer: Aetna Medicare |
$331.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$331.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$577.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$628.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$381.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$364.95
|
| Rate for Payer: Cash Price |
$623.34
|
| Rate for Payer: Cash Price |
$623.34
|
| Rate for Payer: Centivo All Commercial |
$512.75
|
| Rate for Payer: Cigna All Commercial |
$867.65
|
| Rate for Payer: CORVEL All Commercial |
$935.01
|
| Rate for Payer: Coventry All Commercial |
$884.74
|
| Rate for Payer: Encore All Commercial |
$925.46
|
| Rate for Payer: Frontpath All Commercial |
$924.95
|
| Rate for Payer: Humana ChoiceCare |
$868.35
|
| Rate for Payer: Humana Medicare |
$512.75
|
| Rate for Payer: Lucent All Commercial |
$512.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$904.85
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$754.04
|
| Rate for Payer: PHP All Commercial |
$762.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$392.10
|
| Rate for Payer: Sagamore Health Network All Products |
$776.16
|
| Rate for Payer: Signature Care EPO |
$834.47
|
| Rate for Payer: Signature Care PPO |
$884.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$854.58
|
| Rate for Payer: United Healthcare Commercial |
$792.24
|
| Rate for Payer: United Healthcare Medicare |
$331.78
|
|
|
HC HE4, OVARIAN CANCER MONITORING
|
Facility
IP
|
$1,005.38
|
|
|
Service Code
|
CPT 86305
|
| Hospital Charge Code |
63001036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$754.04 |
| Max. Negotiated Rate |
$935.01 |
| Rate for Payer: Aetna Commercial |
$868.65
|
| Rate for Payer: Cash Price |
$623.34
|
| Rate for Payer: Cigna All Commercial |
$867.65
|
| Rate for Payer: CORVEL All Commercial |
$935.01
|
| Rate for Payer: Coventry All Commercial |
$884.74
|
| Rate for Payer: Encore All Commercial |
$925.46
|
| Rate for Payer: Frontpath All Commercial |
$924.95
|
| Rate for Payer: Humana ChoiceCare |
$868.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$904.85
|
| Rate for Payer: PHCS All Commercial |
$754.04
|
| Rate for Payer: PHP All Commercial |
$762.48
|
| Rate for Payer: Sagamore Health Network All Products |
$776.16
|
| Rate for Payer: Signature Care EPO |
$834.47
|
| Rate for Payer: Signature Care PPO |
$884.74
|
| Rate for Payer: United Healthcare Commercial |
$792.24
|
|
|
HC HEART SCAN SPECT MULTIPLE
|
Facility
IP
|
$6,352.10
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
01639452
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$4,764.08 |
| Max. Negotiated Rate |
$5,907.45 |
| Rate for Payer: Aetna Commercial |
$5,488.22
|
| Rate for Payer: Cash Price |
$3,938.30
|
| Rate for Payer: Cigna All Commercial |
$5,481.86
|
| Rate for Payer: CORVEL All Commercial |
$5,907.45
|
| Rate for Payer: Coventry All Commercial |
$5,589.85
|
| Rate for Payer: Encore All Commercial |
$5,847.11
|
| Rate for Payer: Frontpath All Commercial |
$5,843.93
|
| Rate for Payer: Humana ChoiceCare |
$5,486.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,716.89
|
| Rate for Payer: PHCS All Commercial |
$4,764.08
|
| Rate for Payer: PHP All Commercial |
$4,817.43
|
| Rate for Payer: Sagamore Health Network All Products |
$4,903.82
|
| Rate for Payer: Signature Care EPO |
$5,272.24
|
| Rate for Payer: Signature Care PPO |
$5,589.85
|
| Rate for Payer: United Healthcare Commercial |
$5,005.46
|
|
|
HC HEART SCAN SPECT MULTIPLE
|
Facility
OP
|
$6,352.10
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
01639452
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,095.24 |
| Max. Negotiated Rate |
$5,907.45 |
| Rate for Payer: Aetna Commercial |
$5,361.17
|
| Rate for Payer: Aetna Medicare |
$2,096.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,096.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,648.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,970.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,095.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,410.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,305.81
|
| Rate for Payer: Cash Price |
$3,938.30
