|
HC T4, FREE, ED/HPLC
|
Facility
|
IP
|
$123.26
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
63001687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.44 |
| Max. Negotiated Rate |
$114.63 |
| Rate for Payer: Aetna Commercial |
$106.49
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Cigna All Commercial |
$106.37
|
| Rate for Payer: CORVEL All Commercial |
$114.63
|
| Rate for Payer: Coventry All Commercial |
$108.47
|
| Rate for Payer: Encore All Commercial |
$113.46
|
| Rate for Payer: Frontpath All Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$106.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.93
|
| Rate for Payer: PHCS All Commercial |
$92.44
|
| Rate for Payer: PHP All Commercial |
$93.48
|
| Rate for Payer: Sagamore Health Network All Products |
$95.15
|
| Rate for Payer: Signature Care EPO |
$102.30
|
| Rate for Payer: Signature Care PPO |
$108.47
|
| Rate for Payer: United Healthcare Commercial |
$97.13
|
|
|
HC T4, TOTAL - SERUM
|
Facility
|
OP
|
$63.87
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
63001686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna Commercial |
$53.91
|
| Rate for Payer: Aetna Medicare |
$21.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.19
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Centivo All Commercial |
$32.57
|
| Rate for Payer: Cigna All Commercial |
$55.12
|
| Rate for Payer: CORVEL All Commercial |
$59.40
|
| Rate for Payer: Coventry All Commercial |
$56.21
|
| Rate for Payer: Encore All Commercial |
$58.79
|
| Rate for Payer: Frontpath All Commercial |
$58.76
|
| Rate for Payer: Humana ChoiceCare |
$55.17
|
| Rate for Payer: Humana Medicare |
$32.57
|
| Rate for Payer: Lucent All Commercial |
$32.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.49
|
| Rate for Payer: Managed Health Services Medicaid |
$6.87
|
| Rate for Payer: MDWise Medicaid |
$6.87
|
| Rate for Payer: PHCS All Commercial |
$47.90
|
| Rate for Payer: PHP All Commercial |
$48.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.91
|
| Rate for Payer: Sagamore Health Network All Products |
$49.31
|
| Rate for Payer: Signature Care EPO |
$53.01
|
| Rate for Payer: Signature Care PPO |
$56.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.29
|
| Rate for Payer: United Healthcare Commercial |
$50.33
|
| Rate for Payer: United Healthcare Medicare |
$21.08
|
|
|
HC T4, TOTAL - SERUM
|
Facility
|
IP
|
$63.87
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
63001686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna Commercial |
$55.19
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna All Commercial |
$55.12
|
| Rate for Payer: CORVEL All Commercial |
$59.40
|
| Rate for Payer: Coventry All Commercial |
$56.21
|
| Rate for Payer: Encore All Commercial |
$58.79
|
| Rate for Payer: Frontpath All Commercial |
$58.76
|
| Rate for Payer: Humana ChoiceCare |
$55.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.49
|
| Rate for Payer: PHCS All Commercial |
$47.90
|
| Rate for Payer: PHP All Commercial |
$48.44
|
| Rate for Payer: Sagamore Health Network All Products |
$49.31
|
| Rate for Payer: Signature Care EPO |
$53.01
|
| Rate for Payer: Signature Care PPO |
$56.21
|
| Rate for Payer: United Healthcare Commercial |
$50.33
|
|
|
HC TACROLIMUS
|
Facility
|
OP
|
$293.96
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
63001115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$273.39 |
| Rate for Payer: Aetna Commercial |
$248.11
|
| Rate for Payer: Aetna Medicare |
$97.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$135.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.71
|
| Rate for Payer: Cash Price |
$182.26
|
| Rate for Payer: Cash Price |
$182.26
|
| Rate for Payer: Centivo All Commercial |
$149.92
|
| Rate for Payer: Cigna All Commercial |
$253.69
|
| Rate for Payer: CORVEL All Commercial |
$273.39
