|
HC ANTI-ENA ANTI
|
Facility
OP
|
$95.83
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$80.88
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.79
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Centivo All Commercial |
$48.87
|
| Rate for Payer: Cigna All Commercial |
$82.70
|
| Rate for Payer: CORVEL All Commercial |
$89.12
|
| Rate for Payer: Coventry All Commercial |
$84.33
|
| Rate for Payer: Encore All Commercial |
$88.21
|
| Rate for Payer: Frontpath All Commercial |
$88.16
|
| Rate for Payer: Humana ChoiceCare |
$82.77
|
| Rate for Payer: Humana Medicare |
$48.87
|
| Rate for Payer: Lucent All Commercial |
$48.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.25
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$71.87
|
| Rate for Payer: PHP All Commercial |
$72.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.37
|
| Rate for Payer: Sagamore Health Network All Products |
$73.98
|
| Rate for Payer: Signature Care EPO |
$79.54
|
| Rate for Payer: Signature Care PPO |
$84.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.45
|
| Rate for Payer: United Healthcare Commercial |
$75.51
|
| Rate for Payer: United Healthcare Medicare |
$31.62
|
|
|
HC ANTI-ENDOMYSIAL
|
Facility
IP
|
$130.86
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
|
|
HC ANTI-ENDOMYSIAL
|
Facility
OP
|
$130.86
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.44
|
| Rate for Payer: Aetna Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.50
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Centivo All Commercial |
$66.74
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$66.74
|
| Rate for Payer: Lucent All Commercial |
$66.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$12.09
|
| Rate for Payer: MDWise Medicaid |
$12.09
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.03
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
| Rate for Payer: United Healthcare Medicare |
$43.18
|
|
|
HC ANTI-ENDOMYSIAL IGA TITER
|
Facility
IP
|
$147.40
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.55 |
| Max. Negotiated Rate |
$137.08 |
| Rate for Payer: Aetna Commercial |
$127.35
|
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Cigna All Commercial |
$127.21
|
| Rate for Payer: CORVEL All Commercial |
$137.08
|
| Rate for Payer: Coventry All Commercial |
$129.71
|
| Rate for Payer: Encore All Commercial |
$135.68
|
| Rate for Payer: Frontpath All Commercial |
$135.61
|
| Rate for Payer: Humana ChoiceCare |
$127.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.66
|
| Rate for Payer: PHCS All Commercial |
$110.55
|
| Rate for Payer: PHP All Commercial |
$111.79
|
| Rate for Payer: Sagamore Health Network All Products |
$113.79
|
| Rate for Payer: Signature Care EPO |
$122.34
|
| Rate for Payer: Signature Care PPO |
$129.71
|
| Rate for Payer: United Healthcare Commercial |
$116.15
|
|
|
HC ANTI-ENDOMYSIAL IGA TITER
|
Facility
OP
|
$147.40
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$137.08 |
| Rate for Payer: Aetna Commercial |
$124.41
|
| Rate for Payer: Aetna Medicare |
$48.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$84.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.51
|
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Centivo All Commercial |
$75.17
|
| Rate for Payer: Cigna All Commercial |
$127.21
|
| Rate for Payer: CORVEL All Commercial |
$137.08
|
| Rate for Payer: Coventry All Commercial |
$129.71
|
| Rate for Payer: Encore All Commercial |
$135.68
|
| Rate for Payer: Frontpath All Commercial |
$135.61
|
| Rate for Payer: Humana ChoiceCare |
$127.31
|
| Rate for Payer: Humana Medicare |
$75.17
|
| Rate for Payer: Lucent All Commercial |
$75.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.66
|
| Rate for Payer: Managed Health Services Medicaid |
$12.09
|
| Rate for Payer: MDWise Medicaid |
$12.09
|
| Rate for Payer: PHCS All Commercial |
$110.55
|
| Rate for Payer: PHP All Commercial |
$111.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.49
|
| Rate for Payer: Sagamore Health Network All Products |
$113.79
|
| Rate for Payer: Signature Care EPO |
$122.34
|
| Rate for Payer: Signature Care PPO |
$129.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$125.29
|
| Rate for Payer: United Healthcare Commercial |
$116.15
|
| Rate for Payer: United Healthcare Medicare |
$48.64
|
|
|
HC ANTI-ENDOMYSIAL TITE
|
Facility
IP
|
$194.36
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.77 |
| Max. Negotiated Rate |
$180.76 |
| Rate for Payer: Aetna Commercial |
$167.93
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.76
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
|
|
