|
HC HOME SLEEP STUDY
|
Facility
OP
|
$1,103.53
|
|
|
Service Code
|
CPT G0399
|
| Hospital Charge Code |
01369580
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$364.16 |
| Max. Negotiated Rate |
$1,026.28 |
| Rate for Payer: Aetna Commercial |
$931.38
|
| Rate for Payer: Aetna Medicare |
$364.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$364.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$633.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$689.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$418.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$400.58
|
| Rate for Payer: Cash Price |
$684.19
|
| Rate for Payer: Centivo All Commercial |
$562.80
|
| Rate for Payer: Cigna All Commercial |
$952.34
|
| Rate for Payer: CORVEL All Commercial |
$1,026.28
|
| Rate for Payer: Coventry All Commercial |
$971.10
|
| Rate for Payer: Encore All Commercial |
$1,015.80
|
| Rate for Payer: Frontpath All Commercial |
$1,015.25
|
| Rate for Payer: Humana ChoiceCare |
$953.12
|
| Rate for Payer: Humana Medicare |
$562.80
|
| Rate for Payer: Lucent All Commercial |
$562.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.18
|
| Rate for Payer: PHCS All Commercial |
$827.65
|
| Rate for Payer: PHP All Commercial |
$836.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$430.38
|
| Rate for Payer: Sagamore Health Network All Products |
$851.92
|
| Rate for Payer: Signature Care EPO |
$915.93
|
| Rate for Payer: Signature Care PPO |
$971.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.00
|
| Rate for Payer: United Healthcare Commercial |
$869.58
|
| Rate for Payer: United Healthcare Medicare |
$364.16
|
|
|
HC HOME SLEEP STUDY
|
Facility
IP
|
$1,103.53
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
01365806
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$827.65 |
| Max. Negotiated Rate |
$1,026.28 |
| Rate for Payer: Aetna Commercial |
$953.45
|
| Rate for Payer: Cash Price |
$684.19
|
| Rate for Payer: Cigna All Commercial |
$952.34
|
| Rate for Payer: CORVEL All Commercial |
$1,026.28
|
| Rate for Payer: Coventry All Commercial |
$971.10
|
| Rate for Payer: Encore All Commercial |
$1,015.80
|
| Rate for Payer: Frontpath All Commercial |
$1,015.25
|
| Rate for Payer: Humana ChoiceCare |
$953.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.18
|
| Rate for Payer: PHCS All Commercial |
$827.65
|
| Rate for Payer: PHP All Commercial |
$836.92
|
| Rate for Payer: Sagamore Health Network All Products |
$851.92
|
| Rate for Payer: Signature Care EPO |
$915.93
|
| Rate for Payer: Signature Care PPO |
$971.10
|
| Rate for Payer: United Healthcare Commercial |
$869.58
|
|
|
HC HOME SLEEP STUDY
|
Facility
OP
|
$1,103.53
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
01365806
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$364.16 |
| Max. Negotiated Rate |
$1,026.28 |
| Rate for Payer: Aetna Commercial |
$931.38
|
| Rate for Payer: Aetna Medicare |
$364.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$364.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$633.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$689.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$498.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$418.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$400.58
|
| Rate for Payer: Cash Price |
$684.19
|
| Rate for Payer: Cash Price |
$684.19
|
| Rate for Payer: Centivo All Commercial |
$562.80
|
| Rate for Payer: Cigna All Commercial |
$952.34
|
| Rate for Payer: CORVEL All Commercial |
$1,026.28
|
| Rate for Payer: Coventry All Commercial |
$971.10
|
| Rate for Payer: Encore All Commercial |
$1,015.80
|
| Rate for Payer: Frontpath All Commercial |
$1,015.25
|
| Rate for Payer: Humana ChoiceCare |
$953.12
|
| Rate for Payer: Humana Medicare |
$562.80
|
| Rate for Payer: Lucent All Commercial |
$562.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.18
|
| Rate for Payer: Managed Health Services Medicaid |
$498.34
|
| Rate for Payer: MDWise Medicaid |
$498.34
|
| Rate for Payer: PHCS All Commercial |
