|
HC ALLERGEN WALNUT TREE
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN WALNUT TREE
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN WHEAT
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN WHEAT
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN WHITE ASH
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN WHITE ASH
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN WHITE PINE TREE
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN WHITE PINE TREE
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN WILLOW IGE
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN WILLOW IGE
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALL INSIDE DBL TENDON 7X7X200
|
Facility
OP
|
$7,452.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41605852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,289.49
|
| Rate for Payer: Aetna Medicare |
$2,459.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,459.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,279.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,658.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,828.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,705.08
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Centivo All Commercial |
$3,800.52
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Humana Medicare |
$3,800.52
|
| Rate for Payer: Lucent All Commercial |
$3,800.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,906.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,334.20
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
| Rate for Payer: United Healthcare Medicare |
$2,459.16
|
|
|
HC ALL INSIDE DBL TENDON 7X7X200
|
Facility
IP
|
$7,452.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41605852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,589.00 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,438.53
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
|
|
HC ALLOSYNC GEL 10CC
|
Facility
IP
|
$4,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,564.00 |
| Max. Negotiated Rate |
$4,419.36 |
| Rate for Payer: Aetna Commercial |
$4,105.73
|
| Rate for Payer: Cash Price |
$2,946.24
|
| Rate for Payer: Cigna All Commercial |
$4,100.98
|
| Rate for Payer: CORVEL All Commercial |
$4,419.36
|
| Rate for Payer: Coventry All Commercial |
$4,181.76
|
| Rate for Payer: Encore All Commercial |
$4,374.22
|
| Rate for Payer: Frontpath All Commercial |
$4,371.84
|
| Rate for Payer: Humana ChoiceCare |
$4,104.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,276.80
|
| Rate for Payer: PHCS All Commercial |
$3,564.00
|
| Rate for Payer: PHP All Commercial |
$3,603.92
|
| Rate for Payer: Sagamore Health Network All Products |
$3,668.54
|
| Rate for Payer: Signature Care EPO |
$3,944.16
|
| Rate for Payer: Signature Care PPO |
$4,181.76
|
| Rate for Payer: United Healthcare Commercial |
$3,744.58
|
|
|
HC ALLOSYNC GEL 10CC
|
Facility
OP
|
$4,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,419.36 |
| Rate for Payer: Aetna Commercial |
$4,010.69
|
| Rate for Payer: Aetna Medicare |
$1,568.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,568.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,729.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,970.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,803.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,724.98
|
| Rate for Payer: Cash Price |
$2,946.24
|
| Rate for Payer: Cash Price |
$2,946.24
|
| Rate for Payer: Centivo All Commercial |
$2,423.52
|
| Rate for Payer: Cigna All Commercial |
$4,100.98
|
| Rate for Payer: CORVEL All Commercial |
$4,419.36
|
| Rate for Payer: Coventry All Commercial |
$4,181.76
|
| Rate for Payer: Encore All Commercial |
$4,374.22
|
| Rate for Payer: Frontpath All Commercial |
$4,371.84
|
| Rate for Payer: Humana ChoiceCare |
$4,104.30
|
| Rate for Payer: Humana Medicare |
$2,423.52
|
| Rate for Payer: Lucent All Commercial |
$2,423.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,276.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,564.00
|
| Rate for Payer: PHP All Commercial |
$3,603.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,853.28
|
| Rate for Payer: Sagamore Health Network All Products |
$3,668.54
|
| Rate for Payer: Signature Care EPO |
$3,944.16
|
| Rate for Payer: Signature Care PPO |
$4,181.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,039.20
|
| Rate for Payer: United Healthcare Commercial |
$3,744.58
|
| Rate for Payer: United Healthcare Medicare |
$1,568.16
|
|
|
HC ALPHA-1-ANTITRYPSIN
|
Facility
