|
HC ABO BLOOD GROUP
|
Facility
IP
|
$84.57
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
63001351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.43 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Cash Price |
$52.43
|
| Rate for Payer: Cigna All Commercial |
$72.98
|
| Rate for Payer: CORVEL All Commercial |
$78.65
|
| Rate for Payer: Coventry All Commercial |
$74.42
|
| Rate for Payer: Encore All Commercial |
$77.85
|
| Rate for Payer: Frontpath All Commercial |
$77.80
|
| Rate for Payer: Humana ChoiceCare |
$73.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.11
|
| Rate for Payer: PHCS All Commercial |
$63.43
|
| Rate for Payer: PHP All Commercial |
$64.14
|
| Rate for Payer: Sagamore Health Network All Products |
$65.29
|
| Rate for Payer: Signature Care EPO |
$70.19
|
| Rate for Payer: Signature Care PPO |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$66.64
|
|
|
HC ABO BLOOD GROUP
|
Facility
OP
|
$84.57
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
63001351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$71.38
|
| Rate for Payer: Aetna Medicare |
$27.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.70
|
| Rate for Payer: Cash Price |
$52.43
|
| Rate for Payer: Cash Price |
$52.43
|
| Rate for Payer: Centivo All Commercial |
$43.13
|
| Rate for Payer: Cigna All Commercial |
$72.98
|
| Rate for Payer: CORVEL All Commercial |
$78.65
|
| Rate for Payer: Coventry All Commercial |
$74.42
|
| Rate for Payer: Encore All Commercial |
$77.85
|
| Rate for Payer: Frontpath All Commercial |
$77.80
|
| Rate for Payer: Humana ChoiceCare |
$73.04
|
| Rate for Payer: Humana Medicare |
$43.13
|
| Rate for Payer: Lucent All Commercial |
$43.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.11
|
| Rate for Payer: Managed Health Services Medicaid |
$2.99
|
| Rate for Payer: MDWise Medicaid |
$2.99
|
| Rate for Payer: PHCS All Commercial |
$63.43
|
| Rate for Payer: PHP All Commercial |
$64.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.98
|
| Rate for Payer: Sagamore Health Network All Products |
$65.29
|
| Rate for Payer: Signature Care EPO |
$70.19
|
| Rate for Payer: Signature Care PPO |
$74.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.88
|
| Rate for Payer: United Healthcare Commercial |
$66.64
|
| Rate for Payer: United Healthcare Medicare |
$27.91
|
|
|
HC ABSOLUTE EOSINOPHIL COUNT
|
Facility
OP
|
$56.95
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
63001241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$48.06
|
| Rate for Payer: Aetna Medicare |
$18.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.67
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Centivo All Commercial |
$29.04
|
| Rate for Payer: Cigna All Commercial |
$49.14
|
| Rate for Payer: CORVEL All Commercial |
$52.96
|
| Rate for Payer: Coventry All Commercial |
$50.11
|
| Rate for Payer: Encore All Commercial |
$52.42
|
| Rate for Payer: Frontpath All Commercial |
$52.39
|
| Rate for Payer: Humana ChoiceCare |
$49.18
|
| Rate for Payer: Humana Medicare |
$29.04
|
| Rate for Payer: Lucent All Commercial |
$29.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.25
|
| Rate for Payer: Managed Health Services Medicaid |
$2.54
|
| Rate for Payer: MDWise Medicaid |
$2.54
|
| Rate for Payer: PHCS All Commercial |
$42.71
|
| Rate for Payer: PHP All Commercial |
$43.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.21
|
| Rate for Payer: Sagamore Health Network All Products |
$43.96
|
| Rate for Payer: Signature Care EPO |
$47.27
|
| Rate for Payer: Signature Care PPO |
$50.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.40
|
| Rate for Payer: United Healthcare Commercial |
$44.87
|
| Rate for Payer: United Healthcare Medicare |
$18.79
|
|
|
HC ABSOLUTE EOSINOPHIL COUNT
|
Facility
IP
|
$56.95
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
63001241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Cigna All Commercial |
$49.14
|
| Rate for Payer: CORVEL All Commercial |
$52.96
|
| Rate for Payer: Coventry All Commercial |
$50.11
|
| Rate for Payer: Encore All Commercial |
