|
HC CALCIUM UR
|
Facility
IP
|
$47.14
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
63001475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$43.84 |
| Rate for Payer: Aetna Commercial |
$40.73
|
| Rate for Payer: Cash Price |
$29.23
|
| Rate for Payer: Cigna All Commercial |
$40.69
|
| Rate for Payer: CORVEL All Commercial |
$43.84
|
| Rate for Payer: Coventry All Commercial |
$41.49
|
| Rate for Payer: Encore All Commercial |
$43.40
|
| Rate for Payer: Frontpath All Commercial |
$43.37
|
| Rate for Payer: Humana ChoiceCare |
$40.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.43
|
| Rate for Payer: PHCS All Commercial |
$35.36
|
| Rate for Payer: PHP All Commercial |
$35.75
|
| Rate for Payer: Sagamore Health Network All Products |
$36.40
|
| Rate for Payer: Signature Care EPO |
$39.13
|
| Rate for Payer: Signature Care PPO |
$41.49
|
| Rate for Payer: United Healthcare Commercial |
$37.15
|
|
|
HC CALPROTECTIN, FECES
|
Facility
IP
|
$403.92
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
63001652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$302.94 |
| Max. Negotiated Rate |
$375.65 |
| Rate for Payer: Aetna Commercial |
$348.99
|
| Rate for Payer: Cash Price |
$250.43
|
| Rate for Payer: Cigna All Commercial |
$348.58
|
| Rate for Payer: CORVEL All Commercial |
$375.65
|
| Rate for Payer: Coventry All Commercial |
$355.45
|
| Rate for Payer: Encore All Commercial |
$371.81
|
| Rate for Payer: Frontpath All Commercial |
$371.61
|
| Rate for Payer: Humana ChoiceCare |
$348.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$363.53
|
| Rate for Payer: PHCS All Commercial |
$302.94
|
| Rate for Payer: PHP All Commercial |
$306.33
|
| Rate for Payer: Sagamore Health Network All Products |
$311.83
|
| Rate for Payer: Signature Care EPO |
$335.25
|
| Rate for Payer: Signature Care PPO |
$355.45
|
| Rate for Payer: United Healthcare Commercial |
$318.29
|
|
|
HC CALPROTECTIN, FECES
|
Facility
OP
|
$403.92
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
63001652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$375.65 |
| Rate for Payer: Aetna Commercial |
$340.91
|
| Rate for Payer: Aetna Medicare |
$133.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$133.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$185.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$185.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.62
|
| Rate for Payer: Cash Price |
$250.43
|
| Rate for Payer: Cash Price |
$250.43
|
| Rate for Payer: Centivo All Commercial |
$206.00
|
| Rate for Payer: Cigna All Commercial |
$348.58
|
| Rate for Payer: CORVEL All Commercial |
$375.65
|
| Rate for Payer: Coventry All Commercial |
$355.45
|
| Rate for Payer: Encore All Commercial |
$371.81
|
| Rate for Payer: Frontpath All Commercial |
$371.61
|
| Rate for Payer: Humana ChoiceCare |
$348.87
|
| Rate for Payer: Humana Medicare |
$206.00
|
| Rate for Payer: Lucent All Commercial |
$206.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$363.53
|
| Rate for Payer: Managed Health Services Medicaid |
$19.63
|
| Rate for Payer: MDWise Medicaid |
$19.63
|
| Rate for Payer: PHCS All Commercial |
$302.94
|
| Rate for Payer: PHP All Commercial |
$306.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$157.53
|
| Rate for Payer: Sagamore Health Network All Products |
$311.83
|
| Rate for Payer: Signature Care EPO |
$335.25
|
| Rate for Payer: Signature Care PPO |
$355.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$343.33
|
| Rate for Payer: United Healthcare Commercial |
$318.29
|
| Rate for Payer: United Healthcare Medicare |
$133.29
|
|
|
HC CALRETICULIN (CALR) MUTATION ANALYSIS
|
Facility
OP
|
$397.80
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
63044024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.63 |
| Max. Negotiated Rate |
$369.95 |
| Rate for Payer: Aetna Commercial |
$335.74
|
| Rate for Payer: Aetna Medicare |
$131.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.40
|
| Rate for Payer: Cash Price |
