|
HC AMPHETAMINE/METHAMPHETAMINE QT-URINE
|
Facility
IP
|
$156.37
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001407
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.27 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$135.10
|
| Rate for Payer: Cash Price |
$96.95
|
| Rate for Payer: Cigna All Commercial |
$134.94
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.60
|
| Rate for Payer: Encore All Commercial |
$143.93
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: PHCS All Commercial |
$117.27
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Sagamore Health Network All Products |
$120.71
|
| Rate for Payer: Signature Care EPO |
$129.78
|
| Rate for Payer: Signature Care PPO |
$137.60
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
|
|
HC AMPLIFIED PROBE, EACH ORGANISM
|
Facility
IP
|
$66.66
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63002052
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna Commercial |
$57.59
|
| Rate for Payer: Cash Price |
$41.33
|
| Rate for Payer: Cigna All Commercial |
$57.52
|
| Rate for Payer: CORVEL All Commercial |
$61.99
|
| Rate for Payer: Coventry All Commercial |
$58.66
|
| Rate for Payer: Encore All Commercial |
$61.36
|
| Rate for Payer: Frontpath All Commercial |
$61.32
|
| Rate for Payer: Humana ChoiceCare |
$57.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.99
|
| Rate for Payer: PHCS All Commercial |
$49.99
|
| Rate for Payer: PHP All Commercial |
$50.55
|
| Rate for Payer: Sagamore Health Network All Products |
$51.46
|
| Rate for Payer: Signature Care EPO |
$55.33
|
| Rate for Payer: Signature Care PPO |
$58.66
|
| Rate for Payer: United Healthcare Commercial |
$52.53
|
|
|
HC AMPLIFIED PROBE, EACH ORGANISM
|
Facility
OP
|
$66.66
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63002052
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna Commercial |
$56.26
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.20
|
| Rate for Payer: Cash Price |
$41.33
|
| Rate for Payer: Cash Price |
$41.33
|
| Rate for Payer: Centivo All Commercial |
$34.00
|
| Rate for Payer: Cigna All Commercial |
$57.52
|
| Rate for Payer: CORVEL All Commercial |
$61.99
|
| Rate for Payer: Coventry All Commercial |
$58.66
|
| Rate for Payer: Encore All Commercial |
$61.36
|
| Rate for Payer: Frontpath All Commercial |
$61.32
|
| Rate for Payer: Humana ChoiceCare |
$57.57
|
| Rate for Payer: Humana Medicare |
$34.00
|
| Rate for Payer: Lucent All Commercial |
$34.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.99
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$49.99
|
| Rate for Payer: PHP All Commercial |
$50.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.00
|
| Rate for Payer: Sagamore Health Network All Products |
$51.46
|
| Rate for Payer: Signature Care EPO |
$55.33
|
| Rate for Payer: Signature Care PPO |
$58.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.66
|
| Rate for Payer: United Healthcare Commercial |
$52.53
|
| Rate for Payer: United Healthcare Medicare |
$22.00
|
|
|
HC AMYLASE - 24HR URINE
|
Facility
IP
|
$116.38
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.29 |
| Max. Negotiated Rate |
$108.24 |
| Rate for Payer: Aetna Commercial |
$100.55
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cigna All Commercial |
$100.44
|
| Rate for Payer: CORVEL All Commercial |
$108.24
|
| Rate for Payer: Coventry All Commercial |
$102.42
|
| Rate for Payer: Encore All Commercial |
$107.13
|
| Rate for Payer: Frontpath All Commercial |
$107.07
|
| Rate for Payer: Humana ChoiceCare |
$100.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.74
|
| Rate for Payer: PHCS All Commercial |
$87.29
|
| Rate for Payer: PHP All Commercial |
$88.26
|
| Rate for Payer: Sagamore Health Network All Products |
$89.85
|
| Rate for Payer: Signature Care EPO |
$96.60
|
| Rate for Payer: Signature Care PPO |
$102.42
|
| Rate for Payer: United Healthcare Commercial |
$91.71
|
|
|
HC AMYLASE - 24HR URINE
|
Facility
OP
|
$116.38
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$108.24 |
| Rate for Payer: Aetna Commercial |