|
| Rate for Payer: Cash Price |
$3,938.30
|
| Rate for Payer: Centivo All Commercial |
$3,239.57
|
| Rate for Payer: Cigna All Commercial |
$5,481.86
|
| Rate for Payer: CORVEL All Commercial |
$5,907.45
|
| Rate for Payer: Coventry All Commercial |
$5,589.85
|
| Rate for Payer: Encore All Commercial |
$5,847.11
|
| Rate for Payer: Frontpath All Commercial |
$5,843.93
|
| Rate for Payer: Humana ChoiceCare |
$5,486.31
|
| Rate for Payer: Humana Medicare |
$3,239.57
|
| Rate for Payer: Lucent All Commercial |
$3,239.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,716.89
|
| Rate for Payer: Managed Health Services Medicaid |
$1,095.24
|
| Rate for Payer: MDWise Medicaid |
$1,095.24
|
| Rate for Payer: PHCS All Commercial |
$4,764.08
|
| Rate for Payer: PHP All Commercial |
$4,817.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,477.32
|
| Rate for Payer: Sagamore Health Network All Products |
$4,903.82
|
| Rate for Payer: Signature Care EPO |
$5,272.24
|
| Rate for Payer: Signature Care PPO |
$5,589.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,399.29
|
| Rate for Payer: United Healthcare Commercial |
$5,005.46
|
| Rate for Payer: United Healthcare Medicare |
$2,096.19
|
|
|
HC HEART SCAN SPECT SINGLE
|
Facility
IP
|
$3,207.02
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
01639451
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,405.27 |
| Max. Negotiated Rate |
$2,982.53 |
| Rate for Payer: Aetna Commercial |
$2,770.87
|
| Rate for Payer: Cash Price |
$1,988.35
|
| Rate for Payer: Cigna All Commercial |
$2,767.66
|
| Rate for Payer: CORVEL All Commercial |
$2,982.53
|
| Rate for Payer: Coventry All Commercial |
$2,822.18
|
| Rate for Payer: Encore All Commercial |
$2,952.06
|
| Rate for Payer: Frontpath All Commercial |
$2,950.46
|
| Rate for Payer: Humana ChoiceCare |
$2,769.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,886.32
|
| Rate for Payer: PHCS All Commercial |
$2,405.27
|
| Rate for Payer: PHP All Commercial |
$2,432.21
|
| Rate for Payer: Sagamore Health Network All Products |
$2,475.82
|
| Rate for Payer: Signature Care EPO |
$2,661.83
|
| Rate for Payer: Signature Care PPO |
$2,822.18
|
| Rate for Payer: United Healthcare Commercial |
$2,527.13
|
|
|
HC HEART SCAN SPECT SINGLE
|
Facility
OP
|
$3,207.02
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
01639451
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$761.28 |
| Max. Negotiated Rate |
$2,982.53 |
| Rate for Payer: Aetna Commercial |
$2,706.73
|
| Rate for Payer: Aetna Medicare |
$1,058.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,058.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,841.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,004.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$761.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,217.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,164.15
|
| Rate for Payer: Cash Price |
$1,988.35
|
| Rate for Payer: Cash Price |
$1,988.35
|
| Rate for Payer: Centivo All Commercial |
$1,635.58
|
| Rate for Payer: Cigna All Commercial |
$2,767.66
|
| Rate for Payer: CORVEL All Commercial |
$2,982.53
|
| Rate for Payer: Coventry All Commercial |
$2,822.18
|
| Rate for Payer: Encore All Commercial |
$2,952.06
|
| Rate for Payer: Frontpath All Commercial |
$2,950.46
|
| Rate for Payer: Humana ChoiceCare |
$2,769.91
|
| Rate for Payer: Humana Medicare |
$1,635.58
|
| Rate for Payer: Lucent All Commercial |
$1,635.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,886.32
|
| Rate for Payer: Managed Health Services Medicaid |
$761.28
|
| Rate for Payer: MDWise Medicaid |
$761.28
|
| Rate for Payer: PHCS All Commercial |
$2,405.27
|
| Rate for Payer: PHP All Commercial |
$2,432.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,250.74
|
| Rate for Payer: Sagamore Health Network All Products |
$2,475.82
|
| Rate for Payer: Signature Care EPO |
$2,661.83
|
| Rate for Payer: Signature Care PPO |
$2,822.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,725.97
|
| Rate for Payer: United Healthcare Commercial |
$2,527.13
|
| Rate for Payer: United Healthcare Medicare |
$1,058.32
|
|
|
HC HEART SMART CT
