|
HC RESOLUTION ULTRA 17MM
|
Facility
OP
|
$1,127.85
|
|
| Hospital Charge Code |
41608201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Aetna Commercial |
$951.91
|
| Rate for Payer: Aetna Medicare |
$372.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$372.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$647.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$705.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$428.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$409.41
|
| Rate for Payer: Cash Price |
$699.27
|
| Rate for Payer: Cash Price |
$699.27
|
| Rate for Payer: Centivo All Commercial |
$575.20
|
| Rate for Payer: Cigna All Commercial |
$973.33
|
| Rate for Payer: CORVEL All Commercial |
$1,048.90
|
| Rate for Payer: Coventry All Commercial |
$992.51
|
| Rate for Payer: Encore All Commercial |
$1,038.19
|
| Rate for Payer: Frontpath All Commercial |
$1,037.62
|
| Rate for Payer: Humana ChoiceCare |
$974.12
|
| Rate for Payer: Humana Medicare |
$575.20
|
| Rate for Payer: Lucent All Commercial |
$575.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,015.06
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$845.89
|
| Rate for Payer: PHP All Commercial |
$855.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$439.86
|
| Rate for Payer: Sagamore Health Network All Products |
$870.70
|
| Rate for Payer: Signature Care EPO |
$936.12
|
| Rate for Payer: Signature Care PPO |
$992.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$958.67
|
| Rate for Payer: United Healthcare Commercial |
$888.75
|
| Rate for Payer: United Healthcare Medicare |
$372.19
|
|
|
HC RESOLUTION ULTRA 17MM
|
Facility
IP
|
$1,127.85
|
|
| Hospital Charge Code |
41608201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.89 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Aetna Commercial |
$974.46
|
| Rate for Payer: Cash Price |
$699.27
|
| Rate for Payer: Cigna All Commercial |
$973.33
|
| Rate for Payer: CORVEL All Commercial |
$1,048.90
|
| Rate for Payer: Coventry All Commercial |
$992.51
|
| Rate for Payer: Encore All Commercial |
$1,038.19
|
| Rate for Payer: Frontpath All Commercial |
$1,037.62
|
| Rate for Payer: Humana ChoiceCare |
$974.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,015.06
|
| Rate for Payer: PHCS All Commercial |
$845.89
|
| Rate for Payer: PHP All Commercial |
$855.36
|
| Rate for Payer: Sagamore Health Network All Products |
$870.70
|
| Rate for Payer: Signature Care EPO |
$936.12
|
| Rate for Payer: Signature Care PPO |
$992.51
|
| Rate for Payer: United Healthcare Commercial |
$888.75
|
|
|
HC RESPIRATORY PATHOGENS PANEL - QUAL-PCR
|
Facility
IP
|
$1,082.73
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
63002049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$812.05 |
| Max. Negotiated Rate |
$1,006.94 |
| Rate for Payer: Aetna Commercial |
$935.48
|
| Rate for Payer: Cash Price |
$671.29
|
| Rate for Payer: Cigna All Commercial |
$934.40
|
| Rate for Payer: CORVEL All Commercial |
$1,006.94
|
| Rate for Payer: Coventry All Commercial |
$952.80
|
| Rate for Payer: Encore All Commercial |
$996.65
|
| Rate for Payer: Frontpath All Commercial |
$996.11
|
| Rate for Payer: Humana ChoiceCare |
$935.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$974.46
|
| Rate for Payer: PHCS All Commercial |
$812.05
|
| Rate for Payer: PHP All Commercial |
$821.14
|
| Rate for Payer: Sagamore Health Network All Products |
$835.87
|
| Rate for Payer: Signature Care EPO |
$898.67
|
| Rate for Payer: Signature Care PPO |
$952.80
|
| Rate for Payer: United Healthcare Commercial |
$853.19
|
|
|
HC RESPIRATORY PATHOGENS PANEL - QUAL-PCR
|
Facility
OP
|
$1,082.73
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
63002049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$357.30 |
| Max. Negotiated Rate |
$1,006.94 |
| Rate for Payer: Aetna Commercial |
$913.82
|
| Rate for Payer: Aetna Medicare |
$357.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$357.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$621.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$676.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$416.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$410.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$393.03
|
| Rate for Payer: Cash Price |
$671.29
|
| Rate for Payer: Cash Price |
$671.29
|
| Rate for Payer: Centivo All Commercial |
$552.19
|