HC ANTI-ENDOMYSIAL TITE
|
Facility
OP
|
$194.36
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
63001893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$180.76 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$64.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$111.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.55
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Centivo All Commercial |
$99.12
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.76
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Humana Medicare |
$99.12
|
| Rate for Payer: Lucent All Commercial |
$99.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: Managed Health Services Medicaid |
$12.09
|
| Rate for Payer: MDWise Medicaid |
$12.09
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.80
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.21
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
| Rate for Payer: United Healthcare Medicare |
$64.14
|
|
|
HC ANTIGEN SCREEN EA AG
|
Facility
OP
|
$120.08
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
63001349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$111.68 |
| Rate for Payer: Aetna Commercial |
$101.35
|
| Rate for Payer: Aetna Medicare |
$39.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.59
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Centivo All Commercial |
$61.24
|
| Rate for Payer: Cigna All Commercial |
$103.63
|
| Rate for Payer: CORVEL All Commercial |
$111.68
|
| Rate for Payer: Coventry All Commercial |
$105.67
|
| Rate for Payer: Encore All Commercial |
$110.54
|
| Rate for Payer: Frontpath All Commercial |
$110.48
|
| Rate for Payer: Humana ChoiceCare |
$103.72
|
| Rate for Payer: Humana Medicare |
$61.24
|
| Rate for Payer: Lucent All Commercial |
$61.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.08
|
| Rate for Payer: Managed Health Services Medicaid |
$5.20
|
| Rate for Payer: MDWise Medicaid |
$5.20
|
| Rate for Payer: PHCS All Commercial |
$90.06
|
| Rate for Payer: PHP All Commercial |
$91.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.83
|
| Rate for Payer: Sagamore Health Network All Products |
$92.71
|
| Rate for Payer: Signature Care EPO |
$99.67
|
| Rate for Payer: Signature Care PPO |
$105.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.07
|
| Rate for Payer: United Healthcare Commercial |
$94.63
|
| Rate for Payer: United Healthcare Medicare |
$39.63
|
|
|
HC ANTIGEN SCREEN EA AG
|
Facility
IP
|
$120.08
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
63001349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$111.68 |
| Rate for Payer: Aetna Commercial |
$103.75
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cigna All Commercial |
$103.63
|
| Rate for Payer: CORVEL All Commercial |
$111.68
|
| Rate for Payer: Coventry All Commercial |
$105.67
|
| Rate for Payer: Encore All Commercial |
$110.54
|
| Rate for Payer: Frontpath All Commercial |
$110.48
|
| Rate for Payer: Humana ChoiceCare |
$103.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.08
|
| Rate for Payer: PHCS All Commercial |
$90.06
|
| Rate for Payer: PHP All Commercial |
$91.07
|
| Rate for Payer: Sagamore Health Network All Products |
$92.71
|
| Rate for Payer: Signature Care EPO |
$99.67
|
| Rate for Payer: Signature Care PPO |
$105.67
|
| Rate for Payer: United Healthcare Commercial |
$94.63
|
|
|
HC ANTIGEN TYPING, RBC
|
Facility
OP
|
$187.37
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
63001348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$174.26 |
| Rate for Payer: Aetna Commercial |
$158.14
|
| Rate for Payer: Aetna Medicare |
$61.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.02
|
| Rate for Payer: Cash Price |
$116.17
|
| Rate for Payer: Cash Price |
$116.17
|
| Rate for Payer: Centivo All Commercial |
$95.56
|
| Rate for Payer: Cigna All Commercial |
$161.70
|
| Rate for Payer: CORVEL All Commercial |
$174.26
|
| Rate for Payer: Coventry All Commercial |
$164.89
|
| Rate for Payer: Encore All Commercial |
$172.48
|
| Rate for Payer: Frontpath All Commercial |
$172.38
|
| Rate for Payer: Humana ChoiceCare |
$161.83
|
| Rate for Payer: Humana Medicare |
$95.56
|
| Rate for Payer: Lucent All Commercial |
$95.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.64
|
| Rate for Payer: Managed Health Services Medicaid |
$3.83
|
| Rate for Payer: MDWise Medicaid |
$3.83
|
| Rate for Payer: PHCS All Commercial |
$140.53
|
| Rate for Payer: PHP All Commercial |
$142.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.08
|
| Rate for Payer: Sagamore Health Network All Products |
$144.65
|
| Rate for Payer: Signature Care EPO |
