|
HC IGE
|
Facility
IP
|
$179.52
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
63001191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$166.95 |
| Rate for Payer: Aetna Commercial |
$155.11
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna All Commercial |
$154.93
|
| Rate for Payer: CORVEL All Commercial |
$166.95
|
| Rate for Payer: Coventry All Commercial |
$157.98
|
| Rate for Payer: Encore All Commercial |
$165.25
|
| Rate for Payer: Frontpath All Commercial |
$165.16
|
| Rate for Payer: Humana ChoiceCare |
$155.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.57
|
| Rate for Payer: PHCS All Commercial |
$134.64
|
| Rate for Payer: PHP All Commercial |
$136.15
|
| Rate for Payer: Sagamore Health Network All Products |
$138.59
|
| Rate for Payer: Signature Care EPO |
$149.00
|
| Rate for Payer: Signature Care PPO |
$157.98
|
| Rate for Payer: United Healthcare Commercial |
$141.46
|
|
|
HC IGE - PANEL
|
Facility
OP
|
$145.52
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
63001545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$135.34 |
| Rate for Payer: Aetna Commercial |
$122.82
|
| Rate for Payer: Aetna Medicare |
$48.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.82
|
| Rate for Payer: Cash Price |
$90.23
|
| Rate for Payer: Cash Price |
$90.23
|
| Rate for Payer: Centivo All Commercial |
$74.22
|
| Rate for Payer: Cigna All Commercial |
$125.59
|
| Rate for Payer: CORVEL All Commercial |
$135.34
|
| Rate for Payer: Coventry All Commercial |
$128.06
|
| Rate for Payer: Encore All Commercial |
$133.95
|
| Rate for Payer: Frontpath All Commercial |
$133.88
|
| Rate for Payer: Humana ChoiceCare |
$125.69
|
| Rate for Payer: Humana Medicare |
$74.22
|
| Rate for Payer: Lucent All Commercial |
$74.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.97
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: MDWise Medicaid |
$16.46
|
| Rate for Payer: PHCS All Commercial |
$109.14
|
| Rate for Payer: PHP All Commercial |
$110.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.75
|
| Rate for Payer: Sagamore Health Network All Products |
$112.34
|
| Rate for Payer: Signature Care EPO |
$120.78
|
| Rate for Payer: Signature Care PPO |
$128.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.69
|
| Rate for Payer: United Healthcare Commercial |
$114.67
|
| Rate for Payer: United Healthcare Medicare |
$48.02
|
|
|
HC IGE - PANEL
|
Facility
IP
|
$145.52
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
63001545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.14 |
| Max. Negotiated Rate |
$135.34 |
| Rate for Payer: Aetna Commercial |
$125.73
|
| Rate for Payer: Cash Price |
$90.23
|
| Rate for Payer: Cigna All Commercial |
$125.59
|
| Rate for Payer: CORVEL All Commercial |
$135.34
|
| Rate for Payer: Coventry All Commercial |
$128.06
|
| Rate for Payer: Encore All Commercial |
$133.95
|
| Rate for Payer: Frontpath All Commercial |
$133.88
|
| Rate for Payer: Humana ChoiceCare |
$125.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.97
|
| Rate for Payer: PHCS All Commercial |
$109.14
|
| Rate for Payer: PHP All Commercial |
$110.36
|
| Rate for Payer: Sagamore Health Network All Products |
$112.34
|
| Rate for Payer: Signature Care EPO |
$120.78
|
| Rate for Payer: Signature Care PPO |
$128.06
|
| Rate for Payer: United Healthcare Commercial |
$114.67
|
|
|
HC IGF BINDING PROTEIN3
|
Facility
OP
|
$145.61
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
63001489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$135.41 |
| Rate for Payer: Aetna Commercial |
$122.89
|
| Rate for Payer: Aetna Medicare |
$48.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.85
|
| Rate for Payer: Cash Price |
$90.28
|
| Rate for Payer: Cash Price |
$90.28
|
| Rate for Payer: Centivo All Commercial |
$74.26
|
| Rate for Payer: Cigna All Commercial |
$125.66
|
| Rate for Payer: CORVEL All Commercial |
$135.41
|
| Rate for Payer: Coventry All Commercial |
$128.13
|
| Rate for Payer: Encore All Commercial |
$134.03
|
| Rate for Payer: Frontpath All Commercial |