$98.23
|
| Rate for Payer: Aetna Medicare |
$38.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.25
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Centivo All Commercial |
$59.35
|
| Rate for Payer: Cigna All Commercial |
$100.44
|
| Rate for Payer: CORVEL All Commercial |
$108.24
|
| Rate for Payer: Coventry All Commercial |
$102.42
|
| Rate for Payer: Encore All Commercial |
$107.13
|
| Rate for Payer: Frontpath All Commercial |
$107.07
|
| Rate for Payer: Humana ChoiceCare |
$100.52
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: Lucent All Commercial |
$59.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.74
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: MDWise Medicaid |
$6.48
|
| Rate for Payer: PHCS All Commercial |
$87.29
|
| Rate for Payer: PHP All Commercial |
$88.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.39
|
| Rate for Payer: Sagamore Health Network All Products |
$89.85
|
| Rate for Payer: Signature Care EPO |
$96.60
|
| Rate for Payer: Signature Care PPO |
$102.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.92
|
| Rate for Payer: United Healthcare Commercial |
$91.71
|
| Rate for Payer: United Healthcare Medicare |
$38.41
|
|
|
HC AMYLASE - 2HR URINE
|
Facility
IP
|
$116.38
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.29 |
| Max. Negotiated Rate |
$108.24 |
| Rate for Payer: Aetna Commercial |
$100.55
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cigna All Commercial |
$100.44
|
| Rate for Payer: CORVEL All Commercial |
$108.24
|
| Rate for Payer: Coventry All Commercial |
$102.42
|
| Rate for Payer: Encore All Commercial |
$107.13
|
| Rate for Payer: Frontpath All Commercial |
$107.07
|
| Rate for Payer: Humana ChoiceCare |
$100.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.74
|
| Rate for Payer: PHCS All Commercial |
$87.29
|
| Rate for Payer: PHP All Commercial |
$88.26
|
| Rate for Payer: Sagamore Health Network All Products |
$89.85
|
| Rate for Payer: Signature Care EPO |
$96.60
|
| Rate for Payer: Signature Care PPO |
$102.42
|
| Rate for Payer: United Healthcare Commercial |
$91.71
|
|
|
HC AMYLASE - 2HR URINE
|
Facility
OP
|
$116.38
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$108.24 |
| Rate for Payer: Aetna Commercial |
$98.23
|
| Rate for Payer: Aetna Medicare |
$38.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.25
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Centivo All Commercial |
$59.35
|
| Rate for Payer: Cigna All Commercial |
$100.44
|
| Rate for Payer: CORVEL All Commercial |
$108.24
|
| Rate for Payer: Coventry All Commercial |
$102.42
|
| Rate for Payer: Encore All Commercial |
$107.13
|
| Rate for Payer: Frontpath All Commercial |
$107.07
|
| Rate for Payer: Humana ChoiceCare |
$100.52
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: Lucent All Commercial |
$59.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.74
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: MDWise Medicaid |
$6.48
|
| Rate for Payer: PHCS All Commercial |
$87.29
|
| Rate for Payer: PHP All Commercial |
$88.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.39
|
| Rate for Payer: Sagamore Health Network All Products |
$89.85
|
| Rate for Payer: Signature Care EPO |
$96.60
|
| Rate for Payer: Signature Care PPO |
$102.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.92
|
| Rate for Payer: United Healthcare Commercial |
$91.71
|
| Rate for Payer: United Healthcare Medicare |
$38.41
|
|
|
HC AMYLASE - BODY FLUID
|
Facility
IP
|
$166.06
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001182
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$154.43 |
| Rate for Payer: Aetna Commercial |
$143.47
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cigna All Commercial |
$143.31
|
| Rate for Payer: CORVEL All Commercial |
$154.43
|
| Rate for Payer: Coventry All Commercial |
$146.13
|
| Rate for Payer: Encore All Commercial |
$152.85
|
| Rate for Payer: Frontpath All Commercial |
$152.77
|
| Rate for Payer: Humana ChoiceCare |
$143.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.45