$246.64
|
| Rate for Payer: Cash Price |
$246.64
|
| Rate for Payer: Centivo All Commercial |
$202.88
|
| Rate for Payer: Cigna All Commercial |
$343.30
|
| Rate for Payer: CORVEL All Commercial |
$369.95
|
| Rate for Payer: Coventry All Commercial |
$350.06
|
| Rate for Payer: Encore All Commercial |
$366.17
|
| Rate for Payer: Frontpath All Commercial |
$365.98
|
| Rate for Payer: Humana ChoiceCare |
$343.58
|
| Rate for Payer: Humana Medicare |
$202.88
|
| Rate for Payer: Lucent All Commercial |
$202.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.63
|
| Rate for Payer: MDWise Medicaid |
$121.63
|
| Rate for Payer: PHCS All Commercial |
$298.35
|
| Rate for Payer: PHP All Commercial |
$301.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.14
|
| Rate for Payer: Sagamore Health Network All Products |
$307.10
|
| Rate for Payer: Signature Care EPO |
$330.17
|
| Rate for Payer: Signature Care PPO |
$350.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$338.13
|
| Rate for Payer: United Healthcare Commercial |
$313.47
|
| Rate for Payer: United Healthcare Medicare |
$131.27
|
|
|
HC CALRETICULIN (CALR) MUTATION ANALYSIS
|
Facility
IP
|
$397.80
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
63044024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$369.95 |
| Rate for Payer: Aetna Commercial |
$343.70
|
| Rate for Payer: Cash Price |
$246.64
|
| Rate for Payer: Cigna All Commercial |
$343.30
|
| Rate for Payer: CORVEL All Commercial |
$369.95
|
| Rate for Payer: Coventry All Commercial |
$350.06
|
| Rate for Payer: Encore All Commercial |
$366.17
|
| Rate for Payer: Frontpath All Commercial |
$365.98
|
| Rate for Payer: Humana ChoiceCare |
$343.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.02
|
| Rate for Payer: PHCS All Commercial |
$298.35
|
| Rate for Payer: PHP All Commercial |
$301.69
|
| Rate for Payer: Sagamore Health Network All Products |
$307.10
|
| Rate for Payer: Signature Care EPO |
$330.17
|
| Rate for Payer: Signature Care PPO |
$350.06
|
| Rate for Payer: United Healthcare Commercial |
$313.47
|
|
|
HC CANALITH PROCEDURE - PT
|
Facility
IP
|
$255.00
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
01722016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Cigna All Commercial |
$220.06
|
| Rate for Payer: CORVEL All Commercial |
$237.15
|
| Rate for Payer: Coventry All Commercial |
$224.40
|
| Rate for Payer: Encore All Commercial |
$234.73
|
| Rate for Payer: Frontpath All Commercial |
$234.60
|
| Rate for Payer: Humana ChoiceCare |
$220.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.50
|
| Rate for Payer: PHCS All Commercial |
$191.25
|
| Rate for Payer: PHP All Commercial |
$193.39
|
| Rate for Payer: Sagamore Health Network All Products |
$196.86
|
| Rate for Payer: Signature Care EPO |
$211.65
|
| Rate for Payer: Signature Care PPO |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$200.94
|
|
|
HC CANALITH PROCEDURE - PT
|
Facility
OP
|
$255.00
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
01722016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: Aetna Commercial |
$215.22
|
| Rate for Payer: Aetna Medicare |
$84.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$146.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.56
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Centivo All Commercial |
$130.05
|
| Rate for Payer: Cigna All Commercial |
$220.06
|
| Rate for Payer: CORVEL All Commercial |
$237.15
|
| Rate for Payer: Coventry All Commercial |
$224.40
|
| Rate for Payer: Encore All Commercial |
$234.73
|
| Rate for Payer: Frontpath All Commercial |
$234.60
|
| Rate for Payer: Humana ChoiceCare |
$220.24
|
| Rate for Payer: Humana Medicare |
$130.05
|
| Rate for Payer: Lucent All Commercial |
$130.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.50
|
| Rate for Payer: PHCS All Commercial |
$191.25
|
| Rate for Payer: PHP All Commercial |
$193.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.45
|
| Rate for Payer: Sagamore Health Network All Products |
