|
HC HERPES 6(HHV6) IGM
|
Facility
|
OP
|
$277.13
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
63001978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$257.73 |
| Rate for Payer: Aetna Commercial |
$233.90
|
| Rate for Payer: Aetna Medicare |
$88.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$127.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.55
|
| Rate for Payer: Cash Price |
$166.28
|
| Rate for Payer: Cash Price |
$166.28
|
| Rate for Payer: Centivo All Commercial |
$150.76
|
| Rate for Payer: Cigna All Commercial |
$239.16
|
| Rate for Payer: CORVEL All Commercial |
$257.73
|
| Rate for Payer: Coventry All Commercial |
$243.87
|
| Rate for Payer: Encore All Commercial |
$255.10
|
| Rate for Payer: Frontpath All Commercial |
$254.96
|
| Rate for Payer: Humana ChoiceCare |
$239.36
|
| Rate for Payer: Humana Medicare |
$88.68
|
| Rate for Payer: Lucent All Commercial |
$150.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.42
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: MDWise Medicaid |
$12.88
|
| Rate for Payer: PHCS All Commercial |
$207.85
|
| Rate for Payer: PHP All Commercial |
$210.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.08
|
| Rate for Payer: Sagamore Health Network All Products |
$213.94
|
| Rate for Payer: Signature Care EPO |
$230.02
|
| Rate for Payer: Signature Care PPO |
$243.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$235.56
|
| Rate for Payer: United Healthcare Commercial |
$218.38
|
| Rate for Payer: United Healthcare Medicare |
$88.68
|
|
|
HC HERPES 6(HHV6) IGM
|
Facility
|
IP
|
$277.13
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
63001978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$207.85 |
| Max. Negotiated Rate |
$257.73 |
| Rate for Payer: Aetna Commercial |
$239.44
|
| Rate for Payer: Cash Price |
$166.28
|
| Rate for Payer: Cigna All Commercial |
$239.16
|
| Rate for Payer: CORVEL All Commercial |
$257.73
|
| Rate for Payer: Coventry All Commercial |
$243.87
|
| Rate for Payer: Encore All Commercial |
$255.10
|
| Rate for Payer: Frontpath All Commercial |
$254.96
|
| Rate for Payer: Humana ChoiceCare |
$239.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.42
|
| Rate for Payer: PHCS All Commercial |
$207.85
|
| Rate for Payer: PHP All Commercial |
$210.18
|
| Rate for Payer: Sagamore Health Network All Products |
$213.94
|
| Rate for Payer: Signature Care EPO |
$230.02
|
| Rate for Payer: Signature Care PPO |
$243.87
|
| Rate for Payer: United Healthcare Commercial |
$218.38
|
|
|
HC HERPES CULTURE
|
Facility
|
OP
|
$240.67
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$223.82 |
| Rate for Payer: Aetna Commercial |
$203.13
|
| Rate for Payer: Aetna Medicare |
$77.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$26.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$110.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.72
|
| Rate for Payer: Cash Price |
$144.40
|
| Rate for Payer: Cash Price |
$144.40
|
| Rate for Payer: Centivo All Commercial |
$130.92
|
| Rate for Payer: Cigna All Commercial |
$207.70
|
| Rate for Payer: CORVEL All Commercial |
$223.82
|
| Rate for Payer: Coventry All Commercial |
$211.79
|
| Rate for Payer: Encore All Commercial |
$221.54
|
| Rate for Payer: Frontpath All Commercial |
$221.42
|
| Rate for Payer: Humana ChoiceCare |
$207.87
|
| Rate for Payer: Humana Medicare |
$77.01
|
| Rate for Payer: Lucent All Commercial |
$130.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.60
|
| Rate for Payer: Managed Health Services Medicaid |
$26.07
|
| Rate for Payer: MDWise Medicaid |
$26.07
|
| Rate for Payer: PHCS All Commercial |
$180.50
|
| Rate for Payer: PHP All Commercial |
$182.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.86
|
| Rate for Payer: Sagamore Health Network All Products |
$185.80
|
| Rate for Payer: Signature Care EPO |
$199.76
|
| Rate for Payer: Signature Care PPO |
$211.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$204.57
|
| Rate for Payer: United Healthcare Commercial |
$189.65
|
| Rate for Payer: United Healthcare Medicare |
$77.01
|
|
|
HC HERPES CULTURE
|
Facility
|
IP
|
$240.67
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.50 |
| Max. Negotiated Rate |
$223.82 |
| Rate for Payer: Aetna Commercial |
$207.94
|
| Rate for Payer: Cash Price |
$144.40
|
| Rate for Payer: Cigna All Commercial |
$207.70
|
| Rate for Payer: CORVEL All Commercial |
$223.82
|
| Rate for Payer: Coventry All Commercial |
$211.79
|
| Rate for Payer: Encore All Commercial |
$221.54
|
| Rate for Payer: Frontpath All Commercial |
$221.42
|
| Rate for Payer: Humana ChoiceCare |
$207.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.60
|
| Rate for Payer: PHCS All Commercial |
$180.50
