|
HC RSV
|
Facility
|
OP
|
$253.20
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
63087801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$235.48 |
| Rate for Payer: Aetna Commercial |
$213.70
|
| Rate for Payer: Aetna Medicare |
$81.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$70.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$116.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$116.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$70.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.13
|
| Rate for Payer: Cash Price |
$151.92
|
| Rate for Payer: Cash Price |
$151.92
|
| Rate for Payer: Centivo All Commercial |
$137.74
|
| Rate for Payer: Cigna All Commercial |
$218.51
|
| Rate for Payer: CORVEL All Commercial |
$235.48
|
| Rate for Payer: Coventry All Commercial |
$222.82
|
| Rate for Payer: Encore All Commercial |
$233.07
|
| Rate for Payer: Frontpath All Commercial |
$232.94
|
| Rate for Payer: Humana ChoiceCare |
$218.69
|
| Rate for Payer: Humana Medicare |
$81.02
|
| Rate for Payer: Lucent All Commercial |
$137.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.88
|
| Rate for Payer: Managed Health Services Medicaid |
$70.20
|
| Rate for Payer: MDWise Medicaid |
$70.20
|
| Rate for Payer: PHCS All Commercial |
$189.90
|
| Rate for Payer: PHP All Commercial |
$192.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.75
|
| Rate for Payer: Sagamore Health Network All Products |
$195.47
|
| Rate for Payer: Signature Care EPO |
$210.16
|
| Rate for Payer: Signature Care PPO |
$222.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$215.22
|
| Rate for Payer: United Healthcare Commercial |
$199.52
|
| Rate for Payer: United Healthcare Medicare |
$81.02
|
|
|
HC RSV
|
Facility
|
IP
|
$253.20
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
63087801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.90 |
| Max. Negotiated Rate |
$235.48 |
| Rate for Payer: Aetna Commercial |
$218.76
|
| Rate for Payer: Cash Price |
$151.92
|
| Rate for Payer: Cigna All Commercial |
$218.51
|
| Rate for Payer: CORVEL All Commercial |
$235.48
|
| Rate for Payer: Coventry All Commercial |
$222.82
|
| Rate for Payer: Encore All Commercial |
$233.07
|
| Rate for Payer: Frontpath All Commercial |
$232.94
|
| Rate for Payer: Humana ChoiceCare |
$218.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.88
|
| Rate for Payer: PHCS All Commercial |
$189.90
|
| Rate for Payer: PHP All Commercial |
$192.03
|
| Rate for Payer: Sagamore Health Network All Products |
$195.47
|
| Rate for Payer: Signature Care EPO |
$210.16
|
| Rate for Payer: Signature Care PPO |
$222.82
|
| Rate for Payer: United Healthcare Commercial |
$199.52
|
|
|
HC RUBELLA IGG
|
Facility
|
OP
|
$111.08
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
63001968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$103.30 |
| Rate for Payer: Aetna Commercial |
$93.75
|
| Rate for Payer: Aetna Medicare |
$35.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.10
|
| Rate for Payer: Cash Price |
$66.65
|
| Rate for Payer: Cash Price |
$66.65
|
| Rate for Payer: Centivo All Commercial |
$60.43
|
| Rate for Payer: Cigna All Commercial |
$95.86
|
| Rate for Payer: CORVEL All Commercial |
$103.30
|
| Rate for Payer: Coventry All Commercial |
$97.75
|
| Rate for Payer: Encore All Commercial |
$102.25
|
| Rate for Payer: Frontpath All Commercial |
$102.19
|
| Rate for Payer: Humana ChoiceCare |
$95.94
|
| Rate for Payer: Humana Medicare |
$35.55
|
| Rate for Payer: Lucent All Commercial |
$60.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.97
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$83.31
|
| Rate for Payer: PHP All Commercial |
$84.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.32
|
| Rate for Payer: Sagamore Health Network All Products |
$85.75
|
| Rate for Payer: Signature Care EPO |
$92.20
|
| Rate for Payer: Signature Care PPO |
$97.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.42
|
| Rate for Payer: United Healthcare Commercial |
$87.53
|