|
| Rate for Payer: PHCS All Commercial |
$124.54
|
| Rate for Payer: PHP All Commercial |
$125.94
|
| Rate for Payer: Sagamore Health Network All Products |
$128.20
|
| Rate for Payer: Signature Care EPO |
$137.83
|
| Rate for Payer: Signature Care PPO |
$146.13
|
| Rate for Payer: United Healthcare Commercial |
$130.85
|
|
|
HC AMYLASE - BODY FLUID
|
Facility
OP
|
$166.06
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001182
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$154.43 |
| Rate for Payer: Aetna Commercial |
$140.15
|
| Rate for Payer: Aetna Medicare |
$54.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.28
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Centivo All Commercial |
$84.69
|
| Rate for Payer: Cigna All Commercial |
$143.31
|
| Rate for Payer: CORVEL All Commercial |
$154.43
|
| Rate for Payer: Coventry All Commercial |
$146.13
|
| Rate for Payer: Encore All Commercial |
$152.85
|
| Rate for Payer: Frontpath All Commercial |
$152.77
|
| Rate for Payer: Humana ChoiceCare |
$143.42
|
| Rate for Payer: Humana Medicare |
$84.69
|
| Rate for Payer: Lucent All Commercial |
$84.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.45
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: MDWise Medicaid |
$6.48
|
| Rate for Payer: PHCS All Commercial |
$124.54
|
| Rate for Payer: PHP All Commercial |
$125.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.76
|
| Rate for Payer: Sagamore Health Network All Products |
$128.20
|
| Rate for Payer: Signature Care EPO |
$137.83
|
| Rate for Payer: Signature Care PPO |
$146.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.15
|
| Rate for Payer: United Healthcare Commercial |
$130.85
|
| Rate for Payer: United Healthcare Medicare |
$54.80
|
|
|
HC AMYLASE ISOENZYMES
|
Facility
OP
|
$137.70
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$116.22
|
| Rate for Payer: Aetna Medicare |
$45.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.99
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Centivo All Commercial |
$70.23
|
| Rate for Payer: Cigna All Commercial |
$118.84
|
| Rate for Payer: CORVEL All Commercial |
$128.06
|
| Rate for Payer: Coventry All Commercial |
$121.18
|
| Rate for Payer: Encore All Commercial |
$126.75
|
| Rate for Payer: Frontpath All Commercial |
$126.68
|
| Rate for Payer: Humana ChoiceCare |
$118.93
|
| Rate for Payer: Humana Medicare |
$70.23
|
| Rate for Payer: Lucent All Commercial |
$70.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.93
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: MDWise Medicaid |
$6.48
|
| Rate for Payer: PHCS All Commercial |
$103.28
|
| Rate for Payer: PHP All Commercial |
$104.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.70
|
| Rate for Payer: Sagamore Health Network All Products |
$106.30
|
| Rate for Payer: Signature Care EPO |
$114.29
|
| Rate for Payer: Signature Care PPO |
$121.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.04
|
| Rate for Payer: United Healthcare Commercial |
$108.51
|
| Rate for Payer: United Healthcare Medicare |
$45.44
|
|
|
HC AMYLASE ISOENZYMES
|
Facility
IP
|
$137.70
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.28 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$118.97
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Cigna All Commercial |
$118.84
|
| Rate for Payer: CORVEL All Commercial |
$128.06
|
| Rate for Payer: Coventry All Commercial |
$121.18
|
| Rate for Payer: Encore All Commercial |
$126.75
|
| Rate for Payer: Frontpath All Commercial |
$126.68
|
| Rate for Payer: Humana ChoiceCare |
$118.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.93
|
| Rate for Payer: PHCS All Commercial |
$103.28
|
| Rate for Payer: PHP All Commercial |
$104.43
|
| Rate for Payer: Sagamore Health Network All Products |
$106.30
|
| Rate for Payer: Signature Care EPO |
$114.29
|
| Rate for Payer: Signature Care PPO |
$121.18
|
| Rate for Payer: United Healthcare Commercial |
$108.51
|
|
|
HC AMYLASE SERUM
|
Facility
OP
|
$166.06
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$154.43 |
