|
HC ALLERGEN ORCHARD GRASS
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN ORCHARD GRASS
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN PEANUT
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001825
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN PEANUT
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001825
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN PECAN FOOD IGE
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN PECAN FOOD IGE
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN PECAN/HICKORY TREE
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001827
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN PECAN/HICKORY TREE
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001827
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN PENICILLIUM
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001828
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN PENICILLIUM
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001828
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN PHOMA BETAE (IGE) / P HERBARUM
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN PHOMA BETAE (IGE) / P HERBARUM
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN PIGWEED
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN PIGWEED
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN POPLAR
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN POPLAR
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN POTATO
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN POTATO
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN RABBIT
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN RABBIT
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN REDTOP
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001834
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN REDTOP
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001834
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN RHIZOPUS NIGRICANS
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC ALLERGEN RHIZOPUS NIGRICANS
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN RUSSIAN THS
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