$52.42
|
| Rate for Payer: Frontpath All Commercial |
$52.39
|
| Rate for Payer: Humana ChoiceCare |
$49.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.25
|
| Rate for Payer: PHCS All Commercial |
$42.71
|
| Rate for Payer: PHP All Commercial |
$43.19
|
| Rate for Payer: Sagamore Health Network All Products |
$43.96
|
| Rate for Payer: Signature Care EPO |
$47.27
|
| Rate for Payer: Signature Care PPO |
$50.11
|
| Rate for Payer: United Healthcare Commercial |
$44.87
|
|
|
HC ABSORBA TACK 5MM
|
Facility
OP
|
$698.83
|
|
| Hospital Charge Code |
41602252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.61 |
| Max. Negotiated Rate |
$649.91 |
| Rate for Payer: Aetna Commercial |
$589.81
|
| Rate for Payer: Aetna Medicare |
$230.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$436.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.68
|
| Rate for Payer: Cash Price |
$433.28
|
| Rate for Payer: Cash Price |
$433.28
|
| Rate for Payer: Centivo All Commercial |
$356.40
|
| Rate for Payer: Cigna All Commercial |
$603.09
|
| Rate for Payer: CORVEL All Commercial |
$649.91
|
| Rate for Payer: Coventry All Commercial |
$614.97
|
| Rate for Payer: Encore All Commercial |
$643.27
|
| Rate for Payer: Frontpath All Commercial |
$642.92
|
| Rate for Payer: Humana ChoiceCare |
$603.58
|
| Rate for Payer: Humana Medicare |
$356.40
|
| Rate for Payer: Lucent All Commercial |
$356.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$628.95
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.12
|
| Rate for Payer: PHP All Commercial |
$529.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.54
|
| Rate for Payer: Sagamore Health Network All Products |
$539.50
|
| Rate for Payer: Signature Care EPO |
$580.03
|
| Rate for Payer: Signature Care PPO |
$614.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.01
|
| Rate for Payer: United Healthcare Commercial |
$550.68
|
| Rate for Payer: United Healthcare Medicare |
$230.61
|
|
|
HC ABSORBA TACK 5MM
|
Facility
IP
|
$698.83
|
|
| Hospital Charge Code |
41602252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.12 |
| Max. Negotiated Rate |
$649.91 |
| Rate for Payer: Aetna Commercial |
$603.79
|
| Rate for Payer: Cash Price |
$433.28
|
| Rate for Payer: Cigna All Commercial |
$603.09
|
| Rate for Payer: CORVEL All Commercial |
$649.91
|
| Rate for Payer: Coventry All Commercial |
$614.97
|
| Rate for Payer: Encore All Commercial |
$643.27
|
| Rate for Payer: Frontpath All Commercial |
$642.92
|
| Rate for Payer: Humana ChoiceCare |
$603.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$628.95
|
| Rate for Payer: PHCS All Commercial |
$524.12
|
| Rate for Payer: PHP All Commercial |
$529.99
|
| Rate for Payer: Sagamore Health Network All Products |
$539.50
|
| Rate for Payer: Signature Care EPO |
$580.03
|
| Rate for Payer: Signature Care PPO |
$614.97
|
| Rate for Payer: United Healthcare Commercial |
$550.68
|
|
|
HC ABTHERA OPEN ABD THER MACH/DAY
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
01895200
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$229.81 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$264.74
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
|
|
HC ABTHERA OPEN ABD THER MACH/DAY
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
01895200
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Aetna Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.23
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Centivo All Commercial |
$156.27
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Humana Medicare |
$156.27
|
| Rate for Payer: Lucent All Commercial |
$156.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.50
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.45
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
| Rate for Payer: United Healthcare Medicare |
$101.11
|
|
|
HC ACCUCATH 20GX2.25IN
|
Facility
OP
|
$304.79
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41605857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.58 |
| Max. Negotiated Rate |
$283.45 |
| Rate for Payer: Aetna Commercial |