$155.52
|
| Rate for Payer: Signature Care PPO |
$164.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.27
|
| Rate for Payer: United Healthcare Commercial |
$147.65
|
| Rate for Payer: United Healthcare Medicare |
$61.83
|
|
|
HC ANTIGEN TYPING, RBC
|
Facility
IP
|
$187.37
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
63001348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.53 |
| Max. Negotiated Rate |
$174.26 |
| Rate for Payer: Aetna Commercial |
$161.89
|
| Rate for Payer: Cash Price |
$116.17
|
| Rate for Payer: Cigna All Commercial |
$161.70
|
| Rate for Payer: CORVEL All Commercial |
$174.26
|
| Rate for Payer: Coventry All Commercial |
$164.89
|
| Rate for Payer: Encore All Commercial |
$172.48
|
| Rate for Payer: Frontpath All Commercial |
$172.38
|
| Rate for Payer: Humana ChoiceCare |
$161.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.64
|
| Rate for Payer: PHCS All Commercial |
$140.53
|
| Rate for Payer: PHP All Commercial |
$142.10
|
| Rate for Payer: Sagamore Health Network All Products |
$144.65
|
| Rate for Payer: Signature Care EPO |
$155.52
|
| Rate for Payer: Signature Care PPO |
$164.89
|
| Rate for Payer: United Healthcare Commercial |
$147.65
|
|
|
HC ANTIMICROSOMAL AB EA
|
Facility
OP
|
$88.34
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$82.16 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$29.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.07
|
| Rate for Payer: Cash Price |
$54.77
|
| Rate for Payer: Cash Price |
$54.77
|
| Rate for Payer: Centivo All Commercial |
$45.05
|
| Rate for Payer: Cigna All Commercial |
$76.24
|
| Rate for Payer: CORVEL All Commercial |
$82.16
|
| Rate for Payer: Coventry All Commercial |
$77.74
|
| Rate for Payer: Encore All Commercial |
$81.32
|
| Rate for Payer: Frontpath All Commercial |
$81.27
|
| Rate for Payer: Humana ChoiceCare |
$76.30
|
| Rate for Payer: Humana Medicare |
$45.05
|
| Rate for Payer: Lucent All Commercial |
$45.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.51
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: MDWise Medicaid |
$14.55
|
| Rate for Payer: PHCS All Commercial |
$66.26
|
| Rate for Payer: PHP All Commercial |
$67.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.45
|
| Rate for Payer: Sagamore Health Network All Products |
$68.20
|
| Rate for Payer: Signature Care EPO |
$73.32
|
| Rate for Payer: Signature Care PPO |
$77.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75.09
|
| Rate for Payer: United Healthcare Commercial |
$69.61
|
| Rate for Payer: United Healthcare Medicare |
$29.15
|
|
|
HC ANTIMICROSOMAL AB EA
|
Facility
IP
|
$88.34
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.26 |
| Max. Negotiated Rate |
$82.16 |
| Rate for Payer: Aetna Commercial |
$76.33
|
| Rate for Payer: Cash Price |
$54.77
|
| Rate for Payer: Cigna All Commercial |
$76.24
|
| Rate for Payer: CORVEL All Commercial |
$82.16
|
| Rate for Payer: Coventry All Commercial |
$77.74
|
| Rate for Payer: Encore All Commercial |
$81.32
|
| Rate for Payer: Frontpath All Commercial |
$81.27
|
| Rate for Payer: Humana ChoiceCare |
$76.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.51
|
| Rate for Payer: PHCS All Commercial |
$66.26
|
| Rate for Payer: PHP All Commercial |
$67.00
|
| Rate for Payer: Sagamore Health Network All Products |
$68.20
|
| Rate for Payer: Signature Care EPO |
$73.32
|
| Rate for Payer: Signature Care PPO |
$77.74
|
| Rate for Payer: United Healthcare Commercial |
$69.61
|
|
|
HC ANTINUCLEAR ANTIBODY
|
Facility
IP
|
$104.35
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
63001858
|
|
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 ANTINUCLEAR ANTIBODY
|
Facility
OP
|
$104.35
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
63001858
|
|
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 ANTI-PARIETAL AB
|
Facility
IP
|
$105.57
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.18 |
| Max. Negotiated Rate |
$98.18 |
| Rate for Payer: Aetna Commercial |
$91.21
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Cigna All Commercial |
$91.11
|
| Rate for Payer: CORVEL All Commercial |
$98.18
|
| Rate for Payer: Coventry All Commercial |
$92.90
|
| Rate for Payer: Encore All Commercial |
$97.18
|
| Rate for Payer: Frontpath All Commercial |
$97.12
|
| Rate for Payer: Humana ChoiceCare |
$91.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.01
|
| Rate for Payer: PHCS All Commercial |
$79.18
|
| Rate for Payer: PHP All Commercial |
$80.06
|
| Rate for Payer: Sagamore Health Network All Products |
$81.50
|
| Rate for Payer: Signature Care EPO |
$87.62
|
| Rate for Payer: Signature Care PPO |
