|
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
|
|
|
HC HEMOSTATIC ERASER 18G WETFIELD
|
Facility
OP
|
$57.96
|
|
| Hospital Charge Code |
41602206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$48.92
|
| Rate for Payer: Aetna Medicare |
$19.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.04
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Centivo All Commercial |
$29.56
|
| Rate for Payer: Cigna All Commercial |
$50.02
|
| Rate for Payer: CORVEL All Commercial |
$53.90
|
| Rate for Payer: Coventry All Commercial |
$51.00
|
| Rate for Payer: Encore All Commercial |
$53.35
|
| Rate for Payer: Frontpath All Commercial |
$53.32
|
| Rate for Payer: Humana ChoiceCare |
$50.06
|
| Rate for Payer: Humana Medicare |
$29.56
|
| Rate for Payer: Lucent All Commercial |
$29.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.16
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$43.47
|
| Rate for Payer: PHP All Commercial |
$43.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.60
|
| Rate for Payer: Sagamore Health Network All Products |
$44.75
|
| Rate for Payer: Signature Care EPO |
$48.11
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.27
|
| Rate for Payer: United Healthcare Commercial |
$45.67
|
| Rate for Payer: United Healthcare Medicare |
$19.13
|
|
|
HC HEMOSTATIC ERASER 18G WETFIELD
|
Facility
IP
|
$57.96
|
|
| Hospital Charge Code |
41602206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.47 |
| Max. Negotiated Rate |
$53.90 |
| Rate for Payer: Aetna Commercial |
$50.08
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Cigna All Commercial |
$50.02
|
| Rate for Payer: CORVEL All Commercial |
$53.90
|
| Rate for Payer: Coventry All Commercial |
$51.00
|
| Rate for Payer: Encore All Commercial |
$53.35
|
| Rate for Payer: Frontpath All Commercial |
$53.32
|
| Rate for Payer: Humana ChoiceCare |
$50.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.16
|
| Rate for Payer: PHCS All Commercial |
$43.47
|
| Rate for Payer: PHP All Commercial |
$43.96
|
| Rate for Payer: Sagamore Health Network All Products |
$44.75
|
| Rate for Payer: Signature Care EPO |
$48.11
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$45.67
|
|
|
HC HEPARIN ASSAY
|
Facility
OP
|
$150.29
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
63001746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$139.77 |
| Rate for Payer: Aetna Commercial |
$126.84
|
| Rate for Payer: Aetna Medicare |
$49.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.55
|
| Rate for Payer: Cash Price |
$93.18
|
| Rate for Payer: Cash Price |
$93.18
|
| Rate for Payer: Centivo All Commercial |
$76.65
|
| Rate for Payer: Cigna All Commercial |
$129.70
|
| Rate for Payer: CORVEL All Commercial |
$139.77
|
| Rate for Payer: Coventry All Commercial |
$132.25
|
| Rate for Payer: Encore All Commercial |
$138.34
|
| Rate for Payer: Frontpath All Commercial |
$138.26
|
| Rate for Payer: Humana ChoiceCare |
$129.80
|
| Rate for Payer: Humana Medicare |
$76.65
|
| Rate for Payer: Lucent All Commercial |
$76.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.26
|
| Rate for Payer: Managed Health Services Medicaid |
$13.09
|
| Rate for Payer: MDWise Medicaid |
$13.09
|
| Rate for Payer: PHCS All Commercial |
$112.72
|
| Rate for Payer: PHP All Commercial |
$113.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.61
|
| Rate for Payer: Sagamore Health Network All Products |
$116.02
|
| Rate for Payer: Signature Care EPO |
$124.74
|
| Rate for Payer: Signature Care PPO |
$132.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$127.74
|
| Rate for Payer: United Healthcare Commercial |
$118.43
|
| Rate for Payer: United Healthcare Medicare |
$49.59
|
|
|
HC HEPARIN ASSAY
|
Facility
IP
|
$150.29
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
63001746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.72 |
| Max. Negotiated Rate |
$139.77 |
| Rate for Payer: Aetna Commercial |
$129.85
|
| Rate for Payer: Cash Price |
$93.18
|
| Rate for Payer: Cigna All Commercial |
$129.70
|
| Rate for Payer: CORVEL All Commercial |
$139.77
|
| Rate for Payer: Coventry All Commercial |
