|
HC RUBELLA IGG ANTIBODY
|
Facility
OP
|
$65.18
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
63001969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$60.62 |
| Rate for Payer: Aetna Commercial |
$55.01
|
| Rate for Payer: Aetna Medicare |
$21.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.66
|
| Rate for Payer: Cash Price |
$40.41
|
| Rate for Payer: Cash Price |
$40.41
|
| Rate for Payer: Centivo All Commercial |
$33.24
|
| Rate for Payer: Cigna All Commercial |
$56.25
|
| Rate for Payer: CORVEL All Commercial |
$60.62
|
| Rate for Payer: Coventry All Commercial |
$57.36
|
| Rate for Payer: Encore All Commercial |
$60.00
|
| Rate for Payer: Frontpath All Commercial |
$59.96
|
| Rate for Payer: Humana ChoiceCare |
$56.29
|
| Rate for Payer: Humana Medicare |
$33.24
|
| Rate for Payer: Lucent All Commercial |
$33.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.66
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$48.88
|
| Rate for Payer: PHP All Commercial |
$49.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.42
|
| Rate for Payer: Sagamore Health Network All Products |
$50.32
|
| Rate for Payer: Signature Care EPO |
$54.10
|
| Rate for Payer: Signature Care PPO |
$57.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.40
|
| Rate for Payer: United Healthcare Commercial |
$51.36
|
| Rate for Payer: United Healthcare Medicare |
$21.51
|
|
|
HC RUBELLA IGG ANTIBODY
|
Facility
IP
|
$65.18
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
63001969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$60.62 |
| Rate for Payer: Aetna Commercial |
$56.31
|
| Rate for Payer: Cash Price |
$40.41
|
| Rate for Payer: Cigna All Commercial |
$56.25
|
| Rate for Payer: CORVEL All Commercial |
$60.62
|
| Rate for Payer: Coventry All Commercial |
$57.36
|
| Rate for Payer: Encore All Commercial |
$60.00
|
| Rate for Payer: Frontpath All Commercial |
$59.96
|
| Rate for Payer: Humana ChoiceCare |
$56.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.66
|
| Rate for Payer: PHCS All Commercial |
$48.88
|
| Rate for Payer: PHP All Commercial |
$49.43
|
| Rate for Payer: Sagamore Health Network All Products |
$50.32
|
| Rate for Payer: Signature Care EPO |
$54.10
|
| Rate for Payer: Signature Care PPO |
$57.36
|
| Rate for Payer: United Healthcare Commercial |
$51.36
|
|
|
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 |
$108.68
|
| Rate for Payer: Aetna Medicare |
$42.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.74
|
| Rate for Payer: Cash Price |
$79.83
|
| Rate for Payer: Cash Price |
$79.83
|
| Rate for Payer: Centivo All Commercial |
$65.67
|
| 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 |
$118.53
|
| Rate for Payer: Frontpath All Commercial |
$118.46
|
| Rate for Payer: Humana ChoiceCare |
$111.21
|
| Rate for Payer: Humana Medicare |
$65.67
|
| Rate for Payer: Lucent All Commercial |
$65.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.89
|
| 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 |
$97.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.22
|
| Rate for Payer: Sagamore Health Network All Products |
$99.41
|
| 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 |
$101.47
|
| Rate for Payer: United Healthcare Medicare |
$42.49
|
|
|
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 |
$79.83
|
| 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 |
$118.53
|
| Rate for Payer: Frontpath All Commercial |
$118.46
|
| Rate for Payer: Humana ChoiceCare |
$111.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.89
|
| Rate for Payer: PHCS All Commercial |
$96.57
|
| Rate for Payer: PHP All Commercial |
$97.66
|
| Rate for Payer: Sagamore Health Network All Products |
$99.41
|
| Rate for Payer: Signature Care EPO |
$106.87
|
| Rate for Payer: Signature Care PPO |
$113.31
|
| Rate for Payer: United Healthcare Commercial |
$101.47
|
|
|
HC RUBEOLA IGM AB
|
Facility
IP
|
$62.97
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
63001970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$58.57 |
| Rate for Payer: Aetna Commercial |
$54.41
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cigna All Commercial |
$54.35
|
| Rate for Payer: CORVEL All Commercial |
$58.57
|
| Rate for Payer: Coventry All Commercial |
$55.42
|
| Rate for Payer: Encore All Commercial |
$57.97
|