$257.24
|
| Rate for Payer: Aetna Medicare |
$100.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$190.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.64
|
| Rate for Payer: Cash Price |
$188.97
|
| Rate for Payer: Cash Price |
$188.97
|
| Rate for Payer: Centivo All Commercial |
$155.44
|
| Rate for Payer: Cigna All Commercial |
$263.03
|
| Rate for Payer: CORVEL All Commercial |
$283.45
|
| Rate for Payer: Coventry All Commercial |
$268.22
|
| Rate for Payer: Encore All Commercial |
$280.56
|
| Rate for Payer: Frontpath All Commercial |
$280.41
|
| Rate for Payer: Humana ChoiceCare |
$263.25
|
| Rate for Payer: Humana Medicare |
$155.44
|
| Rate for Payer: Lucent All Commercial |
$155.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$274.31
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$228.59
|
| Rate for Payer: PHP All Commercial |
$231.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.87
|
| Rate for Payer: Sagamore Health Network All Products |
$235.30
|
| Rate for Payer: Signature Care EPO |
$252.98
|
| Rate for Payer: Signature Care PPO |
$268.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$259.07
|
| Rate for Payer: United Healthcare Commercial |
$240.17
|
| Rate for Payer: United Healthcare Medicare |
$100.58
|
|
|
HC ACCUCATH 20GX2.25IN
|
Facility
IP
|
$304.79
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41605857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$283.45 |
| Rate for Payer: Aetna Commercial |
$263.34
|
| Rate for Payer: Cash Price |
$188.97
|
| Rate for Payer: Cigna All Commercial |
$263.03
|
| Rate for Payer: CORVEL All Commercial |
$283.45
|
| Rate for Payer: Coventry All Commercial |
$268.22
|
| Rate for Payer: Encore All Commercial |
$280.56
|
| Rate for Payer: Frontpath All Commercial |
$280.41
|
| Rate for Payer: Humana ChoiceCare |
$263.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$274.31
|
| Rate for Payer: PHCS All Commercial |
$228.59
|
| Rate for Payer: PHP All Commercial |
$231.15
|
| Rate for Payer: Sagamore Health Network All Products |
$235.30
|
| Rate for Payer: Signature Care EPO |
$252.98
|
| Rate for Payer: Signature Care PPO |
$268.22
|
| Rate for Payer: United Healthcare Commercial |
$240.17
|
|
|
HC ACCUCHECK BEDSIDE
|
Facility
OP
|
$26.60
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
01239001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$24.74 |
| Rate for Payer: Aetna Commercial |
$22.45
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.66
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Centivo All Commercial |
$13.57
|
| Rate for Payer: Cigna All Commercial |
$22.96
|
| Rate for Payer: CORVEL All Commercial |
$24.74
|
| Rate for Payer: Coventry All Commercial |
$23.41
|
| Rate for Payer: Encore All Commercial |
$24.49
|
| Rate for Payer: Frontpath All Commercial |
$24.47
|
| Rate for Payer: Humana ChoiceCare |
$22.98
|
| Rate for Payer: Humana Medicare |
$13.57
|
| Rate for Payer: Lucent All Commercial |
$13.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.94
|
| Rate for Payer: Managed Health Services Medicaid |
$4.31
|
| Rate for Payer: MDWise Medicaid |
$4.31
|
| Rate for Payer: PHCS All Commercial |
$19.95
|
| Rate for Payer: PHP All Commercial |
$20.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.37
|
| Rate for Payer: Sagamore Health Network All Products |
$20.54
|
| Rate for Payer: Signature Care EPO |
$22.08
|
| Rate for Payer: Signature Care PPO |
$23.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.61
|
| Rate for Payer: United Healthcare Commercial |
$20.96
|
| Rate for Payer: United Healthcare Medicare |
$8.78
|
|
|
HC ACCUCHECK BEDSIDE
|
Facility
IP
|
$26.60
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
01239001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$24.74 |
| Rate for Payer: Aetna Commercial |
$22.98
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cigna All Commercial |
$22.96
|
| Rate for Payer: CORVEL All Commercial |
$24.74
|
| Rate for Payer: Coventry All Commercial |
$23.41
|
| Rate for Payer: Encore All Commercial |