$132.25
|
| Rate for Payer: Encore All Commercial |
$138.34
|
| Rate for Payer: Frontpath All Commercial |
$138.26
|
| Rate for Payer: Humana ChoiceCare |
$129.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.26
|
| Rate for Payer: PHCS All Commercial |
$112.72
|
| Rate for Payer: PHP All Commercial |
$113.98
|
| Rate for Payer: Sagamore Health Network All Products |
$116.02
|
| Rate for Payer: Signature Care EPO |
$124.74
|
| Rate for Payer: Signature Care PPO |
$132.25
|
| Rate for Payer: United Healthcare Commercial |
$118.43
|
|
|
HC HEPARIN-DEPENDENT PLATELET ANTIBODY (SEROTONIN RELEASE ASSAY)
|
Facility
IP
|
$420.75
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63044079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.56 |
| Max. Negotiated Rate |
$391.30 |
| Rate for Payer: Aetna Commercial |
$363.53
|
| Rate for Payer: Cash Price |
$260.87
|
| Rate for Payer: Cigna All Commercial |
$363.11
|
| Rate for Payer: CORVEL All Commercial |
$391.30
|
| Rate for Payer: Coventry All Commercial |
$370.26
|
| Rate for Payer: Encore All Commercial |
$387.30
|
| Rate for Payer: Frontpath All Commercial |
$387.09
|
| Rate for Payer: Humana ChoiceCare |
$363.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.68
|
| Rate for Payer: PHCS All Commercial |
$315.56
|
| Rate for Payer: PHP All Commercial |
$319.10
|
| Rate for Payer: Sagamore Health Network All Products |
$324.82
|
| Rate for Payer: Signature Care EPO |
$349.22
|
| Rate for Payer: Signature Care PPO |
$370.26
|
| Rate for Payer: United Healthcare Commercial |
$331.55
|
|
|
HC HEPARIN-DEPENDENT PLATELET ANTIBODY (SEROTONIN RELEASE ASSAY)
|
Facility
OP
|
$420.75
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63044079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$391.30 |
| Rate for Payer: Aetna Commercial |
$355.11
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.73
|
| Rate for Payer: Cash Price |
$260.87
|
| Rate for Payer: Cash Price |
$260.87
|
| Rate for Payer: Centivo All Commercial |
$214.58
|
| Rate for Payer: Cigna All Commercial |
$363.11
|
| Rate for Payer: CORVEL All Commercial |
$391.30
|
| Rate for Payer: Coventry All Commercial |
$370.26
|
| Rate for Payer: Encore All Commercial |
$387.30
|
| Rate for Payer: Frontpath All Commercial |
$387.09
|
| Rate for Payer: Humana ChoiceCare |
$363.40
|
| Rate for Payer: Humana Medicare |
$214.58
|
| Rate for Payer: Lucent All Commercial |
$214.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.68
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$315.56
|
| Rate for Payer: PHP All Commercial |
$319.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.09
|
| Rate for Payer: Sagamore Health Network All Products |
$324.82
|
| Rate for Payer: Signature Care EPO |
$349.22
|
| Rate for Payer: Signature Care PPO |
$370.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.64
|
| Rate for Payer: United Healthcare Commercial |
$331.55
|
| Rate for Payer: United Healthcare Medicare |
$138.85
|
|
|
HC HEPARIN-LOW MOLECULAR WGT
|
Facility
OP
|
$224.92
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
63001747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$209.18 |
| Rate for Payer: Aetna Commercial |
$189.83
|
| Rate for Payer: Aetna Medicare |
$74.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$129.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.65
|
| Rate for Payer: Cash Price |
$139.45
|
| Rate for Payer: Cash Price |
$139.45
|
| Rate for Payer: Centivo All Commercial |
$114.71
|
| Rate for Payer: Cigna All Commercial |
$194.11
|
| Rate for Payer: CORVEL All Commercial |
$209.18
|
| Rate for Payer: Coventry All Commercial |
$197.93
|
| Rate for Payer: Encore All Commercial |
$207.04
|
| Rate for Payer: Frontpath All Commercial |
$206.93
|
| Rate for Payer: Humana ChoiceCare |
$194.26
|
| Rate for Payer: Humana Medicare |
$114.71
|
| Rate for Payer: Lucent All Commercial |
$114.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$202.43
|
| Rate for Payer: Managed Health Services Medicaid |
$13.09
|
| Rate for Payer: MDWise Medicaid |
$13.09
|
| Rate for Payer: PHCS All Commercial |