$196.86
|
| Rate for Payer: Signature Care EPO |
$211.65
|
| Rate for Payer: Signature Care PPO |
$224.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$216.75
|
| Rate for Payer: United Healthcare Commercial |
$200.94
|
| Rate for Payer: United Healthcare Medicare |
$84.15
|
|
|
HC CANDIDA AB - ID
|
Facility
IP
|
$57.92
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
63001927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna Commercial |
$50.04
|
| Rate for Payer: Cash Price |
$35.91
|
| Rate for Payer: Cigna All Commercial |
$49.98
|
| Rate for Payer: CORVEL All Commercial |
$53.86
|
| Rate for Payer: Coventry All Commercial |
$50.97
|
| Rate for Payer: Encore All Commercial |
$53.31
|
| Rate for Payer: Frontpath All Commercial |
$53.28
|
| Rate for Payer: Humana ChoiceCare |
$50.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.12
|
| Rate for Payer: PHCS All Commercial |
$43.44
|
| Rate for Payer: PHP All Commercial |
$43.92
|
| Rate for Payer: Sagamore Health Network All Products |
$44.71
|
| Rate for Payer: Signature Care EPO |
$48.07
|
| Rate for Payer: Signature Care PPO |
$50.97
|
| Rate for Payer: United Healthcare Commercial |
$45.64
|
|
|
HC CANDIDA AB - ID
|
Facility
OP
|
$57.92
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
63001927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna Commercial |
$48.88
|
| Rate for Payer: Aetna Medicare |
$19.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.02
|
| Rate for Payer: Cash Price |
$35.91
|
| Rate for Payer: Cash Price |
$35.91
|
| Rate for Payer: Centivo All Commercial |
$29.54
|
| Rate for Payer: Cigna All Commercial |
$49.98
|
| Rate for Payer: CORVEL All Commercial |
$53.86
|
| Rate for Payer: Coventry All Commercial |
$50.97
|
| Rate for Payer: Encore All Commercial |
$53.31
|
| Rate for Payer: Frontpath All Commercial |
$53.28
|
| Rate for Payer: Humana ChoiceCare |
$50.02
|
| Rate for Payer: Humana Medicare |
$29.54
|
| Rate for Payer: Lucent All Commercial |
$29.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.12
|
| Rate for Payer: Managed Health Services Medicaid |
$12.01
|
| Rate for Payer: MDWise Medicaid |
$12.01
|
| Rate for Payer: PHCS All Commercial |
$43.44
|
| Rate for Payer: PHP All Commercial |
$43.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.59
|
| Rate for Payer: Sagamore Health Network All Products |
$44.71
|
| Rate for Payer: Signature Care EPO |
$48.07
|
| Rate for Payer: Signature Care PPO |
$50.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.23
|
| Rate for Payer: United Healthcare Commercial |
$45.64
|
| Rate for Payer: United Healthcare Medicare |
$19.11
|
|
|
HC CANDIDA AG
|
Facility
IP
|
$110.68
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
63001910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.01 |
| Max. Negotiated Rate |
$102.93 |
| Rate for Payer: Aetna Commercial |
$95.63
|
| Rate for Payer: Cash Price |
$68.62
|
| Rate for Payer: Cigna All Commercial |
$95.52
|
| Rate for Payer: CORVEL All Commercial |
$102.93
|
| Rate for Payer: Coventry All Commercial |
$97.40
|
| Rate for Payer: Encore All Commercial |
$101.88
|
| Rate for Payer: Frontpath All Commercial |
$101.83
|
| Rate for Payer: Humana ChoiceCare |
$95.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.61
|
| Rate for Payer: PHCS All Commercial |
$83.01
|
| Rate for Payer: PHP All Commercial |
$83.94
|
| Rate for Payer: Sagamore Health Network All Products |
$85.45
|
| Rate for Payer: Signature Care EPO |
$91.86
|
| Rate for Payer: Signature Care PPO |
$97.40
|
| Rate for Payer: United Healthcare Commercial |
$87.22
|
|
|
HC CANDIDA AG
|
Facility
OP
|
$110.68
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
63001910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$102.93 |
| Rate for Payer: Aetna Commercial |
$93.41
|
| Rate for Payer: Aetna Medicare |
$36.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.18
|
| Rate for Payer: Cash Price |
$68.62
|
| Rate for Payer: Cash Price |
$68.62
|
| Rate for Payer: Centivo All Commercial |