| Rate for Payer: Cigna All Commercial |
$934.40
|
| Rate for Payer: CORVEL All Commercial |
$1,006.94
|
| Rate for Payer: Coventry All Commercial |
$952.80
|
| Rate for Payer: Encore All Commercial |
$996.65
|
| Rate for Payer: Frontpath All Commercial |
$996.11
|
| Rate for Payer: Humana ChoiceCare |
$935.15
|
| Rate for Payer: Humana Medicare |
$552.19
|
| Rate for Payer: Lucent All Commercial |
$552.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$974.46
|
| Rate for Payer: Managed Health Services Medicaid |
$416.78
|
| Rate for Payer: MDWise Medicaid |
$416.78
|
| Rate for Payer: PHCS All Commercial |
$812.05
|
| Rate for Payer: PHP All Commercial |
$821.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$422.26
|
| Rate for Payer: Sagamore Health Network All Products |
$835.87
|
| Rate for Payer: Signature Care EPO |
$898.67
|
| Rate for Payer: Signature Care PPO |
$952.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$920.32
|
| Rate for Payer: United Healthcare Commercial |
$853.19
|
| Rate for Payer: United Healthcare Medicare |
$357.30
|
|
|
HC RESULT PMPA FENTANYL QT
|
Facility
OP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001516
|
|
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 RESULT PMPA FENTANYL QT
|
Facility
IP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001516
|
|
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 RESULT TRAMADOL QT
|
Facility
OP
|
$147.12
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$136.83 |
| Rate for Payer: Aetna Commercial |
$124.17
|
| Rate for Payer: Aetna Medicare |
$48.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$84.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.41
|
| Rate for Payer: Cash Price |
$91.22
|
| Rate for Payer: Cash Price |
$91.22
|
| Rate for Payer: Centivo All Commercial |
$75.03
|
| Rate for Payer: Cigna All Commercial |
$126.97
|
| Rate for Payer: CORVEL All Commercial |
$136.83
|
| Rate for Payer: Coventry All Commercial |
$129.47
|
| Rate for Payer: Encore All Commercial |
$135.43
|
| Rate for Payer: Frontpath All Commercial |
$135.35
|
| Rate for Payer: Humana ChoiceCare |
$127.07
|
| Rate for Payer: Humana Medicare |
$75.03
|
| Rate for Payer: Lucent All Commercial |
$75.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.41
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$110.34
|
| Rate for Payer: PHP All Commercial |
$111.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.38
|
| Rate for Payer: Sagamore Health Network All Products |
$113.58
|
| Rate for Payer: Signature Care EPO |
$122.11
|
| Rate for Payer: Signature Care PPO |
$129.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$125.06
|
| Rate for Payer: United Healthcare Commercial |
$115.93
|
| Rate for Payer: United Healthcare Medicare |
$48.55
|
|
|
HC RESULT TRAMADOL QT
|
Facility
IP
|
$147.12
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.34 |
| Max. Negotiated Rate |
$136.83 |
| Rate for Payer: Aetna Commercial |
$127.12
|
| Rate for Payer: Cash Price |
$91.22
|
| Rate for Payer: Cigna All Commercial |
$126.97
|
| Rate for Payer: CORVEL All Commercial |
$136.83
|
| Rate for Payer: Coventry All Commercial |
$129.47
|
| Rate for Payer: Encore All Commercial |
$135.43
|
| Rate for Payer: Frontpath All Commercial |
$135.35
|
| Rate for Payer: Humana ChoiceCare |
$127.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.41
|
| Rate for Payer: PHCS All Commercial |
$110.34
|
| Rate for Payer: PHP All Commercial |
$111.58
|
| Rate for Payer: Sagamore Health Network All Products |
$113.58
|
| Rate for Payer: Signature Care EPO |
$122.11
|
| Rate for Payer: Signature Care PPO |
$129.47
|
| Rate for Payer: United Healthcare Commercial |
$115.93
|
|
|
HC RESUSCITATOR/AMBU BAG ADULT
|
Facility
OP
|
$199.56
|
|
| Hospital Charge Code |
41601213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.85 |
| Max. Negotiated Rate |
$185.59 |
| Rate for Payer: Aetna Commercial |
$168.43
|
| Rate for Payer: Aetna Medicare |
$65.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$114.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.44
|
| Rate for Payer: Cash Price |
$123.73
|
| Rate for Payer: Cash Price |
$123.73
|
| Rate for Payer: Centivo All Commercial |
$101.78
|
| Rate for Payer: Cigna All Commercial |
$172.22
|
| Rate for Payer: CORVEL All Commercial |
$185.59
|
| Rate for Payer: Coventry All Commercial |
$175.61
|
| Rate for Payer: Encore All Commercial |