$168.69
|
| Rate for Payer: PHP All Commercial |
$170.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.72
|
| Rate for Payer: Sagamore Health Network All Products |
$173.64
|
| Rate for Payer: Signature Care EPO |
$186.68
|
| Rate for Payer: Signature Care PPO |
$197.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$191.18
|
| Rate for Payer: United Healthcare Commercial |
$177.24
|
| Rate for Payer: United Healthcare Medicare |
$74.22
|
|
|
HC HEPARIN-LOW MOLECULAR WGT
|
Facility
IP
|
$224.92
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
63001747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$209.18 |
| Rate for Payer: Aetna Commercial |
$194.33
|
| Rate for Payer: Cash Price |
$139.45
|
| Rate for Payer: Cigna All Commercial |
$194.11
|
| Rate for Payer: CORVEL All Commercial |
$209.18
|
| Rate for Payer: Coventry All Commercial |
$197.93
|
| Rate for Payer: Encore All Commercial |
$207.04
|
| Rate for Payer: Frontpath All Commercial |
$206.93
|
| Rate for Payer: Humana ChoiceCare |
$194.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$202.43
|
| Rate for Payer: PHCS All Commercial |
$168.69
|
| Rate for Payer: PHP All Commercial |
$170.58
|
| Rate for Payer: Sagamore Health Network All Products |
$173.64
|
| Rate for Payer: Signature Care EPO |
$186.68
|
| Rate for Payer: Signature Care PPO |
$197.93
|
| Rate for Payer: United Healthcare Commercial |
$177.24
|
|
|
HC HEPARIN PF4 AB
|
Facility
OP
|
$440.45
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
63001193
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$409.61 |
| Rate for Payer: Aetna Commercial |
$371.74
|
| Rate for Payer: Aetna Medicare |
$145.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$252.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$275.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.88
|
| Rate for Payer: Cash Price |
$273.08
|
| Rate for Payer: Cash Price |
$273.08
|
| Rate for Payer: Centivo All Commercial |
$224.63
|
| Rate for Payer: Cigna All Commercial |
$380.11
|
| Rate for Payer: CORVEL All Commercial |
$409.61
|
| Rate for Payer: Coventry All Commercial |
$387.59
|
| Rate for Payer: Encore All Commercial |
$405.43
|
| Rate for Payer: Frontpath All Commercial |
$405.21
|
| Rate for Payer: Humana ChoiceCare |
$380.41
|
| Rate for Payer: Humana Medicare |
$224.63
|
| Rate for Payer: Lucent All Commercial |
$224.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$396.40
|
| Rate for Payer: Managed Health Services Medicaid |
$7.23
|
| Rate for Payer: MDWise Medicaid |
$7.23
|
| Rate for Payer: PHCS All Commercial |
$330.33
|
| Rate for Payer: PHP All Commercial |
$334.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.77
|
| Rate for Payer: Sagamore Health Network All Products |
$340.02
|
| Rate for Payer: Signature Care EPO |
$365.57
|
| Rate for Payer: Signature Care PPO |
$387.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$374.38
|
| Rate for Payer: United Healthcare Commercial |
$347.07
|
| Rate for Payer: United Healthcare Medicare |
$145.35
|
|
|
HC HEPARIN PF4 AB
|
Facility
IP
|
$440.45
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
63001193
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$330.33 |
| Max. Negotiated Rate |
$409.61 |
| Rate for Payer: Aetna Commercial |
$380.55
|
| Rate for Payer: Cash Price |
$273.08
|
| Rate for Payer: Cigna All Commercial |
$380.11
|
| Rate for Payer: CORVEL All Commercial |
$409.61
|
| Rate for Payer: Coventry All Commercial |
$387.59
|
| Rate for Payer: Encore All Commercial |
$405.43
|
| Rate for Payer: Frontpath All Commercial |
$405.21
|
| Rate for Payer: Humana ChoiceCare |
$380.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$396.40
|
| Rate for Payer: PHCS All Commercial |
$330.33
|
| Rate for Payer: PHP All Commercial |
$334.03
|
| Rate for Payer: Sagamore Health Network All Products |
$340.02
|
| Rate for Payer: Signature Care EPO |
$365.57
|
| Rate for Payer: Signature Care PPO |
$387.59
|
| Rate for Payer: United Healthcare Commercial |
$347.07
|
|
|
HC HEPATITIS A IGM
|
Facility
OP
|
$155.05
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
