|
HC HERPES SIMPLEX TYPING
|
Facility
IP
|
$74.04
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
63002010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.53 |
| Max. Negotiated Rate |
$68.86 |
| Rate for Payer: Aetna Commercial |
$63.97
|
| Rate for Payer: Cash Price |
$45.91
|
| Rate for Payer: Cigna All Commercial |
$63.90
|
| Rate for Payer: CORVEL All Commercial |
$68.86
|
| Rate for Payer: Coventry All Commercial |
$65.16
|
| Rate for Payer: Encore All Commercial |
$68.16
|
| Rate for Payer: Frontpath All Commercial |
$68.12
|
| Rate for Payer: Humana ChoiceCare |
$63.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.64
|
| Rate for Payer: PHCS All Commercial |
$55.53
|
| Rate for Payer: PHP All Commercial |
$56.15
|
| Rate for Payer: Sagamore Health Network All Products |
$57.16
|
| Rate for Payer: Signature Care EPO |
$61.45
|
| Rate for Payer: Signature Care PPO |
$65.16
|
| Rate for Payer: United Healthcare Commercial |
$58.34
|
|
|
HC HERPES SIMPLEX TYPING
|
Facility
OP
|
$74.04
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
63002010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$68.86 |
| Rate for Payer: Aetna Commercial |
$62.49
|
| Rate for Payer: Aetna Medicare |
$24.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.88
|
| Rate for Payer: Cash Price |
$45.91
|
| Rate for Payer: Cash Price |
$45.91
|
| Rate for Payer: Centivo All Commercial |
$37.76
|
| Rate for Payer: Cigna All Commercial |
$63.90
|
| Rate for Payer: CORVEL All Commercial |
$68.86
|
| Rate for Payer: Coventry All Commercial |
$65.16
|
| Rate for Payer: Encore All Commercial |
$68.16
|
| Rate for Payer: Frontpath All Commercial |
$68.12
|
| Rate for Payer: Humana ChoiceCare |
$63.95
|
| Rate for Payer: Humana Medicare |
$37.76
|
| Rate for Payer: Lucent All Commercial |
$37.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.64
|
| Rate for Payer: Managed Health Services Medicaid |
$5.57
|
| Rate for Payer: MDWise Medicaid |
$5.57
|
| Rate for Payer: PHCS All Commercial |
$55.53
|
| Rate for Payer: PHP All Commercial |
$56.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.88
|
| Rate for Payer: Sagamore Health Network All Products |
$57.16
|
| Rate for Payer: Signature Care EPO |
$61.45
|
| Rate for Payer: Signature Care PPO |
$65.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.94
|
| Rate for Payer: United Healthcare Commercial |
$58.34
|
| Rate for Payer: United Healthcare Medicare |
$24.43
|
|
|
HC HERPES VIRUS BY PCR
|
Facility
IP
|
$248.03
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
63001037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$186.03 |
| Max. Negotiated Rate |
$230.67 |
| Rate for Payer: Aetna Commercial |
$214.30
|
| Rate for Payer: Cash Price |
$153.78
|
| Rate for Payer: Cigna All Commercial |
$214.05
|
| Rate for Payer: CORVEL All Commercial |
$230.67
|
| Rate for Payer: Coventry All Commercial |
$218.27
|
| Rate for Payer: Encore All Commercial |
$228.31
|
| Rate for Payer: Frontpath All Commercial |
$228.19
|
| Rate for Payer: Humana ChoiceCare |
$214.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$223.23
|
| Rate for Payer: PHCS All Commercial |
$186.03
|
| Rate for Payer: PHP All Commercial |
$188.11
|
| Rate for Payer: Sagamore Health Network All Products |
$191.48
|
| Rate for Payer: Signature Care EPO |
$205.87
|
| Rate for Payer: Signature Care PPO |
$218.27
|
| Rate for Payer: United Healthcare Commercial |
$195.45
|
|
|
HC HERPES VIRUS BY PCR
|
Facility
OP
|
$248.03
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
63001037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$230.67 |
| Rate for Payer: Aetna Commercial |
$209.34
|
| Rate for Payer: Aetna Medicare |
$81.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$114.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.04
|
| Rate for Payer: Cash Price |
$153.78
|
| Rate for Payer: Cash Price |
$153.78
|
| Rate for Payer: Centivo All Commercial |
$126.50
|
| Rate for Payer: Cigna All Commercial |
$214.05
|
| Rate for Payer: CORVEL All Commercial |
$230.67
|
| Rate for Payer: Coventry All Commercial |
$218.27
|
| Rate for Payer: Encore All Commercial |
