|
HC RAT TOOTH ALLIGATOR
|
Facility
OP
|
$612.85
|
|
| Hospital Charge Code |
41608206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$569.95 |
| Rate for Payer: Aetna Commercial |
$517.25
|
| Rate for Payer: Aetna Medicare |
$202.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$351.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$383.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$232.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$222.46
|
| Rate for Payer: Cash Price |
$379.97
|
| Rate for Payer: Cash Price |
$379.97
|
| Rate for Payer: Centivo All Commercial |
$312.55
|
| Rate for Payer: Cigna All Commercial |
$528.89
|
| Rate for Payer: CORVEL All Commercial |
$569.95
|
| Rate for Payer: Coventry All Commercial |
$539.31
|
| Rate for Payer: Encore All Commercial |
$564.13
|
| Rate for Payer: Frontpath All Commercial |
$563.82
|
| Rate for Payer: Humana ChoiceCare |
$529.32
|
| Rate for Payer: Humana Medicare |
$312.55
|
| Rate for Payer: Lucent All Commercial |
$312.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$459.64
|
| Rate for Payer: PHP All Commercial |
$464.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$239.01
|
| Rate for Payer: Sagamore Health Network All Products |
$473.12
|
| Rate for Payer: Signature Care EPO |
$508.67
|
| Rate for Payer: Signature Care PPO |
$539.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$520.92
|
| Rate for Payer: United Healthcare Commercial |
$482.93
|
| Rate for Payer: United Healthcare Medicare |
$202.24
|
|
|
HC RAT TOOTH ALLIGATOR
|
Facility
IP
|
$612.85
|
|
| Hospital Charge Code |
41608206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.64 |
| Max. Negotiated Rate |
$569.95 |
| Rate for Payer: Aetna Commercial |
$529.50
|
| Rate for Payer: Cash Price |
$379.97
|
| Rate for Payer: Cigna All Commercial |
$528.89
|
| Rate for Payer: CORVEL All Commercial |
$569.95
|
| Rate for Payer: Coventry All Commercial |
$539.31
|
| Rate for Payer: Encore All Commercial |
$564.13
|
| Rate for Payer: Frontpath All Commercial |
$563.82
|
| Rate for Payer: Humana ChoiceCare |
$529.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.56
|
| Rate for Payer: PHCS All Commercial |
$459.64
|
| Rate for Payer: PHP All Commercial |
$464.79
|
| Rate for Payer: Sagamore Health Network All Products |
$473.12
|
| Rate for Payer: Signature Care EPO |
$508.67
|
| Rate for Payer: Signature Care PPO |
$539.31
|
| Rate for Payer: United Healthcare Commercial |
$482.93
|
|
|
HC RECOVERY PHASE 1 EA ADD MIN
|
Facility
IP
|
$49.47
|
|
| Hospital Charge Code |
01216651
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$46.01 |
| Rate for Payer: Aetna Commercial |
$42.74
|
| Rate for Payer: Cash Price |
$30.67
|
| Rate for Payer: Cigna All Commercial |
$42.69
|
| Rate for Payer: CORVEL All Commercial |
$46.01
|
| Rate for Payer: Coventry All Commercial |
$43.53
|
| Rate for Payer: Encore All Commercial |
$45.54
|
| Rate for Payer: Frontpath All Commercial |
$45.51
|
| Rate for Payer: Humana ChoiceCare |
$42.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.52
|
| Rate for Payer: PHCS All Commercial |
$37.10
|
| Rate for Payer: PHP All Commercial |
$37.52
|
| Rate for Payer: Sagamore Health Network All Products |
$38.19
|
| Rate for Payer: Signature Care EPO |
$41.06
|
| Rate for Payer: Signature Care PPO |
$43.53
|
| Rate for Payer: United Healthcare Commercial |
$38.98
|
|
|
HC RECOVERY PHASE 1 EA ADD MIN
|
Facility
OP
|
$49.47
|
|
| Hospital Charge Code |
01216651
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$41.75
|
| Rate for Payer: Aetna Medicare |
$16.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$401.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.96
|
| Rate for Payer: Cash Price |
$30.67
|
| Rate for Payer: Cash Price |
$30.67
|