63002203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Aetna Commercial |
$130.86
|
| Rate for Payer: Aetna Medicare |
$51.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$96.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.28
|
| Rate for Payer: Cash Price |
$96.13
|
| Rate for Payer: Cash Price |
$96.13
|
| Rate for Payer: Centivo All Commercial |
$79.08
|
| Rate for Payer: Cigna All Commercial |
$133.81
|
| Rate for Payer: CORVEL All Commercial |
$144.20
|
| Rate for Payer: Coventry All Commercial |
$136.44
|
| Rate for Payer: Encore All Commercial |
$142.72
|
| Rate for Payer: Frontpath All Commercial |
$142.65
|
| Rate for Payer: Humana ChoiceCare |
$133.92
|
| Rate for Payer: Humana Medicare |
$79.08
|
| Rate for Payer: Lucent All Commercial |
$79.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.55
|
| Rate for Payer: Managed Health Services Medicaid |
$11.26
|
| Rate for Payer: MDWise Medicaid |
$11.26
|
| Rate for Payer: PHCS All Commercial |
$116.29
|
| Rate for Payer: PHP All Commercial |
$117.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.47
|
| Rate for Payer: Sagamore Health Network All Products |
$119.70
|
| Rate for Payer: Signature Care EPO |
$128.69
|
| Rate for Payer: Signature Care PPO |
$136.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.79
|
| Rate for Payer: United Healthcare Commercial |
$122.18
|
| Rate for Payer: United Healthcare Medicare |
$51.17
|
|
|
HC HEPATITIS A IGM
|
Facility
IP
|
$155.05
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
63002203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.29 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Aetna Commercial |
$133.96
|
| Rate for Payer: Cash Price |
$96.13
|
| Rate for Payer: Cigna All Commercial |
$133.81
|
| Rate for Payer: CORVEL All Commercial |
$144.20
|
| Rate for Payer: Coventry All Commercial |
$136.44
|
| Rate for Payer: Encore All Commercial |
$142.72
|
| Rate for Payer: Frontpath All Commercial |
$142.65
|
| Rate for Payer: Humana ChoiceCare |
$133.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.55
|
| Rate for Payer: PHCS All Commercial |
$116.29
|
| Rate for Payer: PHP All Commercial |
$117.59
|
| Rate for Payer: Sagamore Health Network All Products |
$119.70
|
| Rate for Payer: Signature Care EPO |
$128.69
|
| Rate for Payer: Signature Care PPO |
$136.44
|
| Rate for Payer: United Healthcare Commercial |
$122.18
|
|
|
HC HEPATITIS B CORE AN
|
Facility
OP
|
$168.30
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
63001954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.09
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Centivo All Commercial |
$85.83
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$85.83
|
| Rate for Payer: Lucent All Commercial |
$85.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$55.54
|
|
|
HC HEPATITIS B CORE AN
|
Facility
IP
|
$168.30
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
63001954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC HEPATITIS B SUR ANT
|
Facility
OP
|
$132.35
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
63001335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$123.08 |
| Rate for Payer: Aetna Commercial |
$111.70
|
| Rate for Payer: Aetna Medicare |
$43.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.04
|
| Rate for Payer: Cash Price |
$82.05
|
| Rate for Payer: Cash Price |
$82.05
|
| Rate for Payer: Centivo All Commercial |
$67.50
|
| Rate for Payer: Cigna All Commercial |
$114.21
|
| Rate for Payer: CORVEL All Commercial |
$123.08
|
| Rate for Payer: Coventry All Commercial |
$116.46
|
| Rate for Payer: Encore All Commercial |
$121.82
|
| Rate for Payer: Frontpath All Commercial |
$121.76
|
| Rate for Payer: Humana ChoiceCare |
$114.31
|
| Rate for Payer: Humana Medicare |
$67.50
|
| Rate for Payer: Lucent All Commercial |
$67.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.11
|
| Rate for Payer: Managed Health Services Medicaid |
$8.73
|
| Rate for Payer: MDWise Medicaid |
$8.73
|
| Rate for Payer: PHCS All Commercial |
$99.26
|
| Rate for Payer: PHP All Commercial |