$827.65
|
| Rate for Payer: PHP All Commercial |
$836.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$430.38
|
| Rate for Payer: Sagamore Health Network All Products |
$851.92
|
| Rate for Payer: Signature Care EPO |
$915.93
|
| Rate for Payer: Signature Care PPO |
$971.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.00
|
| Rate for Payer: United Healthcare Commercial |
$869.58
|
| Rate for Payer: United Healthcare Medicare |
$364.16
|
|
|
HC HOME SLEEP STUDY
|
Facility
IP
|
$1,103.53
|
|
|
Service Code
|
CPT G0399
|
| Hospital Charge Code |
01369580
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$827.65 |
| Max. Negotiated Rate |
$1,026.28 |
| Rate for Payer: Aetna Commercial |
$953.45
|
| Rate for Payer: Cash Price |
$684.19
|
| Rate for Payer: Cigna All Commercial |
$952.34
|
| Rate for Payer: CORVEL All Commercial |
$1,026.28
|
| Rate for Payer: Coventry All Commercial |
$971.10
|
| Rate for Payer: Encore All Commercial |
$1,015.80
|
| Rate for Payer: Frontpath All Commercial |
$1,015.25
|
| Rate for Payer: Humana ChoiceCare |
$953.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.18
|
| Rate for Payer: PHCS All Commercial |
$827.65
|
| Rate for Payer: PHP All Commercial |
$836.92
|
| Rate for Payer: Sagamore Health Network All Products |
$851.92
|
| Rate for Payer: Signature Care EPO |
$915.93
|
| Rate for Payer: Signature Care PPO |
$971.10
|
| Rate for Payer: United Healthcare Commercial |
$869.58
|
|
|
HC HOMOCYSTEINE
|
Facility
IP
|
$255.24
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
63001305
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.43 |
| Max. Negotiated Rate |
$237.38 |
| Rate for Payer: Aetna Commercial |
$220.53
|
| Rate for Payer: Cash Price |
$158.25
|
| Rate for Payer: Cigna All Commercial |
$220.28
|
| Rate for Payer: CORVEL All Commercial |
$237.38
|
| Rate for Payer: Coventry All Commercial |
$224.62
|
| Rate for Payer: Encore All Commercial |
$234.95
|
| Rate for Payer: Frontpath All Commercial |
$234.83
|
| Rate for Payer: Humana ChoiceCare |
$220.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.72
|
| Rate for Payer: PHCS All Commercial |
$191.43
|
| Rate for Payer: PHP All Commercial |
$193.58
|
| Rate for Payer: Sagamore Health Network All Products |
$197.05
|
| Rate for Payer: Signature Care EPO |
$211.85
|
| Rate for Payer: Signature Care PPO |
$224.62
|
| Rate for Payer: United Healthcare Commercial |
$201.13
|
|
|
HC HOMOCYSTEINE
|
Facility
OP
|
$255.24
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
63001305
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$237.38 |
| Rate for Payer: Aetna Commercial |
$215.43
|
| Rate for Payer: Aetna Medicare |
$84.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.65
|
| Rate for Payer: Cash Price |
$158.25
|
| Rate for Payer: Cash Price |
$158.25
|
| Rate for Payer: Centivo All Commercial |
$130.17
|
| Rate for Payer: Cigna All Commercial |
$220.28
|
| Rate for Payer: CORVEL All Commercial |
$237.38
|
| Rate for Payer: Coventry All Commercial |
$224.62
|
| Rate for Payer: Encore All Commercial |
$234.95
|
| Rate for Payer: Frontpath All Commercial |
$234.83
|
| Rate for Payer: Humana ChoiceCare |
$220.45
|
| Rate for Payer: Humana Medicare |
$130.17
|
| Rate for Payer: Lucent All Commercial |
$130.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.72
|
| Rate for Payer: Managed Health Services Medicaid |
$17.92
|
| Rate for Payer: MDWise Medicaid |
$17.92
|
| Rate for Payer: PHCS All Commercial |
$191.43
|
| Rate for Payer: PHP All Commercial |
$193.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.55
|
| Rate for Payer: Sagamore Health Network All Products |
$197.05
|
| Rate for Payer: Signature Care EPO |
$211.85
|
| Rate for Payer: Signature Care PPO |
$224.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$216.96
|
| Rate for Payer: United Healthcare Commercial |
$201.13
|
| Rate for Payer: United Healthcare Medicare |
$84.23
|
|
|
HC HOSPICE ROOM
|
Facility
IP
|
$1,644.24
|
|
| Hospital Charge Code |
10010054
|
|
Hospital Revenue Code