|
| Rate for Payer: PHP All Commercial |
$182.52
|
| Rate for Payer: Sagamore Health Network All Products |
$185.80
|
| Rate for Payer: Signature Care EPO |
$199.76
|
| Rate for Payer: Signature Care PPO |
$211.79
|
| Rate for Payer: United Healthcare Commercial |
$189.65
|
|
|
HC HERPES CULTURE W/TYPING IF IND
|
Facility
|
OP
|
$497.68
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$462.84 |
| Rate for Payer: Aetna Commercial |
$420.04
|
| Rate for Payer: Aetna Medicare |
$159.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$26.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$154.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$228.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$228.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.18
|
| Rate for Payer: Cash Price |
$298.61
|
| Rate for Payer: Cash Price |
$298.61
|
| Rate for Payer: Centivo All Commercial |
$270.74
|
| Rate for Payer: Cigna All Commercial |
$429.50
|
| Rate for Payer: CORVEL All Commercial |
$462.84
|
| Rate for Payer: Coventry All Commercial |
$437.96
|
| Rate for Payer: Encore All Commercial |
$458.11
|
| Rate for Payer: Frontpath All Commercial |
$457.87
|
| Rate for Payer: Humana ChoiceCare |
$429.85
|
| Rate for Payer: Humana Medicare |
$159.26
|
| Rate for Payer: Lucent All Commercial |
$270.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.91
|
| Rate for Payer: Managed Health Services Medicaid |
$26.07
|
| Rate for Payer: MDWise Medicaid |
$26.07
|
| Rate for Payer: PHCS All Commercial |
$373.26
|
| Rate for Payer: PHP All Commercial |
$377.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$194.10
|
| Rate for Payer: Sagamore Health Network All Products |
$384.21
|
| Rate for Payer: Signature Care EPO |
$413.07
|
| Rate for Payer: Signature Care PPO |
$437.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$423.03
|
| Rate for Payer: United Healthcare Commercial |
$392.17
|
| Rate for Payer: United Healthcare Medicare |
$159.26
|
|
|
HC HERPES CULTURE W/TYPING IF IND
|
Facility
|
IP
|
$497.68
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$373.26 |
| Max. Negotiated Rate |
$462.84 |
| Rate for Payer: Aetna Commercial |
$430.00
|
| Rate for Payer: Cash Price |
$298.61
|
| Rate for Payer: Cigna All Commercial |
$429.50
|
| Rate for Payer: CORVEL All Commercial |
$462.84
|
| Rate for Payer: Coventry All Commercial |
$437.96
|
| Rate for Payer: Encore All Commercial |
$458.11
|
| Rate for Payer: Frontpath All Commercial |
$457.87
|
| Rate for Payer: Humana ChoiceCare |
$429.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.91
|
| Rate for Payer: PHCS All Commercial |
$373.26
|
| Rate for Payer: PHP All Commercial |
$377.44
|
| Rate for Payer: Sagamore Health Network All Products |
$384.21
|
| Rate for Payer: Signature Care EPO |
$413.07
|
| Rate for Payer: Signature Care PPO |
$437.96
|
| Rate for Payer: United Healthcare Commercial |
$392.17
|
|
|
HC HERPESELECT 1 IGG
|
Facility
|
OP
|
$144.36
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
63001944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Aetna Commercial |
$121.84
|
| Rate for Payer: Aetna Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.81
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Centivo All Commercial |
$78.53
|
| Rate for Payer: Cigna All Commercial |
$124.58
|
| Rate for Payer: CORVEL All Commercial |
$134.25
|
| Rate for Payer: Coventry All Commercial |
$127.04
|
| Rate for Payer: Encore All Commercial |
$132.88
|
| Rate for Payer: Frontpath All Commercial |
$132.81
|
| Rate for Payer: Humana ChoiceCare |
$124.68
|
| Rate for Payer: Humana Medicare |
$46.20
|
| Rate for Payer: Lucent All Commercial |
$78.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.92
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: MDWise Medicaid |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$108.27
|
| Rate for Payer: PHP All Commercial |
$109.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.30
|
| Rate for Payer: Sagamore Health Network All Products |
$111.45
|
| Rate for Payer: Signature Care EPO |
$119.82
|
| Rate for Payer: Signature Care PPO |
$127.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.71
|
| Rate for Payer: United Healthcare Commercial |
$113.76
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
|
|
HC HERPESELECT 1 IGG
|
Facility
|
IP
|
$144.36
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
63001944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.27 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Aetna Commercial |
$124.73
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Cigna All Commercial |
$124.58
|
| Rate for Payer: CORVEL All Commercial |
$134.25
|
| Rate for Payer: Coventry All Commercial |