|
| Rate for Payer: Coventry All Commercial |
$258.69
|
| Rate for Payer: Encore All Commercial |
$270.59
|
| Rate for Payer: Frontpath All Commercial |
$270.45
|
| Rate for Payer: Humana ChoiceCare |
$253.90
|
| Rate for Payer: Humana Medicare |
$149.92
|
| Rate for Payer: Lucent All Commercial |
$149.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.57
|
| Rate for Payer: Managed Health Services Medicaid |
$13.73
|
| Rate for Payer: MDWise Medicaid |
$13.73
|
| Rate for Payer: PHCS All Commercial |
$220.47
|
| Rate for Payer: PHP All Commercial |
$222.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.65
|
| Rate for Payer: Sagamore Health Network All Products |
$226.94
|
| Rate for Payer: Signature Care EPO |
$243.99
|
| Rate for Payer: Signature Care PPO |
$258.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$249.87
|
| Rate for Payer: United Healthcare Commercial |
$231.64
|
| Rate for Payer: United Healthcare Medicare |
$97.01
|
|
|
HC TACROLIMUS
|
Facility
|
IP
|
$293.96
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
63001115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$220.47 |
| Max. Negotiated Rate |
$273.39 |
| Rate for Payer: Aetna Commercial |
$253.98
|
| Rate for Payer: Cash Price |
$182.26
|
| Rate for Payer: Cigna All Commercial |
$253.69
|
| Rate for Payer: CORVEL All Commercial |
$273.39
|
| Rate for Payer: Coventry All Commercial |
$258.69
|
| Rate for Payer: Encore All Commercial |
$270.59
|
| Rate for Payer: Frontpath All Commercial |
$270.45
|
| Rate for Payer: Humana ChoiceCare |
$253.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.57
|
| Rate for Payer: PHCS All Commercial |
$220.47
|
| Rate for Payer: PHP All Commercial |
$222.94
|
| Rate for Payer: Sagamore Health Network All Products |
$226.94
|
| Rate for Payer: Signature Care EPO |
$243.99
|
| Rate for Payer: Signature Care PPO |
$258.69
|
| Rate for Payer: United Healthcare Commercial |
$231.64
|
|
|
HC TALON GRASPING DEVICE
|
Facility
|
OP
|
$952.00
|
|
| Hospital Charge Code |
41601223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$885.36 |
| Rate for Payer: Aetna Commercial |
$803.49
|
| Rate for Payer: Aetna Medicare |
$314.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$314.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$546.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$595.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$361.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$345.58
|
| Rate for Payer: Cash Price |
$590.24
|
| Rate for Payer: Cash Price |
$590.24
|
| Rate for Payer: Centivo All Commercial |
$485.52
|
| Rate for Payer: Cigna All Commercial |
$821.58
|
| Rate for Payer: CORVEL All Commercial |
$885.36
|
| Rate for Payer: Coventry All Commercial |
$837.76
|
| Rate for Payer: Encore All Commercial |
$876.32
|
| Rate for Payer: Frontpath All Commercial |
$875.84
|
| Rate for Payer: Humana ChoiceCare |
$822.24
|
| Rate for Payer: Humana Medicare |
$485.52
|
| Rate for Payer: Lucent All Commercial |
$485.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$856.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$714.00
|
| Rate for Payer: PHP All Commercial |
$722.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$371.28
|
| Rate for Payer: Sagamore Health Network All Products |
$734.94
|
| Rate for Payer: Signature Care EPO |
$790.16
|
| Rate for Payer: Signature Care PPO |
$837.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$809.20
|
| Rate for Payer: United Healthcare Commercial |
$750.18
|
| Rate for Payer: United Healthcare Medicare |
$314.16
|
|
|
HC TALON GRASPING DEVICE
|
Facility
|
IP
|
$952.00
|
|
| Hospital Charge Code |
41601223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$885.36 |
| Rate for Payer: Aetna Commercial |
$822.53
|
| Rate for Payer: Cash Price |
$590.24
|
| Rate for Payer: Cigna All Commercial |
$821.58