|
125
|
| Min. Negotiated Rate |
$1,233.18 |
| Max. Negotiated Rate |
$5,584.50 |
| Rate for Payer: Aetna Commercial |
$1,420.62
|
| Rate for Payer: Aetna Medicare |
$3,285.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,285.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,777.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,613.50
|
| Rate for Payer: Cash Price |
$1,019.43
|
| Rate for Payer: Cash Price |
$1,019.43
|
| Rate for Payer: Centivo All Commercial |
$3,613.50
|
| Rate for Payer: Cigna All Commercial |
$1,418.98
|
| Rate for Payer: CORVEL All Commercial |
$1,529.14
|
| Rate for Payer: Coventry All Commercial |
$1,446.93
|
| Rate for Payer: Encore All Commercial |
$1,513.52
|
| Rate for Payer: Frontpath All Commercial |
$1,512.70
|
| Rate for Payer: Humana ChoiceCare |
$1,420.13
|
| Rate for Payer: Humana Medicare |
$3,285.00
|
| Rate for Payer: Lucent All Commercial |
$5,584.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,479.82
|
| Rate for Payer: PHCS All Commercial |
$1,233.18
|
| Rate for Payer: PHP All Commercial |
$1,246.99
|
| Rate for Payer: Sagamore Health Network All Products |
$1,269.35
|
| Rate for Payer: Signature Care EPO |
$1,364.72
|
| Rate for Payer: Signature Care PPO |
$1,446.93
|
| Rate for Payer: United Healthcare Commercial |
$1,295.66
|
| Rate for Payer: United Healthcare Medicare |
$3,285.00
|
|
|
HC HPV
|
Facility
OP
|
$114.75
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
63087803
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$96.85
|
| Rate for Payer: Aetna Medicare |
$37.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.65
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Centivo All Commercial |
$58.52
|
| Rate for Payer: Cigna All Commercial |
$99.03
|
| Rate for Payer: CORVEL All Commercial |
$106.72
|
| Rate for Payer: Coventry All Commercial |
$100.98
|
| Rate for Payer: Encore All Commercial |
$105.63
|
| Rate for Payer: Frontpath All Commercial |
$105.57
|
| Rate for Payer: Humana ChoiceCare |
$99.11
|
| Rate for Payer: Humana Medicare |
$58.52
|
| Rate for Payer: Lucent All Commercial |
$58.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.28
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$86.06
|
| Rate for Payer: PHP All Commercial |
$87.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.75
|
| Rate for Payer: Sagamore Health Network All Products |
$88.59
|
| Rate for Payer: Signature Care EPO |
$95.24
|
| Rate for Payer: Signature Care PPO |
$100.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$97.54
|
| Rate for Payer: United Healthcare Commercial |
$90.42
|
| Rate for Payer: United Healthcare Medicare |
$37.87
|
|
|
HC HPV
|
Facility
IP
|
$114.75
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
63087803
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$99.14
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Cigna All Commercial |
$99.03
|
| Rate for Payer: CORVEL All Commercial |
$106.72
|
| Rate for Payer: Coventry All Commercial |
$100.98
|
| Rate for Payer: Encore All Commercial |
$105.63
|
| Rate for Payer: Frontpath All Commercial |
$105.57
|
| Rate for Payer: Humana ChoiceCare |
$99.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.28
|
| Rate for Payer: PHCS All Commercial |
$86.06
|
| Rate for Payer: PHP All Commercial |
$87.03
|
| Rate for Payer: Sagamore Health Network All Products |
$88.59
|
| Rate for Payer: Signature Care EPO |
$95.24
|
| Rate for Payer: Signature Care PPO |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$90.42
|
|
|
HC HSV1 GLYCO-G CSF
|
Facility
OP
|
$104.91
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
63001946
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$97.56 |
| Rate for Payer: Aetna Commercial |
$88.54
|
| Rate for Payer: Aetna Medicare |
$34.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.08
|
| Rate for Payer: Cash Price |
$65.04
|
| Rate for Payer: Cash Price |
$65.04
|
| Rate for Payer: Centivo All Commercial |
$53.50
|
| Rate for Payer: Cigna All Commercial |
$90.53
|