$56.45
|
| Rate for Payer: Cigna All Commercial |
$95.52
|
| Rate for Payer: CORVEL All Commercial |
$102.93
|
| Rate for Payer: Coventry All Commercial |
$97.40
|
| Rate for Payer: Encore All Commercial |
$101.88
|
| Rate for Payer: Frontpath All Commercial |
$101.83
|
| Rate for Payer: Humana ChoiceCare |
$95.59
|
| Rate for Payer: Humana Medicare |
$56.45
|
| Rate for Payer: Lucent All Commercial |
$56.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.61
|
| Rate for Payer: Managed Health Services Medicaid |
$11.54
|
| Rate for Payer: MDWise Medicaid |
$11.54
|
| Rate for Payer: PHCS All Commercial |
$83.01
|
| Rate for Payer: PHP All Commercial |
$83.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.17
|
| Rate for Payer: Sagamore Health Network All Products |
$85.45
|
| Rate for Payer: Signature Care EPO |
$91.86
|
| Rate for Payer: Signature Care PPO |
$97.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.08
|
| Rate for Payer: United Healthcare Commercial |
$87.22
|
| Rate for Payer: United Healthcare Medicare |
$36.52
|
|
|
HC CANDIDA ALBICANS ABS
|
Facility
OP
|
$88.64
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
63001928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$82.43 |
| Rate for Payer: Aetna Commercial |
$74.81
|
| Rate for Payer: Aetna Medicare |
$29.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.18
|
| Rate for Payer: Cash Price |
$54.96
|
| Rate for Payer: Cash Price |
$54.96
|
| Rate for Payer: Centivo All Commercial |
$45.21
|
| Rate for Payer: Cigna All Commercial |
$76.49
|
| Rate for Payer: CORVEL All Commercial |
$82.43
|
| Rate for Payer: Coventry All Commercial |
$78.00
|
| Rate for Payer: Encore All Commercial |
$81.59
|
| Rate for Payer: Frontpath All Commercial |
$81.55
|
| Rate for Payer: Humana ChoiceCare |
$76.56
|
| Rate for Payer: Humana Medicare |
$45.21
|
| Rate for Payer: Lucent All Commercial |
$45.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.77
|
| Rate for Payer: Managed Health Services Medicaid |
$12.01
|
| Rate for Payer: MDWise Medicaid |
$12.01
|
| Rate for Payer: PHCS All Commercial |
$66.48
|
| Rate for Payer: PHP All Commercial |
$67.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.57
|
| Rate for Payer: Sagamore Health Network All Products |
$68.43
|
| Rate for Payer: Signature Care EPO |
$73.57
|
| Rate for Payer: Signature Care PPO |
$78.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75.34
|
| Rate for Payer: United Healthcare Commercial |
$69.85
|
| Rate for Payer: United Healthcare Medicare |
$29.25
|
|
|
HC CANDIDA ALBICANS ABS
|
Facility
IP
|
$88.64
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
63001928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.48 |
| Max. Negotiated Rate |
$82.43 |
| Rate for Payer: Aetna Commercial |
$76.58
|
| Rate for Payer: Cash Price |
$54.96
|
| Rate for Payer: Cigna All Commercial |
$76.49
|
| Rate for Payer: CORVEL All Commercial |
$82.43
|
| Rate for Payer: Coventry All Commercial |
$78.00
|
| Rate for Payer: Encore All Commercial |
$81.59
|
| Rate for Payer: Frontpath All Commercial |
$81.55
|
| Rate for Payer: Humana ChoiceCare |
$76.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.77
|
| Rate for Payer: PHCS All Commercial |
$66.48
|
| Rate for Payer: PHP All Commercial |
$67.22
|
| Rate for Payer: Sagamore Health Network All Products |
$68.43
|
| Rate for Payer: Signature Care EPO |
$73.57
|
| Rate for Payer: Signature Care PPO |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$69.85
|
|
|
HC CANDIDA AURIS SCREEN
|
Facility
OP
|
$61.20
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
63087810
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$51.65
|
| Rate for Payer: Aetna Medicare |
$20.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.22
|
| Rate for Payer: Cash Price |
$37.94
|
| Rate for Payer: Cash Price |
$37.94
|
| Rate for Payer: Centivo All Commercial |
$31.21
|
| Rate for Payer: Cigna All Commercial |
$52.82
|
| Rate for Payer: CORVEL All Commercial |