$127.04
|
| Rate for Payer: Encore All Commercial |
$132.88
|
| Rate for Payer: Frontpath All Commercial |
$132.81
|
| Rate for Payer: Humana ChoiceCare |
$124.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.92
|
| Rate for Payer: PHCS All Commercial |
$108.27
|
| Rate for Payer: PHP All Commercial |
$109.48
|
| Rate for Payer: Sagamore Health Network All Products |
$111.45
|
| Rate for Payer: Signature Care EPO |
$119.82
|
| Rate for Payer: Signature Care PPO |
$127.04
|
| Rate for Payer: United Healthcare Commercial |
$113.76
|
|
|
HC HERPESELECT 2 IGG
|
Facility
|
OP
|
$149.23
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
63001947
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$138.78 |
| Rate for Payer: Aetna Commercial |
$125.95
|
| Rate for Payer: Aetna Medicare |
$47.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$68.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.53
|
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Centivo All Commercial |
$81.18
|
| Rate for Payer: Cigna All Commercial |
$128.79
|
| Rate for Payer: CORVEL All Commercial |
$138.78
|
| Rate for Payer: Coventry All Commercial |
$131.32
|
| Rate for Payer: Encore All Commercial |
$137.37
|
| Rate for Payer: Frontpath All Commercial |
$137.29
|
| Rate for Payer: Humana ChoiceCare |
$128.89
|
| Rate for Payer: Humana Medicare |
$47.75
|
| Rate for Payer: Lucent All Commercial |
$81.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.31
|
| Rate for Payer: Managed Health Services Medicaid |
$19.35
|
| Rate for Payer: MDWise Medicaid |
$19.35
|
| Rate for Payer: PHCS All Commercial |
$111.92
|
| Rate for Payer: PHP All Commercial |
$113.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.20
|
| Rate for Payer: Sagamore Health Network All Products |
$115.21
|
| Rate for Payer: Signature Care EPO |
$123.86
|
| Rate for Payer: Signature Care PPO |
$131.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.85
|
| Rate for Payer: United Healthcare Commercial |
$117.59
|
| Rate for Payer: United Healthcare Medicare |
$47.75
|
|
|
HC HERPESELECT 2 IGG
|
Facility
|
IP
|
$149.23
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
63001947
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.92 |
| Max. Negotiated Rate |
$138.78 |
| Rate for Payer: Aetna Commercial |
$128.93
|
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Cigna All Commercial |
$128.79
|
| Rate for Payer: CORVEL All Commercial |
$138.78
|
| Rate for Payer: Coventry All Commercial |
$131.32
|
| Rate for Payer: Encore All Commercial |
$137.37
|
| Rate for Payer: Frontpath All Commercial |
$137.29
|
| Rate for Payer: Humana ChoiceCare |
$128.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.31
|
| Rate for Payer: PHCS All Commercial |
$111.92
|
| Rate for Payer: PHP All Commercial |
$113.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.21
|
| Rate for Payer: Signature Care EPO |
$123.86
|
| Rate for Payer: Signature Care PPO |
$131.32
|
| Rate for Payer: United Healthcare Commercial |
$117.59
|
|
|
HC HERPES VIRUS BY PCR
|
Facility
|
IP
|
$248.03
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
63001037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$186.02 |
| Max. Negotiated Rate |
$230.67 |
| Rate for Payer: Aetna Commercial |
$214.30
|
| Rate for Payer: Cash Price |
$148.82
|
| 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 |
$214.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$223.23
|
| Rate for Payer: PHCS All Commercial |
$186.02
|
| Rate for Payer: PHP All Commercial |
$188.11
|
| Rate for Payer: Sagamore Health Network All Products |
$191.48
|
| Rate for Payer: Signature Care EPO |
$205.86
|
| 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 |
$79.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$113.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.31
|
| Rate for Payer: Cash Price |
$148.82
|
| Rate for Payer: Cash Price |
$148.82
|
| Rate for Payer: Centivo All Commercial |
$134.93
|
| 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 |
$214.22
|
| Rate for Payer: Humana Medicare |
$79.37
|
| Rate for Payer: Lucent All Commercial |
$134.93
|
| 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 |
$186.02
|
| 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 |
$205.86
|
| 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 |
$79.37
|
|
|
HC HEXAGONAL PHOSPHOLIPID NEUTRALIZATION
|
Facility
|
IP
|
$76.30
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
63001748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cigna All Commercial |
$65.85
|
| 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 |
$70.20
|
| Rate for Payer: Humana ChoiceCare |
$65.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.67
|