| Rate for Payer: CORVEL All Commercial |
$97.56
|
| Rate for Payer: Coventry All Commercial |
$92.32
|
| Rate for Payer: Encore All Commercial |
$96.57
|
| Rate for Payer: Frontpath All Commercial |
$96.51
|
| Rate for Payer: Humana ChoiceCare |
$90.61
|
| Rate for Payer: Humana Medicare |
$53.50
|
| Rate for Payer: Lucent All Commercial |
$53.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.42
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: MDWise Medicaid |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$78.68
|
| Rate for Payer: PHP All Commercial |
$79.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.91
|
| Rate for Payer: Sagamore Health Network All Products |
$80.99
|
| Rate for Payer: Signature Care EPO |
$87.07
|
| Rate for Payer: Signature Care PPO |
$92.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.17
|
| Rate for Payer: United Healthcare Commercial |
$82.67
|
| Rate for Payer: United Healthcare Medicare |
$34.62
|
|
|
HC HSV1 GLYCO-G CSF
|
Facility
IP
|
$104.91
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
63001946
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.68 |
| Max. Negotiated Rate |
$97.56 |
| Rate for Payer: Aetna Commercial |
$90.64
|
| Rate for Payer: Cash Price |
$65.04
|
| Rate for Payer: Cigna All Commercial |
$90.53
|
| Rate for Payer: CORVEL All Commercial |
$97.56
|
| Rate for Payer: Coventry All Commercial |
$92.32
|
| Rate for Payer: Encore All Commercial |
$96.57
|
| Rate for Payer: Frontpath All Commercial |
$96.51
|
| Rate for Payer: Humana ChoiceCare |
$90.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.42
|
| Rate for Payer: PHCS All Commercial |
$78.68
|
| Rate for Payer: PHP All Commercial |
$79.56
|
| Rate for Payer: Sagamore Health Network All Products |
$80.99
|
| Rate for Payer: Signature Care EPO |
$87.07
|
| Rate for Payer: Signature Care PPO |
$92.32
|
| Rate for Payer: United Healthcare Commercial |
$82.67
|
|
|
HC HSV1 GLYCO G-SPECIFI
|
Facility
OP
|
$83.43
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
63001945
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$77.59 |
| Rate for Payer: Aetna Commercial |
$70.41
|
| Rate for Payer: Aetna Medicare |
$27.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.28
|
| Rate for Payer: Cash Price |
$51.72
|
| Rate for Payer: Cash Price |
$51.72
|
| Rate for Payer: Centivo All Commercial |
$42.55
|
| Rate for Payer: Cigna All Commercial |
$72.00
|
| Rate for Payer: CORVEL All Commercial |
$77.59
|
| Rate for Payer: Coventry All Commercial |
$73.41
|
| Rate for Payer: Encore All Commercial |
$76.79
|
| Rate for Payer: Frontpath All Commercial |
$76.75
|
| Rate for Payer: Humana ChoiceCare |
$72.05
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Lucent All Commercial |
$42.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.08
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: MDWise Medicaid |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$62.57
|
| Rate for Payer: PHP All Commercial |
$63.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.54
|
| Rate for Payer: Sagamore Health Network All Products |
$64.40
|
| Rate for Payer: Signature Care EPO |
$69.24
|
| Rate for Payer: Signature Care PPO |
$73.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.91
|
| Rate for Payer: United Healthcare Commercial |
$65.74
|
| Rate for Payer: United Healthcare Medicare |
$27.53
|
|
|
HC HSV1 GLYCO G-SPECIFI
|
Facility
IP
|
$83.43
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
63001945
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.57 |
| Max. Negotiated Rate |
$77.59 |
| Rate for Payer: Aetna Commercial |
$72.08
|
| Rate for Payer: Cash Price |
$51.72
|
| Rate for Payer: Cigna All Commercial |
$72.00
|
| Rate for Payer: CORVEL All Commercial |
$77.59
|
| Rate for Payer: Coventry All Commercial |
$73.41
|
| Rate for Payer: Encore All Commercial |
$76.79
|
| Rate for Payer: Frontpath All Commercial |
$76.75
|
| Rate for Payer: Humana ChoiceCare |
$72.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.08
|
