|
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
|
|
|
HC REFLEX MARIJUANA(THC) GCMS
|
Facility
IP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001515
|
|
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 MARIJUANA(THC) GCMS
|
Facility
OP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001515
|
|
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 PROPOXYPHENE GCMS CONFIRM
|
Facility
OP
|
$179.11
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$166.57 |
| Rate for Payer: Aetna Commercial |
$151.17
|
| Rate for Payer: Aetna Medicare |
$59.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.02
|
| Rate for Payer: Cash Price |
$111.05
|
| Rate for Payer: Cash Price |
$111.05
|
| Rate for Payer: Centivo All Commercial |
$91.35
|
| Rate for Payer: Cigna All Commercial |
$154.57
|
| Rate for Payer: CORVEL All Commercial |
$166.57
|
| Rate for Payer: Coventry All Commercial |
$157.62
|
| Rate for Payer: Encore All Commercial |
$164.87
|
| Rate for Payer: Frontpath All Commercial |
$164.78
|
| Rate for Payer: Humana ChoiceCare |
$154.70
|
| Rate for Payer: Humana Medicare |
$91.35
|
| Rate for Payer: Lucent All Commercial |
$91.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.20
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$134.33
|
| Rate for Payer: PHP All Commercial |
$135.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.85
|
| Rate for Payer: Sagamore Health Network All Products |
$138.27
|
| Rate for Payer: Signature Care EPO |
$148.66
|
| Rate for Payer: Signature Care PPO |
$157.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$152.25
|
| Rate for Payer: United Healthcare Commercial |
$141.14
|
| Rate for Payer: United Healthcare Medicare |
$59.11
|
|
|
HC REFLEX PROPOXYPHENE GCMS CONFIRM
|
Facility
IP
|
$179.11
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.33 |
| Max. Negotiated Rate |
$166.57 |
| Rate for Payer: Aetna Commercial |
$154.75
|
| Rate for Payer: Cash Price |
$111.05
|
| Rate for Payer: Cigna All Commercial |
$154.57
|
| Rate for Payer: CORVEL All Commercial |
$166.57
|
| Rate for Payer: Coventry All Commercial |
$157.62
|
| Rate for Payer: Encore All Commercial |
$164.87
|
| Rate for Payer: Frontpath All Commercial |
$164.78
|
| Rate for Payer: Humana ChoiceCare |
$154.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.20
|
| Rate for Payer: PHCS All Commercial |
$134.33
|
| Rate for Payer: PHP All Commercial |
$135.84
|
| Rate for Payer: Sagamore Health Network All Products |
$138.27
|
| Rate for Payer: Signature Care EPO |
$148.66
|
| Rate for Payer: Signature Care PPO |
$157.62
|
| Rate for Payer: United Healthcare Commercial |
$141.14
|
|
|
HC REGIONAL ANESTH EA ADD MIN
|
Facility
OP
|
$14.03
|
|
| Hospital Charge Code |
01246653
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$11.84
|
| Rate for Payer: Aetna Medicare |
$4.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.09
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Centivo All Commercial |
$7.15
|
| Rate for Payer: Cigna All Commercial |
$12.10
|
| Rate for Payer: CORVEL All Commercial |
$13.04
|
| Rate for Payer: Coventry All Commercial |
$12.34
|
| Rate for Payer: Encore All Commercial |
$12.91
|
| Rate for Payer: Frontpath All Commercial |
$12.90
|
| Rate for Payer: Humana ChoiceCare |
$12.11
|
| Rate for Payer: Humana Medicare |
$7.15
|
| Rate for Payer: Lucent All Commercial |
$7.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.62
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$10.52
|
| Rate for Payer: PHP All Commercial |
$10.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.47
|
| Rate for Payer: Sagamore Health Network All Products |
$10.83
|
| Rate for Payer: Signature Care EPO |
$11.64
|
| Rate for Payer: Signature Care PPO |
$12.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.92
|
| Rate for Payer: United Healthcare Commercial |
$11.05
|
| Rate for Payer: United Healthcare Medicare |
$4.63
|
|
|