| Rate for Payer: Aetna Commercial |
$140.15
|
| Rate for Payer: Aetna Medicare |
$54.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.28
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Centivo All Commercial |
$84.69
|
| Rate for Payer: Cigna All Commercial |
$143.31
|
| Rate for Payer: CORVEL All Commercial |
$154.43
|
| Rate for Payer: Coventry All Commercial |
$146.13
|
| Rate for Payer: Encore All Commercial |
$152.85
|
| Rate for Payer: Frontpath All Commercial |
$152.77
|
| Rate for Payer: Humana ChoiceCare |
$143.42
|
| Rate for Payer: Humana Medicare |
$84.69
|
| Rate for Payer: Lucent All Commercial |
$84.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.45
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: MDWise Medicaid |
$6.48
|
| Rate for Payer: PHCS All Commercial |
$124.54
|
| Rate for Payer: PHP All Commercial |
$125.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.76
|
| Rate for Payer: Sagamore Health Network All Products |
$128.20
|
| Rate for Payer: Signature Care EPO |
$137.83
|
| Rate for Payer: Signature Care PPO |
$146.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.15
|
| Rate for Payer: United Healthcare Commercial |
$130.85
|
| Rate for Payer: United Healthcare Medicare |
$54.80
|
|
|
HC AMYLASE SERUM
|
Facility
IP
|
$166.06
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$154.43 |
| Rate for Payer: Aetna Commercial |
$143.47
|
| Rate for Payer: Cash Price |
$102.96
|
| Rate for Payer: Cigna All Commercial |
$143.31
|
| Rate for Payer: CORVEL All Commercial |
$154.43
|
| Rate for Payer: Coventry All Commercial |
$146.13
|
| Rate for Payer: Encore All Commercial |
$152.85
|
| Rate for Payer: Frontpath All Commercial |
$152.77
|
| Rate for Payer: Humana ChoiceCare |
$143.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.45
|
| Rate for Payer: PHCS All Commercial |
$124.54
|
| Rate for Payer: PHP All Commercial |
$125.94
|
| Rate for Payer: Sagamore Health Network All Products |
$128.20
|
| Rate for Payer: Signature Care EPO |
$137.83
|
| Rate for Payer: Signature Care PPO |
$146.13
|
| Rate for Payer: United Healthcare Commercial |
$130.85
|
|
|
HC AMYLASE URINE
|
Facility
OP
|
$138.20
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$128.53 |
| Rate for Payer: Aetna Commercial |
$116.64
|
| Rate for Payer: Aetna Medicare |
$45.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.17
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Centivo All Commercial |
$70.48
|
| Rate for Payer: Cigna All Commercial |
$119.27
|
| Rate for Payer: CORVEL All Commercial |
$128.53
|
| Rate for Payer: Coventry All Commercial |
$121.62
|
| Rate for Payer: Encore All Commercial |
$127.21
|
| Rate for Payer: Frontpath All Commercial |
$127.14
|
| Rate for Payer: Humana ChoiceCare |
$119.36
|
| Rate for Payer: Humana Medicare |
$70.48
|
| Rate for Payer: Lucent All Commercial |
$70.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.38
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: MDWise Medicaid |
$6.48
|
| Rate for Payer: PHCS All Commercial |
$103.65
|
| Rate for Payer: PHP All Commercial |
$104.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.90
|
| Rate for Payer: Sagamore Health Network All Products |
$106.69
|
| Rate for Payer: Signature Care EPO |
$114.71
|
| Rate for Payer: Signature Care PPO |
$121.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.47
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
| Rate for Payer: United Healthcare Medicare |
$45.61
|
|
|
HC AMYLASE URINE
|
Facility
IP
|
$138.20
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
63001117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.65 |
| Max. Negotiated Rate |
$128.53 |
| Rate for Payer: Aetna Commercial |
$119.40
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cigna All Commercial |
$119.27
|
| Rate for Payer: CORVEL All Commercial |
$128.53
|
| Rate for Payer: Coventry All Commercial |
$121.62
|
| Rate for Payer: Encore All Commercial |
$127.21
|
| Rate for Payer: Frontpath All Commercial |
$127.14
|
| Rate for Payer: Humana ChoiceCare |