|
| Rate for Payer: CORVEL All Commercial |
$885.36
|
| Rate for Payer: Coventry All Commercial |
$837.76
|
| Rate for Payer: Encore All Commercial |
$876.32
|
| Rate for Payer: Frontpath All Commercial |
$875.84
|
| Rate for Payer: Humana ChoiceCare |
$822.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$856.80
|
| Rate for Payer: PHCS All Commercial |
$714.00
|
| Rate for Payer: PHP All Commercial |
$722.00
|
| Rate for Payer: Sagamore Health Network All Products |
$734.94
|
| Rate for Payer: Signature Care EPO |
$790.16
|
| Rate for Payer: Signature Care PPO |
$837.76
|
| Rate for Payer: United Healthcare Commercial |
$750.18
|
|
|
HC T CELL ABSOLUTE COUNT/RATIO
|
Facility
|
IP
|
$53.55
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
63087812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
|
HC T CELL ABSOLUTE COUNT/RATIO
|
Facility
|
OP
|
$53.55
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
63087812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$46.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.44
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Centivo All Commercial |
$27.31
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$27.31
|
| Rate for Payer: Lucent All Commercial |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$46.98
|
| Rate for Payer: MDWise Medicaid |
$46.98
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.67
|
|
|
HC T-CELL GENE REARRANGEMENT, PCR 1STCHARGE
|
Facility
|
IP
|
$1,850.62
|
|
|
Service Code
|
CPT 81340
|
| Hospital Charge Code |
63001441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,387.96 |
| Max. Negotiated Rate |
$1,721.07 |
| Rate for Payer: Aetna Commercial |
$1,598.93
|
| Rate for Payer: Cash Price |
$1,147.38
|
| Rate for Payer: Cigna All Commercial |
$1,597.08
|
| Rate for Payer: CORVEL All Commercial |
$1,721.07
|
| Rate for Payer: Coventry All Commercial |
$1,628.54
|
| Rate for Payer: Encore All Commercial |
$1,703.49
|
| Rate for Payer: Frontpath All Commercial |
$1,702.57
|
| Rate for Payer: Humana ChoiceCare |
$1,598.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,665.55
|
| Rate for Payer: PHCS All Commercial |
$1,387.96
|
| Rate for Payer: PHP All Commercial |
$1,403.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,428.68
|
| Rate for Payer: Signature Care EPO |
$1,536.01
|
| Rate for Payer: Signature Care PPO |
$1,628.54
|
| Rate for Payer: United Healthcare Commercial |
$1,458.29
|
|
|
HC T-CELL GENE REARRANGEMENT, PCR 1STCHARGE
|
Facility
|
OP
|
$1,850.62
|
|
|
Service Code
|
CPT 81340
|
| Hospital Charge Code |
63001441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$610.70 |
| Max. Negotiated Rate |
$1,721.07 |
| Rate for Payer: Aetna Commercial |
$1,561.92
|
| Rate for Payer: Aetna Medicare |
$610.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$610.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,062.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,156.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$702.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$671.77
|
| Rate for Payer: Cash Price |
$1,147.38
|
| Rate for Payer: Centivo All Commercial |
$943.81
|
| Rate for Payer: Cigna All Commercial |
$1,597.08
|
| Rate for Payer: CORVEL All Commercial |
$1,721.07
|
| Rate for Payer: Coventry All Commercial |
$1,628.54
|
| Rate for Payer: Encore All Commercial |
$1,703.49
|
| Rate for Payer: Frontpath All Commercial |
$1,702.57
|
| Rate for Payer: Humana ChoiceCare |
$1,598.38
|
| Rate for Payer: Humana Medicare |
$943.81
|
| Rate for Payer: Lucent All Commercial |
$943.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,665.55
|
| Rate for Payer: PHCS All Commercial |
$1,387.96
|
| Rate for Payer: PHP All Commercial |
$1,403.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$721.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,428.68
|