HC REGIONAL ANESTH EA ADD MIN
|
Facility
IP
|
$14.03
|
|
| Hospital Charge Code |
01246653
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$13.04 |
| Rate for Payer: Aetna Commercial |
$12.12
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna All Commercial |
$12.10
|
| Rate for Payer: CORVEL All Commercial |
$13.04
|
| Rate for Payer: Coventry All Commercial |
$12.34
|
| Rate for Payer: Encore All Commercial |
$12.91
|
| Rate for Payer: Frontpath All Commercial |
$12.90
|
| Rate for Payer: Humana ChoiceCare |
$12.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.62
|
| Rate for Payer: PHCS All Commercial |
$10.52
|
| Rate for Payer: PHP All Commercial |
$10.64
|
| Rate for Payer: Sagamore Health Network All Products |
$10.83
|
| Rate for Payer: Signature Care EPO |
$11.64
|
| Rate for Payer: Signature Care PPO |
$12.34
|
| Rate for Payer: United Healthcare Commercial |
$11.05
|
|
|
HC REGIONAL ANESTH INITIAL 15 MIN
|
Facility
IP
|
$209.90
|
|
| Hospital Charge Code |
01246652
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$157.42 |
| Max. Negotiated Rate |
$195.20 |
| Rate for Payer: Aetna Commercial |
$181.35
|
| Rate for Payer: Cash Price |
$130.14
|
| Rate for Payer: Cigna All Commercial |
$181.14
|
| Rate for Payer: CORVEL All Commercial |
$195.20
|
| Rate for Payer: Coventry All Commercial |
$184.71
|
| Rate for Payer: Encore All Commercial |
$193.21
|
| Rate for Payer: Frontpath All Commercial |
$193.10
|
| Rate for Payer: Humana ChoiceCare |
$181.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.91
|
| Rate for Payer: PHCS All Commercial |
$157.42
|
| Rate for Payer: PHP All Commercial |
$159.18
|
| Rate for Payer: Sagamore Health Network All Products |
$162.04
|
| Rate for Payer: Signature Care EPO |
$174.21
|
| Rate for Payer: Signature Care PPO |
$184.71
|
| Rate for Payer: United Healthcare Commercial |
$165.40
|
|
|
HC REGIONAL ANESTH INITIAL 15 MIN
|
Facility
OP
|
$209.90
|
|
| Hospital Charge Code |
01246652
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$69.27 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna Commercial |
$177.15
|
| Rate for Payer: Aetna Medicare |
$69.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.19
|
| Rate for Payer: Cash Price |
$130.14
|
| Rate for Payer: Cash Price |
$130.14
|
| Rate for Payer: Centivo All Commercial |
$107.05
|
| Rate for Payer: Cigna All Commercial |
$181.14
|
| Rate for Payer: CORVEL All Commercial |
$195.20
|
| Rate for Payer: Coventry All Commercial |
$184.71
|
| Rate for Payer: Encore All Commercial |
$193.21
|
| Rate for Payer: Frontpath All Commercial |
$193.10
|
| Rate for Payer: Humana ChoiceCare |
$181.29
|
| Rate for Payer: Humana Medicare |
$107.05
|
| Rate for Payer: Lucent All Commercial |
$107.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.91
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$157.42
|
| Rate for Payer: PHP All Commercial |
$159.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.86
|
| Rate for Payer: Sagamore Health Network All Products |
$162.04
|
| Rate for Payer: Signature Care EPO |
$174.21
|
| Rate for Payer: Signature Care PPO |
$184.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.41
|
| Rate for Payer: United Healthcare Commercial |
$165.40
|
| Rate for Payer: United Healthcare Medicare |
$69.27
|
|
|
HC REHAB SWALLOW STUDY (MBS)-SP
|
Facility
IP
|
$617.26
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
01748069
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$462.95 |
| Max. Negotiated Rate |
$574.05 |
| Rate for Payer: Aetna Commercial |
$533.32
|
| Rate for Payer: Cash Price |
$382.70
|
| Rate for Payer: Cigna All Commercial |
$532.70
|
| Rate for Payer: CORVEL All Commercial |
$574.05
|
| Rate for Payer: Coventry All Commercial |
$543.19
|
| Rate for Payer: Encore All Commercial |
$568.19
|
| Rate for Payer: Frontpath All Commercial |
$567.88
|
| Rate for Payer: Humana ChoiceCare |