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 75571 GY
|
| Hospital Charge Code |
01669971
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna All Commercial |
$43.15
|
| Rate for Payer: CORVEL All Commercial |
$46.50
|
| Rate for Payer: Coventry All Commercial |
$44.00
|
| Rate for Payer: Encore All Commercial |
$46.02
|
| Rate for Payer: Frontpath All Commercial |
$46.00
|
| Rate for Payer: Humana ChoiceCare |
$43.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.00
|
| Rate for Payer: PHCS All Commercial |
$37.50
|
| Rate for Payer: PHP All Commercial |
$37.92
|
| Rate for Payer: Sagamore Health Network All Products |
$38.60
|
| Rate for Payer: Signature Care EPO |
$41.50
|
| Rate for Payer: Signature Care PPO |
$44.00
|
| Rate for Payer: United Healthcare Commercial |
$39.40
|
|
|
HC HEART SMART CT
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 75571 GY
|
| Hospital Charge Code |
01669971
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Aetna Commercial |
$42.20
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.15
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Centivo All Commercial |
$25.50
|
| Rate for Payer: Cigna All Commercial |
$43.15
|
| Rate for Payer: CORVEL All Commercial |
$46.50
|
| Rate for Payer: Coventry All Commercial |
$44.00
|
| Rate for Payer: Encore All Commercial |
$46.02
|
| Rate for Payer: Frontpath All Commercial |
$46.00
|
| Rate for Payer: Humana ChoiceCare |
$43.18
|
| Rate for Payer: Humana Medicare |
$25.50
|
| Rate for Payer: Lucent All Commercial |
$25.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.00
|
| Rate for Payer: PHCS All Commercial |
$37.50
|
| Rate for Payer: PHP All Commercial |
$37.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.50
|
| Rate for Payer: Sagamore Health Network All Products |
$38.60
|
| Rate for Payer: Signature Care EPO |
$41.50
|
| Rate for Payer: Signature Care PPO |
$44.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.50
|
| Rate for Payer: United Healthcare Commercial |
$39.40
|
| Rate for Payer: United Healthcare Medicare |
$16.50
|
|
|
HC HEEL LIFT STANDARD SMOOTH
|
Facility
OP
|
$281.96
|
|
|
Service Code
|
CPT E0191
|
| Hospital Charge Code |
41601454
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna Commercial |
$237.97
|
| Rate for Payer: Aetna Medicare |
$93.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$93.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$161.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$176.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.35
|
| Rate for Payer: Cash Price |
$174.82
|
| Rate for Payer: Cash Price |
$174.82
|
| Rate for Payer: Centivo All Commercial |
$143.80
|
| Rate for Payer: Cigna All Commercial |
$243.33
|
| Rate for Payer: CORVEL All Commercial |
$262.22
|
| Rate for Payer: Coventry All Commercial |
$248.12
|
| Rate for Payer: Encore All Commercial |
$259.54
|
| Rate for Payer: Frontpath All Commercial |
$259.40
|
| Rate for Payer: Humana ChoiceCare |
$243.53
|
| Rate for Payer: Humana Medicare |
$143.80
|
| Rate for Payer: Lucent All Commercial |
$143.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.76
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$211.47
|
| Rate for Payer: PHP All Commercial |
$213.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.96
|
| Rate for Payer: Sagamore Health Network All Products |
$217.67
|
| Rate for Payer: Signature Care EPO |
$234.03
|
| Rate for Payer: Signature Care PPO |
$248.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.67
|
| Rate for Payer: United Healthcare Commercial |
$222.18
|
| Rate for Payer: United Healthcare Medicare |
$93.05
|
|
|
HC HEEL LIFT STANDARD SMOOTH
|
Facility
IP
|
$281.96
|
|
|
Service Code
|
CPT E0191
|
| Hospital Charge Code |
41601454
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$211.47 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna Commercial |
$243.61
|
| Rate for Payer: Cash Price |
$174.82
|
| Rate for Payer: Cigna All Commercial |
$243.33
|
| Rate for Payer: CORVEL All Commercial |
$262.22
|
| Rate for Payer: Coventry All Commercial |
$248.12
|
| Rate for Payer: Encore All Commercial |
$259.54
|