$100.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.61
|
| Rate for Payer: Sagamore Health Network All Products |
$102.17
|
| Rate for Payer: Signature Care EPO |
$109.85
|
| Rate for Payer: Signature Care PPO |
$116.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.49
|
| Rate for Payer: United Healthcare Commercial |
$104.29
|
| Rate for Payer: United Healthcare Medicare |
$43.67
|
|
|
HC HEPATITIS B SUR ANT
|
Facility
IP
|
$132.35
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
63001335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$123.08 |
| Rate for Payer: Aetna Commercial |
$114.35
|
| Rate for Payer: Cash Price |
$82.05
|
| Rate for Payer: Cigna All Commercial |
$114.21
|
| Rate for Payer: CORVEL All Commercial |
$123.08
|
| Rate for Payer: Coventry All Commercial |
$116.46
|
| Rate for Payer: Encore All Commercial |
$121.82
|
| Rate for Payer: Frontpath All Commercial |
$121.76
|
| Rate for Payer: Humana ChoiceCare |
$114.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.11
|
| Rate for Payer: PHCS All Commercial |
$99.26
|
| Rate for Payer: PHP All Commercial |
$100.37
|
| Rate for Payer: Sagamore Health Network All Products |
$102.17
|
| Rate for Payer: Signature Care EPO |
$109.85
|
| Rate for Payer: Signature Care PPO |
$116.46
|
| Rate for Payer: United Healthcare Commercial |
$104.29
|
|
|
HC HEPATITIS C VIRUS
|
Facility
OP
|
$223.18
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
63001980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$207.55 |
| Rate for Payer: Aetna Commercial |
$188.36
|
| Rate for Payer: Aetna Medicare |
$73.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.01
|
| Rate for Payer: Cash Price |
$138.37
|
| Rate for Payer: Cash Price |
$138.37
|
| Rate for Payer: Centivo All Commercial |
$113.82
|
| Rate for Payer: Cigna All Commercial |
$192.60
|
| Rate for Payer: CORVEL All Commercial |
$207.55
|
| Rate for Payer: Coventry All Commercial |
$196.39
|
| Rate for Payer: Encore All Commercial |
$205.43
|
| Rate for Payer: Frontpath All Commercial |
$205.32
|
| Rate for Payer: Humana ChoiceCare |
$192.76
|
| Rate for Payer: Humana Medicare |
$113.82
|
| Rate for Payer: Lucent All Commercial |
$113.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.86
|
| Rate for Payer: Managed Health Services Medicaid |
$14.27
|
| Rate for Payer: MDWise Medicaid |
$14.27
|
| Rate for Payer: PHCS All Commercial |
$167.38
|
| Rate for Payer: PHP All Commercial |
$169.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.04
|
| Rate for Payer: Sagamore Health Network All Products |
$172.29
|
| Rate for Payer: Signature Care EPO |
$185.24
|
| Rate for Payer: Signature Care PPO |
$196.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$189.70
|
| Rate for Payer: United Healthcare Commercial |
$175.86
|
| Rate for Payer: United Healthcare Medicare |
$73.65
|
|
|
HC HEPATITIS C VIRUS
|
Facility
IP
|
$223.18
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
63001980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.38 |
| Max. Negotiated Rate |
$207.55 |
| Rate for Payer: Aetna Commercial |
$192.82
|
| Rate for Payer: Cash Price |
$138.37
|
| Rate for Payer: Cigna All Commercial |
$192.60
|
| Rate for Payer: CORVEL All Commercial |
$207.55
|
| Rate for Payer: Coventry All Commercial |
$196.39
|
| Rate for Payer: Encore All Commercial |
$205.43
|
| Rate for Payer: Frontpath All Commercial |
$205.32
|
| Rate for Payer: Humana ChoiceCare |
$192.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.86
|
| Rate for Payer: PHCS All Commercial |
$167.38
|
| Rate for Payer: PHP All Commercial |
$169.26
|
| Rate for Payer: Sagamore Health Network All Products |
$172.29
|
| Rate for Payer: Signature Care EPO |
$185.24
|
| Rate for Payer: Signature Care PPO |
$196.39
|
| Rate for Payer: United Healthcare Commercial |
$175.86
|
|
|
HC HEPATITIS PANEL-ACUTE
|
Facility
OP
|
$582.32
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
63001297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$541.56 |
| Rate for Payer: Aetna Commercial |
$491.48
|
| Rate for Payer: Aetna Medicare |