$533.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.54
|
| Rate for Payer: PHCS All Commercial |
$462.95
|
| Rate for Payer: PHP All Commercial |
$468.13
|
| Rate for Payer: Sagamore Health Network All Products |
$476.53
|
| Rate for Payer: Signature Care EPO |
$512.33
|
| Rate for Payer: Signature Care PPO |
$543.19
|
| Rate for Payer: United Healthcare Commercial |
$486.40
|
|
|
HC REHAB SWALLOW STUDY (MBS)-SP
|
Facility
OP
|
$617.26
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
01748069
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$574.05 |
| Rate for Payer: Aetna Commercial |
$520.97
|
| Rate for Payer: Aetna Medicare |
$203.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$354.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$234.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$224.07
|
| Rate for Payer: Cash Price |
$382.70
|
| Rate for Payer: Centivo All Commercial |
$314.80
|
| Rate for Payer: Cigna All Commercial |
$532.70
|
| Rate for Payer: CORVEL All Commercial |
$574.05
|
| Rate for Payer: Coventry All Commercial |
$543.19
|
| Rate for Payer: Encore All Commercial |
$568.19
|
| Rate for Payer: Frontpath All Commercial |
$567.88
|
| Rate for Payer: Humana ChoiceCare |
$533.13
|
| Rate for Payer: Humana Medicare |
$314.80
|
| Rate for Payer: Lucent All Commercial |
$314.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.54
|
| Rate for Payer: PHCS All Commercial |
$462.95
|
| Rate for Payer: PHP All Commercial |
$468.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.73
|
| Rate for Payer: Sagamore Health Network All Products |
$476.53
|
| Rate for Payer: Signature Care EPO |
$512.33
|
| Rate for Payer: Signature Care PPO |
$543.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$524.67
|
| Rate for Payer: United Healthcare Commercial |
$486.40
|
| Rate for Payer: United Healthcare Medicare |
$203.70
|
|
|
HC RELIANCE EZ4 CONNECTOR TOOL
|
Facility
IP
|
$1,875.00
|
|
| Hospital Charge Code |
41607312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,406.25 |
| Max. Negotiated Rate |
$1,743.75 |
| Rate for Payer: Aetna Commercial |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna All Commercial |
$1,618.12
|
| Rate for Payer: CORVEL All Commercial |
$1,743.75
|
| Rate for Payer: Coventry All Commercial |
$1,650.00
|
| Rate for Payer: Encore All Commercial |
$1,725.94
|
| Rate for Payer: Frontpath All Commercial |
$1,725.00
|
| Rate for Payer: Humana ChoiceCare |
$1,619.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,687.50
|
| Rate for Payer: PHCS All Commercial |
$1,406.25
|
| Rate for Payer: PHP All Commercial |
$1,422.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,447.50
|
| Rate for Payer: Signature Care EPO |
$1,556.25
|
| Rate for Payer: Signature Care PPO |
$1,650.00
|
| Rate for Payer: United Healthcare Commercial |
$1,477.50
|
|
|
HC RELIANCE EZ4 CONNECTOR TOOL
|
Facility
OP
|
$1,875.00
|
|
| Hospital Charge Code |
41607312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,743.75 |
| Rate for Payer: Aetna Commercial |
$1,582.50
|
| Rate for Payer: Aetna Medicare |
$618.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$618.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,076.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,172.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$711.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$680.62
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Centivo All Commercial |
$956.25
|
| Rate for Payer: Cigna All Commercial |
$1,618.12
|
| Rate for Payer: CORVEL All Commercial |
$1,743.75
|
| Rate for Payer: Coventry All Commercial |
$1,650.00
|
| Rate for Payer: Encore All Commercial |
$1,725.94
|
| Rate for Payer: Frontpath All Commercial |
$1,725.00
|
| Rate for Payer: Humana ChoiceCare |
$1,619.44
|
| Rate for Payer: Humana Medicare |
$956.25
|
| Rate for Payer: Lucent All Commercial |
$956.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,687.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,406.25
