|
HC IV PUSH INSULIN EA ADD SAME DRUG
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 96376 GZ
|
| Hospital Charge Code |
21689108
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$132.19
|
| Rate for Payer: Cash Price |
$94.86
|
| Rate for Payer: Cigna All Commercial |
$132.04
|
| Rate for Payer: CORVEL All Commercial |
$142.29
|
| Rate for Payer: Coventry All Commercial |
$134.64
|
| Rate for Payer: Encore All Commercial |
$140.84
|
| Rate for Payer: Frontpath All Commercial |
$140.76
|
| Rate for Payer: Humana ChoiceCare |
$132.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.70
|
| Rate for Payer: PHCS All Commercial |
$114.75
|
| Rate for Payer: PHP All Commercial |
$116.04
|
| Rate for Payer: Sagamore Health Network All Products |
$118.12
|
| Rate for Payer: Signature Care EPO |
$126.99
|
| Rate for Payer: Signature Care PPO |
$134.64
|
| Rate for Payer: United Healthcare Commercial |
$120.56
|
|
|
HC IV PUSH INSULIN EA ADD SAME DRUG
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 96376 GZ
|
| Hospital Charge Code |
21689108
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$129.13
|
| Rate for Payer: Aetna Medicare |
$50.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$87.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.54
|
| Rate for Payer: Cash Price |
$94.86
|
| Rate for Payer: Centivo All Commercial |
$78.03
|
| Rate for Payer: Cigna All Commercial |
$132.04
|
| Rate for Payer: CORVEL All Commercial |
$142.29
|
| Rate for Payer: Coventry All Commercial |
$134.64
|
| Rate for Payer: Encore All Commercial |
$140.84
|
| Rate for Payer: Frontpath All Commercial |
$140.76
|
| Rate for Payer: Humana ChoiceCare |
$132.15
|
| Rate for Payer: Humana Medicare |
$78.03
|
| Rate for Payer: Lucent All Commercial |
$78.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.70
|
| Rate for Payer: PHCS All Commercial |
$114.75
|
| Rate for Payer: PHP All Commercial |
$116.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.67
|
| Rate for Payer: Sagamore Health Network All Products |
$118.12
|
| Rate for Payer: Signature Care EPO |
$126.99
|
| Rate for Payer: Signature Care PPO |
$134.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.05
|
| Rate for Payer: United Healthcare Commercial |
$120.56
|
| Rate for Payer: United Healthcare Medicare |
$50.49
|
|
|
HC IV PUSH INSULIN INITIAL
|
Facility
OP
|
$164.42
|
|
|
Service Code
|
CPT 96374 GZ
|
| Hospital Charge Code |
21689107
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$152.91 |
| Rate for Payer: Aetna Commercial |
$138.77
|
| Rate for Payer: Aetna Medicare |
$54.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.69
|
| Rate for Payer: Cash Price |
$101.94
|
| Rate for Payer: Centivo All Commercial |
$83.86
|
| Rate for Payer: Cigna All Commercial |
$141.90
|
| Rate for Payer: CORVEL All Commercial |
$152.91
|
| Rate for Payer: Coventry All Commercial |
$144.69
|
| Rate for Payer: Encore All Commercial |
$151.35
|
| Rate for Payer: Frontpath All Commercial |
$151.27
|
| Rate for Payer: Humana ChoiceCare |
$142.01
|
| Rate for Payer: Humana Medicare |
$83.86
|
| Rate for Payer: Lucent All Commercial |
$83.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.98
|
| Rate for Payer: PHCS All Commercial |
$123.32
|
| Rate for Payer: PHP All Commercial |
$124.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.13
|
| Rate for Payer: Sagamore Health Network All Products |
$126.94
|
| Rate for Payer: Signature Care EPO |
$136.47
|
| Rate for Payer: Signature Care PPO |
$144.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.76
|
| Rate for Payer: United Healthcare Commercial |
$129.57
|
| Rate for Payer: United Healthcare Medicare |
$54.26
|
|
|
HC IV PUSH INSULIN INITIAL
|
Facility
IP
|
$164.42
|
|
|
Service Code
|
CPT 96374 GZ
|
| Hospital Charge Code |
21689107