| Rate for Payer: Signature Care EPO |
$1,536.01
|
| Rate for Payer: Signature Care PPO |
$1,628.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,573.02
|
| Rate for Payer: United Healthcare Commercial |
$1,458.29
|
| Rate for Payer: United Healthcare Medicare |
$610.70
|
|
|
HC T-CELL GENE REARRANGEMENT, PCR 2NDCHARGE
|
Facility
|
IP
|
$1,384.26
|
|
|
Service Code
|
CPT 81342
|
| Hospital Charge Code |
63001442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,038.20 |
| Max. Negotiated Rate |
$1,287.36 |
| Rate for Payer: Aetna Commercial |
$1,196.00
|
| Rate for Payer: Cash Price |
$858.24
|
| Rate for Payer: Cigna All Commercial |
$1,194.62
|
| Rate for Payer: CORVEL All Commercial |
$1,287.36
|
| Rate for Payer: Coventry All Commercial |
$1,218.15
|
| Rate for Payer: Encore All Commercial |
$1,274.21
|
| Rate for Payer: Frontpath All Commercial |
$1,273.52
|
| Rate for Payer: Humana ChoiceCare |
$1,195.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,245.84
|
| Rate for Payer: PHCS All Commercial |
$1,038.20
|
| Rate for Payer: PHP All Commercial |
$1,049.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1,068.65
|
| Rate for Payer: Signature Care EPO |
$1,148.94
|
| Rate for Payer: Signature Care PPO |
$1,218.15
|
| Rate for Payer: United Healthcare Commercial |
$1,090.80
|
|
|
HC T-CELL GENE REARRANGEMENT, PCR 2NDCHARGE
|
Facility
|
OP
|
$1,384.26
|
|
|
Service Code
|
CPT 81342
|
| Hospital Charge Code |
63001442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$456.81 |
| Max. Negotiated Rate |
$1,287.36 |
| Rate for Payer: Aetna Commercial |
$1,168.32
|
| Rate for Payer: Aetna Medicare |
$456.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$456.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$794.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$865.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$525.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$502.49
|
| Rate for Payer: Cash Price |
$858.24
|
| Rate for Payer: Centivo All Commercial |
$705.97
|
| Rate for Payer: Cigna All Commercial |
$1,194.62
|
| Rate for Payer: CORVEL All Commercial |
$1,287.36
|
| Rate for Payer: Coventry All Commercial |
$1,218.15
|
| Rate for Payer: Encore All Commercial |
$1,274.21
|
| Rate for Payer: Frontpath All Commercial |
$1,273.52
|
| Rate for Payer: Humana ChoiceCare |
$1,195.59
|
| Rate for Payer: Humana Medicare |
$705.97
|
| Rate for Payer: Lucent All Commercial |
$705.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,245.84
|
| Rate for Payer: PHCS All Commercial |
$1,038.20
|
| Rate for Payer: PHP All Commercial |
$1,049.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$539.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,068.65
|
| Rate for Payer: Signature Care EPO |
$1,148.94
|
| Rate for Payer: Signature Care PPO |
$1,218.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,176.62
|
| Rate for Payer: United Healthcare Commercial |
$1,090.80
|
| Rate for Payer: United Healthcare Medicare |
$456.81
|
|
|
HC T CELLS TOTAL COUNT
|
Facility
|
IP
|
$53.55
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
63087811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
|
HC T CELLS TOTAL COUNT
|
Facility
|
OP
|
$53.55
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
63087811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.44
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Centivo All Commercial |
$27.31
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$27.31
|
| Rate for Payer: Lucent All Commercial |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$37.73
|
| Rate for Payer: MDWise Medicaid |
$37.73
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.67
|
|
|
HC TEGRETOL
|
Facility
|
OP
|
$259.18
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
63001314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$218.75
|
| Rate for Payer: Aetna Medicare |