$133.96
|
| Rate for Payer: Humana ChoiceCare |
$125.76
|
| Rate for Payer: Humana Medicare |
$74.26
|
| Rate for Payer: Lucent All Commercial |
$74.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.04
|
| Rate for Payer: Managed Health Services Medicaid |
$12.16
|
| Rate for Payer: MDWise Medicaid |
$12.16
|
| Rate for Payer: PHCS All Commercial |
$109.20
|
| Rate for Payer: PHP All Commercial |
$110.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.79
|
| Rate for Payer: Sagamore Health Network All Products |
$112.41
|
| Rate for Payer: Signature Care EPO |
$120.85
|
| Rate for Payer: Signature Care PPO |
$128.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.76
|
| Rate for Payer: United Healthcare Commercial |
$114.74
|
| Rate for Payer: United Healthcare Medicare |
$48.05
|
|
|
HC IGF BINDING PROTEIN3
|
Facility
IP
|
$145.61
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
63001489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$135.41 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Cash Price |
$90.28
|
| Rate for Payer: Cigna All Commercial |
$125.66
|
| Rate for Payer: CORVEL All Commercial |
$135.41
|
| Rate for Payer: Coventry All Commercial |
$128.13
|
| Rate for Payer: Encore All Commercial |
$134.03
|
| Rate for Payer: Frontpath All Commercial |
$133.96
|
| Rate for Payer: Humana ChoiceCare |
$125.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.04
|
| Rate for Payer: PHCS All Commercial |
$109.20
|
| Rate for Payer: PHP All Commercial |
$110.43
|
| Rate for Payer: Sagamore Health Network All Products |
$112.41
|
| Rate for Payer: Signature Care EPO |
$120.85
|
| Rate for Payer: Signature Care PPO |
$128.13
|
| Rate for Payer: United Healthcare Commercial |
$114.74
|
|
|
HC IGG
|
Facility
IP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.03 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$100.25
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.91
|
| Rate for Payer: Coventry All Commercial |
$102.11
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.75
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.43
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.11
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
|
|
HC IGG
|
Facility
OP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$97.93
|
| Rate for Payer: Aetna Medicare |
$38.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.12
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Centivo All Commercial |
$59.18
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.91
|
| Rate for Payer: Coventry All Commercial |
$102.11
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.75
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Humana Medicare |
$59.18
|
| Rate for Payer: Lucent All Commercial |
$59.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.43
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: MDWise Medicaid |
$9.30
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.25
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.63
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
| Rate for Payer: United Healthcare Medicare |
$38.29
|
|
|
HC IGG SUBCLASSES
|
Facility
IP
|
$71.06
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
63001546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna Commercial |
$61.40
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cigna All Commercial |
$61.33
|
| Rate for Payer: CORVEL All Commercial |
$66.09
|
| Rate for Payer: Coventry All Commercial |
$62.54
|
| Rate for Payer: Encore All Commercial |
$65.41
|
| Rate for Payer: Frontpath All Commercial |
$65.38
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.96
|
| Rate for Payer: PHCS All Commercial |
$53.30
|
| Rate for Payer: PHP All Commercial |
$53.89
|
| Rate for Payer: Sagamore Health Network All Products |
$54.86
|
| Rate for Payer: Signature Care EPO |
$58.98
|
| Rate for Payer: Signature Care PPO |
$62.54
|
| Rate for Payer: United Healthcare Commercial |
$56.00
|
|
|
HC IGG SUBCLASSES
|
Facility
OP
|
$71.06