$228.31
|
| Rate for Payer: Frontpath All Commercial |
$228.19
|
| Rate for Payer: Humana ChoiceCare |
$214.23
|
| Rate for Payer: Humana Medicare |
$126.50
|
| Rate for Payer: Lucent All Commercial |
$126.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$223.23
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$186.03
|
| Rate for Payer: PHP All Commercial |
$188.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.73
|
| Rate for Payer: Sagamore Health Network All Products |
$191.48
|
| Rate for Payer: Signature Care EPO |
$205.87
|
| Rate for Payer: Signature Care PPO |
$218.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$210.83
|
| Rate for Payer: United Healthcare Commercial |
$195.45
|
| Rate for Payer: United Healthcare Medicare |
$81.85
|
|
|
HC HEXAGONAL PHOSPHOLIPID NEUTRALIZATION
|
Facility
OP
|
$76.30
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
63001748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Aetna Commercial |
$64.39
|
| Rate for Payer: Aetna Medicare |
$25.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.70
|
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Centivo All Commercial |
$38.91
|
| Rate for Payer: Cigna All Commercial |
$65.84
|
| Rate for Payer: CORVEL All Commercial |
$70.96
|
| Rate for Payer: Coventry All Commercial |
$67.14
|
| Rate for Payer: Encore All Commercial |
$70.23
|
| Rate for Payer: Frontpath All Commercial |
$70.19
|
| Rate for Payer: Humana ChoiceCare |
$65.90
|
| Rate for Payer: Humana Medicare |
$38.91
|
| Rate for Payer: Lucent All Commercial |
$38.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.67
|
| Rate for Payer: Managed Health Services Medicaid |
$8.02
|
| Rate for Payer: MDWise Medicaid |
$8.02
|
| Rate for Payer: PHCS All Commercial |
$57.22
|
| Rate for Payer: PHP All Commercial |
$57.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.76
|
| Rate for Payer: Sagamore Health Network All Products |
$58.90
|
| Rate for Payer: Signature Care EPO |
$63.33
|
| Rate for Payer: Signature Care PPO |
$67.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.85
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
| Rate for Payer: United Healthcare Medicare |
$25.18
|
|
|
HC HEXAGONAL PHOSPHOLIPID NEUTRALIZATION
|
Facility
IP
|
$76.30
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
63001748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Cigna All Commercial |
$65.84
|
| Rate for Payer: CORVEL All Commercial |
$70.96
|
| Rate for Payer: Coventry All Commercial |
$67.14
|
| Rate for Payer: Encore All Commercial |
$70.23
|
| Rate for Payer: Frontpath All Commercial |
$70.19
|
| Rate for Payer: Humana ChoiceCare |
$65.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.67
|
| Rate for Payer: PHCS All Commercial |
$57.22
|
| Rate for Payer: PHP All Commercial |
$57.86
|
| Rate for Payer: Sagamore Health Network All Products |
$58.90
|
| Rate for Payer: Signature Care EPO |
$63.33
|
| Rate for Payer: Signature Care PPO |
$67.14
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
|
|
HC HGB
|
Facility
IP
|
$60.21
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
63001235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Cigna All Commercial |
$51.96
|
| Rate for Payer: CORVEL All Commercial |
$56.00
|
| Rate for Payer: Coventry All Commercial |
$52.99
|
| Rate for Payer: Encore All Commercial |
$55.42
|
| Rate for Payer: Frontpath All Commercial |
$55.39
|
| Rate for Payer: Humana ChoiceCare |
$52.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.19
|
| Rate for Payer: PHCS All Commercial |
$45.16
|
| Rate for Payer: PHP All Commercial |
$45.66
|
| Rate for Payer: Sagamore Health Network All Products |
$46.48
|
| Rate for Payer: Signature Care EPO |
$49.97
|
| Rate for Payer: Signature Care PPO |
$52.99
|
| Rate for Payer: United Healthcare Commercial |
$47.45
|
|
|
HC HGB
|
Facility
OP
|
$60.21
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
63001235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Aetna Medicare |
$19.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.86
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Centivo All Commercial |
$30.71
|