| Rate for Payer: Frontpath All Commercial |
$57.94
|
| Rate for Payer: Humana ChoiceCare |
$54.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.68
|
| Rate for Payer: PHCS All Commercial |
$47.23
|
| Rate for Payer: PHP All Commercial |
$47.76
|
| Rate for Payer: Sagamore Health Network All Products |
$48.62
|
| Rate for Payer: Signature Care EPO |
$52.27
|
| Rate for Payer: Signature Care PPO |
$55.42
|
| Rate for Payer: United Healthcare Commercial |
$49.62
|
|
|
HC RUBEOLA IGM AB
|
Facility
OP
|
$62.97
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
63001970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$58.57 |
| Rate for Payer: Aetna Commercial |
$53.15
|
| Rate for Payer: Aetna Medicare |
$20.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.86
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Centivo All Commercial |
$32.12
|
| Rate for Payer: Cigna All Commercial |
$54.35
|
| Rate for Payer: CORVEL All Commercial |
$58.57
|
| Rate for Payer: Coventry All Commercial |
$55.42
|
| Rate for Payer: Encore All Commercial |
$57.97
|
| Rate for Payer: Frontpath All Commercial |
$57.94
|
| Rate for Payer: Humana ChoiceCare |
$54.39
|
| Rate for Payer: Humana Medicare |
$32.12
|
| Rate for Payer: Lucent All Commercial |
$32.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.68
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: MDWise Medicaid |
$12.88
|
| Rate for Payer: PHCS All Commercial |
$47.23
|
| Rate for Payer: PHP All Commercial |
$47.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.56
|
| Rate for Payer: Sagamore Health Network All Products |
$48.62
|
| Rate for Payer: Signature Care EPO |
$52.27
|
| Rate for Payer: Signature Care PPO |
$55.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.53
|
| Rate for Payer: United Healthcare Commercial |
$49.62
|
| Rate for Payer: United Healthcare Medicare |
$20.78
|
|
|
HC RUFINAMIDE, SERUM OR PLASMA
|
Facility
OP
|
$189.16
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.42 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$159.65
|
| Rate for Payer: Aetna Medicare |
$62.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.66
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Centivo All Commercial |
$96.47
|
| Rate for Payer: Cigna All Commercial |
$163.24
|
| Rate for Payer: CORVEL All Commercial |
$175.92
|
| Rate for Payer: Coventry All Commercial |
$166.46
|
| Rate for Payer: Encore All Commercial |
$174.12
|
| Rate for Payer: Frontpath All Commercial |
$174.03
|
| Rate for Payer: Humana ChoiceCare |
$163.38
|
| Rate for Payer: Humana Medicare |
$96.47
|
| Rate for Payer: Lucent All Commercial |
$96.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.77
|
| Rate for Payer: Sagamore Health Network All Products |
$146.03
|
| Rate for Payer: Signature Care EPO |
$157.00
|
| Rate for Payer: Signature Care PPO |
$166.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.79
|
| Rate for Payer: United Healthcare Commercial |
$149.06
|
| Rate for Payer: United Healthcare Medicare |
$62.42
|
|
|
HC RUFINAMIDE, SERUM OR PLASMA
|
Facility
IP
|
$189.16
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.87 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$163.43
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Cigna All Commercial |
$163.24
|
| Rate for Payer: CORVEL All Commercial |
$175.92
|
| Rate for Payer: Coventry All Commercial |
$166.46
|
| Rate for Payer: Encore All Commercial |
$174.12
|
| Rate for Payer: Frontpath All Commercial |
$174.03
|
| Rate for Payer: Humana ChoiceCare |
$163.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Sagamore Health Network All Products |
$146.03
|
| Rate for Payer: Signature Care EPO |
$157.00
|
| Rate for Payer: Signature Care PPO |
$166.46
|
| Rate for Payer: United Healthcare Commercial |
$149.06
|
|
|
HC RUMI KOH OCCULDER
|
Facility
OP
|
$575.04
|
|
| Hospital Charge Code |
41601985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$534.79 |
| Rate for Payer: Aetna Commercial |
$485.33
|
| Rate for Payer: Aetna Medicare |
$189.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$189.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$330.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$359.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$218.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$208.74
|