| Rate for Payer: Centivo All Commercial |
$25.23
|
| Rate for Payer: Cigna All Commercial |
$42.69
|
| Rate for Payer: CORVEL All Commercial |
$46.01
|
| Rate for Payer: Coventry All Commercial |
$43.53
|
| Rate for Payer: Encore All Commercial |
$45.54
|
| Rate for Payer: Frontpath All Commercial |
$45.51
|
| Rate for Payer: Humana ChoiceCare |
$42.73
|
| Rate for Payer: Humana Medicare |
$25.23
|
| Rate for Payer: Lucent All Commercial |
$25.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.52
|
| Rate for Payer: Managed Health Services Medicaid |
$401.86
|
| Rate for Payer: MDWise Medicaid |
$401.86
|
| Rate for Payer: PHCS All Commercial |
$37.10
|
| Rate for Payer: PHP All Commercial |
$37.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.29
|
| Rate for Payer: Sagamore Health Network All Products |
$38.19
|
| Rate for Payer: Signature Care EPO |
$41.06
|
| Rate for Payer: Signature Care PPO |
$43.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.05
|
| Rate for Payer: United Healthcare Commercial |
$38.98
|
| Rate for Payer: United Healthcare Medicare |
$16.33
|
|
|
HC RECOVERY PHASE 1 INITIAL 30 MIN
|
Facility
OP
|
$1,280.18
|
|
| Hospital Charge Code |
01216650
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$401.86 |
| Max. Negotiated Rate |
$1,190.57 |
| Rate for Payer: Aetna Commercial |
$1,080.47
|
| Rate for Payer: Aetna Medicare |
$422.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$422.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$735.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$800.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$401.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$485.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$464.71
|
| Rate for Payer: Cash Price |
$793.71
|
| Rate for Payer: Cash Price |
$793.71
|
| Rate for Payer: Centivo All Commercial |
$652.89
|
| Rate for Payer: Cigna All Commercial |
$1,104.80
|
| Rate for Payer: CORVEL All Commercial |
$1,190.57
|
| Rate for Payer: Coventry All Commercial |
$1,126.56
|
| Rate for Payer: Encore All Commercial |
$1,178.41
|
| Rate for Payer: Frontpath All Commercial |
$1,177.77
|
| Rate for Payer: Humana ChoiceCare |
$1,105.69
|
| Rate for Payer: Humana Medicare |
$652.89
|
| Rate for Payer: Lucent All Commercial |
$652.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,152.16
|
| Rate for Payer: Managed Health Services Medicaid |
$401.86
|
| Rate for Payer: MDWise Medicaid |
$401.86
|
| Rate for Payer: PHCS All Commercial |
$960.14
|
| Rate for Payer: PHP All Commercial |
$970.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$499.27
|
| Rate for Payer: Sagamore Health Network All Products |
$988.30
|
| Rate for Payer: Signature Care EPO |
$1,062.55
|
| Rate for Payer: Signature Care PPO |
$1,126.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,088.15
|
| Rate for Payer: United Healthcare Commercial |
$1,008.78
|
| Rate for Payer: United Healthcare Medicare |
$422.46
|
|
|
HC RECOVERY PHASE 1 INITIAL 30 MIN
|
Facility
IP
|
$1,280.18
|
|
| Hospital Charge Code |
01216650
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$960.14 |
| Max. Negotiated Rate |
$1,190.57 |
| Rate for Payer: Aetna Commercial |
$1,106.08
|
| Rate for Payer: Cash Price |
$793.71
|
| Rate for Payer: Cigna All Commercial |
$1,104.80
|
| Rate for Payer: CORVEL All Commercial |
$1,190.57
|
| Rate for Payer: Coventry All Commercial |
$1,126.56
|
| Rate for Payer: Encore All Commercial |
$1,178.41
|
| Rate for Payer: Frontpath All Commercial |
$1,177.77
|
| Rate for Payer: Humana ChoiceCare |
$1,105.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,152.16
|
| Rate for Payer: PHCS All Commercial |
$960.14
|
| Rate for Payer: PHP All Commercial |
$970.89
|
| Rate for Payer: Sagamore Health Network All Products |
$988.30
|
| Rate for Payer: Signature Care EPO |