| Rate for Payer: Cigna All Commercial |
$51.96
|
| Rate for Payer: CORVEL All Commercial |
$56.00
|
| Rate for Payer: Coventry All Commercial |
$52.99
|
| Rate for Payer: Encore All Commercial |
$55.42
|
| Rate for Payer: Frontpath All Commercial |
$55.39
|
| Rate for Payer: Humana ChoiceCare |
$52.00
|
| Rate for Payer: Humana Medicare |
$30.71
|
| Rate for Payer: Lucent All Commercial |
$30.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.19
|
| Rate for Payer: Managed Health Services Medicaid |
$2.37
|
| Rate for Payer: MDWise Medicaid |
$2.37
|
| Rate for Payer: PHCS All Commercial |
$45.16
|
| Rate for Payer: PHP All Commercial |
$45.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.48
|
| Rate for Payer: Sagamore Health Network All Products |
$46.48
|
| Rate for Payer: Signature Care EPO |
$49.97
|
| Rate for Payer: Signature Care PPO |
$52.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.18
|
| Rate for Payer: United Healthcare Commercial |
$47.45
|
| Rate for Payer: United Healthcare Medicare |
$19.87
|
|
|
HC HGB
|
Facility
OP
|
$34.74
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
63001234
|
|
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 HGB
|
Facility
IP
|
$34.74
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
63001234
|
|
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 HGB*
|
Facility
IP
|
$34.74
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
63001236
|
|
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 HGB*
|
Facility
OP
|
$34.74
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
63001236
|
|
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 HGB PLASMA
|
Facility
OP
|
$92.53
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
63001570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$86.06 |
| Rate for Payer: Aetna Commercial |
$78.10
|
| Rate for Payer: Aetna Medicare |
$30.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.59
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Centivo All Commercial |
$47.19
|
| Rate for Payer: Cigna All Commercial |
$79.86
|
| Rate for Payer: CORVEL All Commercial |
$86.06
|
| Rate for Payer: Coventry All Commercial |
$81.43
|
| Rate for Payer: Encore All Commercial |
$85.18
|
| Rate for Payer: Frontpath All Commercial |
$85.13
|
| Rate for Payer: Humana ChoiceCare |
$79.92
|
| Rate for Payer: Humana Medicare |
$47.19
|
| Rate for Payer: Lucent All Commercial |
$47.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.28
|
| Rate for Payer: Managed Health Services Medicaid |
$7.10
|
| Rate for Payer: MDWise Medicaid |
$7.10
|
| Rate for Payer: PHCS All Commercial |
$69.40
|
| Rate for Payer: PHP All Commercial |
$70.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.09
|
| Rate for Payer: Sagamore Health Network All Products |
$71.44
|
| Rate for Payer: Signature Care EPO |
$76.80
|
| Rate for Payer: Signature Care PPO |
$81.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.65
|
| Rate for Payer: United Healthcare Commercial |
$72.92
|
| Rate for Payer: United Healthcare Medicare |
$30.54
|
|
|
HC HGB PLASMA
|
Facility
IP
|
$92.53
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
63001570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$86.06 |
| Rate for Payer: Aetna Commercial |
$79.95
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Cigna All Commercial |
$79.86
|
| Rate for Payer: CORVEL All Commercial |
$86.06
|
| Rate for Payer: Coventry All Commercial |
$81.43
|
| Rate for Payer: Encore All Commercial |
$85.18
|
| Rate for Payer: Frontpath All Commercial |
$85.13
|
| Rate for Payer: Humana ChoiceCare |
$79.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.28
|
| Rate for Payer: PHCS All Commercial |
$69.40
|
| Rate for Payer: PHP All Commercial |
$70.18
|
| Rate for Payer: Sagamore Health Network All Products |
$71.44
|
| Rate for Payer: Signature Care EPO |
$76.80
|
| Rate for Payer: Signature Care PPO |
$81.43
|
| Rate for Payer: United Healthcare Commercial |
$72.92
|
|
|
HC HILL ROM ROTATION MATTRESS
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
01890130
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Aetna Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.23