$192.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$267.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$267.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$47.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.38
|
| Rate for Payer: Cash Price |
$361.04
|
| Rate for Payer: Cash Price |
$361.04
|
| Rate for Payer: Centivo All Commercial |
$296.98
|
| Rate for Payer: Cigna All Commercial |
$502.54
|
| Rate for Payer: CORVEL All Commercial |
$541.56
|
| Rate for Payer: Coventry All Commercial |
$512.44
|
| Rate for Payer: Encore All Commercial |
$536.02
|
| Rate for Payer: Frontpath All Commercial |
$535.73
|
| Rate for Payer: Humana ChoiceCare |
$502.95
|
| Rate for Payer: Humana Medicare |
$296.98
|
| Rate for Payer: Lucent All Commercial |
$296.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$524.09
|
| Rate for Payer: Managed Health Services Medicaid |
$47.63
|
| Rate for Payer: MDWise Medicaid |
$47.63
|
| Rate for Payer: PHCS All Commercial |
$436.74
|
| Rate for Payer: PHP All Commercial |
$441.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.10
|
| Rate for Payer: Sagamore Health Network All Products |
$449.55
|
| Rate for Payer: Signature Care EPO |
$483.32
|
| Rate for Payer: Signature Care PPO |
$512.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$494.97
|
| Rate for Payer: United Healthcare Commercial |
$458.87
|
| Rate for Payer: United Healthcare Medicare |
$192.16
|
|
|
HC HEPATITIS PANEL-ACUTE
|
Facility
IP
|
$582.32
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
63001297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$436.74 |
| Max. Negotiated Rate |
$541.56 |
| Rate for Payer: Aetna Commercial |
$503.12
|
| Rate for Payer: Cash Price |
$361.04
|
| Rate for Payer: Cigna All Commercial |
$502.54
|
| Rate for Payer: CORVEL All Commercial |
$541.56
|
| Rate for Payer: Coventry All Commercial |
$512.44
|
| Rate for Payer: Encore All Commercial |
$536.02
|
| Rate for Payer: Frontpath All Commercial |
$535.73
|
| Rate for Payer: Humana ChoiceCare |
$502.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$524.09
|
| Rate for Payer: PHCS All Commercial |
$436.74
|
| Rate for Payer: PHP All Commercial |
$441.63
|
| Rate for Payer: Sagamore Health Network All Products |
$449.55
|
| Rate for Payer: Signature Care EPO |
$483.32
|
| Rate for Payer: Signature Care PPO |
$512.44
|
| Rate for Payer: United Healthcare Commercial |
$458.87
|
|
|
HC HEPATOBILIARY SYSTEM IMAGING
|
Facility
OP
|
$2,456.43
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
01638226
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$810.62 |
| Max. Negotiated Rate |
$2,284.48 |
| Rate for Payer: Aetna Commercial |
$2,073.22
|
| Rate for Payer: Aetna Medicare |
$810.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$810.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,410.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,535.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$811.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$932.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$891.68
|
| Rate for Payer: Cash Price |
$1,522.98
|
| Rate for Payer: Cash Price |
$1,522.98
|
| Rate for Payer: Centivo All Commercial |
$1,252.78
|
| Rate for Payer: Cigna All Commercial |
$2,119.89
|
| Rate for Payer: CORVEL All Commercial |
$2,284.48
|
| Rate for Payer: Coventry All Commercial |
$2,161.65
|
| Rate for Payer: Encore All Commercial |
$2,261.14
|
| Rate for Payer: Frontpath All Commercial |
$2,259.91
|
| Rate for Payer: Humana ChoiceCare |
$2,121.61
|
| Rate for Payer: Humana Medicare |
$1,252.78
|
| Rate for Payer: Lucent All Commercial |
$1,252.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,210.78
|
| Rate for Payer: Managed Health Services Medicaid |
$811.51
|
| Rate for Payer: MDWise Medicaid |
$811.51
|
| Rate for Payer: PHCS All Commercial |
$1,842.32
|
| Rate for Payer: PHP All Commercial |
$1,862.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$958.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,896.36
|
| Rate for Payer: Signature Care EPO |
$2,038.83
|
| Rate for Payer: Signature Care PPO |