|
| Rate for Payer: PHP All Commercial |
$1,422.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$731.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,447.50
|
| Rate for Payer: Signature Care EPO |
$1,556.25
|
| Rate for Payer: Signature Care PPO |
$1,650.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,593.75
|
| Rate for Payer: United Healthcare Commercial |
$1,477.50
|
| Rate for Payer: United Healthcare Medicare |
$618.75
|
|
|
HC RELOAD ENDO GIA 30-2.0
|
Facility
IP
|
$930.03
|
|
| Hospital Charge Code |
41601971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$697.52 |
| Max. Negotiated Rate |
$864.93 |
| Rate for Payer: Aetna Commercial |
$803.55
|
| Rate for Payer: Cash Price |
$576.62
|
| Rate for Payer: Cigna All Commercial |
$802.62
|
| Rate for Payer: CORVEL All Commercial |
$864.93
|
| Rate for Payer: Coventry All Commercial |
$818.43
|
| Rate for Payer: Encore All Commercial |
$856.09
|
| Rate for Payer: Frontpath All Commercial |
$855.63
|
| Rate for Payer: Humana ChoiceCare |
$803.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.03
|
| Rate for Payer: PHCS All Commercial |
$697.52
|
| Rate for Payer: PHP All Commercial |
$705.33
|
| Rate for Payer: Sagamore Health Network All Products |
$717.98
|
| Rate for Payer: Signature Care EPO |
$771.92
|
| Rate for Payer: Signature Care PPO |
$818.43
|
| Rate for Payer: United Healthcare Commercial |
$732.86
|
|
|
HC RELOAD ENDO GIA 30-2.0
|
Facility
OP
|
$930.03
|
|
| Hospital Charge Code |
41601971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$864.93 |
| Rate for Payer: Aetna Commercial |
$784.95
|
| Rate for Payer: Aetna Medicare |
$306.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$306.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$352.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.60
|
| Rate for Payer: Cash Price |
$576.62
|
| Rate for Payer: Cash Price |
$576.62
|
| Rate for Payer: Centivo All Commercial |
$474.32
|
| Rate for Payer: Cigna All Commercial |
$802.62
|
| Rate for Payer: CORVEL All Commercial |
$864.93
|
| Rate for Payer: Coventry All Commercial |
$818.43
|
| Rate for Payer: Encore All Commercial |
$856.09
|
| Rate for Payer: Frontpath All Commercial |
$855.63
|
| Rate for Payer: Humana ChoiceCare |
$803.27
|
| Rate for Payer: Humana Medicare |
$474.32
|
| Rate for Payer: Lucent All Commercial |
$474.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$697.52
|
| Rate for Payer: PHP All Commercial |
$705.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$362.71
|
| Rate for Payer: Sagamore Health Network All Products |
$717.98
|
| Rate for Payer: Signature Care EPO |
$771.92
|
| Rate for Payer: Signature Care PPO |
$818.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$790.53
|
| Rate for Payer: United Healthcare Commercial |
$732.86
|
| Rate for Payer: United Healthcare Medicare |
$306.91
|
|
|
HC RELOAD ENDO GIA 30-2.5
|
Facility
IP
|
$980.25
|
|
| Hospital Charge Code |
41601972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$735.19 |
| Max. Negotiated Rate |
$911.63 |
| Rate for Payer: Aetna Commercial |
$846.94
|
| Rate for Payer: Cash Price |
$607.76
|
| Rate for Payer: Cigna All Commercial |
$845.96
|
| Rate for Payer: CORVEL All Commercial |
$911.63
|
| Rate for Payer: Coventry All Commercial |
$862.62
|
| Rate for Payer: Encore All Commercial |
$902.32
|
| Rate for Payer: Frontpath All Commercial |
$901.83
|
| Rate for Payer: Humana ChoiceCare |
$846.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$882.22
|
| Rate for Payer: PHCS All Commercial |
$735.19
|
| Rate for Payer: PHP All Commercial |
$743.42
|
| Rate for Payer: Sagamore Health Network All Products |
$756.75
|
| Rate for Payer: Signature Care EPO |
$813.61
|
| Rate for Payer: Signature Care PPO |
$862.62
|
| Rate for Payer: United Healthcare Commercial |
$772.44
|
|
|
HC RELOAD ENDO GIA 30-2.5
|
Facility
OP
|
$980.25
|
|