$85.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$148.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.08
|
| Rate for Payer: Cash Price |
$160.69
|
| Rate for Payer: Cash Price |
$160.69
|
| Rate for Payer: Centivo All Commercial |
$132.18
|
| Rate for Payer: Cigna All Commercial |
$223.67
|
| Rate for Payer: CORVEL All Commercial |
$241.04
|
| Rate for Payer: Coventry All Commercial |
$228.08
|
| Rate for Payer: Encore All Commercial |
$238.58
|
| Rate for Payer: Frontpath All Commercial |
$238.45
|
| Rate for Payer: Humana ChoiceCare |
$223.86
|
| Rate for Payer: Humana Medicare |
$132.18
|
| Rate for Payer: Lucent All Commercial |
$132.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.26
|
| Rate for Payer: Managed Health Services Medicaid |
$14.57
|
| Rate for Payer: MDWise Medicaid |
$14.57
|
| Rate for Payer: PHCS All Commercial |
$194.39
|
| Rate for Payer: PHP All Commercial |
$196.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.08
|
| Rate for Payer: Sagamore Health Network All Products |
$200.09
|
| Rate for Payer: Signature Care EPO |
$215.12
|
| Rate for Payer: Signature Care PPO |
$228.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$220.30
|
| Rate for Payer: United Healthcare Commercial |
$204.24
|
| Rate for Payer: United Healthcare Medicare |
$85.53
|
|
|
HC TEGRETOL
|
Facility
|
IP
|
$259.18
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
63001314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$223.93
|
| Rate for Payer: Cash Price |
$160.69
|
| Rate for Payer: Cigna All Commercial |
$223.67
|
| Rate for Payer: CORVEL All Commercial |
$241.04
|
| Rate for Payer: Coventry All Commercial |
$228.08
|
| Rate for Payer: Encore All Commercial |
$238.58
|
| Rate for Payer: Frontpath All Commercial |
$238.45
|
| Rate for Payer: Humana ChoiceCare |
$223.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.26
|
| Rate for Payer: PHCS All Commercial |
$194.39
|
| Rate for Payer: PHP All Commercial |
$196.56
|
| Rate for Payer: Sagamore Health Network All Products |
$200.09
|
| Rate for Payer: Signature Care EPO |
$215.12
|
| Rate for Payer: Signature Care PPO |
$228.08
|
| Rate for Payer: United Healthcare Commercial |
$204.24
|
|
|
HC TELEMETRY MONITORING PER DAY
|
Facility
|
OP
|
$254.59
|
|
| Hospital Charge Code |
01950195
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$236.77 |
| Rate for Payer: Aetna Commercial |
$214.88
|
| Rate for Payer: Aetna Medicare |
$84.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$146.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.42
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Centivo All Commercial |
$129.84
|
| Rate for Payer: Cigna All Commercial |
$219.71
|
| Rate for Payer: CORVEL All Commercial |
$236.77
|
| Rate for Payer: Coventry All Commercial |
$224.04
|
| Rate for Payer: Encore All Commercial |
$234.35
|
| Rate for Payer: Frontpath All Commercial |
$234.22
|
| Rate for Payer: Humana ChoiceCare |
$219.89
|
| Rate for Payer: Humana Medicare |
$129.84
|
| Rate for Payer: Lucent All Commercial |
$129.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.13
|
| Rate for Payer: Managed Health Services Medicaid |
$235.87
|
| Rate for Payer: MDWise Medicaid |
$235.87
|
| Rate for Payer: PHCS All Commercial |
$190.94
|
| Rate for Payer: PHP All Commercial |
$193.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.29
|
| Rate for Payer: Sagamore Health Network All Products |
$196.55
|
| Rate for Payer: Signature Care EPO |
$211.31
|
| Rate for Payer: Signature Care PPO |
$224.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$216.40
|
| Rate for Payer: United Healthcare Commercial |
$200.62
|
| Rate for Payer: United Healthcare Medicare |
$84.02
|
|
|
HC TELEMETRY MONITORING PER DAY
|
Facility
|
IP
|
$254.59
|
|
| Hospital Charge Code |
01950195
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$190.94 |