| Rate for Payer: PHCS All Commercial |
$57.23
|
| Rate for Payer: PHP All Commercial |
$57.87
|
| 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 HEXAGONAL PHOSPHOLIPID NEUTRALIZATION
|
Facility
|
OP
|
$76.30
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
63001748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$24.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.86
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Centivo All Commercial |
$41.51
|
| Rate for Payer: Cigna All Commercial |
$65.85
|
| 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 |
$70.20
|
| Rate for Payer: Humana ChoiceCare |
$65.90
|
| Rate for Payer: Humana Medicare |
$24.42
|
| Rate for Payer: Lucent All Commercial |
$41.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.67
|
| Rate for Payer: Managed Health Services Medicaid |
$17.98
|
| Rate for Payer: MDWise Medicaid |
$17.98
|
| Rate for Payer: PHCS All Commercial |
$57.23
|
| Rate for Payer: PHP All Commercial |
$57.87
|
| 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 |
$64.86
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
|
|
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 |
$19.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.19
|
| Rate for Payer: Cash Price |
$36.13
|
| Rate for Payer: Cash Price |
$36.13
|
| Rate for Payer: Centivo All Commercial |
$32.75
|
| Rate for Payer: Cigna All Commercial |
$51.96
|
| Rate for Payer: CORVEL All Commercial |
$56.00
|
| Rate for Payer: Coventry All Commercial |
$52.98
|
| 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 |
$19.27
|
| Rate for Payer: Lucent All Commercial |
$32.75
|
| 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 |
$52.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.18
|
| Rate for Payer: United Healthcare Commercial |
$47.45
|
| Rate for Payer: United Healthcare Medicare |
$19.27
|
|
|
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 |
$36.13
|
| Rate for Payer: Cigna All Commercial |
$51.96
|
| Rate for Payer: CORVEL All Commercial |
$56.00
|
| Rate for Payer: Coventry All Commercial |
$52.98
|
| 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 |
$52.98
|
| Rate for Payer: United Healthcare Commercial |
$47.45
|
|
|
HC HIP ARTHROGRAM LT
|
Facility
|
OP
|
$1,153.51
|
|
|
Service Code
|
CPT 73525 LT
|
| Hospital Charge Code |
1616074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$1,072.76 |
| Rate for Payer: Aetna Commercial |
$973.56
|
| Rate for Payer: Aetna Medicare |
$369.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$52.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$357.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$662.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$52.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$424.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$406.04
|
| Rate for Payer: Cash Price |
$692.11
|
| Rate for Payer: Cash Price |
$692.11
|
| Rate for Payer: Centivo All Commercial |
$627.51
|
| 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 |
$1,061.81
|
| Rate for Payer: Frontpath All Commercial |
$1,061.23
|
| Rate for Payer: Humana ChoiceCare |
$996.29
|
| Rate for Payer: Humana Medicare |
$369.12
|
| Rate for Payer: Lucent All Commercial |
$627.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,038.16
|
| Rate for Payer: Managed Health Services Medicaid |
$52.43
|
| Rate for Payer: MDWise Medicaid |
$52.43
|
| 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 |
$908.97
|
| Rate for Payer: United Healthcare Medicare |
$369.12
|
|
|
HC HIP ARTHROGRAM LT
|
Facility
|
IP
|
$1,153.51
|
|
|
Service Code
|
CPT 73525 LT
|
| Hospital Charge Code |
1616074
|
|
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 |
$692.11
|
| 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 |
$1,061.81
|
| Rate for Payer: Frontpath All Commercial |
$1,061.23
|
| Rate for Payer: Humana ChoiceCare |
$996.29
|
| 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: 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 |
$908.97
|
|
|
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 |
$692.11
|
| 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 |
$1,061.81
|
| Rate for Payer: Frontpath All Commercial |
$1,061.23
|
| Rate for Payer: Humana ChoiceCare |
$996.29
|
| 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: 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 |
$908.97
|
|
|
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 |
$52.43 |
| Max. Negotiated Rate |
$1,072.76 |
| Rate for Payer: Aetna Commercial |
$973.56
|
| Rate for Payer: Aetna Medicare |