| Rate for Payer: Frontpath All Commercial |
$259.40
|
| Rate for Payer: Humana ChoiceCare |
$243.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.76
|
| Rate for Payer: PHCS All Commercial |
$211.47
|
| Rate for Payer: PHP All Commercial |
$213.84
|
| Rate for Payer: Sagamore Health Network All Products |
$217.67
|
| Rate for Payer: Signature Care EPO |
$234.03
|
| Rate for Payer: Signature Care PPO |
$248.12
|
| Rate for Payer: United Healthcare Commercial |
$222.18
|
|
|
HC HELICOBACTER PYLORIA AG-FECES
|
Facility
IP
|
$235.62
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
63002029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$219.13 |
| Rate for Payer: Aetna Commercial |
$203.58
|
| Rate for Payer: Cash Price |
$146.08
|
| Rate for Payer: Cigna All Commercial |
$203.34
|
| Rate for Payer: CORVEL All Commercial |
$219.13
|
| Rate for Payer: Coventry All Commercial |
$207.35
|
| Rate for Payer: Encore All Commercial |
$216.89
|
| Rate for Payer: Frontpath All Commercial |
$216.77
|
| Rate for Payer: Humana ChoiceCare |
$203.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.06
|
| Rate for Payer: PHCS All Commercial |
$176.72
|
| Rate for Payer: PHP All Commercial |
$178.69
|
| Rate for Payer: Sagamore Health Network All Products |
$181.90
|
| Rate for Payer: Signature Care EPO |
$195.56
|
| Rate for Payer: Signature Care PPO |
$207.35
|
| Rate for Payer: United Healthcare Commercial |
$185.67
|
|
|
HC HELICOBACTER PYLORIA AG-FECES
|
Facility
OP
|
$235.62
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
63002029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$219.13 |
| Rate for Payer: Aetna Commercial |
$198.86
|
| Rate for Payer: Aetna Medicare |
$77.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.53
|
| Rate for Payer: Cash Price |
$146.08
|
| Rate for Payer: Cash Price |
$146.08
|
| Rate for Payer: Centivo All Commercial |
$120.17
|
| Rate for Payer: Cigna All Commercial |
$203.34
|
| Rate for Payer: CORVEL All Commercial |
$219.13
|
| Rate for Payer: Coventry All Commercial |
$207.35
|
| Rate for Payer: Encore All Commercial |
$216.89
|
| Rate for Payer: Frontpath All Commercial |
$216.77
|
| Rate for Payer: Humana ChoiceCare |
$203.50
|
| Rate for Payer: Humana Medicare |
$120.17
|
| Rate for Payer: Lucent All Commercial |
$120.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.06
|
| Rate for Payer: Managed Health Services Medicaid |
$14.38
|
| Rate for Payer: MDWise Medicaid |
$14.38
|
| Rate for Payer: PHCS All Commercial |
$176.72
|
| Rate for Payer: PHP All Commercial |
$178.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.89
|
| Rate for Payer: Sagamore Health Network All Products |
$181.90
|
| Rate for Payer: Signature Care EPO |
$195.56
|
| Rate for Payer: Signature Care PPO |
$207.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.28
|
| Rate for Payer: United Healthcare Commercial |
$185.67
|
| Rate for Payer: United Healthcare Medicare |
$77.75
|
|
|
HC HELICOBACTER PYLORI ANTIBODY (IGG)-SERUM
|
Facility
OP
|
$120.33
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
63001005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$111.91 |
| Rate for Payer: Aetna Commercial |
$101.56
|
| Rate for Payer: Aetna Medicare |
$39.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.68
|
| Rate for Payer: Cash Price |
$74.60
|
| Rate for Payer: Cash Price |
$74.60
|
| Rate for Payer: Centivo All Commercial |
$61.37
|
| Rate for Payer: Cigna All Commercial |
$103.84
|
| Rate for Payer: CORVEL All Commercial |
$111.91
|
| Rate for Payer: Coventry All Commercial |
$105.89
|
| Rate for Payer: Encore All Commercial |
$110.76
|
| Rate for Payer: Frontpath All Commercial |
$110.70
|
| Rate for Payer: Humana ChoiceCare |
$103.93
|
| Rate for Payer: Humana Medicare |
$61.37
|
| Rate for Payer: Lucent All Commercial |
$61.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.30
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$90.25
|
| Rate for Payer: PHP All Commercial |
$91.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.93
|
| Rate for Payer: Sagamore Health Network All Products |
$92.89
|
| Rate for Payer: Signature Care EPO |
$99.87
|
| Rate for Payer: Signature Care PPO |