IP
|
$178.17
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
63001452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.63 |
| Max. Negotiated Rate |
$165.70 |
| Rate for Payer: Aetna Commercial |
$153.94
|
| Rate for Payer: Cash Price |
$110.47
|
| Rate for Payer: Cigna All Commercial |
$153.76
|
| Rate for Payer: CORVEL All Commercial |
$165.70
|
| Rate for Payer: Coventry All Commercial |
$156.79
|
| Rate for Payer: Encore All Commercial |
$164.01
|
| Rate for Payer: Frontpath All Commercial |
$163.92
|
| Rate for Payer: Humana ChoiceCare |
$153.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.36
|
| Rate for Payer: PHCS All Commercial |
$133.63
|
| Rate for Payer: PHP All Commercial |
$135.13
|
| Rate for Payer: Sagamore Health Network All Products |
$137.55
|
| Rate for Payer: Signature Care EPO |
$147.88
|
| Rate for Payer: Signature Care PPO |
$156.79
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
|
|
HC ALPHA-1-ANTITRYPSIN
|
Facility
OP
|
$178.17
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
63001452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$165.70 |
| Rate for Payer: Aetna Commercial |
$150.38
|
| Rate for Payer: Aetna Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.68
|
| Rate for Payer: Cash Price |
$110.47
|
| Rate for Payer: Cash Price |
$110.47
|
| Rate for Payer: Centivo All Commercial |
$90.87
|
| Rate for Payer: Cigna All Commercial |
$153.76
|
| Rate for Payer: CORVEL All Commercial |
$165.70
|
| Rate for Payer: Coventry All Commercial |
$156.79
|
| Rate for Payer: Encore All Commercial |
$164.01
|
| Rate for Payer: Frontpath All Commercial |
$163.92
|
| Rate for Payer: Humana ChoiceCare |
$153.89
|
| Rate for Payer: Humana Medicare |
$90.87
|
| Rate for Payer: Lucent All Commercial |
$90.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.36
|
| Rate for Payer: Managed Health Services Medicaid |
$13.44
|
| Rate for Payer: MDWise Medicaid |
$13.44
|
| Rate for Payer: PHCS All Commercial |
$133.63
|
| Rate for Payer: PHP All Commercial |
$135.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.49
|
| Rate for Payer: Sagamore Health Network All Products |
$137.55
|
| Rate for Payer: Signature Care EPO |
$147.88
|
| Rate for Payer: Signature Care PPO |
$156.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.45
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
| Rate for Payer: United Healthcare Medicare |
$58.80
|
|
|
HC ALPHA-1-ANTITRYPSIN - FECES
|
Facility
IP
|
$109.65
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
63001453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.24 |
| Max. Negotiated Rate |
$101.97 |
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: Cash Price |
$67.98
|
| Rate for Payer: Cigna All Commercial |
$94.63
|
| Rate for Payer: CORVEL All Commercial |
$101.97
|
| Rate for Payer: Coventry All Commercial |
$96.49
|
| Rate for Payer: Encore All Commercial |
$100.93
|
| Rate for Payer: Frontpath All Commercial |
$100.88
|
| Rate for Payer: Humana ChoiceCare |
$94.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.68
|
| Rate for Payer: PHCS All Commercial |
$82.24
|
| Rate for Payer: PHP All Commercial |
$83.16
|
| Rate for Payer: Sagamore Health Network All Products |
$84.65
|
| Rate for Payer: Signature Care EPO |
$91.01
|
| Rate for Payer: Signature Care PPO |
$96.49
|
| Rate for Payer: United Healthcare Commercial |
$86.40
|
|
|
HC ALPHA-1-ANTITRYPSIN - FECES
|
Facility
OP
|
$109.65
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
63001453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$101.97 |
| Rate for Payer: Aetna Commercial |
$92.54
|
| Rate for Payer: Aetna Medicare |
$36.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.80
|
| Rate for Payer: Cash Price |
$67.98
|
| Rate for Payer: Cash Price |
$67.98
|
| Rate for Payer: Centivo All Commercial |
$55.92
|
| Rate for Payer: Cigna All Commercial |
$94.63
|
| Rate for Payer: CORVEL All Commercial |
$101.97
|
| Rate for Payer: Coventry All Commercial |
$96.49
|
| Rate for Payer: Encore All Commercial |
$100.93
|
| Rate for Payer: Frontpath All Commercial |
$100.88
|
| Rate for Payer: Humana ChoiceCare |
$94.70
|
| Rate for Payer: Humana Medicare |
$55.92
|
| Rate for Payer: Lucent All Commercial |
$55.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.68
|
| Rate for Payer: Managed Health Services Medicaid |
$13.44
|
| Rate for Payer: MDWise Medicaid |
$13.44
|
| Rate for Payer: PHCS All Commercial |
$82.24
|
| Rate for Payer: PHP All Commercial |
$83.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.76