$183.69
|
| Rate for Payer: Frontpath All Commercial |
$183.60
|
| Rate for Payer: Humana ChoiceCare |
$172.36
|
| Rate for Payer: Humana Medicare |
$101.78
|
| Rate for Payer: Lucent All Commercial |
$101.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.60
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$149.67
|
| Rate for Payer: PHP All Commercial |
$151.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.83
|
| Rate for Payer: Sagamore Health Network All Products |
$154.06
|
| Rate for Payer: Signature Care EPO |
$165.63
|
| Rate for Payer: Signature Care PPO |
$175.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$169.63
|
| Rate for Payer: United Healthcare Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare |
$65.85
|
|
|
HC RESUSCITATOR/AMBU BAG ADULT
|
Facility
IP
|
$199.56
|
|
| Hospital Charge Code |
41601213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.67 |
| Max. Negotiated Rate |
$185.59 |
| Rate for Payer: Aetna Commercial |
$172.42
|
| Rate for Payer: Cash Price |
$123.73
|
| Rate for Payer: Cigna All Commercial |
$172.22
|
| Rate for Payer: CORVEL All Commercial |
$185.59
|
| Rate for Payer: Coventry All Commercial |
$175.61
|
| Rate for Payer: Encore All Commercial |
$183.69
|
| Rate for Payer: Frontpath All Commercial |
$183.60
|
| Rate for Payer: Humana ChoiceCare |
$172.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.60
|
| Rate for Payer: PHCS All Commercial |
$149.67
|
| Rate for Payer: PHP All Commercial |
$151.35
|
| Rate for Payer: Sagamore Health Network All Products |
$154.06
|
| Rate for Payer: Signature Care EPO |
$165.63
|
| Rate for Payer: Signature Care PPO |
$175.61
|
| Rate for Payer: United Healthcare Commercial |
$157.25
|
|
|
HC RETIC-AUTOMATED
|
Facility
OP
|
$108.73
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
63001044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Aetna Commercial |
$91.77
|
| Rate for Payer: Aetna Medicare |
$35.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.47
|
| Rate for Payer: Cash Price |
$67.41
|
| Rate for Payer: Cash Price |
$67.41
|
| Rate for Payer: Centivo All Commercial |
$55.45
|
| Rate for Payer: Cigna All Commercial |
$93.84
|
| Rate for Payer: CORVEL All Commercial |
$101.12
|
| Rate for Payer: Coventry All Commercial |
$95.68
|
| Rate for Payer: Encore All Commercial |
$100.09
|
| Rate for Payer: Frontpath All Commercial |
$100.03
|
| Rate for Payer: Humana ChoiceCare |
$93.91
|
| Rate for Payer: Humana Medicare |
$55.45
|
| Rate for Payer: Lucent All Commercial |
$55.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.86
|
| Rate for Payer: Managed Health Services Medicaid |
$3.99
|
| Rate for Payer: MDWise Medicaid |
$3.99
|
| Rate for Payer: PHCS All Commercial |
$81.55
|
| Rate for Payer: PHP All Commercial |
$82.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.41
|
| Rate for Payer: Sagamore Health Network All Products |
$83.94
|
| Rate for Payer: Signature Care EPO |
$90.25
|
| Rate for Payer: Signature Care PPO |
$95.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.42
|
| Rate for Payer: United Healthcare Commercial |
$85.68
|
| Rate for Payer: United Healthcare Medicare |
$35.88
|
|
|
HC RETIC-AUTOMATED
|
Facility
IP
|
$108.73
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
63001044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Cash Price |
$67.41
|
| Rate for Payer: Cigna All Commercial |
$93.84
|
| Rate for Payer: CORVEL All Commercial |
$101.12
|
| Rate for Payer: Coventry All Commercial |
$95.68
|
| Rate for Payer: Encore All Commercial |
$100.09
|
| Rate for Payer: Frontpath All Commercial |
$100.03
|
| Rate for Payer: Humana ChoiceCare |
$93.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.86
|
| Rate for Payer: PHCS All Commercial |
$81.55
|
| Rate for Payer: PHP All Commercial |
$82.46
|
| Rate for Payer: Sagamore Health Network All Products |
$83.94
|
| Rate for Payer: Signature Care EPO |
$90.25
|
| Rate for Payer: Signature Care PPO |
$95.68
|
| Rate for Payer: United Healthcare Commercial |
$85.68
|
|
|
HC RETICULIN AB IGA
|
Facility
OP
|
$157.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna Commercial |
$132.56
|
| Rate for Payer: Aetna Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.01
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Centivo All Commercial |
$80.10
|
| Rate for Payer: Cigna All Commercial |
$135.54
|
| Rate for Payer: CORVEL All Commercial |