$105.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.28
|
| Rate for Payer: United Healthcare Commercial |
$94.82
|
| Rate for Payer: United Healthcare Medicare |
$39.71
|
|
|
HC HELICOBACTER PYLORI ANTIBODY (IGG)-SERUM
|
Facility
IP
|
$120.33
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
63001005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.25 |
| Max. Negotiated Rate |
$111.91 |
| Rate for Payer: Aetna Commercial |
$103.96
|
| Rate for Payer: Cash Price |
$74.60
|
| Rate for Payer: Cigna All Commercial |
$103.84
|
| Rate for Payer: CORVEL All Commercial |
$111.91
|
| Rate for Payer: Coventry All Commercial |
$105.89
|
| Rate for Payer: Encore All Commercial |
$110.76
|
| Rate for Payer: Frontpath All Commercial |
$110.70
|
| Rate for Payer: Humana ChoiceCare |
$103.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.30
|
| Rate for Payer: PHCS All Commercial |
$90.25
|
| Rate for Payer: PHP All Commercial |
$91.26
|
| Rate for Payer: Sagamore Health Network All Products |
$92.89
|
| Rate for Payer: Signature Care EPO |
$99.87
|
| Rate for Payer: Signature Care PPO |
$105.89
|
| Rate for Payer: United Healthcare Commercial |
$94.82
|
|
|
HC HELICOBACTER PYLORI UREASE BREATH TEST
|
Facility
OP
|
$396.07
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
63001053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$368.34 |
| Rate for Payer: Aetna Commercial |
$334.28
|
| Rate for Payer: Aetna Medicare |
$130.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$130.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$227.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$247.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$67.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.77
|
| Rate for Payer: Cash Price |
$245.56
|
| Rate for Payer: Cash Price |
$245.56
|
| Rate for Payer: Centivo All Commercial |
$201.99
|
| Rate for Payer: Cigna All Commercial |
$341.80
|
| Rate for Payer: CORVEL All Commercial |
$368.34
|
| Rate for Payer: Coventry All Commercial |
$348.54
|
| Rate for Payer: Encore All Commercial |
$364.58
|
| Rate for Payer: Frontpath All Commercial |
$364.38
|
| Rate for Payer: Humana ChoiceCare |
$342.08
|
| Rate for Payer: Humana Medicare |
$201.99
|
| Rate for Payer: Lucent All Commercial |
$201.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$356.46
|
| Rate for Payer: Managed Health Services Medicaid |
$67.36
|
| Rate for Payer: MDWise Medicaid |
$67.36
|
| Rate for Payer: PHCS All Commercial |
$297.05
|
| Rate for Payer: PHP All Commercial |
$300.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$154.47
|
| Rate for Payer: Sagamore Health Network All Products |
$305.76
|
| Rate for Payer: Signature Care EPO |
$328.73
|
| Rate for Payer: Signature Care PPO |
$348.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$336.66
|
| Rate for Payer: United Healthcare Commercial |
$312.10
|
| Rate for Payer: United Healthcare Medicare |
$130.70
|
|
|
HC HELICOBACTER PYLORI UREASE BREATH TEST
|
Facility
IP
|
$396.07
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
63001053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$297.05 |
| Max. Negotiated Rate |
$368.34 |
| Rate for Payer: Aetna Commercial |
$342.20
|
| Rate for Payer: Cash Price |
$245.56
|
| Rate for Payer: Cigna All Commercial |
$341.80
|
| Rate for Payer: CORVEL All Commercial |
$368.34
|
| Rate for Payer: Coventry All Commercial |
$348.54
|
| Rate for Payer: Encore All Commercial |
$364.58
|
| Rate for Payer: Frontpath All Commercial |
$364.38
|
| Rate for Payer: Humana ChoiceCare |
$342.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$356.46
|
| Rate for Payer: PHCS All Commercial |
$297.05
|
| Rate for Payer: PHP All Commercial |
$300.38
|
| Rate for Payer: Sagamore Health Network All Products |
$305.76
|
| Rate for Payer: Signature Care EPO |
$328.73
|
| Rate for Payer: Signature Care PPO |
$348.54
|
| Rate for Payer: United Healthcare Commercial |
$312.10
|
|
|
HC HEMACHROM MUTATION HEREDITARY
|
Facility
IP
|
$988.48
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
63001438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$741.36 |
| Max. Negotiated Rate |