$1,062.55
|
| Rate for Payer: Signature Care PPO |
$1,126.56
|
| Rate for Payer: United Healthcare Commercial |
$1,008.78
|
|
|
HC RECOVERY PHASE 2 EA ADD MIN
|
Facility
OP
|
$17.81
|
|
| Hospital Charge Code |
01216653
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$15.03
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$401.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.46
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Centivo All Commercial |
$9.08
|
| Rate for Payer: Cigna All Commercial |
$15.37
|
| Rate for Payer: CORVEL All Commercial |
$16.56
|
| Rate for Payer: Coventry All Commercial |
$15.67
|
| Rate for Payer: Encore All Commercial |
$16.39
|
| Rate for Payer: Frontpath All Commercial |
$16.38
|
| Rate for Payer: Humana ChoiceCare |
$15.38
|
| Rate for Payer: Humana Medicare |
$9.08
|
| Rate for Payer: Lucent All Commercial |
$9.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.03
|
| Rate for Payer: Managed Health Services Medicaid |
$401.86
|
| Rate for Payer: MDWise Medicaid |
$401.86
|
| Rate for Payer: PHCS All Commercial |
$13.36
|
| Rate for Payer: PHP All Commercial |
$13.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.95
|
| Rate for Payer: Sagamore Health Network All Products |
$13.75
|
| Rate for Payer: Signature Care EPO |
$14.78
|
| Rate for Payer: Signature Care PPO |
$15.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$14.03
|
| Rate for Payer: United Healthcare Medicare |
$5.88
|
|
|
HC RECOVERY PHASE 2 EA ADD MIN
|
Facility
IP
|
$17.81
|
|
| Hospital Charge Code |
01216653
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$15.39
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Cigna All Commercial |
$15.37
|
| Rate for Payer: CORVEL All Commercial |
$16.56
|
| Rate for Payer: Coventry All Commercial |
$15.67
|
| Rate for Payer: Encore All Commercial |
$16.39
|
| Rate for Payer: Frontpath All Commercial |
$16.38
|
| Rate for Payer: Humana ChoiceCare |
$15.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.03
|
| Rate for Payer: PHCS All Commercial |
$13.36
|
| Rate for Payer: PHP All Commercial |
$13.51
|
| Rate for Payer: Sagamore Health Network All Products |
$13.75
|
| Rate for Payer: Signature Care EPO |
$14.78
|
| Rate for Payer: Signature Care PPO |
$15.67
|
| Rate for Payer: United Healthcare Commercial |
$14.03
|
|
|
HC RECOVERY PHASE 2 INITIAL 30 MIN
|
Facility
IP
|
$460.87
|
|
| Hospital Charge Code |
01216652
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$345.65 |
| Max. Negotiated Rate |
$428.61 |
| Rate for Payer: Aetna Commercial |
$398.19
|
| Rate for Payer: Cash Price |
$285.74
|
| Rate for Payer: Cigna All Commercial |
$397.73
|
| Rate for Payer: CORVEL All Commercial |
$428.61
|
| Rate for Payer: Coventry All Commercial |
$405.56
|
| Rate for Payer: Encore All Commercial |
$424.23
|
| Rate for Payer: Frontpath All Commercial |
$424.00
|
| Rate for Payer: Humana ChoiceCare |
$398.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$414.78
|
| Rate for Payer: PHCS All Commercial |
$345.65
|
| Rate for Payer: PHP All Commercial |
$349.52
|
| Rate for Payer: Sagamore Health Network All Products |
$355.79
|
| Rate for Payer: Signature Care EPO |
$382.52
|
| Rate for Payer: Signature Care PPO |
$405.56
|
| Rate for Payer: United Healthcare Commercial |
$363.16
|
|
|
HC RECOVERY PHASE 2 INITIAL 30 MIN
|
Facility
OP
|
$460.87
|
|
| Hospital Charge Code |
01216652
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$152.09 |
| Max. Negotiated Rate |
$428.61 |
| Rate for Payer: Aetna Commercial |
$388.97
|
| Rate for Payer: Aetna Medicare |
$152.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$264.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$288.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$401.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$174.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.29