$119.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.38
|
| Rate for Payer: PHCS All Commercial |
$103.65
|
| Rate for Payer: PHP All Commercial |
$104.81
|
| Rate for Payer: Sagamore Health Network All Products |
$106.69
|
| Rate for Payer: Signature Care EPO |
$114.71
|
| Rate for Payer: Signature Care PPO |
$121.62
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
|
|
HC ANA - ANTINUCLEAR AB W/ TITER IF IND
|
Facility
IP
|
$104.35
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
63001857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$97.04 |
| Rate for Payer: Aetna Commercial |
$90.15
|
| Rate for Payer: Cash Price |
$64.70
|
| Rate for Payer: Cigna All Commercial |
$90.05
|
| Rate for Payer: CORVEL All Commercial |
$97.04
|
| Rate for Payer: Coventry All Commercial |
$91.82
|
| Rate for Payer: Encore All Commercial |
$96.05
|
| Rate for Payer: Frontpath All Commercial |
$96.00
|
| Rate for Payer: Humana ChoiceCare |
$90.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.91
|
| Rate for Payer: PHCS All Commercial |
$78.26
|
| Rate for Payer: PHP All Commercial |
$79.14
|
| Rate for Payer: Sagamore Health Network All Products |
$80.56
|
| Rate for Payer: Signature Care EPO |
$86.61
|
| Rate for Payer: Signature Care PPO |
$91.82
|
| Rate for Payer: United Healthcare Commercial |
$82.22
|
|
|
HC ANA - ANTINUCLEAR AB W/ TITER IF IND
|
Facility
OP
|
$104.35
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
63001857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$97.04 |
| Rate for Payer: Aetna Commercial |
$88.07
|
| Rate for Payer: Aetna Medicare |
$34.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.88
|
| Rate for Payer: Cash Price |
$64.70
|
| Rate for Payer: Cash Price |
$64.70
|
| Rate for Payer: Centivo All Commercial |
$53.22
|
| Rate for Payer: Cigna All Commercial |
$90.05
|
| Rate for Payer: CORVEL All Commercial |
$97.04
|
| Rate for Payer: Coventry All Commercial |
$91.82
|
| Rate for Payer: Encore All Commercial |
$96.05
|
| Rate for Payer: Frontpath All Commercial |
$96.00
|
| Rate for Payer: Humana ChoiceCare |
$90.12
|
| Rate for Payer: Humana Medicare |
$53.22
|
| Rate for Payer: Lucent All Commercial |
$53.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.91
|
| Rate for Payer: Managed Health Services Medicaid |
$12.09
|
| Rate for Payer: MDWise Medicaid |
$12.09
|
| Rate for Payer: PHCS All Commercial |
$78.26
|
| Rate for Payer: PHP All Commercial |
$79.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.69
|
| Rate for Payer: Sagamore Health Network All Products |
$80.56
|
| Rate for Payer: Signature Care EPO |
$86.61
|
| Rate for Payer: Signature Care PPO |
$91.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88.69
|
| Rate for Payer: United Healthcare Commercial |
$82.22
|
| Rate for Payer: United Healthcare Medicare |
$34.43
|
|
|
HC ANA CENTROMERE TITER
|
Facility
OP
|
$357.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$301.31
|
| Rate for Payer: Aetna Medicare |
$117.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$164.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.59
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Centivo All Commercial |
$182.07
|
| Rate for Payer: Cigna All Commercial |
$308.09
|
| Rate for Payer: CORVEL All Commercial |
$332.01
|
| Rate for Payer: Coventry All Commercial |
$314.16
|
| Rate for Payer: Encore All Commercial |
$328.62
|
| Rate for Payer: Frontpath All Commercial |
$328.44
|
| Rate for Payer: Humana ChoiceCare |
$308.34
|
| Rate for Payer: Humana Medicare |
$182.07
|
| Rate for Payer: Lucent All Commercial |
$182.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.30
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$267.75
|
| Rate for Payer: PHP All Commercial |
$270.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.23
|
| Rate for Payer: Sagamore Health Network All Products |
$275.60
|
| Rate for Payer: Signature Care EPO |
$296.31
|
| Rate for Payer: Signature Care PPO |
$314.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$303.45
|
| Rate for Payer: United Healthcare Commercial |