$92.90
|
| Rate for Payer: United Healthcare Commercial |
$83.19
|
|
|
HC ANTI-PARIETAL AB
|
Facility
OP
|
$105.57
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$98.18 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: Aetna Medicare |
$34.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.32
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Centivo All Commercial |
$53.84
|
| Rate for Payer: Cigna All Commercial |
$91.11
|
| Rate for Payer: CORVEL All Commercial |
$98.18
|
| Rate for Payer: Coventry All Commercial |
$92.90
|
| Rate for Payer: Encore All Commercial |
$97.18
|
| Rate for Payer: Frontpath All Commercial |
$97.12
|
| Rate for Payer: Humana ChoiceCare |
$91.18
|
| Rate for Payer: Humana Medicare |
$53.84
|
| Rate for Payer: Lucent All Commercial |
$53.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.01
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$79.18
|
| Rate for Payer: PHP All Commercial |
$80.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.17
|
| Rate for Payer: Sagamore Health Network All Products |
$81.50
|
| Rate for Payer: Signature Care EPO |
$87.62
|
| Rate for Payer: Signature Care PPO |
$92.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.73
|
| Rate for Payer: United Healthcare Commercial |
$83.19
|
| Rate for Payer: United Healthcare Medicare |
$34.84
|
|
|
HC ANTIPARIETAL CELL ANTIBODY (APCA)
|
Facility
OP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63044047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.44
|
| Rate for Payer: Aetna Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.50
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Centivo All Commercial |
$66.74
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$66.74
|
| Rate for Payer: Lucent All Commercial |
$66.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.03
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
| Rate for Payer: United Healthcare Medicare |
$43.18
|
|
|
HC ANTIPARIETAL CELL ANTIBODY (APCA)
|
Facility
IP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63044047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
|
|
HC ANTI-STR-MUSC AB
|
Facility
IP
|
$138.51
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$128.81 |
| Rate for Payer: Aetna Commercial |
$119.67
|
| Rate for Payer: Cash Price |
$85.87
|
| Rate for Payer: Cigna All Commercial |
$119.53
|
| Rate for Payer: CORVEL All Commercial |
$128.81
|
| Rate for Payer: Coventry All Commercial |
$121.89
|
| Rate for Payer: Encore All Commercial |
$127.49
|
| Rate for Payer: Frontpath All Commercial |
$127.43
|
| Rate for Payer: Humana ChoiceCare |
$119.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.66
|
| Rate for Payer: PHCS All Commercial |
$103.88
|
| Rate for Payer: PHP All Commercial |
$105.04
|
| Rate for Payer: Sagamore Health Network All Products |
$106.93
|
| Rate for Payer: Signature Care EPO |
$114.96
|
| Rate for Payer: Signature Care PPO |
$121.89
|
| Rate for Payer: United Healthcare Commercial |
$109.14
|
|
|
HC ANTI-STR-MUSC AB
|
Facility
OP
|
$138.51
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
63001886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$128.81 |
| Rate for Payer: Aetna Commercial |
$116.90
|
| Rate for Payer: Aetna Medicare |
$45.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.28
|
| Rate for Payer: Cash Price |
$85.87
|
| Rate for Payer: Cash Price |
$85.87
|
| Rate for Payer: Centivo All Commercial |
$70.64
|
| Rate for Payer: Cigna All Commercial |
$119.53
|
| Rate for Payer: CORVEL All Commercial |
$128.81
|
| Rate for Payer: Coventry All Commercial |
$121.89
|
| Rate for Payer: Encore All Commercial |
$127.49
|
| Rate for Payer: Frontpath All Commercial |
$127.43
|
| Rate for Payer: Humana ChoiceCare |
$119.63
|
| Rate for Payer: Humana Medicare |
$70.64
|
| Rate for Payer: Lucent All Commercial |
$70.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.66
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$103.88
|
| Rate for Payer: PHP All Commercial |
$105.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.02
|
| Rate for Payer: Sagamore Health Network All Products |
$106.93
|
| Rate for Payer: Signature Care EPO |
$114.96
|
| Rate for Payer: Signature Care PPO |
$121.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.73
|
| Rate for Payer: United Healthcare Commercial |
$109.14
|
| Rate for Payer: United Healthcare Medicare |
$45.71
|
|
|
HC ANTI-STR-MUSC AB TITER
|
Facility
IP
|
$219.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001891
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.28 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Aetna Commercial |