|
| Rate for Payer: Cash Price |
$285.74
|
| Rate for Payer: Cash Price |
$285.74
|
| Rate for Payer: Centivo All Commercial |
$235.04
|
| Rate for Payer: Cigna All Commercial |
$397.73
|
| Rate for Payer: CORVEL All Commercial |
$428.61
|
| Rate for Payer: Coventry All Commercial |
$405.56
|
| Rate for Payer: Encore All Commercial |
$424.23
|
| Rate for Payer: Frontpath All Commercial |
$424.00
|
| Rate for Payer: Humana ChoiceCare |
$398.05
|
| Rate for Payer: Humana Medicare |
$235.04
|
| Rate for Payer: Lucent All Commercial |
$235.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$414.78
|
| Rate for Payer: Managed Health Services Medicaid |
$401.86
|
| Rate for Payer: MDWise Medicaid |
$401.86
|
| Rate for Payer: PHCS All Commercial |
$345.65
|
| Rate for Payer: PHP All Commercial |
$349.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$179.74
|
| Rate for Payer: Sagamore Health Network All Products |
$355.79
|
| Rate for Payer: Signature Care EPO |
$382.52
|
| Rate for Payer: Signature Care PPO |
$405.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$391.74
|
| Rate for Payer: United Healthcare Commercial |
$363.16
|
| Rate for Payer: United Healthcare Medicare |
$152.09
|
|
|
HC RED CELL - LEUKOREDUCED
|
Facility
IP
|
$1,219.92
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
01370017
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$914.94 |
| Max. Negotiated Rate |
$1,134.53 |
| Rate for Payer: Aetna Commercial |
$1,054.01
|
| Rate for Payer: Cash Price |
$756.35
|
| Rate for Payer: Cigna All Commercial |
$1,052.79
|
| Rate for Payer: CORVEL All Commercial |
$1,134.53
|
| Rate for Payer: Coventry All Commercial |
$1,073.53
|
| Rate for Payer: Encore All Commercial |
$1,122.94
|
| Rate for Payer: Frontpath All Commercial |
$1,122.33
|
| Rate for Payer: Humana ChoiceCare |
$1,053.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,097.93
|
| Rate for Payer: PHCS All Commercial |
$914.94
|
| Rate for Payer: PHP All Commercial |
$925.19
|
| Rate for Payer: Sagamore Health Network All Products |
$941.78
|
| Rate for Payer: Signature Care EPO |
$1,012.53
|
| Rate for Payer: Signature Care PPO |
$1,073.53
|
| Rate for Payer: United Healthcare Commercial |
$961.30
|
|
|
HC RED CELL - LEUKOREDUCED
|
Facility
OP
|
$1,219.92
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
01370017
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$1,134.53 |
| Rate for Payer: Aetna Commercial |
$1,029.61
|
| Rate for Payer: Aetna Medicare |
$402.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$402.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$700.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$762.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$462.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$442.83
|
| Rate for Payer: Cash Price |
$756.35
|
| Rate for Payer: Cash Price |
$756.35
|
| Rate for Payer: Centivo All Commercial |
$622.16
|
| Rate for Payer: Cigna All Commercial |
$1,052.79
|
| Rate for Payer: CORVEL All Commercial |
$1,134.53
|
| Rate for Payer: Coventry All Commercial |
$1,073.53
|
| Rate for Payer: Encore All Commercial |
$1,122.94
|
| Rate for Payer: Frontpath All Commercial |
$1,122.33
|
| Rate for Payer: Humana ChoiceCare |
$1,053.64
|
| Rate for Payer: Humana Medicare |
$622.16
|
| Rate for Payer: Lucent All Commercial |
$622.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,097.93
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$914.94
|
| Rate for Payer: PHP All Commercial |
$925.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$475.77
|
| Rate for Payer: Sagamore Health Network All Products |
$941.78
|
| Rate for Payer: Signature Care EPO |
$1,012.53
|