| Hospital Charge Code |
41601972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$911.63 |
| Rate for Payer: Aetna Commercial |
$827.33
|
| Rate for Payer: Aetna Medicare |
$323.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$323.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$562.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$612.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$372.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$355.83
|
| Rate for Payer: Cash Price |
$607.76
|
| Rate for Payer: Cash Price |
$607.76
|
| Rate for Payer: Centivo All Commercial |
$499.93
|
| Rate for Payer: Cigna All Commercial |
$845.96
|
| Rate for Payer: CORVEL All Commercial |
$911.63
|
| Rate for Payer: Coventry All Commercial |
$862.62
|
| Rate for Payer: Encore All Commercial |
$902.32
|
| Rate for Payer: Frontpath All Commercial |
$901.83
|
| Rate for Payer: Humana ChoiceCare |
$846.64
|
| Rate for Payer: Humana Medicare |
$499.93
|
| Rate for Payer: Lucent All Commercial |
$499.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$882.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$735.19
|
| Rate for Payer: PHP All Commercial |
$743.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$382.30
|
| Rate for Payer: Sagamore Health Network All Products |
$756.75
|
| Rate for Payer: Signature Care EPO |
$813.61
|
| Rate for Payer: Signature Care PPO |
$862.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$833.21
|
| Rate for Payer: United Healthcare Commercial |
$772.44
|
| Rate for Payer: United Healthcare Medicare |
$323.48
|
|
|
HC RELOAD ENDO GIA 30-3.5
|
Facility
IP
|
$963.73
|
|
| Hospital Charge Code |
41602489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$722.80 |
| Max. Negotiated Rate |
$896.27 |
| Rate for Payer: Aetna Commercial |
$832.66
|
| Rate for Payer: Cash Price |
$597.51
|
| Rate for Payer: Cigna All Commercial |
$831.70
|
| Rate for Payer: CORVEL All Commercial |
$896.27
|
| Rate for Payer: Coventry All Commercial |
$848.08
|
| Rate for Payer: Encore All Commercial |
$887.11
|
| Rate for Payer: Frontpath All Commercial |
$886.63
|
| Rate for Payer: Humana ChoiceCare |
$832.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$867.36
|
| Rate for Payer: PHCS All Commercial |
$722.80
|
| Rate for Payer: PHP All Commercial |
$730.89
|
| Rate for Payer: Sagamore Health Network All Products |
$744.00
|
| Rate for Payer: Signature Care EPO |
$799.90
|
| Rate for Payer: Signature Care PPO |
$848.08
|
| Rate for Payer: United Healthcare Commercial |
$759.42
|
|
|
HC RELOAD ENDO GIA 30-3.5
|
Facility
OP
|
$963.73
|
|
| Hospital Charge Code |
41602489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$896.27 |
| Rate for Payer: Aetna Commercial |
$813.39
|
| Rate for Payer: Aetna Medicare |
$318.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$553.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$602.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.83
|
| Rate for Payer: Cash Price |
$597.51
|
| Rate for Payer: Cash Price |
$597.51
|
| Rate for Payer: Centivo All Commercial |
$491.50
|
| Rate for Payer: Cigna All Commercial |
$831.70
|
| Rate for Payer: CORVEL All Commercial |
$896.27
|
| Rate for Payer: Coventry All Commercial |
$848.08
|
| Rate for Payer: Encore All Commercial |
$887.11
|
| Rate for Payer: Frontpath All Commercial |
$886.63
|
| Rate for Payer: Humana ChoiceCare |
$832.37
|
| Rate for Payer: Humana Medicare |
$491.50
|
| Rate for Payer: Lucent All Commercial |
$491.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$867.36
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$722.80
|
| Rate for Payer: PHP All Commercial |
$730.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.85
|
| Rate for Payer: Sagamore Health Network All Products |
$744.00
|
| Rate for Payer: Signature Care EPO |
$799.90
|
| Rate for Payer: Signature Care PPO |
$848.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$819.17