$24.49
|
| Rate for Payer: Frontpath All Commercial |
$24.47
|
| Rate for Payer: Humana ChoiceCare |
$22.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.94
|
| Rate for Payer: PHCS All Commercial |
$19.95
|
| Rate for Payer: PHP All Commercial |
$20.17
|
| Rate for Payer: Sagamore Health Network All Products |
$20.54
|
| Rate for Payer: Signature Care EPO |
$22.08
|
| Rate for Payer: Signature Care PPO |
$23.41
|
| Rate for Payer: United Healthcare Commercial |
$20.96
|
|
|
HC ACCUMAX (ENCOMPASS) INFLATOR /DAY
|
Facility
IP
|
$156.57
|
|
| Hospital Charge Code |
01890110
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$117.43 |
| Max. Negotiated Rate |
$145.61 |
| Rate for Payer: Aetna Commercial |
$135.28
|
| Rate for Payer: Cash Price |
$97.07
|
| Rate for Payer: Cigna All Commercial |
$135.12
|
| Rate for Payer: CORVEL All Commercial |
$145.61
|
| Rate for Payer: Coventry All Commercial |
$137.78
|
| Rate for Payer: Encore All Commercial |
$144.12
|
| Rate for Payer: Frontpath All Commercial |
$144.04
|
| Rate for Payer: Humana ChoiceCare |
$135.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.91
|
| Rate for Payer: PHCS All Commercial |
$117.43
|
| Rate for Payer: PHP All Commercial |
$118.74
|
| Rate for Payer: Sagamore Health Network All Products |
$120.87
|
| Rate for Payer: Signature Care EPO |
$129.95
|
| Rate for Payer: Signature Care PPO |
$137.78
|
| Rate for Payer: United Healthcare Commercial |
$123.38
|
|
|
HC ACCUMAX (ENCOMPASS) INFLATOR /DAY
|
Facility
OP
|
$156.57
|
|
| Hospital Charge Code |
01890110
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$145.61 |
| Rate for Payer: Aetna Commercial |
$132.15
|
| Rate for Payer: Aetna Medicare |
$51.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.83
|
| Rate for Payer: Cash Price |
$97.07
|
| Rate for Payer: Cash Price |
$97.07
|
| Rate for Payer: Centivo All Commercial |
$79.85
|
| Rate for Payer: Cigna All Commercial |
$135.12
|
| Rate for Payer: CORVEL All Commercial |
$145.61
|
| Rate for Payer: Coventry All Commercial |
$137.78
|
| Rate for Payer: Encore All Commercial |
$144.12
|
| Rate for Payer: Frontpath All Commercial |
$144.04
|
| Rate for Payer: Humana ChoiceCare |
$135.23
|
| Rate for Payer: Humana Medicare |
$79.85
|
| Rate for Payer: Lucent All Commercial |
$79.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.91
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$117.43
|
| Rate for Payer: PHP All Commercial |
$118.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.06
|
| Rate for Payer: Sagamore Health Network All Products |
$120.87
|
| Rate for Payer: Signature Care EPO |
$129.95
|
| Rate for Payer: Signature Care PPO |
$137.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.08
|
| Rate for Payer: United Healthcare Commercial |
$123.38
|
| Rate for Payer: United Healthcare Medicare |
$51.67
|
|
|
HC ACETAMINOPHEN
|
Facility
OP
|
$186.89
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
63001403
|
|
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 ACETAMINOPHEN
|
Facility
IP
|
$186.89
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
63001403
|
|
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 ACETONE
|
Facility
IP
|
$109.96
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
63001207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.47 |
| Max. Negotiated Rate |
$102.26 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Cash Price |
$68.17
|
| Rate for Payer: Cigna All Commercial |
$94.89
|
| Rate for Payer: CORVEL All Commercial |
$102.26
|
| Rate for Payer: Coventry All Commercial |
$96.76
|
| Rate for Payer: Encore All Commercial |
$101.21
|
| Rate for Payer: Frontpath All Commercial |
$101.16
|
| Rate for Payer: Humana ChoiceCare |
$94.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.96
|
| Rate for Payer: PHCS All Commercial |
$82.47
|
| Rate for Payer: PHP All Commercial |
$83.39
|
| Rate for Payer: Sagamore Health Network All Products |
$84.89
|
| Rate for Payer: Signature Care EPO |
$91.26
|
| Rate for Payer: Signature Care PPO |
$96.76
|