| Max. Negotiated Rate |
$236.77 |
| Rate for Payer: Aetna Commercial |
$219.97
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cigna All Commercial |
$219.71
|
| Rate for Payer: CORVEL All Commercial |
$236.77
|
| Rate for Payer: Coventry All Commercial |
$224.04
|
| Rate for Payer: Encore All Commercial |
$234.35
|
| Rate for Payer: Frontpath All Commercial |
$234.22
|
| Rate for Payer: Humana ChoiceCare |
$219.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.13
|
| Rate for Payer: PHCS All Commercial |
$190.94
|
| Rate for Payer: PHP All Commercial |
$193.08
|
| Rate for Payer: Sagamore Health Network All Products |
$196.55
|
| Rate for Payer: Signature Care EPO |
$211.31
|
| Rate for Payer: Signature Care PPO |
$224.04
|
| Rate for Payer: United Healthcare Commercial |
$200.62
|
|
|
HC TEMP SKIN SENSOR ADULT
|
Facility
|
IP
|
$11.05
|
|
| Hospital Charge Code |
41607464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: Cash Price |
$6.85
|
| Rate for Payer: Cigna All Commercial |
$9.54
|
| Rate for Payer: CORVEL All Commercial |
$10.28
|
| Rate for Payer: Coventry All Commercial |
$9.72
|
| Rate for Payer: Encore All Commercial |
$10.17
|
| Rate for Payer: Frontpath All Commercial |
$10.17
|
| Rate for Payer: Humana ChoiceCare |
$9.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.94
|
| Rate for Payer: PHCS All Commercial |
$8.29
|
| Rate for Payer: PHP All Commercial |
$8.38
|
| Rate for Payer: Sagamore Health Network All Products |
$8.53
|
| Rate for Payer: Signature Care EPO |
$9.17
|
| Rate for Payer: Signature Care PPO |
$9.72
|
| Rate for Payer: United Healthcare Commercial |
$8.71
|
|
|
HC TEMP SKIN SENSOR ADULT
|
Facility
|
OP
|
$11.05
|
|
| Hospital Charge Code |
41607464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna Medicare |
$3.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.01
|
| Rate for Payer: Cash Price |
$6.85
|
| Rate for Payer: Cash Price |
$6.85
|
| Rate for Payer: Centivo All Commercial |
$5.64
|
| Rate for Payer: Cigna All Commercial |
$9.54
|
| Rate for Payer: CORVEL All Commercial |
$10.28
|
| Rate for Payer: Coventry All Commercial |
$9.72
|
| Rate for Payer: Encore All Commercial |
$10.17
|
| Rate for Payer: Frontpath All Commercial |
$10.17
|
| Rate for Payer: Humana ChoiceCare |
$9.54
|
| Rate for Payer: Humana Medicare |
$5.64
|
| Rate for Payer: Lucent All Commercial |
$5.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.94
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.29
|
| Rate for Payer: PHP All Commercial |
$8.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.31
|
| Rate for Payer: Sagamore Health Network All Products |
$8.53
|
| Rate for Payer: Signature Care EPO |
$9.17
|
| Rate for Payer: Signature Care PPO |
$9.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$8.71
|
| Rate for Payer: United Healthcare Medicare |
$3.65
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
IP
|
$218.47
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
63001682
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$203.18 |
| Rate for Payer: Aetna Commercial |
$188.76
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cigna All Commercial |
$188.54
|
| Rate for Payer: CORVEL All Commercial |
$203.18
|
| Rate for Payer: Coventry All Commercial |
$192.26
|
| Rate for Payer: Encore All Commercial |
$201.11
|
| Rate for Payer: Frontpath All Commercial |
$201.00
|
| Rate for Payer: Humana ChoiceCare |
$188.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.63
|
| Rate for Payer: PHCS All Commercial |
$163.86
|
| Rate for Payer: PHP All Commercial |
$165.69
|
| Rate for Payer: Sagamore Health Network All Products |
$168.66
|
| Rate for Payer: Signature Care EPO |
$181.33
|
| Rate for Payer: Signature Care PPO |
$192.26
|
| Rate for Payer: United Healthcare Commercial |
$172.16