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$123.32 |
| Max. Negotiated Rate |
$152.91 |
| Rate for Payer: Aetna Commercial |
$142.06
|
| Rate for Payer: Cash Price |
$101.94
|
| Rate for Payer: Cigna All Commercial |
$141.90
|
| Rate for Payer: CORVEL All Commercial |
$152.91
|
| Rate for Payer: Coventry All Commercial |
$144.69
|
| Rate for Payer: Encore All Commercial |
$151.35
|
| Rate for Payer: Frontpath All Commercial |
$151.27
|
| Rate for Payer: Humana ChoiceCare |
$142.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.98
|
| Rate for Payer: PHCS All Commercial |
$123.32
|
| Rate for Payer: PHP All Commercial |
$124.70
|
| Rate for Payer: Sagamore Health Network All Products |
$126.94
|
| Rate for Payer: Signature Care EPO |
$136.47
|
| Rate for Payer: Signature Care PPO |
$144.69
|
| Rate for Payer: United Healthcare Commercial |
$129.57
|
|
|
HC IV SEDATION EA ADD MIN
|
Facility
IP
|
$11.64
|
|
| Hospital Charge Code |
01246657
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$10.82 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cigna All Commercial |
$10.04
|
| Rate for Payer: CORVEL All Commercial |
$10.82
|
| Rate for Payer: Coventry All Commercial |
$10.24
|
| Rate for Payer: Encore All Commercial |
$10.71
|
| Rate for Payer: Frontpath All Commercial |
$10.71
|
| Rate for Payer: Humana ChoiceCare |
$10.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.47
|
| Rate for Payer: PHCS All Commercial |
$8.73
|
| Rate for Payer: PHP All Commercial |
$8.83
|
| Rate for Payer: Sagamore Health Network All Products |
$8.98
|
| Rate for Payer: Signature Care EPO |
$9.66
|
| Rate for Payer: Signature Care PPO |
$10.24
|
| Rate for Payer: United Healthcare Commercial |
$9.17
|
|
|
HC IV SEDATION EA ADD MIN
|
Facility
OP
|
$11.64
|
|
| Hospital Charge Code |
01246657
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna Medicare |
$3.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.22
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Centivo All Commercial |
$5.94
|
| Rate for Payer: Cigna All Commercial |
$10.04
|
| Rate for Payer: CORVEL All Commercial |
$10.82
|
| Rate for Payer: Coventry All Commercial |
$10.24
|
| Rate for Payer: Encore All Commercial |
$10.71
|
| Rate for Payer: Frontpath All Commercial |
$10.71
|
| Rate for Payer: Humana ChoiceCare |
$10.05
|
| Rate for Payer: Humana Medicare |
$5.94
|
| Rate for Payer: Lucent All Commercial |
$5.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.47
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$8.73
|
| Rate for Payer: PHP All Commercial |
$8.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.54
|
| Rate for Payer: Sagamore Health Network All Products |
$8.98
|
| Rate for Payer: Signature Care EPO |
$9.66
|
| Rate for Payer: Signature Care PPO |
$10.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$9.17
|
| Rate for Payer: United Healthcare Medicare |
$3.84
|
|
|
HC IV SEDATION INITIAL 15 MIN
|
Facility
OP
|
$162.92
|
|
| Hospital Charge Code |
01246656
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$53.77 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$137.51
|
| Rate for Payer: Aetna Medicare |
$53.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.14
|
| Rate for Payer: Cash Price |
$101.01
|
| Rate for Payer: Cash Price |
$101.01
|
| Rate for Payer: Centivo All Commercial |
$83.09
|
| Rate for Payer: Cigna All Commercial |
$140.60
|
| Rate for Payer: CORVEL All Commercial |
$151.52
|
| Rate for Payer: Coventry All Commercial |
$143.37
|
| Rate for Payer: Encore All Commercial |
$149.97
|
| Rate for Payer: Frontpath All Commercial |
$149.89
|
| Rate for Payer: Humana ChoiceCare |
$140.72
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: Lucent All Commercial |
$83.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.63