| Rate for Payer: United Healthcare Commercial |
$86.65
|
|
|
HC ACETONE
|
Facility
OP
|
$109.96
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
63001207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$102.26 |
| Rate for Payer: Aetna Commercial |
$92.80
|
| Rate for Payer: Aetna Medicare |
$36.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.91
|
| Rate for Payer: Cash Price |
$68.17
|
| Rate for Payer: Cash Price |
$68.17
|
| Rate for Payer: Centivo All Commercial |
$56.08
|
| Rate for Payer: Cigna All Commercial |
$94.89
|
| Rate for Payer: CORVEL All Commercial |
$102.26
|
| Rate for Payer: Coventry All Commercial |
$96.76
|
| Rate for Payer: Encore All Commercial |
$101.21
|
| Rate for Payer: Frontpath All Commercial |
$101.16
|
| Rate for Payer: Humana ChoiceCare |
$94.97
|
| Rate for Payer: Humana Medicare |
$56.08
|
| Rate for Payer: Lucent All Commercial |
$56.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.96
|
| Rate for Payer: Managed Health Services Medicaid |
$4.52
|
| Rate for Payer: MDWise Medicaid |
$4.52
|
| Rate for Payer: PHCS All Commercial |
$82.47
|
| Rate for Payer: PHP All Commercial |
$83.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.88
|
| Rate for Payer: Sagamore Health Network All Products |
$84.89
|
| Rate for Payer: Signature Care EPO |
$91.26
|
| Rate for Payer: Signature Care PPO |
$96.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.46
|
| Rate for Payer: United Healthcare Commercial |
$86.65
|
| Rate for Payer: United Healthcare Medicare |
$36.29
|
|
|
HC ACETYLCHOLINE BINDING ANTBY
|
Facility
OP
|
$335.48
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
63001049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.71 |
| Max. Negotiated Rate |
$311.99 |
| Rate for Payer: Aetna Commercial |
$283.14
|
| Rate for Payer: Aetna Medicare |
$110.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$192.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$209.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.78
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Centivo All Commercial |
$171.09
|
| Rate for Payer: Cigna All Commercial |
$289.52
|
| Rate for Payer: CORVEL All Commercial |
$311.99
|
| Rate for Payer: Coventry All Commercial |
$295.22
|
| Rate for Payer: Encore All Commercial |
$308.81
|
| Rate for Payer: Frontpath All Commercial |
$308.64
|
| Rate for Payer: Humana ChoiceCare |
$289.75
|
| Rate for Payer: Humana Medicare |
$171.09
|
| Rate for Payer: Lucent All Commercial |
$171.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.93
|
| Rate for Payer: PHCS All Commercial |
$251.61
|
| Rate for Payer: PHP All Commercial |
$254.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.84
|
| Rate for Payer: Sagamore Health Network All Products |
$258.99
|
| Rate for Payer: Signature Care EPO |
$278.45
|
| Rate for Payer: Signature Care PPO |
$295.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$285.16
|
| Rate for Payer: United Healthcare Commercial |
$264.36
|
| Rate for Payer: United Healthcare Medicare |
$110.71
|
|
|
HC ACETYLCHOLINE BINDING ANTBY
|
Facility
IP
|
$335.48
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
63001049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$251.61 |
| Max. Negotiated Rate |
$311.99 |
| Rate for Payer: Aetna Commercial |
$289.85
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna All Commercial |
$289.52
|
| Rate for Payer: CORVEL All Commercial |
$311.99
|
| Rate for Payer: Coventry All Commercial |
$295.22
|
| Rate for Payer: Encore All Commercial |
$308.81
|
| Rate for Payer: Frontpath All Commercial |
$308.64
|
| Rate for Payer: Humana ChoiceCare |
$289.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.93
|
| Rate for Payer: PHCS All Commercial |
$251.61
|
| Rate for Payer: PHP All Commercial |
$254.43
|
| Rate for Payer: Sagamore Health Network All Products |
$258.99
|
| Rate for Payer: Signature Care EPO |
$278.45
|
| Rate for Payer: Signature Care PPO |
$295.22
|
| Rate for Payer: United Healthcare Commercial |
$264.36
|
|
|
HC ACETYLCHOLINE BLOCKING ANTBY
|
Facility
IP
|
$130.86
|
|
|