| Rate for Payer: United Healthcare Medicare |
$35.55
|
|
|
HC RUBELLA IGG
|
Facility
|
IP
|
$111.08
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
63001968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$103.30 |
| Rate for Payer: Aetna Commercial |
$95.97
|
| Rate for Payer: Cash Price |
$66.65
|
| Rate for Payer: Cigna All Commercial |
$95.86
|
| Rate for Payer: CORVEL All Commercial |
$103.30
|
| Rate for Payer: Coventry All Commercial |
$97.75
|
| Rate for Payer: Encore All Commercial |
$102.25
|
| Rate for Payer: Frontpath All Commercial |
$102.19
|
| Rate for Payer: Humana ChoiceCare |
$95.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.97
|
| Rate for Payer: PHCS All Commercial |
$83.31
|
| Rate for Payer: PHP All Commercial |
$84.24
|
| Rate for Payer: Sagamore Health Network All Products |
$85.75
|
| Rate for Payer: Signature Care EPO |
$92.20
|
| Rate for Payer: Signature Care PPO |
$97.75
|
| Rate for Payer: United Healthcare Commercial |
$87.53
|
|
|
HC RUBEOLA IGG AB
|
Facility
|
OP
|
$128.76
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
63001279
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$119.75 |
| Rate for Payer: Aetna Commercial |
$108.67
|
| Rate for Payer: Aetna Medicare |
$41.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$59.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.32
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Centivo All Commercial |
$70.05
|
| Rate for Payer: Cigna All Commercial |
$111.12
|
| Rate for Payer: CORVEL All Commercial |
$119.75
|
| Rate for Payer: Coventry All Commercial |
$113.31
|
| Rate for Payer: Encore All Commercial |
$118.52
|
| Rate for Payer: Frontpath All Commercial |
$118.46
|
| Rate for Payer: Humana ChoiceCare |
$111.21
|
| Rate for Payer: Humana Medicare |
$41.20
|
| Rate for Payer: Lucent All Commercial |
$70.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.88
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: MDWise Medicaid |
$12.88
|
| Rate for Payer: PHCS All Commercial |
$96.57
|
| Rate for Payer: PHP All Commercial |
$97.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.22
|
| Rate for Payer: Sagamore Health Network All Products |
$99.40
|
| Rate for Payer: Signature Care EPO |
$106.87
|
| Rate for Payer: Signature Care PPO |
$113.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109.45
|
| Rate for Payer: United Healthcare Commercial |
$101.46
|
| Rate for Payer: United Healthcare Medicare |
$41.20
|
|
|
HC RUBEOLA IGG AB
|
Facility
|
IP
|
$128.76
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
63001279
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.57 |
| Max. Negotiated Rate |
$119.75 |
| Rate for Payer: Aetna Commercial |
$111.25
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cigna All Commercial |
$111.12
|
| Rate for Payer: CORVEL All Commercial |
$119.75
|
| Rate for Payer: Coventry All Commercial |
$113.31
|
| Rate for Payer: Encore All Commercial |
$118.52
|
| Rate for Payer: Frontpath All Commercial |
$118.46
|
| Rate for Payer: Humana ChoiceCare |
$111.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.88
|
| Rate for Payer: PHCS All Commercial |
$96.57
|
| Rate for Payer: PHP All Commercial |
$97.65
|
| Rate for Payer: Sagamore Health Network All Products |
$99.40
|
| Rate for Payer: Signature Care EPO |
$106.87
|
| Rate for Payer: Signature Care PPO |
$113.31
|
| Rate for Payer: United Healthcare Commercial |
$101.46
|
|
|
HC RUSSELL VIPER DILUTE
|
Facility
|
IP
|
$121.46
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
63001752
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.09 |
| Max. Negotiated Rate |
$112.96 |
| Rate for Payer: Aetna Commercial |
$104.94
|
| Rate for Payer: Cash Price |
$72.88
|
| Rate for Payer: Cigna All Commercial |
$104.82
|
| Rate for Payer: CORVEL All Commercial |
$112.96
|
| Rate for Payer: Coventry All Commercial |
$106.88
|
| Rate for Payer: Encore All Commercial |
$111.80
|
| Rate for Payer: Frontpath All Commercial |
$111.74
|
| Rate for Payer: Humana ChoiceCare |