| Rate for Payer: Signature Care PPO |
$1,073.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,036.93
|
| Rate for Payer: United Healthcare Commercial |
$961.30
|
| Rate for Payer: United Healthcare Medicare |
$402.57
|
|
|
HC REFLEX #2 MARIJUANA(THC) GCMS
|
Facility
OP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$127.74
|
| Rate for Payer: Aetna Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Centivo All Commercial |
$77.19
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Humana Medicare |
$77.19
|
| Rate for Payer: Lucent All Commercial |
$77.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.03
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.65
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
| Rate for Payer: United Healthcare Medicare |
$49.94
|
|
|
HC REFLEX #2 MARIJUANA(THC) GCMS
|
Facility
IP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$130.76
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
|
|
HC REFLEX #3 MARIJUANA(THC) GCMS
|
Facility
OP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$127.74
|
| Rate for Payer: Aetna Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Centivo All Commercial |
$77.19
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Humana Medicare |
$77.19
|
| Rate for Payer: Lucent All Commercial |
$77.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.03
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.65
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
| Rate for Payer: United Healthcare Medicare |
$49.94
|
|
|
HC REFLEX #3 MARIJUANA(THC) GCMS
|
Facility
IP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$130.76
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
|
|
HC REFLEX: ANTI-GM1 IGG TITER
|
Facility
OP
|
$191.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63044088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$177.86 |
| Rate for Payer: Aetna Commercial |
$161.42
|
| Rate for Payer: Aetna Medicare |
$63.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$109.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$119.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.42
|
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Centivo All Commercial |
$97.54
|
| Rate for Payer: Cigna All Commercial |
$165.05
|
| Rate for Payer: CORVEL All Commercial |
$177.86
|
| Rate for Payer: Coventry All Commercial |
$168.30
|
| Rate for Payer: Encore All Commercial |
$176.05
|
| Rate for Payer: Frontpath All Commercial |
$175.95
|
| Rate for Payer: Humana ChoiceCare |
$165.18
|
| Rate for Payer: Humana Medicare |
$97.54
|
| Rate for Payer: Lucent All Commercial |
$97.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.12
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$143.44
|
| Rate for Payer: PHP All Commercial |
$145.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$74.59
|
| Rate for Payer: Sagamore Health Network All Products |
$147.64
|
| Rate for Payer: Signature Care EPO |
$158.74
|
| Rate for Payer: Signature Care PPO |
$168.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$162.56
|
| Rate for Payer: United Healthcare Commercial |
$150.70
|
| Rate for Payer: United Healthcare Medicare |
$63.11
|
|
|
HC REFLEX: ANTI-GM1 IGG TITER
|
Facility
IP
|
$191.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63044088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.44 |
| Max. Negotiated Rate |
$177.86 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Cigna All Commercial |
$165.05
|
| Rate for Payer: CORVEL All Commercial |
$177.86
|
| Rate for Payer: Coventry All Commercial |
$168.30
|
| Rate for Payer: Encore All Commercial |
$176.05
|
| Rate for Payer: Frontpath All Commercial |
$175.95
|
| Rate for Payer: Humana ChoiceCare |
$165.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.12
|
| Rate for Payer: PHCS All Commercial |