$146.07
|
| Rate for Payer: Coventry All Commercial |
$138.21
|
| Rate for Payer: Encore All Commercial |
$144.57
|
| Rate for Payer: Frontpath All Commercial |
$144.49
|
| Rate for Payer: Humana ChoiceCare |
$135.65
|
| Rate for Payer: Humana Medicare |
$80.10
|
| Rate for Payer: Lucent All Commercial |
$80.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.35
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$117.79
|
| Rate for Payer: PHP All Commercial |
$119.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.25
|
| Rate for Payer: Sagamore Health Network All Products |
$121.25
|
| Rate for Payer: Signature Care EPO |
$130.36
|
| Rate for Payer: Signature Care PPO |
$138.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.50
|
| Rate for Payer: United Healthcare Commercial |
$123.76
|
| Rate for Payer: United Healthcare Medicare |
$51.83
|
|
|
HC RETICULIN AB IGA
|
Facility
IP
|
$157.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.79 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna Commercial |
$135.70
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cigna All Commercial |
$135.54
|
| Rate for Payer: CORVEL All Commercial |
$146.07
|
| Rate for Payer: Coventry All Commercial |
$138.21
|
| Rate for Payer: Encore All Commercial |
$144.57
|
| Rate for Payer: Frontpath All Commercial |
$144.49
|
| Rate for Payer: Humana ChoiceCare |
$135.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.35
|
| Rate for Payer: PHCS All Commercial |
$117.79
|
| Rate for Payer: PHP All Commercial |
$119.11
|
| Rate for Payer: Sagamore Health Network All Products |
$121.25
|
| Rate for Payer: Signature Care EPO |
$130.36
|
| Rate for Payer: Signature Care PPO |
$138.21
|
| Rate for Payer: United Healthcare Commercial |
$123.76
|
|
|
HC RETICULIN AB IGG
|
Facility
OP
|
$156.35
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$145.40 |
| Rate for Payer: Aetna Commercial |
$131.96
|
| Rate for Payer: Aetna Medicare |
$51.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.75
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Centivo All Commercial |
$79.74
|
| Rate for Payer: Cigna All Commercial |
$134.93
|
| Rate for Payer: CORVEL All Commercial |
$145.40
|
| Rate for Payer: Coventry All Commercial |
$137.58
|
| Rate for Payer: Encore All Commercial |
$143.92
|
| Rate for Payer: Frontpath All Commercial |
$143.84
|
| Rate for Payer: Humana ChoiceCare |
$135.04
|
| Rate for Payer: Humana Medicare |
$79.74
|
| Rate for Payer: Lucent All Commercial |
$79.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.71
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$117.26
|
| Rate for Payer: PHP All Commercial |
$118.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.97
|
| Rate for Payer: Sagamore Health Network All Products |
$120.70
|
| Rate for Payer: Signature Care EPO |
$129.77
|
| Rate for Payer: Signature Care PPO |
$137.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.89
|
| Rate for Payer: United Healthcare Commercial |
$123.20
|
| Rate for Payer: United Healthcare Medicare |
$51.59
|
|
|
HC RETICULIN AB IGG
|
Facility
IP
|
$156.35
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.26 |
| Max. Negotiated Rate |
$145.40 |
| Rate for Payer: Aetna Commercial |
$135.08
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Cigna All Commercial |
$134.93
|
| Rate for Payer: CORVEL All Commercial |
$145.40
|
| Rate for Payer: Coventry All Commercial |
$137.58
|
| Rate for Payer: Encore All Commercial |
$143.92
|
| Rate for Payer: Frontpath All Commercial |
$143.84
|
| Rate for Payer: Humana ChoiceCare |
$135.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.71
|
| Rate for Payer: PHCS All Commercial |
$117.26
|
| Rate for Payer: PHP All Commercial |
$118.57
|
| Rate for Payer: Sagamore Health Network All Products |
$120.70
|
| Rate for Payer: Signature Care EPO |
$129.77
|
| Rate for Payer: Signature Care PPO |
$137.58
|
| Rate for Payer: United Healthcare Commercial |
$123.20
|
|
|
HC RETICULIN IGA TITER
|
Facility
OP
|
$219.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Aetna Commercial |
$184.87
|
| Rate for Payer: Aetna Medicare |
$72.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.51
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Centivo All Commercial |
$111.71
|
| Rate for Payer: Cigna All Commercial |
$189.03
|
| Rate for Payer: CORVEL All Commercial |
$203.70
|