|
| Rate for Payer: Sagamore Health Network All Products |
$84.65
|
| Rate for Payer: Signature Care EPO |
$91.01
|
| Rate for Payer: Signature Care PPO |
$96.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.20
|
| Rate for Payer: United Healthcare Commercial |
$86.40
|
| Rate for Payer: United Healthcare Medicare |
$36.18
|
|
|
HC ALPHA-1-ANTITRYPSIN PHENOTYPE
|
Facility
IP
|
$121.42
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
63001455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.07 |
| Max. Negotiated Rate |
$112.92 |
| Rate for Payer: Aetna Commercial |
$104.91
|
| Rate for Payer: Cash Price |
$75.28
|
| Rate for Payer: Cigna All Commercial |
$104.79
|
| Rate for Payer: CORVEL All Commercial |
$112.92
|
| Rate for Payer: Coventry All Commercial |
$106.85
|
| Rate for Payer: Encore All Commercial |
$111.77
|
| Rate for Payer: Frontpath All Commercial |
$111.71
|
| Rate for Payer: Humana ChoiceCare |
$104.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.28
|
| Rate for Payer: PHCS All Commercial |
$91.07
|
| Rate for Payer: PHP All Commercial |
$92.09
|
| Rate for Payer: Sagamore Health Network All Products |
$93.74
|
| Rate for Payer: Signature Care EPO |
$100.78
|
| Rate for Payer: Signature Care PPO |
$106.85
|
| Rate for Payer: United Healthcare Commercial |
$95.68
|
|
|
HC ALPHA-1-ANTITRYPSIN PHENOTYPE
|
Facility
OP
|
$121.42
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
63001455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$112.92 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$40.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.08
|
| Rate for Payer: Cash Price |
$75.28
|
| Rate for Payer: Cash Price |
$75.28
|
| Rate for Payer: Centivo All Commercial |
$61.92
|
| Rate for Payer: Cigna All Commercial |
$104.79
|
| Rate for Payer: CORVEL All Commercial |
$112.92
|
| Rate for Payer: Coventry All Commercial |
$106.85
|
| Rate for Payer: Encore All Commercial |
$111.77
|
| Rate for Payer: Frontpath All Commercial |
$111.71
|
| Rate for Payer: Humana ChoiceCare |
$104.87
|
| Rate for Payer: Humana Medicare |
$61.92
|
| Rate for Payer: Lucent All Commercial |
$61.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.28
|
| Rate for Payer: Managed Health Services Medicaid |
$14.46
|
| Rate for Payer: MDWise Medicaid |
$14.46
|
| Rate for Payer: PHCS All Commercial |
$91.07
|
| Rate for Payer: PHP All Commercial |
$92.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.35
|
| Rate for Payer: Sagamore Health Network All Products |
$93.74
|
| Rate for Payer: Signature Care EPO |
$100.78
|
| Rate for Payer: Signature Care PPO |
$106.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.21
|
| Rate for Payer: United Healthcare Commercial |
$95.68
|
| Rate for Payer: United Healthcare Medicare |
$40.07
|
|
|
HC ALPHA-1-ANTITRYPSIN W/PHENOTYPE
|
Facility
OP
|
$178.17
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
63001454
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$165.70 |
| Rate for Payer: Aetna Commercial |
$150.38
|
| Rate for Payer: Aetna Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.68
|
| Rate for Payer: Cash Price |
$110.47
|
| Rate for Payer: Cash Price |
$110.47
|
| Rate for Payer: Centivo All Commercial |
$90.87
|
| Rate for Payer: Cigna All Commercial |
$153.76
|
| Rate for Payer: CORVEL All Commercial |
$165.70
|
| Rate for Payer: Coventry All Commercial |
$156.79
|
| Rate for Payer: Encore All Commercial |
$164.01
|
| Rate for Payer: Frontpath All Commercial |
$163.92
|
| Rate for Payer: Humana ChoiceCare |
$153.89
|
| Rate for Payer: Humana Medicare |
$90.87
|
| Rate for Payer: Lucent All Commercial |
$90.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.36
|
| Rate for Payer: Managed Health Services Medicaid |
$13.44
|
| Rate for Payer: MDWise Medicaid |
$13.44
|
| Rate for Payer: PHCS All Commercial |
$133.63
|
| Rate for Payer: PHP All Commercial |
$135.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.49
|
| Rate for Payer: Sagamore Health Network All Products |
$137.55
|
| Rate for Payer: Signature Care EPO |
$147.88
|
| Rate for Payer: Signature Care PPO |
$156.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.45
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
| Rate for Payer: United Healthcare Medicare |
$58.80
|
|
|
HC ALPHA-1-ANTITRYPSIN W/PHENOTYPE
|
Facility
IP
|
$178.17
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
63001454
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.63 |
| Max. Negotiated Rate |
$165.70 |