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$122.19
|
| Rate for Payer: PHP All Commercial |
$123.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.54
|
| Rate for Payer: Sagamore Health Network All Products |
$125.78
|
| Rate for Payer: Signature Care EPO |
$135.23
|
| Rate for Payer: Signature Care PPO |
$143.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.49
|
| Rate for Payer: United Healthcare Commercial |
$128.38
|
| Rate for Payer: United Healthcare Medicare |
$53.77
|
|
|
HC IV SEDATION INITIAL 15 MIN
|
Facility
IP
|
$162.92
|
|
| Hospital Charge Code |
01246656
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$122.19 |
| Max. Negotiated Rate |
$151.52 |
| Rate for Payer: Aetna Commercial |
$140.77
|
| Rate for Payer: Cash Price |
$101.01
|
| Rate for Payer: Cigna All Commercial |
$140.60
|
| Rate for Payer: CORVEL All Commercial |
$151.52
|
| Rate for Payer: Coventry All Commercial |
$143.37
|
| Rate for Payer: Encore All Commercial |
$149.97
|
| Rate for Payer: Frontpath All Commercial |
$149.89
|
| Rate for Payer: Humana ChoiceCare |
$140.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.63
|
| Rate for Payer: PHCS All Commercial |
$122.19
|
| Rate for Payer: PHP All Commercial |
$123.56
|
| Rate for Payer: Sagamore Health Network All Products |
$125.78
|
| Rate for Payer: Signature Care EPO |
$135.23
|
| Rate for Payer: Signature Care PPO |
$143.37
|
| Rate for Payer: United Healthcare Commercial |
$128.38
|
|
|
HC JADA SYSTEM HEMORRHAGE
|
Facility
OP
|
$4,662.00
|
|
| Hospital Charge Code |
41608162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,335.66 |
| Rate for Payer: Aetna Commercial |
$3,934.73
|
| Rate for Payer: Aetna Medicare |
$1,538.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,538.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,677.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,914.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,769.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,692.31
|
| Rate for Payer: Cash Price |
$2,890.44
|
| Rate for Payer: Cash Price |
$2,890.44
|
| Rate for Payer: Centivo All Commercial |
$2,377.62
|
| Rate for Payer: Cigna All Commercial |
$4,023.31
|
| Rate for Payer: CORVEL All Commercial |
$4,335.66
|
| Rate for Payer: Coventry All Commercial |
$4,102.56
|
| Rate for Payer: Encore All Commercial |
$4,291.37
|
| Rate for Payer: Frontpath All Commercial |
$4,289.04
|
| Rate for Payer: Humana ChoiceCare |
$4,026.57
|
| Rate for Payer: Humana Medicare |
$2,377.62
|
| Rate for Payer: Lucent All Commercial |
$2,377.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,195.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,496.50
|
| Rate for Payer: PHP All Commercial |
$3,535.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,818.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,599.06
|
| Rate for Payer: Signature Care EPO |
$3,869.46
|
| Rate for Payer: Signature Care PPO |
$4,102.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,962.70
|
| Rate for Payer: United Healthcare Commercial |
$3,673.66
|
| Rate for Payer: United Healthcare Medicare |
$1,538.46
|
|
|
HC JADA SYSTEM HEMORRHAGE
|
Facility
IP
|
$4,662.00
|
|
| Hospital Charge Code |
41608162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,496.50 |
| Max. Negotiated Rate |
$4,335.66 |
| Rate for Payer: Aetna Commercial |
$4,027.97
|
| Rate for Payer: Cash Price |
$2,890.44
|
| Rate for Payer: Cigna All Commercial |
$4,023.31
|
| Rate for Payer: CORVEL All Commercial |
$4,335.66
|
| Rate for Payer: Coventry All Commercial |
$4,102.56
|
| Rate for Payer: Encore All Commercial |
$4,291.37
|
| Rate for Payer: Frontpath All Commercial |
$4,289.04
|
| Rate for Payer: Humana ChoiceCare |
$4,026.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,195.80
|
| Rate for Payer: PHCS All Commercial |