| Rate for Payer: Coventry All Commercial |
$192.75
|
| Rate for Payer: Encore All Commercial |
$201.62
|
| Rate for Payer: Frontpath All Commercial |
$201.51
|
| Rate for Payer: Humana ChoiceCare |
$189.18
|
| Rate for Payer: Humana Medicare |
$111.71
|
| Rate for Payer: Lucent All Commercial |
$111.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.13
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$164.28
|
| Rate for Payer: PHP All Commercial |
$166.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.42
|
| Rate for Payer: Sagamore Health Network All Products |
$169.09
|
| Rate for Payer: Signature Care EPO |
$181.80
|
| Rate for Payer: Signature Care PPO |
$192.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$186.18
|
| Rate for Payer: United Healthcare Commercial |
$172.60
|
| Rate for Payer: United Healthcare Medicare |
$72.28
|
|
|
HC RETICULIN IGA TITER
|
Facility
IP
|
$219.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.28 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Aetna Commercial |
$189.25
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cigna All Commercial |
$189.03
|
| Rate for Payer: CORVEL All Commercial |
$203.70
|
| Rate for Payer: Coventry All Commercial |
$192.75
|
| Rate for Payer: Encore All Commercial |
$201.62
|
| Rate for Payer: Frontpath All Commercial |
$201.51
|
| Rate for Payer: Humana ChoiceCare |
$189.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.13
|
| Rate for Payer: PHCS All Commercial |
$164.28
|
| Rate for Payer: PHP All Commercial |
$166.12
|
| Rate for Payer: Sagamore Health Network All Products |
$169.09
|
| Rate for Payer: Signature Care EPO |
$181.80
|
| Rate for Payer: Signature Care PPO |
$192.75
|
| Rate for Payer: United Healthcare Commercial |
$172.60
|
|
|
HC RETICULOCYTE COUNT
|
Facility
OP
|
$103.20
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
63001045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$95.98 |
| Rate for Payer: Aetna Commercial |
$87.10
|
| Rate for Payer: Aetna Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.46
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Centivo All Commercial |
$52.63
|
| Rate for Payer: Cigna All Commercial |
$89.06
|
| Rate for Payer: CORVEL All Commercial |
$95.98
|
| Rate for Payer: Coventry All Commercial |
$90.82
|
| Rate for Payer: Encore All Commercial |
$95.00
|
| Rate for Payer: Frontpath All Commercial |
$94.95
|
| Rate for Payer: Humana ChoiceCare |
$89.14
|
| Rate for Payer: Humana Medicare |
$52.63
|
| Rate for Payer: Lucent All Commercial |
$52.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.88
|
| Rate for Payer: Managed Health Services Medicaid |
$3.99
|
| Rate for Payer: MDWise Medicaid |
$3.99
|
| Rate for Payer: PHCS All Commercial |
$77.40
|
| Rate for Payer: PHP All Commercial |
$78.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.25
|
| Rate for Payer: Sagamore Health Network All Products |
$79.67
|
| Rate for Payer: Signature Care EPO |
$85.66
|
| Rate for Payer: Signature Care PPO |
$90.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.72
|
| Rate for Payer: United Healthcare Commercial |
$81.32
|
| Rate for Payer: United Healthcare Medicare |
$34.06
|
|
|
HC RETICULOCYTE COUNT
|
Facility
IP
|
$103.20
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
63001045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$95.98 |
| Rate for Payer: Aetna Commercial |
$89.17
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Cigna All Commercial |
$89.06
|
| Rate for Payer: CORVEL All Commercial |
$95.98
|
| Rate for Payer: Coventry All Commercial |
$90.82
|
| Rate for Payer: Encore All Commercial |
$95.00
|
| Rate for Payer: Frontpath All Commercial |
$94.95
|
| Rate for Payer: Humana ChoiceCare |
$89.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.88
|
| Rate for Payer: PHCS All Commercial |
$77.40
|
| Rate for Payer: PHP All Commercial |
$78.27
|
| Rate for Payer: Sagamore Health Network All Products |
$79.67
|
| Rate for Payer: Signature Care EPO |
$85.66
|
| Rate for Payer: Signature Care PPO |
$90.82
|
| Rate for Payer: United Healthcare Commercial |
$81.32
|
|
|
HC RETRACTOR ALEXIS
|
Facility
OP
|
$455.00
|
|
| Hospital Charge Code |
41601983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$384.02
|
| Rate for Payer: Aetna Medicare |
$150.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$261.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$284.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.16