$369.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$52.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$357.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$662.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$52.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$424.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$406.04
|
| Rate for Payer: Cash Price |
$692.11
|
| Rate for Payer: Cash Price |
$692.11
|
| Rate for Payer: Centivo All Commercial |
$627.51
|
| 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 |
$1,061.81
|
| Rate for Payer: Frontpath All Commercial |
$1,061.23
|
| Rate for Payer: Humana ChoiceCare |
$996.29
|
| Rate for Payer: Humana Medicare |
$369.12
|
| Rate for Payer: Lucent All Commercial |
$627.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,038.16
|
| Rate for Payer: Managed Health Services Medicaid |
$52.43
|
| Rate for Payer: MDWise Medicaid |
$52.43
|
| 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 |
$908.97
|
| Rate for Payer: United Healthcare Medicare |
$369.12
|
|
|
HC HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
|
IP
|
$92.06
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.05 |
| Max. Negotiated Rate |
$85.62 |
| Rate for Payer: Aetna Commercial |
$79.54
|
| Rate for Payer: Cash Price |
$55.24
|
| Rate for Payer: Cigna All Commercial |
$79.45
|
| Rate for Payer: CORVEL All Commercial |
$85.62
|
| Rate for Payer: Coventry All Commercial |
$81.01
|
| Rate for Payer: Encore All Commercial |
$84.74
|
| Rate for Payer: Frontpath All Commercial |
$84.70
|
| Rate for Payer: Humana ChoiceCare |
$79.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.85
|
| Rate for Payer: PHCS All Commercial |
$69.05
|
| Rate for Payer: PHP All Commercial |
$69.82
|
| 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 |
$85.62 |
| Rate for Payer: Aetna Commercial |
$77.70
|
| Rate for Payer: Aetna Medicare |
$29.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.41
|
| Rate for Payer: Cash Price |
$55.24
|
| Rate for Payer: Cash Price |
$55.24
|
| Rate for Payer: Centivo All Commercial |
$50.08
|
| Rate for Payer: Cigna All Commercial |
$79.45
|
| Rate for Payer: CORVEL All Commercial |
$85.62
|
| Rate for Payer: Coventry All Commercial |
$81.01
|
| Rate for Payer: Encore All Commercial |
$84.74
|
| Rate for Payer: Frontpath All Commercial |
$84.70
|
| Rate for Payer: Humana ChoiceCare |
$79.51
|
| Rate for Payer: Humana Medicare |
$29.46
|
| Rate for Payer: Lucent All Commercial |
$50.08
|
| 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 |
$69.05
|
| Rate for Payer: PHP All Commercial |
$69.82
|
| 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 |
$29.46
|
|
|
HC HISTOPLASMA CAP AG
|
Facility
|
IP
|
$532.95
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
63001019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$399.71 |
| Max. Negotiated Rate |
$495.64 |
| Rate for Payer: Aetna Commercial |
$460.47
|
| Rate for Payer: Cash Price |
$319.77
|
| 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: Lutheran Preferred All Commercial |
$479.65
|
| Rate for Payer: PHCS All Commercial |
$399.71
|
| Rate for Payer: PHP All Commercial |
$404.19
|
| 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: United Healthcare Commercial |
$419.96
|
|
|
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 |
$170.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$165.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$244.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.60
|
| Rate for Payer: Cash Price |
$319.77
|
| Rate for Payer: Cash Price |
$319.77
|
| Rate for Payer: Centivo All Commercial |
$289.92
|
| 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 |
$170.54
|
| Rate for Payer: Lucent All Commercial |
$289.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$479.65
|
| 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 |
$170.54
|
|
|
HC HISTOPLASMA GALACTOMANNAN ANTIGEN EIA, SERUM
|
Facility
|
IP
|
$137.70
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
63044049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.28 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$118.97
|
| Rate for Payer: Cash Price |
$82.62
|
| Rate for Payer: Cigna All Commercial |
$118.84
|
| Rate for Payer: CORVEL All Commercial |
$128.06
|
| Rate for Payer: Coventry All Commercial |
$121.18
|
| Rate for Payer: Encore All Commercial |
$126.75
|
| Rate for Payer: Frontpath All Commercial |
$126.68
|
| Rate for Payer: Humana ChoiceCare |
$118.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.93
|
| Rate for Payer: PHCS All Commercial |
$103.28
|
| Rate for Payer: PHP All Commercial |
$104.43
|
| Rate for Payer: Sagamore Health Network All Products |
$106.30
|
| Rate for Payer: Signature Care EPO |
$114.29
|
| Rate for Payer: Signature Care PPO |
$121.18
|
| Rate for Payer: United Healthcare Commercial |
$108.51
|
|