$56.92
|
| Rate for Payer: Coventry All Commercial |
$53.86
|
| Rate for Payer: Encore All Commercial |
$56.33
|
| Rate for Payer: Frontpath All Commercial |
$56.30
|
| Rate for Payer: Humana ChoiceCare |
$52.86
|
| Rate for Payer: Humana Medicare |
$31.21
|
| Rate for Payer: Lucent All Commercial |
$31.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.08
|
| Rate for Payer: Managed Health Services Medicaid |
$10.32
|
| Rate for Payer: MDWise Medicaid |
$10.32
|
| Rate for Payer: PHCS All Commercial |
$45.90
|
| Rate for Payer: PHP All Commercial |
$46.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.87
|
| Rate for Payer: Sagamore Health Network All Products |
$47.25
|
| Rate for Payer: Signature Care EPO |
$50.80
|
| Rate for Payer: Signature Care PPO |
$53.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.02
|
| Rate for Payer: United Healthcare Commercial |
$48.23
|
| Rate for Payer: United Healthcare Medicare |
$20.20
|
|
|
HC CANDIDA AURIS SCREEN
|
Facility
IP
|
$61.20
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
63087810
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$52.88
|
| Rate for Payer: Cash Price |
$37.94
|
| Rate for Payer: Cigna All Commercial |
$52.82
|
| Rate for Payer: CORVEL All Commercial |
$56.92
|
| Rate for Payer: Coventry All Commercial |
$53.86
|
| Rate for Payer: Encore All Commercial |
$56.33
|
| Rate for Payer: Frontpath All Commercial |
$56.30
|
| Rate for Payer: Humana ChoiceCare |
$52.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.08
|
| Rate for Payer: PHCS All Commercial |
$45.90
|
| Rate for Payer: PHP All Commercial |
$46.41
|
| Rate for Payer: Sagamore Health Network All Products |
$47.25
|
| Rate for Payer: Signature Care EPO |
$50.80
|
| Rate for Payer: Signature Care PPO |
$53.86
|
| Rate for Payer: United Healthcare Commercial |
$48.23
|
|
|
HC CANDIDA SPECIES BY PCR, BODY FLUID, TISSUE, OR ISOLATE
|
Facility
IP
|
$423.05
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
63087481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$317.28 |
| Max. Negotiated Rate |
$393.43 |
| Rate for Payer: Aetna Commercial |
$365.51
|
| Rate for Payer: Cash Price |
$262.29
|
| Rate for Payer: Cigna All Commercial |
$365.09
|
| Rate for Payer: CORVEL All Commercial |
$393.43
|
| Rate for Payer: Coventry All Commercial |
$372.28
|
| Rate for Payer: Encore All Commercial |
$389.41
|
| Rate for Payer: Frontpath All Commercial |
$389.20
|
| Rate for Payer: Humana ChoiceCare |
$365.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$380.74
|
| Rate for Payer: PHCS All Commercial |
$317.28
|
| Rate for Payer: PHP All Commercial |
$320.84
|
| Rate for Payer: Sagamore Health Network All Products |
$326.59
|
| Rate for Payer: Signature Care EPO |
$351.13
|
| Rate for Payer: Signature Care PPO |
$372.28
|
| Rate for Payer: United Healthcare Commercial |
$333.36
|
|
|
HC CANDIDA SPECIES BY PCR, BODY FLUID, TISSUE, OR ISOLATE
|
Facility
OP
|
$423.05
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
63087481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$393.43 |
| Rate for Payer: Aetna Commercial |
$357.05
|
| Rate for Payer: Aetna Medicare |
$139.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$242.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$264.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.57
|
| Rate for Payer: Cash Price |
$262.29
|
| Rate for Payer: Cash Price |
$262.29
|
| Rate for Payer: Centivo All Commercial |
$215.75
|
| Rate for Payer: Cigna All Commercial |
$365.09
|
| Rate for Payer: CORVEL All Commercial |
$393.43
|
| Rate for Payer: Coventry All Commercial |
$372.28
|
| Rate for Payer: Encore All Commercial |
$389.41
|
| Rate for Payer: Frontpath All Commercial |
$389.20
|
| Rate for Payer: Humana ChoiceCare |
$365.38
|
| Rate for Payer: Humana Medicare |
$215.75
|
| Rate for Payer: Lucent All Commercial |
$215.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$380.74
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$317.28
|