| Rate for Payer: Cash Price |
$356.53
|
| Rate for Payer: Cash Price |
$356.53
|
| Rate for Payer: Centivo All Commercial |
$293.27
|
| Rate for Payer: Cigna All Commercial |
$496.26
|
| Rate for Payer: CORVEL All Commercial |
$534.79
|
| Rate for Payer: Coventry All Commercial |
$506.04
|
| Rate for Payer: Encore All Commercial |
$529.32
|
| Rate for Payer: Frontpath All Commercial |
$529.04
|
| Rate for Payer: Humana ChoiceCare |
$496.66
|
| Rate for Payer: Humana Medicare |
$293.27
|
| Rate for Payer: Lucent All Commercial |
$293.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$517.54
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$431.28
|
| Rate for Payer: PHP All Commercial |
$436.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$224.27
|
| Rate for Payer: Sagamore Health Network All Products |
$443.93
|
| Rate for Payer: Signature Care EPO |
$477.28
|
| Rate for Payer: Signature Care PPO |
$506.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$488.78
|
| Rate for Payer: United Healthcare Commercial |
$453.13
|
| Rate for Payer: United Healthcare Medicare |
$189.76
|
|
|
HC RUMI KOH OCCULDER
|
Facility
IP
|
$575.04
|
|
| Hospital Charge Code |
41601985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$431.28 |
| Max. Negotiated Rate |
$534.79 |
| Rate for Payer: Aetna Commercial |
$496.83
|
| Rate for Payer: Cash Price |
$356.53
|
| Rate for Payer: Cigna All Commercial |
$496.26
|
| Rate for Payer: CORVEL All Commercial |
$534.79
|
| Rate for Payer: Coventry All Commercial |
$506.04
|
| Rate for Payer: Encore All Commercial |
$529.32
|
| Rate for Payer: Frontpath All Commercial |
$529.04
|
| Rate for Payer: Humana ChoiceCare |
$496.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$517.54
|
| Rate for Payer: PHCS All Commercial |
$431.28
|
| Rate for Payer: PHP All Commercial |
$436.11
|
| Rate for Payer: Sagamore Health Network All Products |
$443.93
|
| Rate for Payer: Signature Care EPO |
$477.28
|
| Rate for Payer: Signature Care PPO |
$506.04
|
| Rate for Payer: United Healthcare Commercial |
$453.13
|
|
|
HC RUMI KOH TIP 10CM
|
Facility
OP
|
$282.12
|
|
| Hospital Charge Code |
41601986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$262.37 |
| Rate for Payer: Aetna Commercial |
$238.11
|
| Rate for Payer: Aetna Medicare |
$93.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$93.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$162.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$176.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.41
|
| Rate for Payer: Cash Price |
$174.91
|
| Rate for Payer: Cash Price |
$174.91
|
| Rate for Payer: Centivo All Commercial |
$143.88
|
| Rate for Payer: Cigna All Commercial |
$243.47
|
| Rate for Payer: CORVEL All Commercial |
$262.37
|
| Rate for Payer: Coventry All Commercial |
$248.27
|
| Rate for Payer: Encore All Commercial |
$259.69
|
| Rate for Payer: Frontpath All Commercial |
$259.55
|
| Rate for Payer: Humana ChoiceCare |
$243.67
|
| Rate for Payer: Humana Medicare |
$143.88
|
| Rate for Payer: Lucent All Commercial |
$143.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.91
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$211.59
|
| Rate for Payer: PHP All Commercial |
$213.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.03
|
| Rate for Payer: Sagamore Health Network All Products |
$217.80
|
| Rate for Payer: Signature Care EPO |
$234.16
|
| Rate for Payer: Signature Care PPO |
$248.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.80
|
| Rate for Payer: United Healthcare Commercial |
$222.31
|
| Rate for Payer: United Healthcare Medicare |
$93.10
|
|
|
HC RUMI KOH TIP 10CM
|
Facility
IP
|
$282.12
|
|
| Hospital Charge Code |
41601986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.59 |
| Max. Negotiated Rate |
$262.37 |
| Rate for Payer: Aetna Commercial |
$243.75
|
| Rate for Payer: Cash Price |
$174.91
|
| Rate for Payer: Cigna All Commercial |
$243.47
|
| Rate for Payer: CORVEL All Commercial |
$262.37
|
| Rate for Payer: Coventry All Commercial |
$248.27
|
| Rate for Payer: Encore All Commercial |
$259.69
|
| Rate for Payer: Frontpath All Commercial |
$259.55
|
| Rate for Payer: Humana ChoiceCare |
$243.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.91
|
| Rate for Payer: PHCS All Commercial |
$211.59
|
| Rate for Payer: PHP All Commercial |