| Rate for Payer: PHCS All Commercial |
$62.57
|
| Rate for Payer: PHP All Commercial |
$63.27
|
| Rate for Payer: Sagamore Health Network All Products |
$64.40
|
| Rate for Payer: Signature Care EPO |
$69.24
|
| Rate for Payer: Signature Care PPO |
$73.41
|
| Rate for Payer: United Healthcare Commercial |
$65.74
|
|
|
HC HSV2 GLYCO-G CSF
|
Facility
IP
|
$111.76
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
63001948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.82 |
| Max. Negotiated Rate |
$103.94 |
| Rate for Payer: Aetna Commercial |
$96.56
|
| Rate for Payer: Cash Price |
$69.29
|
| Rate for Payer: Cigna All Commercial |
$96.45
|
| Rate for Payer: CORVEL All Commercial |
$103.94
|
| Rate for Payer: Coventry All Commercial |
$98.35
|
| Rate for Payer: Encore All Commercial |
$102.88
|
| Rate for Payer: Frontpath All Commercial |
$102.82
|
| Rate for Payer: Humana ChoiceCare |
$96.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.59
|
| Rate for Payer: PHCS All Commercial |
$83.82
|
| Rate for Payer: PHP All Commercial |
$84.76
|
| Rate for Payer: Sagamore Health Network All Products |
$86.28
|
| Rate for Payer: Signature Care EPO |
$92.76
|
| Rate for Payer: Signature Care PPO |
$98.35
|
| Rate for Payer: United Healthcare Commercial |
$88.07
|
|
|
HC HSV2 GLYCO-G CSF
|
Facility
OP
|
$111.76
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
63001948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$103.94 |
| Rate for Payer: Aetna Commercial |
$94.33
|
| Rate for Payer: Aetna Medicare |
$36.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.57
|
| Rate for Payer: Cash Price |
$69.29
|
| Rate for Payer: Cash Price |
$69.29
|
| Rate for Payer: Centivo All Commercial |
$57.00
|
| Rate for Payer: Cigna All Commercial |
$96.45
|
| Rate for Payer: CORVEL All Commercial |
$103.94
|
| Rate for Payer: Coventry All Commercial |
$98.35
|
| Rate for Payer: Encore All Commercial |
$102.88
|
| Rate for Payer: Frontpath All Commercial |
$102.82
|
| Rate for Payer: Humana ChoiceCare |
$96.53
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Lucent All Commercial |
$57.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.59
|
| Rate for Payer: Managed Health Services Medicaid |
$19.35
|
| Rate for Payer: MDWise Medicaid |
$19.35
|
| Rate for Payer: PHCS All Commercial |
$83.82
|
| Rate for Payer: PHP All Commercial |
$84.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.59
|
| Rate for Payer: Sagamore Health Network All Products |
$86.28
|
| Rate for Payer: Signature Care EPO |
$92.76
|
| Rate for Payer: Signature Care PPO |
$98.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.00
|
| Rate for Payer: United Healthcare Commercial |
$88.07
|
| Rate for Payer: United Healthcare Medicare |
$36.88
|
|
|
HC HUMAN GROWTH HORMONE
|
Facility
OP
|
$191.86
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
63001566
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.67 |
| Max. Negotiated Rate |
$178.43 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Medicare |
$63.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$110.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$119.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.65
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Centivo All Commercial |
$97.85
|
| Rate for Payer: Cigna All Commercial |
$165.58
|
| Rate for Payer: CORVEL All Commercial |
$178.43
|
| Rate for Payer: Coventry All Commercial |
$168.84
|
| Rate for Payer: Encore All Commercial |
$176.61
|
| Rate for Payer: Frontpath All Commercial |
$176.51
|
| Rate for Payer: Humana ChoiceCare |
$165.71
|
| Rate for Payer: Humana Medicare |
$97.85
|
| Rate for Payer: Lucent All Commercial |
$97.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.68
|
| Rate for Payer: Managed Health Services Medicaid |
$16.67
|
| Rate for Payer: MDWise Medicaid |
$16.67
|
| Rate for Payer: PHCS All Commercial |
$143.90
|
| Rate for Payer: PHP All Commercial |
$145.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$74.83
|
| Rate for Payer: Sagamore Health Network All Products |