$919.29 |
| Rate for Payer: Aetna Commercial |
$854.05
|
| Rate for Payer: Cash Price |
$612.86
|
| Rate for Payer: Cigna All Commercial |
$853.06
|
| Rate for Payer: CORVEL All Commercial |
$919.29
|
| Rate for Payer: Coventry All Commercial |
$869.86
|
| Rate for Payer: Encore All Commercial |
$909.90
|
| Rate for Payer: Frontpath All Commercial |
$909.40
|
| Rate for Payer: Humana ChoiceCare |
$853.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$889.63
|
| Rate for Payer: PHCS All Commercial |
$741.36
|
| Rate for Payer: PHP All Commercial |
$749.66
|
| Rate for Payer: Sagamore Health Network All Products |
$763.11
|
| Rate for Payer: Signature Care EPO |
$820.44
|
| Rate for Payer: Signature Care PPO |
$869.86
|
| Rate for Payer: United Healthcare Commercial |
$778.92
|
|
|
HC HEMACHROM MUTATION HEREDITARY
|
Facility
OP
|
$988.48
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
63001438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$326.20 |
| Max. Negotiated Rate |
$919.29 |
| Rate for Payer: Aetna Commercial |
$834.28
|
| Rate for Payer: Aetna Medicare |
$326.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$326.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$567.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$617.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$358.82
|
| Rate for Payer: Cash Price |
$612.86
|
| Rate for Payer: Centivo All Commercial |
$504.13
|
| Rate for Payer: Cigna All Commercial |
$853.06
|
| Rate for Payer: CORVEL All Commercial |
$919.29
|
| Rate for Payer: Coventry All Commercial |
$869.86
|
| Rate for Payer: Encore All Commercial |
$909.90
|
| Rate for Payer: Frontpath All Commercial |
$909.40
|
| Rate for Payer: Humana ChoiceCare |
$853.75
|
| Rate for Payer: Humana Medicare |
$504.13
|
| Rate for Payer: Lucent All Commercial |
$504.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$889.63
|
| Rate for Payer: PHCS All Commercial |
$741.36
|
| Rate for Payer: PHP All Commercial |
$749.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$385.51
|
| Rate for Payer: Sagamore Health Network All Products |
$763.11
|
| Rate for Payer: Signature Care EPO |
$820.44
|
| Rate for Payer: Signature Care PPO |
$869.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$840.21
|
| Rate for Payer: United Healthcare Commercial |
$778.92
|
| Rate for Payer: United Healthcare Medicare |
$326.20
|
|
|
HC HEMOCUE POCT
|
Facility
OP
|
$5.03
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
01235018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.83
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Centivo All Commercial |
$2.57
|
| Rate for Payer: Cigna All Commercial |
$4.34
|
| Rate for Payer: CORVEL All Commercial |
$4.68
|
| Rate for Payer: Coventry All Commercial |
$4.43
|
| Rate for Payer: Encore All Commercial |
$4.63
|
| Rate for Payer: Frontpath All Commercial |
$4.63
|
| Rate for Payer: Humana ChoiceCare |
$4.34
|
| Rate for Payer: Humana Medicare |
$2.57
|
| Rate for Payer: Lucent All Commercial |
$2.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.53
|
| Rate for Payer: Managed Health Services Medicaid |
$2.37
|
| Rate for Payer: MDWise Medicaid |
$2.37
|
| Rate for Payer: PHCS All Commercial |
$3.77
|
| Rate for Payer: PHP All Commercial |
$3.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.96
|
| Rate for Payer: Sagamore Health Network All Products |
$3.88
|
| Rate for Payer: Signature Care EPO |
$4.17
|
| Rate for Payer: Signature Care PPO |
$4.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.28
|
| Rate for Payer: United Healthcare Commercial |
$3.96
|
| Rate for Payer: United Healthcare Medicare |
$1.66
|
|
|
HC HEMOCUE POCT
|
Facility
IP
|
$5.03
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
01235018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.35
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cigna All Commercial |
$4.34
|
| Rate for Payer: CORVEL All Commercial |
$4.68
|
| Rate for Payer: Coventry All Commercial |
$4.43
|
| Rate for Payer: Encore All Commercial |
$4.63
|
| Rate for Payer: Frontpath All Commercial |
$4.63
|
| Rate for Payer: Humana ChoiceCare |