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
63001546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Aetna Medicare |
$23.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.80
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Centivo All Commercial |
$36.24
|
| Rate for Payer: Cigna All Commercial |
$61.33
|
| Rate for Payer: CORVEL All Commercial |
$66.09
|
| Rate for Payer: Coventry All Commercial |
$62.54
|
| Rate for Payer: Encore All Commercial |
$65.41
|
| Rate for Payer: Frontpath All Commercial |
$65.38
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Humana Medicare |
$36.24
|
| Rate for Payer: Lucent All Commercial |
$36.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.96
|
| Rate for Payer: Managed Health Services Medicaid |
$6.07
|
| Rate for Payer: MDWise Medicaid |
$6.07
|
| Rate for Payer: PHCS All Commercial |
$53.30
|
| Rate for Payer: PHP All Commercial |
$53.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.71
|
| Rate for Payer: Sagamore Health Network All Products |
$54.86
|
| Rate for Payer: Signature Care EPO |
$58.98
|
| Rate for Payer: Signature Care PPO |
$62.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.40
|
| Rate for Payer: United Healthcare Commercial |
$56.00
|
| Rate for Payer: United Healthcare Medicare |
$23.45
|
|
|
HC IGM
|
Facility
OP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001322
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$97.93
|
| Rate for Payer: Aetna Medicare |
$38.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.12
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Centivo All Commercial |
$59.18
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.91
|
| Rate for Payer: Coventry All Commercial |
$102.11
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.75
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Humana Medicare |
$59.18
|
| Rate for Payer: Lucent All Commercial |
$59.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.43
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: MDWise Medicaid |
$9.30
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.25
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.63
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
| Rate for Payer: United Healthcare Medicare |
$38.29
|
|
|
HC IGM
|
Facility
IP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001322
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.03 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$100.25
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.91
|
| Rate for Payer: Coventry All Commercial |
$102.11
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.75
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.43
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.11
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
|
|
HC IGM IMMUNOGLOB
|
Facility
OP
|
$102.78
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$95.58 |
| Rate for Payer: Aetna Commercial |
$86.74
|
| Rate for Payer: Aetna Medicare |
$33.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.31
|
| Rate for Payer: Cash Price |
$63.72
|
| Rate for Payer: Cash Price |
$63.72
|
| Rate for Payer: Centivo All Commercial |
$52.42
|
| Rate for Payer: Cigna All Commercial |
$88.69
|
| Rate for Payer: CORVEL All Commercial |
$95.58
|
| Rate for Payer: Coventry All Commercial |
$90.44
|
| Rate for Payer: Encore All Commercial |
$94.60
|
| Rate for Payer: Frontpath All Commercial |
$94.55
|
| Rate for Payer: Humana ChoiceCare |
$88.77
|
| Rate for Payer: Humana Medicare |
$52.42
|
| Rate for Payer: Lucent All Commercial |
$52.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.50
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: MDWise Medicaid |
$9.30
|
| Rate for Payer: PHCS All Commercial |
$77.08
|
| Rate for Payer: PHP All Commercial |
$77.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.08
|
| Rate for Payer: Sagamore Health Network All Products |
$79.34
|
| Rate for Payer: Signature Care EPO |
$85.30
|
| Rate for Payer: Signature Care PPO |