$148.12
|
| Rate for Payer: Signature Care EPO |
$159.25
|
| Rate for Payer: Signature Care PPO |
$168.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$163.08
|
| Rate for Payer: United Healthcare Commercial |
$151.19
|
| Rate for Payer: United Healthcare Medicare |
$63.31
|
|
|
HC HUMAN GROWTH HORMONE
|
Facility
IP
|
$191.86
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
63001566
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$178.43 |
| Rate for Payer: Aetna Commercial |
$165.77
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Cigna All Commercial |
$165.58
|
| Rate for Payer: CORVEL All Commercial |
$178.43
|
| Rate for Payer: Coventry All Commercial |
$168.84
|
| Rate for Payer: Encore All Commercial |
$176.61
|
| Rate for Payer: Frontpath All Commercial |
$176.51
|
| Rate for Payer: Humana ChoiceCare |
$165.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.68
|
| Rate for Payer: PHCS All Commercial |
$143.90
|
| Rate for Payer: PHP All Commercial |
$145.51
|
| Rate for Payer: Sagamore Health Network All Products |
$148.12
|
| Rate for Payer: Signature Care EPO |
$159.25
|
| Rate for Payer: Signature Care PPO |
$168.84
|
| Rate for Payer: United Healthcare Commercial |
$151.19
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
OP
|
$1,211.69
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
01614741
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$1,126.87 |
| Rate for Payer: Aetna Commercial |
$1,022.67
|
| Rate for Payer: Aetna Medicare |
$399.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$399.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$695.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$757.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$161.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$459.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$439.84
|
| Rate for Payer: Cash Price |
$751.25
|
| Rate for Payer: Cash Price |
$751.25
|
| Rate for Payer: Centivo All Commercial |
$617.96
|
| Rate for Payer: Cigna All Commercial |
$1,045.69
|
| Rate for Payer: CORVEL All Commercial |
$1,126.87
|
| Rate for Payer: Coventry All Commercial |
$1,066.29
|
| Rate for Payer: Encore All Commercial |
$1,115.36
|
| Rate for Payer: Frontpath All Commercial |
$1,114.75
|
| Rate for Payer: Humana ChoiceCare |
$1,046.54
|
| Rate for Payer: Humana Medicare |
$617.96
|
| Rate for Payer: Lucent All Commercial |
$617.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,090.52
|
| Rate for Payer: Managed Health Services Medicaid |
$161.03
|
| Rate for Payer: MDWise Medicaid |
$161.03
|
| Rate for Payer: PHCS All Commercial |
$908.77
|
| Rate for Payer: PHP All Commercial |
$918.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$472.56
|
| Rate for Payer: Sagamore Health Network All Products |
$935.42
|
| Rate for Payer: Signature Care EPO |
$1,005.70
|
| Rate for Payer: Signature Care PPO |
$1,066.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,029.94
|
| Rate for Payer: United Healthcare Commercial |
$954.81
|
| Rate for Payer: United Healthcare Medicare |
$399.86
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
IP
|
$1,211.69
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
01614741
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$908.77 |
| Max. Negotiated Rate |
$1,126.87 |
| Rate for Payer: Aetna Commercial |
$1,046.90
|
| Rate for Payer: Cash Price |
$751.25
|
| Rate for Payer: Cigna All Commercial |
$1,045.69
|
| Rate for Payer: CORVEL All Commercial |
$1,126.87
|
| Rate for Payer: Coventry All Commercial |
$1,066.29
|
| Rate for Payer: Encore All Commercial |
$1,115.36
|
| Rate for Payer: Frontpath All Commercial |
$1,114.75
|
| Rate for Payer: Humana ChoiceCare |
$1,046.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,090.52
|
| Rate for Payer: PHCS All Commercial |
$908.77
|
| Rate for Payer: PHP All Commercial |
$918.94
|
| Rate for Payer: Sagamore Health Network All Products |
$935.42
|
| Rate for Payer: Signature Care EPO |
$1,005.70
|