$4.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.53
|
| Rate for Payer: PHCS All Commercial |
$3.77
|
| Rate for Payer: PHP All Commercial |
$3.81
|
| Rate for Payer: Sagamore Health Network All Products |
$3.88
|
| Rate for Payer: Signature Care EPO |
$4.17
|
| Rate for Payer: Signature Care PPO |
$4.43
|
| Rate for Payer: United Healthcare Commercial |
$3.96
|
|
|
HC HEMOGLOBIN, BLOOD
|
Facility
OP
|
$34.74
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
63001233
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$32.31 |
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.61
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Centivo All Commercial |
$17.72
|
| Rate for Payer: Cigna All Commercial |
$29.98
|
| Rate for Payer: CORVEL All Commercial |
$32.31
|
| Rate for Payer: Coventry All Commercial |
$30.57
|
| Rate for Payer: Encore All Commercial |
$31.98
|
| Rate for Payer: Frontpath All Commercial |
$31.96
|
| Rate for Payer: Humana ChoiceCare |
$30.01
|
| Rate for Payer: Humana Medicare |
$17.72
|
| Rate for Payer: Lucent All Commercial |
$17.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.27
|
| Rate for Payer: Managed Health Services Medicaid |
$2.37
|
| Rate for Payer: MDWise Medicaid |
$2.37
|
| Rate for Payer: PHCS All Commercial |
$26.06
|
| Rate for Payer: PHP All Commercial |
$26.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.55
|
| Rate for Payer: Sagamore Health Network All Products |
$26.82
|
| Rate for Payer: Signature Care EPO |
$28.84
|
| Rate for Payer: Signature Care PPO |
$30.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.53
|
| Rate for Payer: United Healthcare Commercial |
$27.38
|
| Rate for Payer: United Healthcare Medicare |
$11.46
|
|
|
HC HEMOGLOBIN, BLOOD
|
Facility
IP
|
$34.74
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
63001233
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$32.31 |
| Rate for Payer: Aetna Commercial |
$30.02
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cigna All Commercial |
$29.98
|
| Rate for Payer: CORVEL All Commercial |
$32.31
|
| Rate for Payer: Coventry All Commercial |
$30.57
|
| Rate for Payer: Encore All Commercial |
$31.98
|
| Rate for Payer: Frontpath All Commercial |
$31.96
|
| Rate for Payer: Humana ChoiceCare |
$30.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.27
|
| Rate for Payer: PHCS All Commercial |
$26.06
|
| Rate for Payer: PHP All Commercial |
$26.35
|
| Rate for Payer: Sagamore Health Network All Products |
$26.82
|
| Rate for Payer: Signature Care EPO |
$28.84
|
| Rate for Payer: Signature Care PPO |
$30.57
|
| Rate for Payer: United Healthcare Commercial |
$27.38
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
OP
|
$185.13
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
63001304
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$172.17 |
| Rate for Payer: Aetna Commercial |
$156.25
|
| Rate for Payer: Aetna Medicare |
$61.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.20
|
| Rate for Payer: Cash Price |
$114.78
|
| Rate for Payer: Cash Price |
$114.78
|
| Rate for Payer: Centivo All Commercial |
$94.42
|
| Rate for Payer: Cigna All Commercial |
$159.77
|
| Rate for Payer: CORVEL All Commercial |
$172.17
|
| Rate for Payer: Coventry All Commercial |
$162.91
|
| Rate for Payer: Encore All Commercial |
$170.41
|
| Rate for Payer: Frontpath All Commercial |
$170.32
|
| Rate for Payer: Humana ChoiceCare |
$159.90
|
| Rate for Payer: Humana Medicare |
$94.42
|
| Rate for Payer: Lucent All Commercial |
$94.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.62
|
| Rate for Payer: Managed Health Services Medicaid |
$12.87
|
| Rate for Payer: MDWise Medicaid |
$12.87
|
| Rate for Payer: PHCS All Commercial |
$138.85
|
| Rate for Payer: PHP All Commercial |
$140.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.20
|
| Rate for Payer: Sagamore Health Network All Products |
$142.92
|
| Rate for Payer: Signature Care EPO |
$153.66
|
| Rate for Payer: Signature Care PPO |
$162.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$157.36
|
| Rate for Payer: United Healthcare Commercial |
$145.88
|
| Rate for Payer: United Healthcare Medicare |
$61.09
|
|