$104.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.31
|
| Rate for Payer: PHCS All Commercial |
$91.09
|
| Rate for Payer: PHP All Commercial |
$92.12
|
| Rate for Payer: Sagamore Health Network All Products |
$93.77
|
| Rate for Payer: Signature Care EPO |
$100.81
|
| Rate for Payer: Signature Care PPO |
$106.88
|
| Rate for Payer: United Healthcare Commercial |
$95.71
|
|
|
HC RUSSELL VIPER DILUTE
|
Facility
|
OP
|
$121.46
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
63001752
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$112.96 |
| Rate for Payer: Aetna Commercial |
$102.51
|
| Rate for Payer: Aetna Medicare |
$38.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$55.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.75
|
| Rate for Payer: Cash Price |
$72.88
|
| Rate for Payer: Cash Price |
$72.88
|
| Rate for Payer: Centivo All Commercial |
$66.07
|
| Rate for Payer: Cigna All Commercial |
$104.82
|
| Rate for Payer: CORVEL All Commercial |
$112.96
|
| Rate for Payer: Coventry All Commercial |
$106.88
|
| Rate for Payer: Encore All Commercial |
$111.80
|
| Rate for Payer: Frontpath All Commercial |
$111.74
|
| Rate for Payer: Humana ChoiceCare |
$104.91
|
| Rate for Payer: Humana Medicare |
$38.87
|
| Rate for Payer: Lucent All Commercial |
$66.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.31
|
| Rate for Payer: Managed Health Services Medicaid |
$9.58
|
| Rate for Payer: MDWise Medicaid |
$9.58
|
| Rate for Payer: PHCS All Commercial |
$91.09
|
| Rate for Payer: PHP All Commercial |
$92.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.37
|
| Rate for Payer: Sagamore Health Network All Products |
$93.77
|
| Rate for Payer: Signature Care EPO |
$100.81
|
| Rate for Payer: Signature Care PPO |
$106.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.24
|
| Rate for Payer: United Healthcare Commercial |
$95.71
|
| Rate for Payer: United Healthcare Medicare |
$38.87
|
|
|
HC SALICYLATE LEVEL QUA
|
Facility
|
IP
|
$186.89
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
63001399
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Aetna Commercial |
$161.47
|
| Rate for Payer: Cash Price |
$112.13
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.46
|
| Rate for Payer: Encore All Commercial |
$172.03
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.20
|
| Rate for Payer: PHCS All Commercial |
$140.17
|
| Rate for Payer: PHP All Commercial |
$141.74
|
| Rate for Payer: Sagamore Health Network All Products |
$144.28
|
| Rate for Payer: Signature Care EPO |
$155.12
|
| Rate for Payer: Signature Care PPO |
$164.46
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
|
|
HC SALICYLATE LEVEL QUA
|
Facility
|
OP
|
$186.89
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
63001399
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Aetna Commercial |
$157.74
|
| Rate for Payer: Aetna Medicare |
$59.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.79
|
| Rate for Payer: Cash Price |
$112.13
|
| Rate for Payer: Cash Price |
$112.13
|
| Rate for Payer: Centivo All Commercial |
$101.67
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.46
|
| Rate for Payer: Encore All Commercial |
$172.03
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Humana Medicare |
$59.80
|
| Rate for Payer: Lucent All Commercial |
$101.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.20
|
| Rate for Payer: Managed Health Services Medicaid |
$18.64
|
| Rate for Payer: MDWise Medicaid |
$18.64
|
| Rate for Payer: PHCS All Commercial |
$140.17
|
| Rate for Payer: PHP All Commercial |
$141.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.89
|
| Rate for Payer: Sagamore Health Network All Products |
$144.28
|
| Rate for Payer: Signature Care EPO |
$155.12
|
| Rate for Payer: Signature Care PPO |
$164.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158.86
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
| Rate for Payer: United Healthcare Medicare |
$59.80
|
|
|
HC SARS ANTIGEN (COVID-19)
|
Facility
|
IP
|
$162.16
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