$143.44
|
| Rate for Payer: PHP All Commercial |
$145.04
|
| Rate for Payer: Sagamore Health Network All Products |
$147.64
|
| Rate for Payer: Signature Care EPO |
$158.74
|
| Rate for Payer: Signature Care PPO |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$150.70
|
|
|
HC REFLEX: ANTI-GM1 IGM TITER
|
Facility
IP
|
$191.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63044089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.44 |
| Max. Negotiated Rate |
$177.86 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Cigna All Commercial |
$165.05
|
| Rate for Payer: CORVEL All Commercial |
$177.86
|
| Rate for Payer: Coventry All Commercial |
$168.30
|
| Rate for Payer: Encore All Commercial |
$176.05
|
| Rate for Payer: Frontpath All Commercial |
$175.95
|
| Rate for Payer: Humana ChoiceCare |
$165.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.12
|
| Rate for Payer: PHCS All Commercial |
$143.44
|
| Rate for Payer: PHP All Commercial |
$145.04
|
| Rate for Payer: Sagamore Health Network All Products |
$147.64
|
| Rate for Payer: Signature Care EPO |
$158.74
|
| Rate for Payer: Signature Care PPO |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$150.70
|
|
|
HC REFLEX: ANTI-GM1 IGM TITER
|
Facility
OP
|
$191.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63044089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$177.86 |
| Rate for Payer: Aetna Commercial |
$161.42
|
| Rate for Payer: Aetna Medicare |
$63.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$109.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$119.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.42
|
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Centivo All Commercial |
$97.54
|
| Rate for Payer: Cigna All Commercial |
$165.05
|
| Rate for Payer: CORVEL All Commercial |
$177.86
|
| Rate for Payer: Coventry All Commercial |
$168.30
|
| Rate for Payer: Encore All Commercial |
$176.05
|
| Rate for Payer: Frontpath All Commercial |
$175.95
|
| Rate for Payer: Humana ChoiceCare |
$165.18
|
| Rate for Payer: Humana Medicare |
$97.54
|
| Rate for Payer: Lucent All Commercial |
$97.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.12
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$143.44
|
| Rate for Payer: PHP All Commercial |
$145.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$74.59
|
| Rate for Payer: Sagamore Health Network All Products |
$147.64
|
| Rate for Payer: Signature Care EPO |
$158.74
|
| Rate for Payer: Signature Care PPO |
$168.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$162.56
|
| Rate for Payer: United Healthcare Commercial |
$150.70
|
| Rate for Payer: United Healthcare Medicare |
$63.11
|
|
|
HC REFLEX: BENZODIAZEPINES CONFIRMATION, BLOOD
|
Facility
IP
|
$91.80
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
|
|
HC REFLEX: BENZODIAZEPINES CONFIRMATION, BLOOD
|
Facility
OP
|
$91.80
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: Aetna Medicare |
$30.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.32
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Centivo All Commercial |
$46.82
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Humana Medicare |
$46.82
|
| Rate for Payer: Lucent All Commercial |
$46.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.80
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.03
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
| Rate for Payer: United Healthcare Medicare |
$30.29
|
|
|
HC REFLEX: CYTOTOXIN B PRODUCTION
|
Facility
OP
|
$90.27
|
|
|
Service Code
|
CPT 87230
|
| Hospital Charge Code |
63044087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$83.95 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare |
$29.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.77
|
| Rate for Payer: Cash Price |