| Rate for Payer: Aetna Commercial |
$153.94
|
| Rate for Payer: Cash Price |
$110.47
|
| Rate for Payer: Cigna All Commercial |
$153.76
|
| Rate for Payer: CORVEL All Commercial |
$165.70
|
| Rate for Payer: Coventry All Commercial |
$156.79
|
| Rate for Payer: Encore All Commercial |
$164.01
|
| Rate for Payer: Frontpath All Commercial |
$163.92
|
| Rate for Payer: Humana ChoiceCare |
$153.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.36
|
| Rate for Payer: PHCS All Commercial |
$133.63
|
| Rate for Payer: PHP All Commercial |
$135.13
|
| Rate for Payer: Sagamore Health Network All Products |
$137.55
|
| Rate for Payer: Signature Care EPO |
$147.88
|
| Rate for Payer: Signature Care PPO |
$156.79
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
|
|
HC ALPHA-FETOPROTEIN
|
Facility
IP
|
$214.72
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
63001156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.04 |
| Max. Negotiated Rate |
$199.69 |
| Rate for Payer: Aetna Commercial |
$185.52
|
| Rate for Payer: Cash Price |
$133.13
|
| Rate for Payer: Cigna All Commercial |
$185.30
|
| Rate for Payer: CORVEL All Commercial |
$199.69
|
| Rate for Payer: Coventry All Commercial |
$188.95
|
| Rate for Payer: Encore All Commercial |
$197.65
|
| Rate for Payer: Frontpath All Commercial |
$197.54
|
| Rate for Payer: Humana ChoiceCare |
$185.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.25
|
| Rate for Payer: PHCS All Commercial |
$161.04
|
| Rate for Payer: PHP All Commercial |
$162.84
|
| Rate for Payer: Sagamore Health Network All Products |
$165.76
|
| Rate for Payer: Signature Care EPO |
$178.22
|
| Rate for Payer: Signature Care PPO |
$188.95
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
|
|
HC ALPHA-FETOPROTEIN
|
Facility
OP
|
$214.72
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
63001156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$199.69 |
| Rate for Payer: Aetna Commercial |
$181.22
|
| Rate for Payer: Aetna Medicare |
$70.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.94
|
| Rate for Payer: Cash Price |
$133.13
|
| Rate for Payer: Cash Price |
$133.13
|
| Rate for Payer: Centivo All Commercial |
$109.51
|
| Rate for Payer: Cigna All Commercial |
$185.30
|
| Rate for Payer: CORVEL All Commercial |
$199.69
|
| Rate for Payer: Coventry All Commercial |
$188.95
|
| Rate for Payer: Encore All Commercial |
$197.65
|
| Rate for Payer: Frontpath All Commercial |
$197.54
|
| Rate for Payer: Humana ChoiceCare |
$185.45
|
| Rate for Payer: Humana Medicare |
$109.51
|
| Rate for Payer: Lucent All Commercial |
$109.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.25
|
| Rate for Payer: Managed Health Services Medicaid |
$16.77
|
| Rate for Payer: MDWise Medicaid |
$16.77
|
| Rate for Payer: PHCS All Commercial |
$161.04
|
| Rate for Payer: PHP All Commercial |
$162.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.74
|
| Rate for Payer: Sagamore Health Network All Products |
$165.76
|
| Rate for Payer: Signature Care EPO |
$178.22
|
| Rate for Payer: Signature Care PPO |
$188.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.51
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
| Rate for Payer: United Healthcare Medicare |
$70.86
|
|
|
HC ALT COMM DEV THER SVCS-30 M-SP
|
Facility
OP
|
$369.69
|
|
|
Service Code
|
CPT 92606 GN
|
| Hospital Charge Code |
01748004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna Commercial |
$312.02
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.20
|
| Rate for Payer: Cash Price |
$229.21
|
| Rate for Payer: Centivo All Commercial |
$188.54
|
| Rate for Payer: Cigna All Commercial |
$319.04
|
| Rate for Payer: CORVEL All Commercial |
$343.81
|
| Rate for Payer: Coventry All Commercial |
$325.33
|
| Rate for Payer: Encore All Commercial |
$340.30
|
| Rate for Payer: Frontpath All Commercial |
$340.11
|
| Rate for Payer: Humana ChoiceCare |
$319.30
|
| Rate for Payer: Humana Medicare |
$188.54
|
| Rate for Payer: Lucent All Commercial |
$188.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.72
|
| Rate for Payer: PHCS All Commercial |
$277.27
|
| Rate for Payer: PHP All Commercial |
$280.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.18
|
| Rate for Payer: Sagamore Health Network All Products |
$285.40
|
| Rate for Payer: Signature Care EPO |
$306.84
|
| Rate for Payer: Signature Care PPO |
$325.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.24
|
| Rate for Payer: United Healthcare Commercial |
$291.31
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
|