|
| Rate for Payer: United Healthcare Commercial |
$759.42
|
| Rate for Payer: United Healthcare Medicare |
$318.03
|
|
|
HC RELOAD ENDO GIA 45-2.0
|
Facility
OP
|
$1,035.80
|
|
| Hospital Charge Code |
41601973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$963.29 |
| Rate for Payer: Aetna Commercial |
$874.22
|
| Rate for Payer: Aetna Medicare |
$341.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$341.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$594.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$647.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$393.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$376.00
|
| Rate for Payer: Cash Price |
$642.20
|
| Rate for Payer: Cash Price |
$642.20
|
| Rate for Payer: Centivo All Commercial |
$528.26
|
| Rate for Payer: Cigna All Commercial |
$893.90
|
| Rate for Payer: CORVEL All Commercial |
$963.29
|
| Rate for Payer: Coventry All Commercial |
$911.50
|
| Rate for Payer: Encore All Commercial |
$953.45
|
| Rate for Payer: Frontpath All Commercial |
$952.94
|
| Rate for Payer: Humana ChoiceCare |
$894.62
|
| Rate for Payer: Humana Medicare |
$528.26
|
| Rate for Payer: Lucent All Commercial |
$528.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$932.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$776.85
|
| Rate for Payer: PHP All Commercial |
$785.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$403.96
|
| Rate for Payer: Sagamore Health Network All Products |
$799.64
|
| Rate for Payer: Signature Care EPO |
$859.71
|
| Rate for Payer: Signature Care PPO |
$911.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$880.43
|
| Rate for Payer: United Healthcare Commercial |
$816.21
|
| Rate for Payer: United Healthcare Medicare |
$341.81
|
|
|
HC RELOAD ENDO GIA 45-2.0
|
Facility
IP
|
$1,035.80
|
|
| Hospital Charge Code |
41601973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.85 |
| Max. Negotiated Rate |
$963.29 |
| Rate for Payer: Aetna Commercial |
$894.93
|
| Rate for Payer: Cash Price |
$642.20
|
| Rate for Payer: Cigna All Commercial |
$893.90
|
| Rate for Payer: CORVEL All Commercial |
$963.29
|
| Rate for Payer: Coventry All Commercial |
$911.50
|
| Rate for Payer: Encore All Commercial |
$953.45
|
| Rate for Payer: Frontpath All Commercial |
$952.94
|
| Rate for Payer: Humana ChoiceCare |
$894.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$932.22
|
| Rate for Payer: PHCS All Commercial |
$776.85
|
| Rate for Payer: PHP All Commercial |
$785.55
|
| Rate for Payer: Sagamore Health Network All Products |
$799.64
|
| Rate for Payer: Signature Care EPO |
$859.71
|
| Rate for Payer: Signature Care PPO |
$911.50
|
| Rate for Payer: United Healthcare Commercial |
$816.21
|
|
|
HC RELOAD ENDO GIA 45-2.5
|
Facility
OP
|
$1,062.86
|
|
| Hospital Charge Code |
41601974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$988.46 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Aetna Medicare |
$350.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$350.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$610.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$664.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$403.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$385.82
|
| Rate for Payer: Cash Price |
$658.97
|
| Rate for Payer: Cash Price |
$658.97
|
| Rate for Payer: Centivo All Commercial |
$542.06
|
| Rate for Payer: Cigna All Commercial |
$917.25
|
| Rate for Payer: CORVEL All Commercial |
$988.46
|
| Rate for Payer: Coventry All Commercial |
$935.32
|
| Rate for Payer: Encore All Commercial |
$978.36
|
| Rate for Payer: Frontpath All Commercial |
$977.83
|
| Rate for Payer: Humana ChoiceCare |
$917.99
|
| Rate for Payer: Humana Medicare |
$542.06
|
| Rate for Payer: Lucent All Commercial |
$542.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$956.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$797.14
|
| Rate for Payer: PHP All Commercial |