63087426
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$150.81 |
| Rate for Payer: Aetna Commercial |
$140.11
|
| Rate for Payer: Cash Price |
$97.30
|
| Rate for Payer: Cigna All Commercial |
$139.94
|
| Rate for Payer: CORVEL All Commercial |
$150.81
|
| Rate for Payer: Coventry All Commercial |
$142.70
|
| Rate for Payer: Encore All Commercial |
$149.27
|
| Rate for Payer: Frontpath All Commercial |
$149.19
|
| Rate for Payer: Humana ChoiceCare |
$140.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.94
|
| Rate for Payer: PHCS All Commercial |
$121.62
|
| Rate for Payer: PHP All Commercial |
$122.98
|
| Rate for Payer: Sagamore Health Network All Products |
$125.19
|
| Rate for Payer: Signature Care EPO |
$134.59
|
| Rate for Payer: Signature Care PPO |
$142.70
|
| Rate for Payer: United Healthcare Commercial |
$127.78
|
|
|
HC SARS ANTIGEN (COVID-19)
|
Facility
|
OP
|
$162.16
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
63087426
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$150.81 |
| Rate for Payer: Aetna Commercial |
$136.86
|
| Rate for Payer: Aetna Medicare |
$51.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.08
|
| Rate for Payer: Cash Price |
$97.30
|
| Rate for Payer: Cash Price |
$97.30
|
| Rate for Payer: Centivo All Commercial |
$88.22
|
| Rate for Payer: Cigna All Commercial |
$139.94
|
| Rate for Payer: CORVEL All Commercial |
$150.81
|
| Rate for Payer: Coventry All Commercial |
$142.70
|
| Rate for Payer: Encore All Commercial |
$149.27
|
| Rate for Payer: Frontpath All Commercial |
$149.19
|
| Rate for Payer: Humana ChoiceCare |
$140.06
|
| Rate for Payer: Humana Medicare |
$51.89
|
| Rate for Payer: Lucent All Commercial |
$88.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.94
|
| Rate for Payer: Managed Health Services Medicaid |
$35.33
|
| Rate for Payer: MDWise Medicaid |
$35.33
|
| Rate for Payer: PHCS All Commercial |
$121.62
|
| Rate for Payer: PHP All Commercial |
$122.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.24
|
| Rate for Payer: Sagamore Health Network All Products |
$125.19
|
| Rate for Payer: Signature Care EPO |
$134.59
|
| Rate for Payer: Signature Care PPO |
$142.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.84
|
| Rate for Payer: United Healthcare Commercial |
$127.78
|
| Rate for Payer: United Healthcare Medicare |
$51.89
|
|
|
HC SARS-COV-2 ANTIBODIES, NUCLEOCAPSID
|
Facility
|
OP
|
$102.71
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
63026769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$95.52 |
| Rate for Payer: Aetna Commercial |
$86.69
|
| Rate for Payer: Aetna Medicare |
$32.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.15
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Centivo All Commercial |
$55.87
|
| Rate for Payer: Cigna All Commercial |
$88.64
|
| Rate for Payer: CORVEL All Commercial |
$95.52
|
| Rate for Payer: Coventry All Commercial |
$90.38
|
| Rate for Payer: Encore All Commercial |
$94.54
|
| Rate for Payer: Frontpath All Commercial |
$94.49
|
| Rate for Payer: Humana ChoiceCare |
$88.71
|
| Rate for Payer: Humana Medicare |
$32.87
|
| Rate for Payer: Lucent All Commercial |
$55.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.44
|
| Rate for Payer: Managed Health Services Medicaid |
$42.13
|
| Rate for Payer: MDWise Medicaid |
$42.13
|
| Rate for Payer: PHCS All Commercial |
$77.03
|
| Rate for Payer: PHP All Commercial |
$77.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.06
|
| Rate for Payer: Sagamore Health Network All Products |
$79.29
|
| Rate for Payer: Signature Care EPO |
$85.25
|
| Rate for Payer: Signature Care PPO |
$90.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.30
|
| Rate for Payer: United Healthcare Commercial |
$80.94
|
| Rate for Payer: United Healthcare Medicare |
$32.87
|
|
|
HC SARS-COV-2 ANTIBODIES, NUCLEOCAPSID
|
Facility
|
IP
|
$102.71
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
63026769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.03 |
| Max. Negotiated Rate |