$3,496.50
|
| Rate for Payer: PHP All Commercial |
$3,535.66
|
| Rate for Payer: Sagamore Health Network All Products |
$3,599.06
|
| Rate for Payer: Signature Care EPO |
$3,869.46
|
| Rate for Payer: Signature Care PPO |
$4,102.56
|
| Rate for Payer: United Healthcare Commercial |
$3,673.66
|
|
|
HC JAK2 EXON 12, 13, 14 AND 15 MUTATION ANALYSIS
|
Facility
OP
|
$321.30
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
63044053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.03 |
| Max. Negotiated Rate |
$298.81 |
| Rate for Payer: Aetna Commercial |
$271.18
|
| Rate for Payer: Aetna Medicare |
$106.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$184.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$200.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$185.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.63
|
| Rate for Payer: Cash Price |
$199.21
|
| Rate for Payer: Cash Price |
$199.21
|
| Rate for Payer: Centivo All Commercial |
$163.86
|
| Rate for Payer: Cigna All Commercial |
$277.28
|
| Rate for Payer: CORVEL All Commercial |
$298.81
|
| Rate for Payer: Coventry All Commercial |
$282.74
|
| Rate for Payer: Encore All Commercial |
$295.76
|
| Rate for Payer: Frontpath All Commercial |
$295.60
|
| Rate for Payer: Humana ChoiceCare |
$277.51
|
| Rate for Payer: Humana Medicare |
$163.86
|
| Rate for Payer: Lucent All Commercial |
$163.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$289.17
|
| Rate for Payer: Managed Health Services Medicaid |
$185.20
|
| Rate for Payer: MDWise Medicaid |
$185.20
|
| Rate for Payer: PHCS All Commercial |
$240.98
|
| Rate for Payer: PHP All Commercial |
$243.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.31
|
| Rate for Payer: Sagamore Health Network All Products |
$248.04
|
| Rate for Payer: Signature Care EPO |
$266.68
|
| Rate for Payer: Signature Care PPO |
$282.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$273.10
|
| Rate for Payer: United Healthcare Commercial |
$253.18
|
| Rate for Payer: United Healthcare Medicare |
$106.03
|
|
|
HC JAK2 EXON 12, 13, 14 AND 15 MUTATION ANALYSIS
|
Facility
IP
|
$321.30
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
63044053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$240.98 |
| Max. Negotiated Rate |
$298.81 |
| Rate for Payer: Aetna Commercial |
$277.60
|
| Rate for Payer: Cash Price |
$199.21
|
| Rate for Payer: Cigna All Commercial |
$277.28
|
| Rate for Payer: CORVEL All Commercial |
$298.81
|
| Rate for Payer: Coventry All Commercial |
$282.74
|
| Rate for Payer: Encore All Commercial |
$295.76
|
| Rate for Payer: Frontpath All Commercial |
$295.60
|
| Rate for Payer: Humana ChoiceCare |
$277.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$289.17
|
| Rate for Payer: PHCS All Commercial |
$240.98
|
| Rate for Payer: PHP All Commercial |
$243.67
|
| Rate for Payer: Sagamore Health Network All Products |
$248.04
|
| Rate for Payer: Signature Care EPO |
$266.68
|
| Rate for Payer: Signature Care PPO |
$282.74
|
| Rate for Payer: United Healthcare Commercial |
$253.18
|
|
|
HC JAK2V617F MUTATION ANALYSIS, QUALITATIVE, WITH REFLEX TO JAK2 EXON 12-15 MUTATION ANALYSIS
|
Facility
OP
|
$438.59
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
63044052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.66 |
| Max. Negotiated Rate |
$407.89 |
| Rate for Payer: Aetna Commercial |
$370.17
|
| Rate for Payer: Aetna Medicare |
$144.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$251.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$274.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$91.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.21
|
| Rate for Payer: Cash Price |
$271.93
|
| Rate for Payer: Cash Price |
$271.93
|
| Rate for Payer: Centivo All Commercial |
$223.68
|