| Rate for Payer: PHP All Commercial |
$320.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.99
|
| Rate for Payer: Sagamore Health Network All Products |
$326.59
|
| Rate for Payer: Signature Care EPO |
$351.13
|
| Rate for Payer: Signature Care PPO |
$372.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$359.59
|
| Rate for Payer: United Healthcare Commercial |
$333.36
|
| Rate for Payer: United Healthcare Medicare |
$139.60
|
|
|
HC CANISTERS 500CC GEL-5
|
Facility
IP
|
$271.00
|
|
| Hospital Charge Code |
41606591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.25 |
| Max. Negotiated Rate |
$252.03 |
| Rate for Payer: Aetna Commercial |
$234.14
|
| Rate for Payer: Cash Price |
$168.02
|
| Rate for Payer: Cigna All Commercial |
$233.87
|
| Rate for Payer: CORVEL All Commercial |
$252.03
|
| Rate for Payer: Coventry All Commercial |
$238.48
|
| Rate for Payer: Encore All Commercial |
$249.46
|
| Rate for Payer: Frontpath All Commercial |
$249.32
|
| Rate for Payer: Humana ChoiceCare |
$234.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$243.90
|
| Rate for Payer: PHCS All Commercial |
$203.25
|
| Rate for Payer: PHP All Commercial |
$205.53
|
| Rate for Payer: Sagamore Health Network All Products |
$209.21
|
| Rate for Payer: Signature Care EPO |
$224.93
|
| Rate for Payer: Signature Care PPO |
$238.48
|
| Rate for Payer: United Healthcare Commercial |
$213.55
|
|
|
HC CANISTERS 500CC GEL-5
|
Facility
OP
|
$271.00
|
|
| Hospital Charge Code |
41606591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$252.03 |
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna Medicare |
$89.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$89.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$155.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$169.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.37
|
| Rate for Payer: Cash Price |
$168.02
|
| Rate for Payer: Cash Price |
$168.02
|
| Rate for Payer: Centivo All Commercial |
$138.21
|
| Rate for Payer: Cigna All Commercial |
$233.87
|
| Rate for Payer: CORVEL All Commercial |
$252.03
|
| Rate for Payer: Coventry All Commercial |
$238.48
|
| Rate for Payer: Encore All Commercial |
$249.46
|
| Rate for Payer: Frontpath All Commercial |
$249.32
|
| Rate for Payer: Humana ChoiceCare |
$234.06
|
| Rate for Payer: Humana Medicare |
$138.21
|
| Rate for Payer: Lucent All Commercial |
$138.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$243.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$203.25
|
| Rate for Payer: PHP All Commercial |
$205.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.69
|
| Rate for Payer: Sagamore Health Network All Products |
$209.21
|
| Rate for Payer: Signature Care EPO |
$224.93
|
| Rate for Payer: Signature Care PPO |
$238.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$230.35
|
| Rate for Payer: United Healthcare Commercial |
$213.55
|
| Rate for Payer: United Healthcare Medicare |
$89.43
|
|
|
HC CANNULA ENTRE VU EX
|
Facility
OP
|
$329.00
|
|
| Hospital Charge Code |
41601411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$305.97 |
| Rate for Payer: Aetna Commercial |
$277.68
|
| Rate for Payer: Aetna Medicare |
$108.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$188.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.43
|
| Rate for Payer: Cash Price |
$203.98
|
| Rate for Payer: Cash Price |
$203.98
|
| Rate for Payer: Centivo All Commercial |
$167.79
|
| Rate for Payer: Cigna All Commercial |
$283.93
|
| Rate for Payer: CORVEL All Commercial |
$305.97
|
| Rate for Payer: Coventry All Commercial |
$289.52
|
| Rate for Payer: Encore All Commercial |
$302.84
|
| Rate for Payer: Frontpath All Commercial |
$302.68
|
| Rate for Payer: Humana ChoiceCare |
$284.16
|
| Rate for Payer: Humana Medicare |
$167.79
|
| Rate for Payer: Lucent All Commercial |
$167.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$246.75
|
| Rate for Payer: PHP All Commercial |
$249.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.31
|