$281.32
|
| Rate for Payer: United Healthcare Medicare |
$117.81
|
|
|
HC ANA CENTROMERE TITER
|
Facility
IP
|
$357.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$308.45
|
| Rate for Payer: Cash Price |
$221.34
|
| Rate for Payer: Cigna All Commercial |
$308.09
|
| Rate for Payer: CORVEL All Commercial |
$332.01
|
| Rate for Payer: Coventry All Commercial |
$314.16
|
| Rate for Payer: Encore All Commercial |
$328.62
|
| Rate for Payer: Frontpath All Commercial |
$328.44
|
| Rate for Payer: Humana ChoiceCare |
$308.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.30
|
| Rate for Payer: PHCS All Commercial |
$267.75
|
| Rate for Payer: PHP All Commercial |
$270.75
|
| Rate for Payer: Sagamore Health Network All Products |
$275.60
|
| Rate for Payer: Signature Care EPO |
$296.31
|
| Rate for Payer: Signature Care PPO |
$314.16
|
| Rate for Payer: United Healthcare Commercial |
$281.32
|
|
|
HC ANAEROBIC CULTURE
|
Facility
OP
|
$250.67
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
63001073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$233.12 |
| Rate for Payer: Aetna Commercial |
$211.56
|
| Rate for Payer: Aetna Medicare |
$82.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$115.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.99
|
| Rate for Payer: Cash Price |
$155.41
|
| Rate for Payer: Cash Price |
$155.41
|
| Rate for Payer: Centivo All Commercial |
$127.84
|
| Rate for Payer: Cigna All Commercial |
$216.32
|
| Rate for Payer: CORVEL All Commercial |
$233.12
|
| Rate for Payer: Coventry All Commercial |
$220.59
|
| Rate for Payer: Encore All Commercial |
$230.74
|
| Rate for Payer: Frontpath All Commercial |
$230.61
|
| Rate for Payer: Humana ChoiceCare |
$216.50
|
| Rate for Payer: Humana Medicare |
$127.84
|
| Rate for Payer: Lucent All Commercial |
$127.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$225.60
|
| Rate for Payer: Managed Health Services Medicaid |
$8.48
|
| Rate for Payer: MDWise Medicaid |
$8.48
|
| Rate for Payer: PHCS All Commercial |
$188.00
|
| Rate for Payer: PHP All Commercial |
$190.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.76
|
| Rate for Payer: Sagamore Health Network All Products |
$193.51
|
| Rate for Payer: Signature Care EPO |
$208.05
|
| Rate for Payer: Signature Care PPO |
$220.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$213.07
|
| Rate for Payer: United Healthcare Commercial |
$197.52
|
| Rate for Payer: United Healthcare Medicare |
$82.72
|
|
|
HC ANAEROBIC CULTURE
|
Facility
IP
|
$250.67
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
63001073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$233.12 |
| Rate for Payer: Aetna Commercial |
$216.57
|
| Rate for Payer: Cash Price |
$155.41
|
| Rate for Payer: Cigna All Commercial |
$216.32
|
| Rate for Payer: CORVEL All Commercial |
$233.12
|
| Rate for Payer: Coventry All Commercial |
$220.59
|
| Rate for Payer: Encore All Commercial |
$230.74
|
| Rate for Payer: Frontpath All Commercial |
$230.61
|
| Rate for Payer: Humana ChoiceCare |
$216.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$225.60
|
| Rate for Payer: PHCS All Commercial |
$188.00
|
| Rate for Payer: PHP All Commercial |
$190.10
|
| Rate for Payer: Sagamore Health Network All Products |
$193.51
|
| Rate for Payer: Signature Care EPO |
$208.05
|
| Rate for Payer: Signature Care PPO |
$220.59
|
| Rate for Payer: United Healthcare Commercial |
$197.52
|
|
|
HC ANA IGG TITER+PATTERN-IFA
|
Facility
IP
|
$160.45
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
63001287
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.33 |
| Max. Negotiated Rate |
$149.21 |
| Rate for Payer: Aetna Commercial |
$138.63
|
| Rate for Payer: Cash Price |
$99.48
|
| Rate for Payer: Cigna All Commercial |
$138.46
|
| Rate for Payer: CORVEL All Commercial |
$149.21
|
| Rate for Payer: Coventry All Commercial |
$141.19
|
| Rate for Payer: Encore All Commercial |
$147.69
|
| Rate for Payer: Frontpath All Commercial |
$147.61
|
| Rate for Payer: Humana ChoiceCare |