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Centivo All Commercial |
$156.27
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Humana Medicare |
$156.27
|
| Rate for Payer: Lucent All Commercial |
$156.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.50
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.45
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
| Rate for Payer: United Healthcare Medicare |
$101.11
|
|
|
HC HILL ROM ROTATION MATTRESS
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
01890130
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$229.81 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$264.74
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
|
|
HC HIP ARTHROGRAM LT
|
Facility
OP
|
$1,153.51
|
|
|
Service Code
|
CPT 73525 LT
|
| Hospital Charge Code |
01616074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.66 |
| Max. Negotiated Rate |
$1,072.76 |
| Rate for Payer: Aetna Commercial |
$973.56
|
| Rate for Payer: Aetna Medicare |
$380.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$380.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$662.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$437.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$418.72
|
| Rate for Payer: Cash Price |
$715.18
|
| Rate for Payer: Centivo All Commercial |
$588.29
|
| Rate for Payer: Cigna All Commercial |
$995.48
|
| Rate for Payer: CORVEL All Commercial |
$1,072.76
|
| Rate for Payer: Coventry All Commercial |
$1,015.09
|
| Rate for Payer: Encore All Commercial |
$1,061.80
|
| Rate for Payer: Frontpath All Commercial |
$1,061.23
|
| Rate for Payer: Humana ChoiceCare |
$996.28
|
| Rate for Payer: Humana Medicare |
$588.29
|
| Rate for Payer: Lucent All Commercial |
$588.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,038.16
|
| Rate for Payer: PHCS All Commercial |
$865.13
|
| Rate for Payer: PHP All Commercial |
$874.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$449.87
|
| Rate for Payer: Sagamore Health Network All Products |
$890.51
|
| Rate for Payer: Signature Care EPO |
$957.41
|
| Rate for Payer: Signature Care PPO |
$1,015.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$980.48
|
| Rate for Payer: United Healthcare Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare |
$380.66
|
|
|
HC HIP ARTHROGRAM LT
|
Facility
IP
|
$1,153.51
|
|
|
Service Code
|
CPT 73525 LT
|
| Hospital Charge Code |
01616074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$865.13 |
| Max. Negotiated Rate |
$1,072.76 |
| Rate for Payer: Aetna Commercial |
$996.63
|
| Rate for Payer: Cash Price |
$715.18
|
| Rate for Payer: Cigna All Commercial |
$995.48
|
| Rate for Payer: CORVEL All Commercial |
$1,072.76
|
| Rate for Payer: Coventry All Commercial |
$1,015.09
|
| Rate for Payer: Encore All Commercial |
$1,061.80
|
| Rate for Payer: Frontpath All Commercial |
$1,061.23
|
| Rate for Payer: Humana ChoiceCare |
$996.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,038.16
|
| Rate for Payer: PHCS All Commercial |
$865.13
|
| Rate for Payer: PHP All Commercial |
$874.82
|
| Rate for Payer: Sagamore Health Network All Products |
$890.51
|
| Rate for Payer: Signature Care EPO |
$957.41
|
| Rate for Payer: Signature Care PPO |
$1,015.09
|
| Rate for Payer: United Healthcare Commercial |
$908.96
|
|
|
HC HIP ARTHROGRAM RT
|
Facility
OP
|
$1,153.51
|
|
|
Service Code
|
CPT 73525 RT
|
| Hospital Charge Code |
11616074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.66 |
| Max. Negotiated Rate |
$1,072.76 |
| Rate for Payer: Aetna Commercial |
$973.56
|
| Rate for Payer: Aetna Medicare |
$380.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$380.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$662.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$437.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$418.72
|
| Rate for Payer: Cash Price |
$715.18
|
| Rate for Payer: Centivo All Commercial |
$588.29
|
| Rate for Payer: Cigna All Commercial |
$995.48
|
| Rate for Payer: CORVEL All Commercial |
$1,072.76
|
| Rate for Payer: Coventry All Commercial |
$1,015.09
|