$95.52 |
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Cigna All Commercial |
$88.64
|
| Rate for Payer: CORVEL All Commercial |
$95.52
|
| Rate for Payer: Coventry All Commercial |
$90.38
|
| Rate for Payer: Encore All Commercial |
$94.54
|
| Rate for Payer: Frontpath All Commercial |
$94.49
|
| Rate for Payer: Humana ChoiceCare |
$88.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.44
|
| Rate for Payer: PHCS All Commercial |
$77.03
|
| Rate for Payer: PHP All Commercial |
$77.90
|
| Rate for Payer: Sagamore Health Network All Products |
$79.29
|
| Rate for Payer: Signature Care EPO |
$85.25
|
| Rate for Payer: Signature Care PPO |
$90.38
|
| Rate for Payer: United Healthcare Commercial |
$80.94
|
|
|
HC SARS-COV-2 SEMIQUANTITATIVE TOTAL ANTIBODY, SPIKE
|
Facility
|
IP
|
$102.71
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
63016769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.03 |
| Max. Negotiated Rate |
$95.52 |
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Cigna All Commercial |
$88.64
|
| Rate for Payer: CORVEL All Commercial |
$95.52
|
| Rate for Payer: Coventry All Commercial |
$90.38
|
| Rate for Payer: Encore All Commercial |
$94.54
|
| Rate for Payer: Frontpath All Commercial |
$94.49
|
| Rate for Payer: Humana ChoiceCare |
$88.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.44
|
| Rate for Payer: PHCS All Commercial |
$77.03
|
| Rate for Payer: PHP All Commercial |
$77.90
|
| Rate for Payer: Sagamore Health Network All Products |
$79.29
|
| Rate for Payer: Signature Care EPO |
$85.25
|
| Rate for Payer: Signature Care PPO |
$90.38
|
| Rate for Payer: United Healthcare Commercial |
$80.94
|
|
|
HC SARS-COV-2 SEMIQUANTITATIVE TOTAL ANTIBODY, SPIKE
|
Facility
|
OP
|
$102.71
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
63016769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$95.52 |
| Rate for Payer: Aetna Commercial |
$86.69
|
| Rate for Payer: Aetna Medicare |
$32.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.15
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Centivo All Commercial |
$55.87
|
| Rate for Payer: Cigna All Commercial |
$88.64
|
| Rate for Payer: CORVEL All Commercial |
$95.52
|
| Rate for Payer: Coventry All Commercial |
$90.38
|
| Rate for Payer: Encore All Commercial |
$94.54
|
| Rate for Payer: Frontpath All Commercial |
$94.49
|
| Rate for Payer: Humana ChoiceCare |
$88.71
|
| Rate for Payer: Humana Medicare |
$32.87
|
| Rate for Payer: Lucent All Commercial |
$55.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.44
|
| Rate for Payer: Managed Health Services Medicaid |
$42.13
|
| Rate for Payer: MDWise Medicaid |
$42.13
|
| Rate for Payer: PHCS All Commercial |
$77.03
|
| Rate for Payer: PHP All Commercial |
$77.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.06
|
| Rate for Payer: Sagamore Health Network All Products |
$79.29
|
| Rate for Payer: Signature Care EPO |
$85.25
|
| Rate for Payer: Signature Care PPO |
$90.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.30
|
| Rate for Payer: United Healthcare Commercial |
$80.94
|
| Rate for Payer: United Healthcare Medicare |
$32.87
|
|
|
HC S BLADE SAW 18.0X1.27X90
|
Facility
|
OP
|
$357.00
|
|
| Hospital Charge Code |
41607604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$301.31
|
| Rate for Payer: Aetna Medicare |
$114.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$205.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$223.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.66
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Centivo All Commercial |
$194.21
|
| Rate for Payer: Cigna All Commercial |
$308.09
|
| Rate for Payer: CORVEL All Commercial |
$332.01
|
| Rate for Payer: Coventry All Commercial |
$314.16
|
| Rate for Payer: Encore All Commercial |
$328.62
|
| Rate for Payer: Frontpath All Commercial |
$328.44
|
| Rate for Payer: Humana ChoiceCare |
$308.34
|
| Rate for Payer: Humana Medicare |
$114.24
|
| Rate for Payer: Lucent All Commercial |
$194.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.30