| Rate for Payer: Cigna All Commercial |
$378.50
|
| Rate for Payer: CORVEL All Commercial |
$407.89
|
| Rate for Payer: Coventry All Commercial |
$385.96
|
| Rate for Payer: Encore All Commercial |
$403.72
|
| Rate for Payer: Frontpath All Commercial |
$403.50
|
| Rate for Payer: Humana ChoiceCare |
$378.81
|
| Rate for Payer: Humana Medicare |
$223.68
|
| Rate for Payer: Lucent All Commercial |
$223.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.73
|
| Rate for Payer: Managed Health Services Medicaid |
$91.66
|
| Rate for Payer: MDWise Medicaid |
$91.66
|
| Rate for Payer: PHCS All Commercial |
$328.94
|
| Rate for Payer: PHP All Commercial |
$332.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.05
|
| Rate for Payer: Sagamore Health Network All Products |
$338.59
|
| Rate for Payer: Signature Care EPO |
$364.03
|
| Rate for Payer: Signature Care PPO |
$385.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$372.80
|
| Rate for Payer: United Healthcare Commercial |
$345.61
|
| Rate for Payer: United Healthcare Medicare |
$144.73
|
|
|
HC JAK2V617F MUTATION ANALYSIS, QUALITATIVE, WITH REFLEX TO JAK2 EXON 12-15 MUTATION ANALYSIS
|
Facility
IP
|
$438.59
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
63044052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$328.94 |
| Max. Negotiated Rate |
$407.89 |
| Rate for Payer: Aetna Commercial |
$378.94
|
| Rate for Payer: Cash Price |
$271.93
|
| Rate for Payer: Cigna All Commercial |
$378.50
|
| Rate for Payer: CORVEL All Commercial |
$407.89
|
| Rate for Payer: Coventry All Commercial |
$385.96
|
| Rate for Payer: Encore All Commercial |
$403.72
|
| Rate for Payer: Frontpath All Commercial |
$403.50
|
| Rate for Payer: Humana ChoiceCare |
$378.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.73
|
| Rate for Payer: PHCS All Commercial |
$328.94
|
| Rate for Payer: PHP All Commercial |
$332.63
|
| Rate for Payer: Sagamore Health Network All Products |
$338.59
|
| Rate for Payer: Signature Care EPO |
$364.03
|
| Rate for Payer: Signature Care PPO |
$385.96
|
| Rate for Payer: United Healthcare Commercial |
$345.61
|
|
|
HC JAK2 V617F MUTATION-PCR
|
Facility
OP
|
$438.59
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
63001439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.66 |
| Max. Negotiated Rate |
$407.89 |
| Rate for Payer: Aetna Commercial |
$370.17
|
| Rate for Payer: Aetna Medicare |
$144.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$251.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$274.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$91.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.21
|
| Rate for Payer: Cash Price |
$271.93
|
| Rate for Payer: Cash Price |
$271.93
|
| Rate for Payer: Centivo All Commercial |
$223.68
|
| Rate for Payer: Cigna All Commercial |
$378.50
|
| Rate for Payer: CORVEL All Commercial |
$407.89
|
| Rate for Payer: Coventry All Commercial |
$385.96
|
| Rate for Payer: Encore All Commercial |
$403.72
|
| Rate for Payer: Frontpath All Commercial |
$403.50
|
| Rate for Payer: Humana ChoiceCare |
$378.81
|
| Rate for Payer: Humana Medicare |
$223.68
|
| Rate for Payer: Lucent All Commercial |
$223.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.73
|
| Rate for Payer: Managed Health Services Medicaid |
$91.66
|
| Rate for Payer: MDWise Medicaid |
$91.66
|
| Rate for Payer: PHCS All Commercial |
$328.94
|
| Rate for Payer: PHP All Commercial |
$332.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.05
|
| Rate for Payer: Sagamore Health Network All Products |
$338.59
|
| Rate for Payer: Signature Care EPO |
$364.03
|
| Rate for Payer: Signature Care PPO |
$385.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$372.80
|
| Rate for Payer: United Healthcare Commercial |
$345.61
|
| Rate for Payer: United Healthcare Medicare |