| Rate for Payer: Encore All Commercial |
$1,061.80
|
| Rate for Payer: Frontpath All Commercial |
$1,061.23
|
| Rate for Payer: Humana ChoiceCare |
$996.28
|
| Rate for Payer: Humana Medicare |
$588.29
|
| Rate for Payer: Lucent All Commercial |
$588.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,038.16
|
| Rate for Payer: PHCS All Commercial |
$865.13
|
| Rate for Payer: PHP All Commercial |
$874.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$449.87
|
| Rate for Payer: Sagamore Health Network All Products |
$890.51
|
| Rate for Payer: Signature Care EPO |
$957.41
|
| Rate for Payer: Signature Care PPO |
$1,015.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$980.48
|
| Rate for Payer: United Healthcare Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare |
$380.66
|
|
|
HC HIP ARTHROGRAM RT
|
Facility
IP
|
$1,153.51
|
|
|
Service Code
|
CPT 73525 RT
|
| Hospital Charge Code |
11616074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$865.13 |
| Max. Negotiated Rate |
$1,072.76 |
| Rate for Payer: Aetna Commercial |
$996.63
|
| Rate for Payer: Cash Price |
$715.18
|
| Rate for Payer: Cigna All Commercial |
$995.48
|
| Rate for Payer: CORVEL All Commercial |
$1,072.76
|
| Rate for Payer: Coventry All Commercial |
$1,015.09
|
| Rate for Payer: Encore All Commercial |
$1,061.80
|
| Rate for Payer: Frontpath All Commercial |
$1,061.23
|
| Rate for Payer: Humana ChoiceCare |
$996.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,038.16
|
| Rate for Payer: PHCS All Commercial |
$865.13
|
| Rate for Payer: PHP All Commercial |
$874.82
|
| Rate for Payer: Sagamore Health Network All Products |
$890.51
|
| Rate for Payer: Signature Care EPO |
$957.41
|
| Rate for Payer: Signature Care PPO |
$1,015.09
|
| Rate for Payer: United Healthcare Commercial |
$908.96
|
|
|
HC HISTAMINE URINE
|
Facility
OP
|
$522.57
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
63001572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.53 |
| Max. Negotiated Rate |
$485.99 |
| Rate for Payer: Aetna Commercial |
$441.05
|
| Rate for Payer: Aetna Medicare |
$172.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$172.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$240.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$29.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.69
|
| Rate for Payer: Cash Price |
$323.99
|
| Rate for Payer: Cash Price |
$323.99
|
| Rate for Payer: Centivo All Commercial |
$266.51
|
| Rate for Payer: Cigna All Commercial |
$450.97
|
| Rate for Payer: CORVEL All Commercial |
$485.99
|
| Rate for Payer: Coventry All Commercial |
$459.86
|
| Rate for Payer: Encore All Commercial |
$481.02
|
| Rate for Payer: Frontpath All Commercial |
$480.76
|
| Rate for Payer: Humana ChoiceCare |
$451.34
|
| Rate for Payer: Humana Medicare |
$266.51
|
| Rate for Payer: Lucent All Commercial |
$266.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$470.31
|
| Rate for Payer: Managed Health Services Medicaid |
$29.53
|
| Rate for Payer: MDWise Medicaid |
$29.53
|
| Rate for Payer: PHCS All Commercial |
$391.92
|
| Rate for Payer: PHP All Commercial |
$396.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$203.80
|
| Rate for Payer: Sagamore Health Network All Products |
$403.42
|
| Rate for Payer: Signature Care EPO |
$433.73
|
| Rate for Payer: Signature Care PPO |
$459.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$444.18
|
| Rate for Payer: United Healthcare Commercial |
$411.78
|
| Rate for Payer: United Healthcare Medicare |
$172.45
|
|
|
HC HISTAMINE URINE
|
Facility
IP
|
$522.57
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
63001572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$391.92 |
| Max. Negotiated Rate |
$485.99 |
| Rate for Payer: Aetna Commercial |
$451.50
|
| Rate for Payer: Cash Price |
$323.99
|
| Rate for Payer: Cigna All Commercial |
$450.97
|
| Rate for Payer: CORVEL All Commercial |
$485.99
|
| Rate for Payer: Coventry All Commercial |
$459.86
|
| Rate for Payer: Encore All Commercial |
$481.02
|
| Rate for Payer: Frontpath All Commercial |
$480.76
|
| Rate for Payer: Humana ChoiceCare |
$451.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$470.31