$213.96
|
| Rate for Payer: Sagamore Health Network All Products |
$217.80
|
| Rate for Payer: Signature Care EPO |
$234.16
|
| Rate for Payer: Signature Care PPO |
$248.27
|
| Rate for Payer: United Healthcare Commercial |
$222.31
|
|
|
HC RUMI KOH TIP 6CM
|
Facility
OP
|
$355.47
|
|
| Hospital Charge Code |
41601987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.31 |
| Max. Negotiated Rate |
$330.59 |
| Rate for Payer: Aetna Commercial |
$300.02
|
| Rate for Payer: Aetna Medicare |
$117.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$204.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$222.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$134.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.04
|
| Rate for Payer: Cash Price |
$220.39
|
| Rate for Payer: Cash Price |
$220.39
|
| Rate for Payer: Centivo All Commercial |
$181.29
|
| Rate for Payer: Cigna All Commercial |
$306.77
|
| Rate for Payer: CORVEL All Commercial |
$330.59
|
| Rate for Payer: Coventry All Commercial |
$312.81
|
| Rate for Payer: Encore All Commercial |
$327.21
|
| Rate for Payer: Frontpath All Commercial |
$327.03
|
| Rate for Payer: Humana ChoiceCare |
$307.02
|
| Rate for Payer: Humana Medicare |
$181.29
|
| Rate for Payer: Lucent All Commercial |
$181.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$319.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$266.60
|
| Rate for Payer: PHP All Commercial |
$269.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$138.63
|
| Rate for Payer: Sagamore Health Network All Products |
$274.42
|
| Rate for Payer: Signature Care EPO |
$295.04
|
| Rate for Payer: Signature Care PPO |
$312.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$302.15
|
| Rate for Payer: United Healthcare Commercial |
$280.11
|
| Rate for Payer: United Healthcare Medicare |
$117.31
|
|
|
HC RUMI KOH TIP 6CM
|
Facility
IP
|
$355.47
|
|
| Hospital Charge Code |
41601987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.60 |
| Max. Negotiated Rate |
$330.59 |
| Rate for Payer: Aetna Commercial |
$307.13
|
| Rate for Payer: Cash Price |
$220.39
|
| Rate for Payer: Cigna All Commercial |
$306.77
|
| Rate for Payer: CORVEL All Commercial |
$330.59
|
| Rate for Payer: Coventry All Commercial |
$312.81
|
| Rate for Payer: Encore All Commercial |
$327.21
|
| Rate for Payer: Frontpath All Commercial |
$327.03
|
| Rate for Payer: Humana ChoiceCare |
$307.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$319.92
|
| Rate for Payer: PHCS All Commercial |
$266.60
|
| Rate for Payer: PHP All Commercial |
$269.59
|
| Rate for Payer: Sagamore Health Network All Products |
$274.42
|
| Rate for Payer: Signature Care EPO |
$295.04
|
| Rate for Payer: Signature Care PPO |
$312.81
|
| Rate for Payer: United Healthcare Commercial |
$280.11
|
|
|
HC RUMI KOH TIP 8CM
|
Facility
IP
|
$296.23
|
|
| Hospital Charge Code |
41601988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.17 |
| Max. Negotiated Rate |
$275.49 |
| Rate for Payer: Aetna Commercial |
$255.94
|
| Rate for Payer: Cash Price |
$183.66
|
| Rate for Payer: Cigna All Commercial |
$255.65
|
| Rate for Payer: CORVEL All Commercial |
$275.49
|
| Rate for Payer: Coventry All Commercial |
$260.68
|
| Rate for Payer: Encore All Commercial |
$272.68
|
| Rate for Payer: Frontpath All Commercial |
$272.53
|
| Rate for Payer: Humana ChoiceCare |
$255.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.61
|
| Rate for Payer: PHCS All Commercial |
$222.17
|
| Rate for Payer: PHP All Commercial |
$224.66
|
| Rate for Payer: Sagamore Health Network All Products |
$228.69
|
| Rate for Payer: Signature Care EPO |
$245.87
|
| Rate for Payer: Signature Care PPO |
$260.68
|
| Rate for Payer: United Healthcare Commercial |
$233.43
|
|
|
HC RUMI KOH TIP 8CM
|
Facility
OP
|
$296.23
|
|
| Hospital Charge Code |
41601988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$275.49 |
| Rate for Payer: Aetna Commercial |
$250.02
|
| Rate for Payer: Aetna Medicare |
$97.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$170.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$185.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.53
|
| Rate for Payer: Cash Price |
$183.66
|
| Rate for Payer: Cash Price |
$183.66
|
| Rate for Payer: Centivo All Commercial |
$151.08
|
| Rate for Payer: Cigna All Commercial |