$144.73
|
|
|
HC JAK2 V617F MUTATION-PCR
|
Facility
IP
|
$438.59
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
63001439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$328.94 |
| Max. Negotiated Rate |
$407.89 |
| Rate for Payer: Aetna Commercial |
$378.94
|
| Rate for Payer: Cash Price |
$271.93
|
| Rate for Payer: Cigna All Commercial |
$378.50
|
| Rate for Payer: CORVEL All Commercial |
$407.89
|
| Rate for Payer: Coventry All Commercial |
$385.96
|
| Rate for Payer: Encore All Commercial |
$403.72
|
| Rate for Payer: Frontpath All Commercial |
$403.50
|
| Rate for Payer: Humana ChoiceCare |
$378.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.73
|
| Rate for Payer: PHCS All Commercial |
$328.94
|
| Rate for Payer: PHP All Commercial |
$332.63
|
| Rate for Payer: Sagamore Health Network All Products |
$338.59
|
| Rate for Payer: Signature Care EPO |
$364.03
|
| Rate for Payer: Signature Care PPO |
$385.96
|
| Rate for Payer: United Healthcare Commercial |
$345.61
|
|
|
HC JC VIRUS DNA, PCR, CEREBROSPINAL FLUID
|
Facility
IP
|
$206.55
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63044054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$192.09 |
| Rate for Payer: Aetna Commercial |
$178.46
|
| Rate for Payer: Cash Price |
$128.06
|
| Rate for Payer: Cigna All Commercial |
$178.25
|
| Rate for Payer: CORVEL All Commercial |
$192.09
|
| Rate for Payer: Coventry All Commercial |
$181.76
|
| Rate for Payer: Encore All Commercial |
$190.13
|
| Rate for Payer: Frontpath All Commercial |
$190.03
|
| Rate for Payer: Humana ChoiceCare |
$178.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.90
|
| Rate for Payer: PHCS All Commercial |
$154.91
|
| Rate for Payer: PHP All Commercial |
$156.65
|
| Rate for Payer: Sagamore Health Network All Products |
$159.46
|
| Rate for Payer: Signature Care EPO |
$171.44
|
| Rate for Payer: Signature Care PPO |
$181.76
|
| Rate for Payer: United Healthcare Commercial |
$162.76
|
|
|
HC JC VIRUS DNA, PCR, CEREBROSPINAL FLUID
|
Facility
OP
|
$206.55
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63044054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$192.09 |
| Rate for Payer: Aetna Commercial |
$174.33
|
| Rate for Payer: Aetna Medicare |
$68.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.98
|
| Rate for Payer: Cash Price |
$128.06
|
| Rate for Payer: Cash Price |
$128.06
|
| Rate for Payer: Centivo All Commercial |
$105.34
|
| Rate for Payer: Cigna All Commercial |
$178.25
|
| Rate for Payer: CORVEL All Commercial |
$192.09
|
| Rate for Payer: Coventry All Commercial |
$181.76
|
| Rate for Payer: Encore All Commercial |
$190.13
|
| Rate for Payer: Frontpath All Commercial |
$190.03
|
| Rate for Payer: Humana ChoiceCare |
$178.40
|
| Rate for Payer: Humana Medicare |
$105.34
|
| Rate for Payer: Lucent All Commercial |
$105.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.90
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$154.91
|
| Rate for Payer: PHP All Commercial |
$156.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.55
|
| Rate for Payer: Sagamore Health Network All Products |
$159.46
|
| Rate for Payer: Signature Care EPO |
$171.44
|
| Rate for Payer: Signature Care PPO |
$181.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.57
|
| Rate for Payer: United Healthcare Commercial |
$162.76
|
| Rate for Payer: United Healthcare Medicare |
$68.16
|
|
|
HC JC VIRUS DNA, PCR, URINE
|
Facility
IP
|
$206.55
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63044055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$192.09 |
| Rate for Payer: Aetna Commercial |
$178.46
|
| Rate for Payer: Cash Price |
$128.06
|
| Rate for Payer: Cigna All Commercial |
$178.25
|
| Rate for Payer: CORVEL All Commercial |
$192.09
|
| Rate for Payer: Coventry All Commercial |
$181.76