$189.25
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cigna All Commercial |
$189.03
|
| Rate for Payer: CORVEL All Commercial |
$203.70
|
| Rate for Payer: Coventry All Commercial |
$192.75
|
| Rate for Payer: Encore All Commercial |
$201.62
|
| Rate for Payer: Frontpath All Commercial |
$201.51
|
| Rate for Payer: Humana ChoiceCare |
$189.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.13
|
| Rate for Payer: PHCS All Commercial |
$164.28
|
| Rate for Payer: PHP All Commercial |
$166.12
|
| Rate for Payer: Sagamore Health Network All Products |
$169.09
|
| Rate for Payer: Signature Care EPO |
$181.80
|
| Rate for Payer: Signature Care PPO |
$192.75
|
| Rate for Payer: United Healthcare Commercial |
$172.60
|
|
|
HC ANTI-STR-MUSC AB TITER
|
Facility
OP
|
$219.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001891
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Aetna Commercial |
$184.87
|
| Rate for Payer: Aetna Medicare |
$72.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.51
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Centivo All Commercial |
$111.71
|
| Rate for Payer: Cigna All Commercial |
$189.03
|
| Rate for Payer: CORVEL All Commercial |
$203.70
|
| Rate for Payer: Coventry All Commercial |
$192.75
|
| Rate for Payer: Encore All Commercial |
$201.62
|
| Rate for Payer: Frontpath All Commercial |
$201.51
|
| Rate for Payer: Humana ChoiceCare |
$189.18
|
| Rate for Payer: Humana Medicare |
$111.71
|
| Rate for Payer: Lucent All Commercial |
$111.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.13
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$164.28
|
| Rate for Payer: PHP All Commercial |
$166.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.42
|
| Rate for Payer: Sagamore Health Network All Products |
$169.09
|
| Rate for Payer: Signature Care EPO |
$181.80
|
| Rate for Payer: Signature Care PPO |
$192.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$186.18
|
| Rate for Payer: United Healthcare Commercial |
$172.60
|
| Rate for Payer: United Healthcare Medicare |
$72.28
|
|
|
HC ANTITHROMBIN III
|
Facility
IP
|
$279.94
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
63001740
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$260.34 |
| Rate for Payer: Aetna Commercial |
$241.87
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cigna All Commercial |
$241.59
|
| Rate for Payer: CORVEL All Commercial |
$260.34
|
| Rate for Payer: Coventry All Commercial |
$246.35
|
| Rate for Payer: Encore All Commercial |
$257.68
|
| Rate for Payer: Frontpath All Commercial |
$257.54
|
| Rate for Payer: Humana ChoiceCare |
$241.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$251.95
|
| Rate for Payer: PHCS All Commercial |
$209.95
|
| Rate for Payer: PHP All Commercial |
$212.31
|
| Rate for Payer: Sagamore Health Network All Products |
$216.11
|
| Rate for Payer: Signature Care EPO |
$232.35
|
| Rate for Payer: Signature Care PPO |
$246.35
|
| Rate for Payer: United Healthcare Commercial |
$220.59
|
|
|
HC ANTITHROMBIN III
|
Facility
OP
|
$279.94
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
63001740
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$260.34 |
| Rate for Payer: Aetna Commercial |
$236.27
|
| Rate for Payer: Aetna Medicare |
$92.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$160.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$174.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.62
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Centivo All Commercial |
$142.77
|
| Rate for Payer: Cigna All Commercial |
$241.59
|
| Rate for Payer: CORVEL All Commercial |
$260.34
|
| Rate for Payer: Coventry All Commercial |
$246.35
|
| Rate for Payer: Encore All Commercial |
$257.68
|
| Rate for Payer: Frontpath All Commercial |
$257.54
|
| Rate for Payer: Humana ChoiceCare |
$241.78
|
| Rate for Payer: Humana Medicare |
$142.77
|
| Rate for Payer: Lucent All Commercial |
$142.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$251.95
|
| Rate for Payer: Managed Health Services Medicaid |
$11.85
|
| Rate for Payer: MDWise Medicaid |
$11.85
|
| Rate for Payer: PHCS All Commercial |
$209.95
|
| Rate for Payer: PHP All Commercial |
$212.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.18
|
| Rate for Payer: Sagamore Health Network All Products |
$216.11
|
| Rate for Payer: Signature Care EPO |
$232.35
|
| Rate for Payer: Signature Care PPO |
$246.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$237.95
|
| Rate for Payer: United Healthcare Commercial |
$220.59
|
| Rate for Payer: United Healthcare Medicare |
$92.38
|
|