Service Code
|
CPT 86042
|
| Hospital Charge Code |
63001576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
|
|
HC ACETYLCHOLINE BLOCKING ANTBY
|
Facility
OP
|
$130.86
|
|
|
Service Code
|
CPT 86042
|
| Hospital Charge Code |
63001576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.18 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.44
|
| Rate for Payer: Aetna Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.50
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Centivo All Commercial |
$66.74
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$66.74
|
| Rate for Payer: Lucent All Commercial |
$66.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.03
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
| Rate for Payer: United Healthcare Medicare |
$43.18
|
|
|
HC ACETYLCHOLINE MODULATING ANTBY
|
Facility
OP
|
$105.57
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
63001577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$98.18 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: Aetna Medicare |
$34.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.32
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Centivo All Commercial |
$53.84
|
| Rate for Payer: Cigna All Commercial |
$91.11
|
| Rate for Payer: CORVEL All Commercial |
$98.18
|
| Rate for Payer: Coventry All Commercial |
$92.90
|
| Rate for Payer: Encore All Commercial |
$97.18
|
| Rate for Payer: Frontpath All Commercial |
$97.12
|
| Rate for Payer: Humana ChoiceCare |
$91.18
|
| Rate for Payer: Humana Medicare |
$53.84
|
| Rate for Payer: Lucent All Commercial |
$53.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.01
|
| Rate for Payer: PHCS All Commercial |
$79.18
|
| Rate for Payer: PHP All Commercial |
$80.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.17
|
| Rate for Payer: Sagamore Health Network All Products |
$81.50
|
| Rate for Payer: Signature Care EPO |
$87.62
|
| Rate for Payer: Signature Care PPO |
$92.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.73
|
| Rate for Payer: United Healthcare Commercial |
$83.19
|
| Rate for Payer: United Healthcare Medicare |
$34.84
|
|
|
HC ACETYLCHOLINE MODULATING ANTBY
|
Facility
IP
|
$105.57
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
63001577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.18 |
| Max. Negotiated Rate |
$98.18 |
| Rate for Payer: Aetna Commercial |
$91.21
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Cigna All Commercial |
$91.11
|
| Rate for Payer: CORVEL All Commercial |
$98.18
|
| Rate for Payer: Coventry All Commercial |
$92.90
|
| Rate for Payer: Encore All Commercial |
$97.18
|
| Rate for Payer: Frontpath All Commercial |
$97.12
|
| Rate for Payer: Humana ChoiceCare |
$91.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.01
|
| Rate for Payer: PHCS All Commercial |
$79.18
|
| Rate for Payer: PHP All Commercial |
$80.06
|
| Rate for Payer: Sagamore Health Network All Products |
$81.50
|
| Rate for Payer: Signature Care EPO |
$87.62
|
| Rate for Payer: Signature Care PPO |
$92.90
|
| Rate for Payer: United Healthcare Commercial |
$83.19
|
|
|
HC ACID FAST CULTURE
|
Facility
IP
|
$215.94
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
63001063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.96 |
| Max. Negotiated Rate |
$200.83 |
| Rate for Payer: Aetna Commercial |
$186.58
|
| Rate for Payer: Cash Price |
$133.89
|
| Rate for Payer: Cigna All Commercial |
$186.36
|
| Rate for Payer: CORVEL All Commercial |
$200.83
|
| Rate for Payer: Coventry All Commercial |
$190.03
|
| Rate for Payer: Encore All Commercial |
$198.78
|
| Rate for Payer: Frontpath All Commercial |
$198.67
|
| Rate for Payer: Humana ChoiceCare |
$186.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.35
|
| Rate for Payer: PHCS All Commercial |
$161.96
|
| Rate for Payer: PHP All Commercial |
$163.77
|
| Rate for Payer: Sagamore Health Network All Products |
$166.71
|
| Rate for Payer: Signature Care EPO |
$179.23
|
| Rate for Payer: Signature Care PPO |
$190.03
|
| Rate for Payer: United Healthcare Commercial |
$170.16
|
|