$90.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.36
|
| Rate for Payer: United Healthcare Commercial |
$80.99
|
| Rate for Payer: United Healthcare Medicare |
$33.92
|
|
|
HC IGM IMMUNOGLOB
|
Facility
IP
|
$102.78
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.08 |
| Max. Negotiated Rate |
$95.58 |
| Rate for Payer: Aetna Commercial |
$88.80
|
| Rate for Payer: Cash Price |
$63.72
|
| Rate for Payer: Cigna All Commercial |
$88.69
|
| Rate for Payer: CORVEL All Commercial |
$95.58
|
| Rate for Payer: Coventry All Commercial |
$90.44
|
| Rate for Payer: Encore All Commercial |
$94.60
|
| Rate for Payer: Frontpath All Commercial |
$94.55
|
| Rate for Payer: Humana ChoiceCare |
$88.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.50
|
| Rate for Payer: PHCS All Commercial |
$77.08
|
| Rate for Payer: PHP All Commercial |
$77.94
|
| Rate for Payer: Sagamore Health Network All Products |
$79.34
|
| Rate for Payer: Signature Care EPO |
$85.30
|
| Rate for Payer: Signature Care PPO |
$90.44
|
| Rate for Payer: United Healthcare Commercial |
$80.99
|
|
|
HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL
|
Facility
IP
|
$4,909.26
|
|
| Hospital Charge Code |
01669407
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,681.94 |
| Max. Negotiated Rate |
$4,565.61 |
| Rate for Payer: Aetna Commercial |
$4,241.60
|
| Rate for Payer: Cash Price |
$3,043.74
|
| Rate for Payer: Cigna All Commercial |
$4,236.69
|
| Rate for Payer: CORVEL All Commercial |
$4,565.61
|
| Rate for Payer: Coventry All Commercial |
$4,320.15
|
| Rate for Payer: Encore All Commercial |
$4,518.97
|
| Rate for Payer: Frontpath All Commercial |
$4,516.52
|
| Rate for Payer: Humana ChoiceCare |
$4,240.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,418.33
|
| Rate for Payer: PHCS All Commercial |
$3,681.94
|
| Rate for Payer: PHP All Commercial |
$3,723.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,789.95
|
| Rate for Payer: Signature Care EPO |
$4,074.69
|
| Rate for Payer: Signature Care PPO |
$4,320.15
|
| Rate for Payer: United Healthcare Commercial |
$3,868.50
|
|
|
HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL
|
Facility
OP
|
$4,909.26
|
|
| Hospital Charge Code |
01669407
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,620.06 |
| Max. Negotiated Rate |
$4,565.61 |
| Rate for Payer: Aetna Commercial |
$4,143.42
|
| Rate for Payer: Aetna Medicare |
$1,620.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,620.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,819.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,068.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,863.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,782.06
|
| Rate for Payer: Cash Price |
$3,043.74
|
| Rate for Payer: Centivo All Commercial |
$2,503.72
|
| Rate for Payer: Cigna All Commercial |
$4,236.69
|
| Rate for Payer: CORVEL All Commercial |
$4,565.61
|
| Rate for Payer: Coventry All Commercial |
$4,320.15
|
| Rate for Payer: Encore All Commercial |
$4,518.97
|
| Rate for Payer: Frontpath All Commercial |
$4,516.52
|
| Rate for Payer: Humana ChoiceCare |
$4,240.13
|
| Rate for Payer: Humana Medicare |
$2,503.72
|
| Rate for Payer: Lucent All Commercial |
$2,503.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,418.33
|
| Rate for Payer: PHCS All Commercial |
$3,681.94
|
| Rate for Payer: PHP All Commercial |
$3,723.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,914.61
|
| Rate for Payer: Sagamore Health Network All Products |
$3,789.95
|
| Rate for Payer: Signature Care EPO |
$4,074.69
|
| Rate for Payer: Signature Care PPO |
$4,320.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,172.87
|
| Rate for Payer: United Healthcare Commercial |
$3,868.50
|
| Rate for Payer: United Healthcare Medicare |
$1,620.06
|
|
|
HC IMMUN ADMIN EA ADD
|
Facility
OP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
01689116
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: Aetna Medicare |
$30.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.32