$55.97
|
| Rate for Payer: Cash Price |
$55.97
|
| Rate for Payer: Centivo All Commercial |
$46.04
|
| Rate for Payer: Cigna All Commercial |
$77.90
|
| Rate for Payer: CORVEL All Commercial |
$83.95
|
| Rate for Payer: Coventry All Commercial |
$79.44
|
| Rate for Payer: Encore All Commercial |
$83.09
|
| Rate for Payer: Frontpath All Commercial |
$83.05
|
| Rate for Payer: Humana ChoiceCare |
$77.97
|
| Rate for Payer: Humana Medicare |
$46.04
|
| Rate for Payer: Lucent All Commercial |
$46.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.24
|
| Rate for Payer: Managed Health Services Medicaid |
$13.70
|
| Rate for Payer: MDWise Medicaid |
$13.70
|
| Rate for Payer: PHCS All Commercial |
$67.70
|
| Rate for Payer: PHP All Commercial |
$68.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.21
|
| Rate for Payer: Sagamore Health Network All Products |
$69.69
|
| Rate for Payer: Signature Care EPO |
$74.92
|
| Rate for Payer: Signature Care PPO |
$79.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.73
|
| Rate for Payer: United Healthcare Commercial |
$71.13
|
| Rate for Payer: United Healthcare Medicare |
$29.79
|
|
|
HC REFLEX: CYTOTOXIN B PRODUCTION
|
Facility
IP
|
$90.27
|
|
|
Service Code
|
CPT 87230
|
| Hospital Charge Code |
63044087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$83.95 |
| Rate for Payer: Aetna Commercial |
$77.99
|
| Rate for Payer: Cash Price |
$55.97
|
| Rate for Payer: Cigna All Commercial |
$77.90
|
| Rate for Payer: CORVEL All Commercial |
$83.95
|
| Rate for Payer: Coventry All Commercial |
$79.44
|
| Rate for Payer: Encore All Commercial |
$83.09
|
| Rate for Payer: Frontpath All Commercial |
$83.05
|
| Rate for Payer: Humana ChoiceCare |
$77.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.24
|
| Rate for Payer: PHCS All Commercial |
$67.70
|
| Rate for Payer: PHP All Commercial |
$68.46
|
| Rate for Payer: Sagamore Health Network All Products |
$69.69
|
| Rate for Payer: Signature Care EPO |
$74.92
|
| Rate for Payer: Signature Care PPO |
$79.44
|
| Rate for Payer: United Healthcare Commercial |
$71.13
|
|
|
HC REFLEX:JAK2 EXON 12, 13, 14 AND 15 MUTATION ANALYSIS
|
Facility
OP
|
$471.75
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
63044091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$438.73 |
| Rate for Payer: Aetna Commercial |
$398.16
|
| Rate for Payer: Aetna Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$270.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$185.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$179.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.25
|
| Rate for Payer: Cash Price |
$292.49
|
| Rate for Payer: Cash Price |
$292.49
|
| Rate for Payer: Centivo All Commercial |
$240.59
|
| Rate for Payer: Cigna All Commercial |
$407.12
|
| Rate for Payer: CORVEL All Commercial |
$438.73
|
| Rate for Payer: Coventry All Commercial |
$415.14
|
| Rate for Payer: Encore All Commercial |
$434.25
|
| Rate for Payer: Frontpath All Commercial |
$434.01
|
| Rate for Payer: Humana ChoiceCare |
$407.45
|
| Rate for Payer: Humana Medicare |
$240.59
|
| Rate for Payer: Lucent All Commercial |
$240.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.58
|
| Rate for Payer: Managed Health Services Medicaid |
$185.20
|
| Rate for Payer: MDWise Medicaid |
$185.20
|
| Rate for Payer: PHCS All Commercial |
$353.81
|
| Rate for Payer: PHP All Commercial |
$357.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$183.98
|
| Rate for Payer: Sagamore Health Network All Products |
$364.19
|
| Rate for Payer: Signature Care EPO |
$391.55
|
| Rate for Payer: Signature Care PPO |
$415.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.99
|
| Rate for Payer: United Healthcare Commercial |
$371.74
|
| Rate for Payer: United Healthcare Medicare |
$155.68
|
|