|
| Rate for Payer: PHCS All Commercial |
$391.92
|
| Rate for Payer: PHP All Commercial |
$396.31
|
| Rate for Payer: Sagamore Health Network All Products |
$403.42
|
| Rate for Payer: Signature Care EPO |
$433.73
|
| Rate for Payer: Signature Care PPO |
$459.86
|
| Rate for Payer: United Healthcare Commercial |
$411.78
|
|
|
HC HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
IP
|
$92.06
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.04 |
| Max. Negotiated Rate |
$85.61 |
| Rate for Payer: Aetna Commercial |
$79.54
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Cigna All Commercial |
$79.44
|
| Rate for Payer: CORVEL All Commercial |
$85.61
|
| Rate for Payer: Coventry All Commercial |
$81.01
|
| Rate for Payer: Encore All Commercial |
$84.74
|
| Rate for Payer: Frontpath All Commercial |
$84.69
|
| Rate for Payer: Humana ChoiceCare |
$79.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.85
|
| Rate for Payer: PHCS All Commercial |
$69.04
|
| Rate for Payer: PHP All Commercial |
$69.81
|
| Rate for Payer: Sagamore Health Network All Products |
$71.07
|
| Rate for Payer: Signature Care EPO |
$76.41
|
| Rate for Payer: Signature Care PPO |
$81.01
|
| Rate for Payer: United Healthcare Commercial |
$72.54
|
|
|
HC HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
OP
|
$92.06
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$85.61 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Medicare |
$30.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.42
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Centivo All Commercial |
$46.95
|
| Rate for Payer: Cigna All Commercial |
$79.44
|
| Rate for Payer: CORVEL All Commercial |
$85.61
|
| Rate for Payer: Coventry All Commercial |
$81.01
|
| Rate for Payer: Encore All Commercial |
$84.74
|
| Rate for Payer: Frontpath All Commercial |
$84.69
|
| Rate for Payer: Humana ChoiceCare |
$79.51
|
| Rate for Payer: Humana Medicare |
$46.95
|
| Rate for Payer: Lucent All Commercial |
$46.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.85
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$69.04
|
| Rate for Payer: PHP All Commercial |
$69.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.90
|
| Rate for Payer: Sagamore Health Network All Products |
$71.07
|
| Rate for Payer: Signature Care EPO |
$76.41
|
| Rate for Payer: Signature Care PPO |
$81.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.25
|
| Rate for Payer: United Healthcare Commercial |
$72.54
|
| Rate for Payer: United Healthcare Medicare |
$30.38
|
|
|
HC HISTOPLASMA CAP AG
|
Facility
OP
|
$532.95
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
63001019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$495.64 |
| Rate for Payer: Aetna Commercial |
$449.81
|
| Rate for Payer: Aetna Medicare |
$175.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$306.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$333.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$202.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.46
|
| Rate for Payer: Cash Price |
$330.43
|
| Rate for Payer: Cash Price |
$330.43
|
| Rate for Payer: Centivo All Commercial |
$271.80
|
| Rate for Payer: Cigna All Commercial |
$459.94
|
| Rate for Payer: CORVEL All Commercial |
$495.64
|
| Rate for Payer: Coventry All Commercial |
$469.00
|
| Rate for Payer: Encore All Commercial |
$490.58
|
| Rate for Payer: Frontpath All Commercial |
$490.31
|
| Rate for Payer: Humana ChoiceCare |
$460.31
|
| Rate for Payer: Humana Medicare |
$271.80
|
| Rate for Payer: Lucent All Commercial |
$271.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$479.66
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$399.71
|
| Rate for Payer: PHP All Commercial |
$404.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$207.85
|
| Rate for Payer: Sagamore Health Network All Products |
$411.44
|
| Rate for Payer: Signature Care EPO |
$442.35
|
| Rate for Payer: Signature Care PPO |
$469.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$453.01
|
| Rate for Payer: United Healthcare Commercial |
$419.96
|
| Rate for Payer: United Healthcare Medicare |
$175.87
|
|