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Centivo All Commercial |
$46.82
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Humana Medicare |
$46.82
|
| Rate for Payer: Lucent All Commercial |
$46.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.80
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.03
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
| Rate for Payer: United Healthcare Medicare |
$30.29
|
|
|
HC IMMUN ADMIN EA ADD
|
Facility
IP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
01689116
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
|
|
HC IMMUNE ADMIN ORAL/NASAL 1 VACCINE
|
Facility
IP
|
$21.22
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
00520473
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna Commercial |
$18.33
|
| Rate for Payer: Cash Price |
$13.15
|
| Rate for Payer: Cigna All Commercial |
$18.31
|
| Rate for Payer: CORVEL All Commercial |
$19.73
|
| Rate for Payer: Coventry All Commercial |
$18.67
|
| Rate for Payer: Encore All Commercial |
$19.53
|
| Rate for Payer: Frontpath All Commercial |
$19.52
|
| Rate for Payer: Humana ChoiceCare |
$18.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.09
|
| Rate for Payer: PHCS All Commercial |
$15.91
|
| Rate for Payer: PHP All Commercial |
$16.09
|
| Rate for Payer: Sagamore Health Network All Products |
$16.38
|
| Rate for Payer: Signature Care EPO |
$17.61
|
| Rate for Payer: Signature Care PPO |
$18.67
|
| Rate for Payer: United Healthcare Commercial |
$16.72
|
|
|
HC IMMUNE ADMIN ORAL/NASAL 1 VACCINE
|
Facility
OP
|
$21.22
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
00520473
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.70
|
| Rate for Payer: Cash Price |
$13.15
|
| Rate for Payer: Centivo All Commercial |
$10.82
|
| Rate for Payer: Cigna All Commercial |
$18.31
|
| Rate for Payer: CORVEL All Commercial |
$19.73
|
| Rate for Payer: Coventry All Commercial |
$18.67
|
| Rate for Payer: Encore All Commercial |
$19.53
|
| Rate for Payer: Frontpath All Commercial |
$19.52
|
| Rate for Payer: Humana ChoiceCare |
$18.32
|
| Rate for Payer: Humana Medicare |
$10.82
|
| Rate for Payer: Lucent All Commercial |
$10.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.09
|
| Rate for Payer: PHCS All Commercial |
$15.91
|
| Rate for Payer: PHP All Commercial |
$16.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.27
|
| Rate for Payer: Sagamore Health Network All Products |
$16.38
|
| Rate for Payer: Signature Care EPO |
$17.61
|
| Rate for Payer: Signature Care PPO |
$18.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$16.72
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
|
|
HC IMMUNE ADMIN ORAL/NASAL ADDL
|
Facility
IP
|
$21.22
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
00520474
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna Commercial |
$18.33
|
| Rate for Payer: Cash Price |
$13.15
|
| Rate for Payer: Cigna All Commercial |
$18.31
|
| Rate for Payer: CORVEL All Commercial |
$19.73
|
| Rate for Payer: Coventry All Commercial |
$18.67
|
| Rate for Payer: Encore All Commercial |
$19.53
|
| Rate for Payer: Frontpath All Commercial |
$19.52
|
| Rate for Payer: Humana ChoiceCare |
$18.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.09
|
| Rate for Payer: PHCS All Commercial |
$15.91
|
| Rate for Payer: PHP All Commercial |
$16.09
|
| Rate for Payer: Sagamore Health Network All Products |
$16.38
|
| Rate for Payer: Signature Care EPO |
$17.61
|
| Rate for Payer: Signature Care PPO |
$18.67
|
| Rate for Payer: United Healthcare Commercial |
$16.72
|
|
|
HC IMMUNE ADMIN ORAL/NASAL ADDL
|
Facility
OP
|
$21.22
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
00520474
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.70
|
| Rate for Payer: Cash Price |
$13.15
|
| Rate for Payer: Centivo All Commercial |
$10.82
|
| Rate for Payer: Cigna All Commercial |
$18.31
|
| Rate for Payer: CORVEL All Commercial |
$19.73
|
| Rate for Payer: Coventry All Commercial |
$18.67
|
| Rate for Payer: Encore All Commercial |
$19.53
|
| Rate for Payer: Frontpath All Commercial |