|
| Rate for Payer: Encore All Commercial |
$190.13
|
| Rate for Payer: Frontpath All Commercial |
$190.03
|
| Rate for Payer: Humana ChoiceCare |
$178.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.90
|
| Rate for Payer: PHCS All Commercial |
$154.91
|
| Rate for Payer: PHP All Commercial |
$156.65
|
| Rate for Payer: Sagamore Health Network All Products |
$159.46
|
| Rate for Payer: Signature Care EPO |
$171.44
|
| Rate for Payer: Signature Care PPO |
$181.76
|
| Rate for Payer: United Healthcare Commercial |
$162.76
|
|
|
HC JC VIRUS DNA, PCR, URINE
|
Facility
OP
|
$206.55
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63044055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$192.09 |
| Rate for Payer: Aetna Commercial |
$174.33
|
| Rate for Payer: Aetna Medicare |
$68.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.98
|
| Rate for Payer: Cash Price |
$128.06
|
| Rate for Payer: Cash Price |
$128.06
|
| Rate for Payer: Centivo All Commercial |
$105.34
|
| Rate for Payer: Cigna All Commercial |
$178.25
|
| Rate for Payer: CORVEL All Commercial |
$192.09
|
| Rate for Payer: Coventry All Commercial |
$181.76
|
| Rate for Payer: Encore All Commercial |
$190.13
|
| Rate for Payer: Frontpath All Commercial |
$190.03
|
| Rate for Payer: Humana ChoiceCare |
$178.40
|
| Rate for Payer: Humana Medicare |
$105.34
|
| Rate for Payer: Lucent All Commercial |
$105.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.90
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$154.91
|
| Rate for Payer: PHP All Commercial |
$156.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.55
|
| Rate for Payer: Sagamore Health Network All Products |
$159.46
|
| Rate for Payer: Signature Care EPO |
$171.44
|
| Rate for Payer: Signature Care PPO |
$181.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.57
|
| Rate for Payer: United Healthcare Commercial |
$162.76
|
| Rate for Payer: United Healthcare Medicare |
$68.16
|
|
|
HC JC VIRUS DNA, PCR, WHOLE BLOOD
|
Facility
OP
|
$206.55
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63044056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$192.09 |
| Rate for Payer: Aetna Commercial |
$174.33
|
| Rate for Payer: Aetna Medicare |
$68.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.98
|
| Rate for Payer: Cash Price |
$128.06
|
| Rate for Payer: Cash Price |
$128.06
|
| Rate for Payer: Centivo All Commercial |
$105.34
|
| Rate for Payer: Cigna All Commercial |
$178.25
|
| Rate for Payer: CORVEL All Commercial |
$192.09
|
| Rate for Payer: Coventry All Commercial |
$181.76
|
| Rate for Payer: Encore All Commercial |
$190.13
|
| Rate for Payer: Frontpath All Commercial |
$190.03
|
| Rate for Payer: Humana ChoiceCare |
$178.40
|
| Rate for Payer: Humana Medicare |
$105.34
|
| Rate for Payer: Lucent All Commercial |
$105.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.90
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$154.91
|
| Rate for Payer: PHP All Commercial |
$156.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.55
|
| Rate for Payer: Sagamore Health Network All Products |
$159.46
|
| Rate for Payer: Signature Care EPO |
$171.44
|
| Rate for Payer: Signature Care PPO |
$181.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.57
|
| Rate for Payer: United Healthcare Commercial |
$162.76
|
| Rate for Payer: United Healthcare Medicare |
$68.16
|
|
|
HC JC VIRUS DNA, PCR, WHOLE BLOOD
|
Facility
IP
|
$206.55
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63044056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$192.09 |
| Rate for Payer: Aetna Commercial |
$178.46
|
| Rate for Payer: Cash Price |
$128.06
|
| Rate for Payer: Cigna All Commercial |
$178.25
|
| Rate for Payer: CORVEL All Commercial |
$192.09
|
| Rate for Payer: Coventry All Commercial |
$181.76
|