| Rate for Payer: Signature Care PPO |
$1,066.29
|
| Rate for Payer: United Healthcare Commercial |
$954.81
|
|
|
HC I2B 2.0/2.5 COLAG KIT
|
Facility
OP
|
$2,736.00
|
|
| Hospital Charge Code |
41608260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,544.48 |
| Rate for Payer: Aetna Commercial |
$2,309.18
|
| Rate for Payer: Aetna Medicare |
$902.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$902.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,571.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,710.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,038.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$993.17
|
| Rate for Payer: Cash Price |
$1,696.32
|
| Rate for Payer: Cash Price |
$1,696.32
|
| Rate for Payer: Centivo All Commercial |
$1,395.36
|
| Rate for Payer: Cigna All Commercial |
$2,361.17
|
| Rate for Payer: CORVEL All Commercial |
$2,544.48
|
| Rate for Payer: Coventry All Commercial |
$2,407.68
|
| Rate for Payer: Encore All Commercial |
$2,518.49
|
| Rate for Payer: Frontpath All Commercial |
$2,517.12
|
| Rate for Payer: Humana ChoiceCare |
$2,363.08
|
| Rate for Payer: Humana Medicare |
$1,395.36
|
| Rate for Payer: Lucent All Commercial |
$1,395.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,462.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,052.00
|
| Rate for Payer: PHP All Commercial |
$2,074.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,067.04
|
| Rate for Payer: Sagamore Health Network All Products |
$2,112.19
|
| Rate for Payer: Signature Care EPO |
$2,270.88
|
| Rate for Payer: Signature Care PPO |
$2,407.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,325.60
|
| Rate for Payer: United Healthcare Commercial |
$2,155.97
|
| Rate for Payer: United Healthcare Medicare |
$902.88
|
|
|
HC I2B 2.0/2.5 COLAG KIT
|
Facility
IP
|
$2,736.00
|
|
| Hospital Charge Code |
41608260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,052.00 |
| Max. Negotiated Rate |
$2,544.48 |
| Rate for Payer: Aetna Commercial |
$2,363.90
|
| Rate for Payer: Cash Price |
$1,696.32
|
| Rate for Payer: Cigna All Commercial |
$2,361.17
|
| Rate for Payer: CORVEL All Commercial |
$2,544.48
|
| Rate for Payer: Coventry All Commercial |
$2,407.68
|
| Rate for Payer: Encore All Commercial |
$2,518.49
|
| Rate for Payer: Frontpath All Commercial |
$2,517.12
|
| Rate for Payer: Humana ChoiceCare |
$2,363.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,462.40
|
| Rate for Payer: PHCS All Commercial |
$2,052.00
|
| Rate for Payer: PHP All Commercial |
$2,074.98
|
| Rate for Payer: Sagamore Health Network All Products |
$2,112.19
|
| Rate for Payer: Signature Care EPO |
$2,270.88
|
| Rate for Payer: Signature Care PPO |
$2,407.68
|
| Rate for Payer: United Healthcare Commercial |
$2,155.97
|
|
|
HC I2B 2.0/2.5 COUNTERSINK
|
Facility
OP
|
$2,736.00
|
|
| Hospital Charge Code |
41608261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,544.48 |
| Rate for Payer: Aetna Commercial |
$2,309.18
|
| Rate for Payer: Aetna Medicare |
$902.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$902.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,571.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,710.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,038.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$993.17
|
| Rate for Payer: Cash Price |
$1,696.32
|
| Rate for Payer: Cash Price |
$1,696.32
|
| Rate for Payer: Centivo All Commercial |
$1,395.36
|
| Rate for Payer: Cigna All Commercial |
$2,361.17
|
| Rate for Payer: CORVEL All Commercial |
$2,544.48
|
| Rate for Payer: Coventry All Commercial |
$2,407.68
|
| Rate for Payer: Encore All Commercial |
$2,518.49
|
| Rate for Payer: Frontpath All Commercial |
$2,517.12
|
| Rate for Payer: Humana ChoiceCare |
$2,363.08
|
| Rate for Payer: Humana Medicare |
$1,395.36
|
| Rate for Payer: Lucent All Commercial |
$1,395.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,462.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,052.00
|
| Rate for Payer: PHP All Commercial |