$19.52
|
| Rate for Payer: Humana ChoiceCare |
$18.32
|
| Rate for Payer: Humana Medicare |
$10.82
|
| Rate for Payer: Lucent All Commercial |
$10.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.09
|
| Rate for Payer: PHCS All Commercial |
$15.91
|
| Rate for Payer: PHP All Commercial |
$16.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.27
|
| Rate for Payer: Sagamore Health Network All Products |
$16.38
|
| Rate for Payer: Signature Care EPO |
$17.61
|
| Rate for Payer: Signature Care PPO |
$18.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$16.72
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
|
|
HC IMMUNIZATION ADMIN- 1 VAC
|
Facility
IP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
01689115
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna All Commercial |
$82.08
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.70
|
| Rate for Payer: Encore All Commercial |
$87.55
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.60
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
|
|
HC IMMUNIZATION ADMIN- 1 VAC
|
Facility
OP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
01689115
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$31.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.53
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Centivo All Commercial |
$48.51
|
| Rate for Payer: Cigna All Commercial |
$82.08
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.70
|
| Rate for Payer: Encore All Commercial |
$87.55
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.15
|
| Rate for Payer: Humana Medicare |
$48.51
|
| Rate for Payer: Lucent All Commercial |
$48.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.60
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.09
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$31.39
|
|
|
HC IMMUNOASSAY QT NOS
|
Facility
OP
|
$163.95
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$152.48 |
| Rate for Payer: Aetna Commercial |
$138.38
|
| Rate for Payer: Aetna Medicare |
$54.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.52
|
| Rate for Payer: Cash Price |
$101.65
|
| Rate for Payer: Cash Price |
$101.65
|
| Rate for Payer: Centivo All Commercial |
$83.62
|
| Rate for Payer: Cigna All Commercial |
$141.49
|
| Rate for Payer: CORVEL All Commercial |
$152.48
|
| Rate for Payer: Coventry All Commercial |
$144.28
|
| Rate for Payer: Encore All Commercial |
$150.92
|
| Rate for Payer: Frontpath All Commercial |
$150.84
|
| Rate for Payer: Humana ChoiceCare |
$141.61
|
| Rate for Payer: Humana Medicare |
$83.62
|
| Rate for Payer: Lucent All Commercial |
$83.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.56
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$122.97
|
| Rate for Payer: PHP All Commercial |
$124.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.94
|
| Rate for Payer: Sagamore Health Network All Products |
$126.57
|
| Rate for Payer: Signature Care EPO |
$136.08
|
| Rate for Payer: Signature Care PPO |
$144.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.36
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Medicare |
$54.11
|
|
|
HC IMMUNOASSAY QT NOS
|
Facility
IP
|
$163.95
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.97 |
| Max. Negotiated Rate |
$152.48 |
| Rate for Payer: Aetna Commercial |
$141.66
|
| Rate for Payer: Cash Price |
$101.65
|
| Rate for Payer: Cigna All Commercial |
$141.49
|
| Rate for Payer: CORVEL All Commercial |
$152.48
|
| Rate for Payer: Coventry All Commercial |
$144.28
|
| Rate for Payer: Encore All Commercial |
$150.92
|
| Rate for Payer: Frontpath All Commercial |
$150.84
|
| Rate for Payer: Humana ChoiceCare |
$141.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.56
|
| Rate for Payer: PHCS All Commercial |
$122.97
|
| Rate for Payer: PHP All Commercial |
$124.34
|
| Rate for Payer: Sagamore Health Network All Products |
$126.57
|
| Rate for Payer: Signature Care EPO |
$136.08
|
| Rate for Payer: Signature Care PPO |
$144.28
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
|