$255.65
|
| Rate for Payer: CORVEL All Commercial |
$275.49
|
| Rate for Payer: Coventry All Commercial |
$260.68
|
| Rate for Payer: Encore All Commercial |
$272.68
|
| Rate for Payer: Frontpath All Commercial |
$272.53
|
| Rate for Payer: Humana ChoiceCare |
$255.85
|
| Rate for Payer: Humana Medicare |
$151.08
|
| Rate for Payer: Lucent All Commercial |
$151.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.61
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$222.17
|
| Rate for Payer: PHP All Commercial |
$224.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.53
|
| Rate for Payer: Sagamore Health Network All Products |
$228.69
|
| Rate for Payer: Signature Care EPO |
$245.87
|
| Rate for Payer: Signature Care PPO |
$260.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$251.80
|
| Rate for Payer: United Healthcare Commercial |
$233.43
|
| Rate for Payer: United Healthcare Medicare |
$97.76
|
|
|
HC RUSSELL VIPER DILUTE
|
Facility
IP
|
$121.46
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
63001752
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.10 |
| Max. Negotiated Rate |
$112.96 |
| Rate for Payer: Aetna Commercial |
$104.94
|
| Rate for Payer: Cash Price |
$75.31
|
| Rate for Payer: Cigna All Commercial |
$104.82
|
| Rate for Payer: CORVEL All Commercial |
$112.96
|
| Rate for Payer: Coventry All Commercial |
$106.89
|
| Rate for Payer: Encore All Commercial |
$111.81
|
| Rate for Payer: Frontpath All Commercial |
$111.74
|
| Rate for Payer: Humana ChoiceCare |
$104.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.32
|
| Rate for Payer: PHCS All Commercial |
$91.10
|
| 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 |
$106.89
|
| 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 |
$8.10 |
| Max. Negotiated Rate |
$112.96 |
| Rate for Payer: Aetna Commercial |
$102.51
|
| Rate for Payer: Aetna Medicare |
$40.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.09
|
| Rate for Payer: Cash Price |
$75.31
|
| Rate for Payer: Cash Price |
$75.31
|
| Rate for Payer: Centivo All Commercial |
$61.95
|
| Rate for Payer: Cigna All Commercial |
$104.82
|
| Rate for Payer: CORVEL All Commercial |
$112.96
|
| Rate for Payer: Coventry All Commercial |
$106.89
|
| Rate for Payer: Encore All Commercial |
$111.81
|
| Rate for Payer: Frontpath All Commercial |
$111.74
|
| Rate for Payer: Humana ChoiceCare |
$104.91
|
| Rate for Payer: Humana Medicare |
$61.95
|
| Rate for Payer: Lucent All Commercial |
$61.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.32
|
| Rate for Payer: Managed Health Services Medicaid |
$8.10
|
| Rate for Payer: MDWise Medicaid |
$8.10
|
| Rate for Payer: PHCS All Commercial |
$91.10
|
| 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 |
$106.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.24
|
| Rate for Payer: United Healthcare Commercial |
$95.71
|
| Rate for Payer: United Healthcare Medicare |
$40.08
|
|
|
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 |
$61.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$116.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.84
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Centivo All Commercial |
$95.32
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.47
|
| Rate for Payer: Encore All Commercial |
$172.04
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Humana Medicare |
$95.32
|
| Rate for Payer: Lucent All Commercial |
$95.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.21
|
| 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 |
$164.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158.86
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
| Rate for Payer: United Healthcare Medicare |
$61.68
|
|
|
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 |
$161.48
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.47
|
| Rate for Payer: Encore All Commercial |
$172.04
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.21
|
| 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 |
$164.47
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
|
|
HC S ALLOFIBER DBF 1CC
|
Facility
OP
|
$2,498.65
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41608346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,323.74 |
| Rate for Payer: Aetna Commercial |
$2,108.86
|
| Rate for Payer: Aetna Medicare |