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$267.75
|
| Rate for Payer: PHP All Commercial |
$270.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.23
|
| Rate for Payer: Sagamore Health Network All Products |
$275.60
|
| Rate for Payer: Signature Care EPO |
$296.31
|
| Rate for Payer: Signature Care PPO |
$314.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$303.45
|
| Rate for Payer: United Healthcare Commercial |
$281.32
|
| Rate for Payer: United Healthcare Medicare |
$114.24
|
|
|
HC S BLADE SAW 18.0X1.27X90
|
Facility
|
IP
|
$357.00
|
|
| Hospital Charge Code |
41607604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$308.45
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna All Commercial |
$308.09
|
| Rate for Payer: CORVEL All Commercial |
$332.01
|
| Rate for Payer: Coventry All Commercial |
$314.16
|
| Rate for Payer: Encore All Commercial |
$328.62
|
| Rate for Payer: Frontpath All Commercial |
$328.44
|
| Rate for Payer: Humana ChoiceCare |
$308.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.30
|
| Rate for Payer: PHCS All Commercial |
$267.75
|
| Rate for Payer: PHP All Commercial |
$270.75
|
| Rate for Payer: Sagamore Health Network All Products |
$275.60
|
| Rate for Payer: Signature Care EPO |
$296.31
|
| Rate for Payer: Signature Care PPO |
$314.16
|
| Rate for Payer: United Healthcare Commercial |
$281.32
|
|
|
HC S BLADE SAW PREC 5.5X0.38X18
|
Facility
|
IP
|
$265.58
|
|
| Hospital Charge Code |
41607936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.19 |
| Max. Negotiated Rate |
$246.99 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Cash Price |
$159.35
|
| Rate for Payer: Cigna All Commercial |
$229.20
|
| Rate for Payer: CORVEL All Commercial |
$246.99
|
| Rate for Payer: Coventry All Commercial |
$233.71
|
| Rate for Payer: Encore All Commercial |
$244.47
|
| Rate for Payer: Frontpath All Commercial |
$244.33
|
| Rate for Payer: Humana ChoiceCare |
$229.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.02
|
| Rate for Payer: PHCS All Commercial |
$199.19
|
| Rate for Payer: PHP All Commercial |
$201.42
|
| Rate for Payer: Sagamore Health Network All Products |
$205.03
|
| Rate for Payer: Signature Care EPO |
$220.43
|
| Rate for Payer: Signature Care PPO |
$233.71
|
| Rate for Payer: United Healthcare Commercial |
$209.28
|
|
|
HC S BLADE SAW PREC 5.5X0.38X18
|
Facility
|
OP
|
$265.58
|
|
| Hospital Charge Code |
41607936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$246.99 |
| Rate for Payer: Aetna Commercial |
$224.15
|
| Rate for Payer: Aetna Medicare |
$84.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$152.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.48
|
| Rate for Payer: Cash Price |
$159.35
|
| Rate for Payer: Cash Price |
$159.35
|
| Rate for Payer: Centivo All Commercial |
$144.48
|
| Rate for Payer: Cigna All Commercial |
$229.20
|
| Rate for Payer: CORVEL All Commercial |
$246.99
|
| Rate for Payer: Coventry All Commercial |
$233.71
|
| Rate for Payer: Encore All Commercial |
$244.47
|
| Rate for Payer: Frontpath All Commercial |
$244.33
|
| Rate for Payer: Humana ChoiceCare |
$229.38
|
| Rate for Payer: Humana Medicare |
$84.99
|
| Rate for Payer: Lucent All Commercial |
$144.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.02
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$199.19
|
| Rate for Payer: PHP All Commercial |
$201.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.58
|
| Rate for Payer: Sagamore Health Network All Products |
$205.03
|
| Rate for Payer: Signature Care EPO |
$220.43
|
| Rate for Payer: Signature Care PPO |
$233.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$225.74
|
| Rate for Payer: United Healthcare Commercial |
$209.28
|
| Rate for Payer: United Healthcare Medicare |
$84.99
|
|
|
HC S CASSETTE CROSSFLOW
|
Facility
|
IP
|
$440.65
|
|
| Hospital Charge Code |
41607426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.49 |
| Max. Negotiated Rate |
$409.80 |
| Rate for Payer: Aetna Commercial |
$380.72
|