$138.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.40
|
| Rate for Payer: PHCS All Commercial |
$120.33
|
| Rate for Payer: PHP All Commercial |
$121.68
|
| Rate for Payer: Sagamore Health Network All Products |
$123.86
|
| Rate for Payer: Signature Care EPO |
$133.17
|
| Rate for Payer: Signature Care PPO |
$141.19
|
| Rate for Payer: United Healthcare Commercial |
$126.43
|
|
|
HC ANA IGG TITER+PATTERN-IFA
|
Facility
OP
|
$160.45
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
63001287
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$149.21 |
| Rate for Payer: Aetna Commercial |
$135.42
|
| Rate for Payer: Aetna Medicare |
$52.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.24
|
| Rate for Payer: Cash Price |
$99.48
|
| Rate for Payer: Cash Price |
$99.48
|
| Rate for Payer: Centivo All Commercial |
$81.83
|
| Rate for Payer: Cigna All Commercial |
$138.46
|
| Rate for Payer: CORVEL All Commercial |
$149.21
|
| Rate for Payer: Coventry All Commercial |
$141.19
|
| Rate for Payer: Encore All Commercial |
$147.69
|
| Rate for Payer: Frontpath All Commercial |
$147.61
|
| Rate for Payer: Humana ChoiceCare |
$138.58
|
| Rate for Payer: Humana Medicare |
$81.83
|
| Rate for Payer: Lucent All Commercial |
$81.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.40
|
| Rate for Payer: Managed Health Services Medicaid |
$11.16
|
| Rate for Payer: MDWise Medicaid |
$11.16
|
| Rate for Payer: PHCS All Commercial |
$120.33
|
| Rate for Payer: PHP All Commercial |
$121.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.57
|
| Rate for Payer: Sagamore Health Network All Products |
$123.86
|
| Rate for Payer: Signature Care EPO |
$133.17
|
| Rate for Payer: Signature Care PPO |
$141.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.38
|
| Rate for Payer: United Healthcare Commercial |
$126.43
|
| Rate for Payer: United Healthcare Medicare |
$52.95
|
|
|
HC ANCA-NEUT CYT
|
Facility
IP
|
$160.94
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$149.67 |
| Rate for Payer: Aetna Commercial |
$139.05
|
| Rate for Payer: Cash Price |
$99.78
|
| Rate for Payer: Cigna All Commercial |
$138.89
|
| Rate for Payer: CORVEL All Commercial |
$149.67
|
| Rate for Payer: Coventry All Commercial |
$141.62
|
| Rate for Payer: Encore All Commercial |
$148.14
|
| Rate for Payer: Frontpath All Commercial |
$148.06
|
| Rate for Payer: Humana ChoiceCare |
$139.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.84
|
| Rate for Payer: PHCS All Commercial |
$120.70
|
| Rate for Payer: PHP All Commercial |
$122.05
|
| Rate for Payer: Sagamore Health Network All Products |
$124.24
|
| Rate for Payer: Signature Care EPO |
$133.58
|
| Rate for Payer: Signature Care PPO |
$141.62
|
| Rate for Payer: United Healthcare Commercial |
$126.82
|
|
|
HC ANCA-NEUT CYT
|
Facility
OP
|
$160.94
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$149.67 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna Medicare |
$53.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.42
|
| Rate for Payer: Cash Price |
$99.78
|
| Rate for Payer: Cash Price |
$99.78
|
| Rate for Payer: Centivo All Commercial |
$82.08
|
| Rate for Payer: Cigna All Commercial |
$138.89
|
| Rate for Payer: CORVEL All Commercial |
$149.67
|
| Rate for Payer: Coventry All Commercial |
$141.62
|
| Rate for Payer: Encore All Commercial |
$148.14
|
| Rate for Payer: Frontpath All Commercial |
$148.06
|
| Rate for Payer: Humana ChoiceCare |
$139.00
|
| Rate for Payer: Humana Medicare |
$82.08
|
| Rate for Payer: Lucent All Commercial |
$82.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.84
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$120.70
|
| Rate for Payer: PHP All Commercial |
$122.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.76
|
| Rate for Payer: Sagamore Health Network All Products |
$124.24
|
| Rate for Payer: Signature Care EPO |
$133.58
|
| Rate for Payer: Signature Care PPO |
$141.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.80
|
| Rate for Payer: United Healthcare Commercial |
$126.82
|
| Rate for Payer: United Healthcare Medicare |
$53.11
|
|