$806.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$414.52
|
| Rate for Payer: Sagamore Health Network All Products |
$820.53
|
| Rate for Payer: Signature Care EPO |
$882.17
|
| Rate for Payer: Signature Care PPO |
$935.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$903.43
|
| Rate for Payer: United Healthcare Commercial |
$837.53
|
| Rate for Payer: United Healthcare Medicare |
$350.74
|
|
|
HC RELOAD ENDO GIA 45-2.5
|
Facility
IP
|
$1,062.86
|
|
| Hospital Charge Code |
41601974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$797.14 |
| Max. Negotiated Rate |
$988.46 |
| Rate for Payer: Aetna Commercial |
$918.31
|
| Rate for Payer: Cash Price |
$658.97
|
| Rate for Payer: Cigna All Commercial |
$917.25
|
| Rate for Payer: CORVEL All Commercial |
$988.46
|
| Rate for Payer: Coventry All Commercial |
$935.32
|
| Rate for Payer: Encore All Commercial |
$978.36
|
| Rate for Payer: Frontpath All Commercial |
$977.83
|
| Rate for Payer: Humana ChoiceCare |
$917.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$956.57
|
| Rate for Payer: PHCS All Commercial |
$797.14
|
| Rate for Payer: PHP All Commercial |
$806.07
|
| Rate for Payer: Sagamore Health Network All Products |
$820.53
|
| Rate for Payer: Signature Care EPO |
$882.17
|
| Rate for Payer: Signature Care PPO |
$935.32
|
| Rate for Payer: United Healthcare Commercial |
$837.53
|
|
|
HC RELOAD ENDO GIA 45-3.5
|
Facility
IP
|
$1,103.43
|
|
| Hospital Charge Code |
41601975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.57 |
| Max. Negotiated Rate |
$1,026.19 |
| Rate for Payer: Aetna Commercial |
$953.36
|
| Rate for Payer: Cash Price |
$684.13
|
| Rate for Payer: Cigna All Commercial |
$952.26
|
| Rate for Payer: CORVEL All Commercial |
$1,026.19
|
| Rate for Payer: Coventry All Commercial |
$971.02
|
| Rate for Payer: Encore All Commercial |
$1,015.71
|
| Rate for Payer: Frontpath All Commercial |
$1,015.16
|
| Rate for Payer: Humana ChoiceCare |
$953.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.09
|
| Rate for Payer: PHCS All Commercial |
$827.57
|
| Rate for Payer: PHP All Commercial |
$836.84
|
| Rate for Payer: Sagamore Health Network All Products |
$851.85
|
| Rate for Payer: Signature Care EPO |
$915.85
|
| Rate for Payer: Signature Care PPO |
$971.02
|
| Rate for Payer: United Healthcare Commercial |
$869.50
|
|
|
HC RELOAD ENDO GIA 45-3.5
|
Facility
OP
|
$1,103.43
|
|
| Hospital Charge Code |
41601975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,026.19 |
| Rate for Payer: Aetna Commercial |
$931.29
|
| Rate for Payer: Aetna Medicare |
$364.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$364.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$633.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$689.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$418.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$400.55
|
| Rate for Payer: Cash Price |
$684.13
|
| Rate for Payer: Cash Price |
$684.13
|
| Rate for Payer: Centivo All Commercial |
$562.75
|
| Rate for Payer: Cigna All Commercial |
$952.26
|
| Rate for Payer: CORVEL All Commercial |
$1,026.19
|
| Rate for Payer: Coventry All Commercial |
$971.02
|
| Rate for Payer: Encore All Commercial |
$1,015.71
|
| Rate for Payer: Frontpath All Commercial |
$1,015.16
|
| Rate for Payer: Humana ChoiceCare |
$953.03
|
| Rate for Payer: Humana Medicare |
$562.75
|
| Rate for Payer: Lucent All Commercial |
$562.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$827.57
|
| Rate for Payer: PHP All Commercial |
$836.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$430.34
|
| Rate for Payer: Sagamore Health Network All Products |
$851.85
|
| Rate for Payer: Signature Care EPO |
$915.85
|
| Rate for Payer: Signature Care PPO |
$971.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$937.92
|
| Rate for Payer: United Healthcare Commercial |
$869.50
|
| Rate for Payer: United Healthcare Medicare |
$364.13
|
|