$824.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$824.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,434.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,561.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$948.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$907.01
|
| Rate for Payer: Cash Price |
$1,549.16
|
| Rate for Payer: Cash Price |
$1,549.16
|
| Rate for Payer: Centivo All Commercial |
$1,274.31
|
| Rate for Payer: Cigna All Commercial |
$2,156.33
|
| Rate for Payer: CORVEL All Commercial |
$2,323.74
|
| Rate for Payer: Coventry All Commercial |
$2,198.81
|
| Rate for Payer: Encore All Commercial |
$2,300.01
|
| Rate for Payer: Frontpath All Commercial |
$2,298.76
|
| Rate for Payer: Humana ChoiceCare |
$2,158.08
|
| Rate for Payer: Humana Medicare |
$1,274.31
|
| Rate for Payer: Lucent All Commercial |
$1,274.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,248.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,873.99
|
| Rate for Payer: PHP All Commercial |
$1,894.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$974.47
|
| Rate for Payer: Sagamore Health Network All Products |
$1,928.96
|
| Rate for Payer: Signature Care EPO |
$2,073.88
|
| Rate for Payer: Signature Care PPO |
$2,198.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,123.85
|
| Rate for Payer: United Healthcare Commercial |
$1,968.94
|
| Rate for Payer: United Healthcare Medicare |
$824.55
|
|
|
HC S ALLOFIBER DBF 1CC
|
Facility
IP
|
$2,498.65
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41608346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,873.99 |
| Max. Negotiated Rate |
$2,323.74 |
| Rate for Payer: Aetna Commercial |
$2,158.83
|
| Rate for Payer: Cash Price |
$1,549.16
|
| Rate for Payer: Cigna All Commercial |
$2,156.33
|
| Rate for Payer: CORVEL All Commercial |
$2,323.74
|
| Rate for Payer: Coventry All Commercial |
$2,198.81
|
| Rate for Payer: Encore All Commercial |
$2,300.01
|
| Rate for Payer: Frontpath All Commercial |
$2,298.76
|
| Rate for Payer: Humana ChoiceCare |
$2,158.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,248.78
|
| Rate for Payer: PHCS All Commercial |
$1,873.99
|
| Rate for Payer: PHP All Commercial |
$1,894.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,928.96
|
| Rate for Payer: Signature Care EPO |
$2,073.88
|
| Rate for Payer: Signature Care PPO |
$2,198.81
|
| Rate for Payer: United Healthcare Commercial |
$1,968.94
|
|
|
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 |
$53.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$74.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.86
|
| Rate for Payer: Cash Price |
$100.54
|
| Rate for Payer: Cash Price |
$100.54
|
| Rate for Payer: Centivo All Commercial |
$82.70
|
| 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 |
$82.70
|
| Rate for Payer: Lucent All Commercial |
$82.70
|
| 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 |
$53.51
|
|
|
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 |
$100.54
|
| 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-COV-2 ANTIBODIES, NUCLEOCAPSID
|
Facility
OP
|
$102.71
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
63026769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$95.52 |
| Rate for Payer: Aetna Commercial |
$86.69
|
| Rate for Payer: Aetna Medicare |
$33.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$42.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.29
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Centivo All Commercial |
$52.38
|
| Rate for Payer: Cigna All Commercial |
$88.64
|
| Rate for Payer: CORVEL All Commercial |
$95.52
|
| Rate for Payer: Coventry All Commercial |
$90.39
|
| Rate for Payer: Encore All Commercial |
$94.55
|
| Rate for Payer: Frontpath All Commercial |
$94.50
|
| Rate for Payer: Humana ChoiceCare |
$88.71
|
| Rate for Payer: Humana Medicare |
$52.38
|
| Rate for Payer: Lucent All Commercial |
$52.38
|
| 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 |
$77.04
|
| 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 |
$79.30
|
| Rate for Payer: Signature Care EPO |
$85.25
|
| Rate for Payer: Signature Care PPO |
$90.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.31
|
| Rate for Payer: United Healthcare Commercial |
$80.94
|
| Rate for Payer: United Healthcare Medicare |
$33.90
|
|