$2,074.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,067.04
|
| Rate for Payer: Sagamore Health Network All Products |
$2,112.19
|
| Rate for Payer: Signature Care EPO |
$2,270.88
|
| Rate for Payer: Signature Care PPO |
$2,407.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,325.60
|
| Rate for Payer: United Healthcare Commercial |
$2,155.97
|
| Rate for Payer: United Healthcare Medicare |
$902.88
|
|
|
HC I2B 2.0/2.5 COUNTERSINK
|
Facility
IP
|
$2,736.00
|
|
| Hospital Charge Code |
41608261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,052.00 |
| Max. Negotiated Rate |
$2,544.48 |
| Rate for Payer: Aetna Commercial |
$2,363.90
|
| Rate for Payer: Cash Price |
$1,696.32
|
| Rate for Payer: Cigna All Commercial |
$2,361.17
|
| Rate for Payer: CORVEL All Commercial |
$2,544.48
|
| Rate for Payer: Coventry All Commercial |
$2,407.68
|
| Rate for Payer: Encore All Commercial |
$2,518.49
|
| Rate for Payer: Frontpath All Commercial |
$2,517.12
|
| Rate for Payer: Humana ChoiceCare |
$2,363.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,462.40
|
| Rate for Payer: PHCS All Commercial |
$2,052.00
|
| Rate for Payer: PHP All Commercial |
$2,074.98
|
| Rate for Payer: Sagamore Health Network All Products |
$2,112.19
|
| Rate for Payer: Signature Care EPO |
$2,270.88
|
| Rate for Payer: Signature Care PPO |
$2,407.68
|
| Rate for Payer: United Healthcare Commercial |
$2,155.97
|
|
|
HC I2B DRIVER T7
|
Facility
OP
|
$1,805.00
|
|
| Hospital Charge Code |
41608262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,678.65 |
| Rate for Payer: Aetna Commercial |
$1,523.42
|
| Rate for Payer: Aetna Medicare |
$595.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$595.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,036.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,128.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$685.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$655.22
|
| Rate for Payer: Cash Price |
$1,119.10
|
| Rate for Payer: Cash Price |
$1,119.10
|
| Rate for Payer: Centivo All Commercial |
$920.55
|
| Rate for Payer: Cigna All Commercial |
$1,557.72
|
| Rate for Payer: CORVEL All Commercial |
$1,678.65
|
| Rate for Payer: Coventry All Commercial |
$1,588.40
|
| Rate for Payer: Encore All Commercial |
$1,661.50
|
| Rate for Payer: Frontpath All Commercial |
$1,660.60
|
| Rate for Payer: Humana ChoiceCare |
$1,558.98
|
| Rate for Payer: Humana Medicare |
$920.55
|
| Rate for Payer: Lucent All Commercial |
$920.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,624.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,353.75
|
| Rate for Payer: PHP All Commercial |
$1,368.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$703.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,393.46
|
| Rate for Payer: Signature Care EPO |
$1,498.15
|
| Rate for Payer: Signature Care PPO |
$1,588.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,534.25
|
| Rate for Payer: United Healthcare Commercial |
$1,422.34
|
| Rate for Payer: United Healthcare Medicare |
$595.65
|
|
|
HC I2B DRIVER T7
|
Facility
IP
|
$1,805.00
|
|
| Hospital Charge Code |
41608262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,353.75 |
| Max. Negotiated Rate |
$1,678.65 |
| Rate for Payer: Aetna Commercial |
$1,559.52
|
| Rate for Payer: Cash Price |
$1,119.10
|
| Rate for Payer: Cigna All Commercial |
$1,557.72
|
| Rate for Payer: CORVEL All Commercial |
$1,678.65
|
| Rate for Payer: Coventry All Commercial |
$1,588.40
|
| Rate for Payer: Encore All Commercial |
$1,661.50
|
| Rate for Payer: Frontpath All Commercial |
$1,660.60
|
| Rate for Payer: Humana ChoiceCare |
$1,558.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,624.50
|
| Rate for Payer: PHCS All Commercial |
$1,353.75
|
| Rate for Payer: PHP All Commercial |
$1,368.91
|
| Rate for Payer: Sagamore Health Network All Products |
$1,393.46
|
| Rate for Payer: Signature Care EPO |
$1,498.15
|
| Rate for Payer: Signature Care PPO |
$1,588.40
|
| Rate for Payer: United Healthcare Commercial |
$1,422.34
|
|