$2,161.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,087.96
|
| Rate for Payer: United Healthcare Commercial |
$1,935.66
|
| Rate for Payer: United Healthcare Medicare |
$810.62
|
|
|
HC HEPATOBILIARY SYSTEM IMAGING
|
Facility
IP
|
$2,456.43
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
01638226
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,842.32 |
| Max. Negotiated Rate |
$2,284.48 |
| Rate for Payer: Aetna Commercial |
$2,122.35
|
| Rate for Payer: Cash Price |
$1,522.98
|
| Rate for Payer: Cigna All Commercial |
$2,119.89
|
| Rate for Payer: CORVEL All Commercial |
$2,284.48
|
| Rate for Payer: Coventry All Commercial |
$2,161.65
|
| Rate for Payer: Encore All Commercial |
$2,261.14
|
| Rate for Payer: Frontpath All Commercial |
$2,259.91
|
| Rate for Payer: Humana ChoiceCare |
$2,121.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,210.78
|
| Rate for Payer: PHCS All Commercial |
$1,842.32
|
| Rate for Payer: PHP All Commercial |
$1,862.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,896.36
|
| Rate for Payer: Signature Care EPO |
$2,038.83
|
| Rate for Payer: Signature Care PPO |
$2,161.65
|
| Rate for Payer: United Healthcare Commercial |
$1,935.66
|
|
|
HC HEPATOBIL SYST IMAGE W/DRUG
|
Facility
IP
|
$2,510.09
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
01638227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,882.57 |
| Max. Negotiated Rate |
$2,334.38 |
| Rate for Payer: Aetna Commercial |
$2,168.72
|
| Rate for Payer: Cash Price |
$1,556.25
|
| Rate for Payer: Cigna All Commercial |
$2,166.21
|
| Rate for Payer: CORVEL All Commercial |
$2,334.38
|
| Rate for Payer: Coventry All Commercial |
$2,208.88
|
| Rate for Payer: Encore All Commercial |
$2,310.54
|
| Rate for Payer: Frontpath All Commercial |
$2,309.28
|
| Rate for Payer: Humana ChoiceCare |
$2,167.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,259.08
|
| Rate for Payer: PHCS All Commercial |
$1,882.57
|
| Rate for Payer: PHP All Commercial |
$1,903.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,937.79
|
| Rate for Payer: Signature Care EPO |
$2,083.37
|
| Rate for Payer: Signature Care PPO |
$2,208.88
|
| Rate for Payer: United Healthcare Commercial |
$1,977.95
|
|
|
HC HEPATOBIL SYST IMAGE W/DRUG
|
Facility
OP
|
$2,510.09
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
01638227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$828.33 |
| Max. Negotiated Rate |
$2,334.38 |
| Rate for Payer: Aetna Commercial |
$2,118.51
|
| Rate for Payer: Aetna Medicare |
$828.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$828.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,441.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,569.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,113.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$952.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$911.16
|
| Rate for Payer: Cash Price |
$1,556.25
|
| Rate for Payer: Cash Price |
$1,556.25
|
| Rate for Payer: Centivo All Commercial |
$1,280.14
|
| Rate for Payer: Cigna All Commercial |
$2,166.21
|
| Rate for Payer: CORVEL All Commercial |
$2,334.38
|
| Rate for Payer: Coventry All Commercial |
$2,208.88
|
| Rate for Payer: Encore All Commercial |
$2,310.54
|
| Rate for Payer: Frontpath All Commercial |
$2,309.28
|
| Rate for Payer: Humana ChoiceCare |
$2,167.96
|
| Rate for Payer: Humana Medicare |
$1,280.14
|
| Rate for Payer: Lucent All Commercial |
$1,280.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,259.08
|
| Rate for Payer: Managed Health Services Medicaid |
$1,113.57
|
| Rate for Payer: MDWise Medicaid |
$1,113.57
|
| Rate for Payer: PHCS All Commercial |
$1,882.57
|
| Rate for Payer: PHP All Commercial |
$1,903.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$978.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,937.79
|
| Rate for Payer: Signature Care EPO |
$2,083.37
|
| Rate for Payer: Signature Care PPO |
$2,208.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,133.57
|
| Rate for Payer: United Healthcare Commercial |
$1,977.95
|
| Rate for Payer: United Healthcare Medicare |
$828.33
|
|