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Centivo All Commercial |
$232.05
|
| Rate for Payer: Cigna All Commercial |
$392.66
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Humana Medicare |
$232.05
|
| Rate for Payer: Lucent All Commercial |
$232.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$177.45
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$386.75
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
| Rate for Payer: United Healthcare Medicare |
$150.15
|
|
|
HC RETRACTOR ALEXIS
|
Facility
IP
|
$455.00
|
|
| Hospital Charge Code |
41601983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Cigna All Commercial |
$392.66
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
|
|
HC RETRACTOR DEXTRUS MED
|
Facility
IP
|
$315.00
|
|
| Hospital Charge Code |
41602303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$272.16
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna All Commercial |
$271.84
|
| Rate for Payer: CORVEL All Commercial |
$292.95
|
| Rate for Payer: Coventry All Commercial |
$277.20
|
| Rate for Payer: Encore All Commercial |
$289.96
|
| Rate for Payer: Frontpath All Commercial |
$289.80
|
| Rate for Payer: Humana ChoiceCare |
$272.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.50
|
| Rate for Payer: PHCS All Commercial |
$236.25
|
| Rate for Payer: PHP All Commercial |
$238.90
|
| Rate for Payer: Sagamore Health Network All Products |
$243.18
|
| Rate for Payer: Signature Care EPO |
$261.45
|
| Rate for Payer: Signature Care PPO |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$248.22
|
|
|
HC RETRACTOR DEXTRUS MED
|
Facility
OP
|
$315.00
|
|
| Hospital Charge Code |
41602303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$265.86
|
| Rate for Payer: Aetna Medicare |
$103.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.34
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Centivo All Commercial |
$160.65
|
| Rate for Payer: Cigna All Commercial |
$271.84
|
| Rate for Payer: CORVEL All Commercial |
$292.95
|
| Rate for Payer: Coventry All Commercial |
$277.20
|
| Rate for Payer: Encore All Commercial |
$289.96
|
| Rate for Payer: Frontpath All Commercial |
$289.80
|
| Rate for Payer: Humana ChoiceCare |
$272.07
|
| Rate for Payer: Humana Medicare |
$160.65
|
| Rate for Payer: Lucent All Commercial |
$160.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$236.25
|
| Rate for Payer: PHP All Commercial |
$238.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.85
|
| Rate for Payer: Sagamore Health Network All Products |
$243.18
|
| Rate for Payer: Signature Care EPO |
$261.45
|
| Rate for Payer: Signature Care PPO |
$277.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$267.75
|
| Rate for Payer: United Healthcare Commercial |
$248.22
|
| Rate for Payer: United Healthcare Medicare |
$103.95
|
|
|
HC RETRACTOR ELEVATOR VAG/CERV
|
Facility
OP
|
$650.90
|
|
| Hospital Charge Code |
41602382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$605.34 |
| Rate for Payer: Aetna Commercial |
$549.36
|
| Rate for Payer: Aetna Medicare |
$214.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$373.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$247.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$236.28
|
| Rate for Payer: Cash Price |
$403.56
|
| Rate for Payer: Cash Price |
$403.56
|
| Rate for Payer: Centivo All Commercial |
$331.96
|
| Rate for Payer: Cigna All Commercial |
$561.73
|
| Rate for Payer: CORVEL All Commercial |
$605.34
|
| Rate for Payer: Coventry All Commercial |
$572.79
|
| Rate for Payer: Encore All Commercial |
$599.15
|
| Rate for Payer: Frontpath All Commercial |
$598.83
|
| Rate for Payer: Humana ChoiceCare |
$562.18
|
| Rate for Payer: Humana Medicare |
$331.96
|
| Rate for Payer: Lucent All Commercial |
$331.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$585.81
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$488.18
|
| Rate for Payer: PHP All Commercial |
$493.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.85
|
| Rate for Payer: Sagamore Health Network All Products |
$502.49
|
| Rate for Payer: Signature Care EPO |
$540.25
|
| Rate for Payer: Signature Care PPO |
$572.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$553.26
|
| Rate for Payer: United Healthcare Commercial |
$512.91
|
| Rate for Payer: United Healthcare Medicare |
$214.80
|
|