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
OP
|
$218.47
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
63001682
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$203.18 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Medicare |
$72.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.31
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Centivo All Commercial |
$111.42
|
| Rate for Payer: Cigna All Commercial |
$188.54
|
| Rate for Payer: CORVEL All Commercial |
$203.18
|
| Rate for Payer: Coventry All Commercial |
$192.26
|
| Rate for Payer: Encore All Commercial |
$201.11
|
| Rate for Payer: Frontpath All Commercial |
$201.00
|
| Rate for Payer: Humana ChoiceCare |
$188.70
|
| Rate for Payer: Humana Medicare |
$111.42
|
| Rate for Payer: Lucent All Commercial |
$111.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.63
|
| Rate for Payer: Managed Health Services Medicaid |
$25.47
|
| Rate for Payer: MDWise Medicaid |
$25.47
|
| Rate for Payer: PHCS All Commercial |
$163.86
|
| Rate for Payer: PHP All Commercial |
$165.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.20
|
| Rate for Payer: Sagamore Health Network All Products |
$168.66
|
| Rate for Payer: Signature Care EPO |
$181.33
|
| Rate for Payer: Signature Care PPO |
$192.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.70
|
| Rate for Payer: United Healthcare Commercial |
$172.16
|
| Rate for Payer: United Healthcare Medicare |
$72.10
|
|
|
HC TESTOSTERONE FREE-LC-MS/MS(FEMALE/CHILD)
|
Facility
|
OP
|
$218.47
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
63001683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$203.18 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Medicare |
$72.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.31
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Centivo All Commercial |
$111.42
|
| Rate for Payer: Cigna All Commercial |
$188.54
|
| Rate for Payer: CORVEL All Commercial |
$203.18
|
| Rate for Payer: Coventry All Commercial |
$192.26
|
| Rate for Payer: Encore All Commercial |
$201.11
|
| Rate for Payer: Frontpath All Commercial |
$201.00
|
| Rate for Payer: Humana ChoiceCare |
$188.70
|
| Rate for Payer: Humana Medicare |
$111.42
|
| Rate for Payer: Lucent All Commercial |
$111.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.63
|
| Rate for Payer: Managed Health Services Medicaid |
$25.47
|
| Rate for Payer: MDWise Medicaid |
$25.47
|
| Rate for Payer: PHCS All Commercial |
$163.86
|
| Rate for Payer: PHP All Commercial |
$165.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.20
|
| Rate for Payer: Sagamore Health Network All Products |
$168.66
|
| Rate for Payer: Signature Care EPO |
$181.33
|
| Rate for Payer: Signature Care PPO |
$192.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.70
|
| Rate for Payer: United Healthcare Commercial |
$172.16
|
| Rate for Payer: United Healthcare Medicare |
$72.10
|
|
|
HC TESTOSTERONE FREE-LC-MS/MS(FEMALE/CHILD)
|
Facility
|
IP
|
$218.47
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
63001683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$203.18 |
| Rate for Payer: Aetna Commercial |
$188.76
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cigna All Commercial |
$188.54
|
| Rate for Payer: CORVEL All Commercial |
$203.18
|
| Rate for Payer: Coventry All Commercial |
$192.26
|
| Rate for Payer: Encore All Commercial |
$201.11
|
| Rate for Payer: Frontpath All Commercial |
$201.00
|
| Rate for Payer: Humana ChoiceCare |
$188.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.63
|
| Rate for Payer: PHCS All Commercial |
$163.86
|
| Rate for Payer: PHP All Commercial |
$165.69
|
| Rate for Payer: Sagamore Health Network All Products |
$168.66
|
| Rate for Payer: Signature Care EPO |
$181.33
|
| Rate for Payer: Signature Care PPO |
$192.26
|
| Rate for Payer: United Healthcare Commercial |
$172.16
|
|