| Rate for Payer: Cash Price |
$264.39
|
| Rate for Payer: Cigna All Commercial |
$380.28
|
| Rate for Payer: CORVEL All Commercial |
$409.80
|
| Rate for Payer: Coventry All Commercial |
$387.77
|
| Rate for Payer: Encore All Commercial |
$405.62
|
| Rate for Payer: Frontpath All Commercial |
$405.40
|
| Rate for Payer: Humana ChoiceCare |
$380.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$396.58
|
| Rate for Payer: PHCS All Commercial |
$330.49
|
| Rate for Payer: PHP All Commercial |
$334.19
|
| Rate for Payer: Sagamore Health Network All Products |
$340.18
|
| Rate for Payer: Signature Care EPO |
$365.74
|
| Rate for Payer: Signature Care PPO |
$387.77
|
| Rate for Payer: United Healthcare Commercial |
$347.23
|
|
|
HC S CASSETTE CROSSFLOW
|
Facility
|
OP
|
$440.65
|
|
| Hospital Charge Code |
41607426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$409.80 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Aetna Medicare |
$141.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$136.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$253.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$275.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.11
|
| Rate for Payer: Cash Price |
$264.39
|
| Rate for Payer: Cash Price |
$264.39
|
| Rate for Payer: Centivo All Commercial |
$239.71
|
| Rate for Payer: Cigna All Commercial |
$380.28
|
| Rate for Payer: CORVEL All Commercial |
$409.80
|
| Rate for Payer: Coventry All Commercial |
$387.77
|
| Rate for Payer: Encore All Commercial |
$405.62
|
| Rate for Payer: Frontpath All Commercial |
$405.40
|
| Rate for Payer: Humana ChoiceCare |
$380.59
|
| Rate for Payer: Humana Medicare |
$141.01
|
| Rate for Payer: Lucent All Commercial |
$239.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$396.58
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$330.49
|
| Rate for Payer: PHP All Commercial |
$334.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.85
|
| Rate for Payer: Sagamore Health Network All Products |
$340.18
|
| Rate for Payer: Signature Care EPO |
$365.74
|
| Rate for Payer: Signature Care PPO |
$387.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$374.55
|
| Rate for Payer: United Healthcare Commercial |
$347.23
|
| Rate for Payer: United Healthcare Medicare |
$141.01
|
|
|
HC SCLERODERMA AB
|
Facility
|
IP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$134.43
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: United Healthcare Commercial |
$122.60
|
|
|
HC SCLERODERMA AB
|
Facility
|
OP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$131.32
|
| Rate for Payer: Aetna Medicare |
$49.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.77
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Centivo All Commercial |
$84.64
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Humana Medicare |
$49.79
|
| Rate for Payer: Lucent All Commercial |
$84.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.68
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.25
|
| Rate for Payer: United Healthcare Commercial |
$122.60
|
| Rate for Payer: United Healthcare Medicare |
$49.79
|
|
|
HC SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL
|
Facility
|
IP
|
$83.25
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
1617063
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$71.93
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cigna All Commercial |
$71.84
|
| Rate for Payer: CORVEL All Commercial |
$77.42
|
| Rate for Payer: Coventry All Commercial |
$73.26
|
| Rate for Payer: Encore All Commercial |
$76.63
|
| Rate for Payer: Frontpath All Commercial |
$76.59
|
| Rate for Payer: Humana ChoiceCare |
$71.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.92
|
| Rate for Payer: PHCS All Commercial |
$62.44
|
| Rate for Payer: PHP All Commercial |
$63.14
|
| Rate for Payer: Sagamore Health Network All Products |
$64.27
|
| Rate for Payer: Signature Care EPO |
$69.10
|
| Rate for Payer: Signature Care PPO |
$73.26
|
| Rate for Payer: United Healthcare Commercial |
$65.60
|
|