| Rate for Payer: Encore All Commercial |
$190.13
|
| Rate for Payer: Frontpath All Commercial |
$190.03
|
| Rate for Payer: Humana ChoiceCare |
$178.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.90
|
| Rate for Payer: PHCS All Commercial |
$154.91
|
| Rate for Payer: PHP All Commercial |
$156.65
|
| Rate for Payer: Sagamore Health Network All Products |
$159.46
|
| Rate for Payer: Signature Care EPO |
$171.44
|
| Rate for Payer: Signature Care PPO |
$181.76
|
| Rate for Payer: United Healthcare Commercial |
$162.76
|
|
|
HC JEVITY 1.5CAL 1500ML
|
Facility
IP
|
$17.15
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
41602458
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cigna All Commercial |
$14.80
|
| Rate for Payer: CORVEL All Commercial |
$15.95
|
| Rate for Payer: Coventry All Commercial |
$15.09
|
| Rate for Payer: Encore All Commercial |
$15.79
|
| Rate for Payer: Frontpath All Commercial |
$15.78
|
| Rate for Payer: Humana ChoiceCare |
$14.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.44
|
| Rate for Payer: PHCS All Commercial |
$12.86
|
| Rate for Payer: PHP All Commercial |
$13.01
|
| Rate for Payer: Sagamore Health Network All Products |
$13.24
|
| Rate for Payer: Signature Care EPO |
$14.23
|
| Rate for Payer: Signature Care PPO |
$15.09
|
| Rate for Payer: United Healthcare Commercial |
$13.51
|
|
|
HC JEVITY 1.5CAL 1500ML
|
Facility
OP
|
$17.15
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
41602458
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Medicare |
$5.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.23
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Centivo All Commercial |
$8.75
|
| Rate for Payer: Cigna All Commercial |
$14.80
|
| Rate for Payer: CORVEL All Commercial |
$15.95
|
| Rate for Payer: Coventry All Commercial |
$15.09
|
| Rate for Payer: Encore All Commercial |
$15.79
|
| Rate for Payer: Frontpath All Commercial |
$15.78
|
| Rate for Payer: Humana ChoiceCare |
$14.81
|
| Rate for Payer: Humana Medicare |
$8.75
|
| Rate for Payer: Lucent All Commercial |
$8.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.44
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$12.86
|
| Rate for Payer: PHP All Commercial |
$13.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.69
|
| Rate for Payer: Sagamore Health Network All Products |
$13.24
|
| Rate for Payer: Signature Care EPO |
$14.23
|
| Rate for Payer: Signature Care PPO |
$15.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.58
|
| Rate for Payer: United Healthcare Commercial |
$13.51
|
| Rate for Payer: United Healthcare Medicare |
$5.66
|
|
|
HC JEVITY 1.5CAL 8OZ
|
Facility
OP
|
$2.36
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
41602457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$1.99
|
| Rate for Payer: Aetna Medicare |
$0.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.86
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Centivo All Commercial |
$1.20
|
| Rate for Payer: Cigna All Commercial |
$2.04
|
| Rate for Payer: CORVEL All Commercial |
$2.19
|
| Rate for Payer: Coventry All Commercial |
$2.08
|
| Rate for Payer: Encore All Commercial |
$2.17
|
| Rate for Payer: Frontpath All Commercial |
$2.17
|
| Rate for Payer: Humana ChoiceCare |
$2.04
|
| Rate for Payer: Humana Medicare |
$1.20
|
| Rate for Payer: Lucent All Commercial |
$1.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.12
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$1.77
|
| Rate for Payer: PHP All Commercial |
$1.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1.82
|
| Rate for Payer: Signature Care EPO |
$1.96
|
| Rate for Payer: Signature Care PPO |
$2.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.01
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
| Rate for Payer: United Healthcare Medicare |
$0.78
|
|