| Rate for Payer: Sagamore Health Network All Products |
$253.99
|
| Rate for Payer: Signature Care EPO |
$273.07
|
| Rate for Payer: Signature Care PPO |
$289.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$279.65
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Medicare |
$108.57
|
|
|
HC CANNULA ENTRE VU EX
|
Facility
IP
|
$329.00
|
|
| Hospital Charge Code |
41601411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.75 |
| Max. Negotiated Rate |
$305.97 |
| Rate for Payer: Aetna Commercial |
$284.26
|
| Rate for Payer: Cash Price |
$203.98
|
| Rate for Payer: Cigna All Commercial |
$283.93
|
| Rate for Payer: CORVEL All Commercial |
$305.97
|
| Rate for Payer: Coventry All Commercial |
$289.52
|
| Rate for Payer: Encore All Commercial |
$302.84
|
| Rate for Payer: Frontpath All Commercial |
$302.68
|
| Rate for Payer: Humana ChoiceCare |
$284.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.10
|
| Rate for Payer: PHCS All Commercial |
$246.75
|
| Rate for Payer: PHP All Commercial |
$249.51
|
| Rate for Payer: Sagamore Health Network All Products |
$253.99
|
| Rate for Payer: Signature Care EPO |
$273.07
|
| Rate for Payer: Signature Care PPO |
$289.52
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
|
|
HC CAPILLARY BLOOD DRAW
|
Facility
OP
|
$56.10
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
63001358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna Medicare |
$18.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Centivo All Commercial |
$28.61
|
| Rate for Payer: Cigna All Commercial |
$48.41
|
| Rate for Payer: CORVEL All Commercial |
$52.17
|
| Rate for Payer: Coventry All Commercial |
$49.37
|
| Rate for Payer: Encore All Commercial |
$51.64
|
| Rate for Payer: Frontpath All Commercial |
$51.61
|
| Rate for Payer: Humana ChoiceCare |
$48.45
|
| Rate for Payer: Humana Medicare |
$28.61
|
| Rate for Payer: Lucent All Commercial |
$28.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.49
|
| Rate for Payer: Managed Health Services Medicaid |
$11.70
|
| Rate for Payer: MDWise Medicaid |
$11.70
|
| Rate for Payer: PHCS All Commercial |
$42.08
|
| Rate for Payer: PHP All Commercial |
$42.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.88
|
| Rate for Payer: Sagamore Health Network All Products |
$43.31
|
| Rate for Payer: Signature Care EPO |
$46.56
|
| Rate for Payer: Signature Care PPO |
$49.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.68
|
| Rate for Payer: United Healthcare Commercial |
$44.21
|
| Rate for Payer: United Healthcare Medicare |
$18.51
|
|
|
HC CAPILLARY BLOOD DRAW
|
Facility
IP
|
$56.10
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
63001358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: Aetna Commercial |
$48.47
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cigna All Commercial |
$48.41
|
| Rate for Payer: CORVEL All Commercial |
$52.17
|
| Rate for Payer: Coventry All Commercial |
$49.37
|
| Rate for Payer: Encore All Commercial |
$51.64
|
| Rate for Payer: Frontpath All Commercial |
$51.61
|
| Rate for Payer: Humana ChoiceCare |
$48.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.49
|
| Rate for Payer: PHCS All Commercial |
$42.08
|
| Rate for Payer: PHP All Commercial |
$42.55
|
| Rate for Payer: Sagamore Health Network All Products |
$43.31
|
| Rate for Payer: Signature Care EPO |
$46.56
|
| Rate for Payer: Signature Care PPO |
$49.37
|
| Rate for Payer: United Healthcare Commercial |
$44.21
|
|
|
HC CAP SCOPE DISTAL CF-H180AL
|
Facility
IP
|
$177.25
|
|
| Hospital Charge Code |
41603093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.94 |
| Max. Negotiated Rate |
$164.84 |
| Rate for Payer: Aetna Commercial |
$153.14
|
| Rate for Payer: Cash Price |
$109.90
|
| Rate for Payer: Cigna All Commercial |
$152.97
|
| Rate for Payer: CORVEL All Commercial |
$164.84
|
| Rate for Payer: Coventry All Commercial |
$155.98
|
| Rate for Payer: Encore All Commercial |
$163.16
|
| Rate for Payer: Frontpath All Commercial |
$163.07
|
| Rate for Payer: Humana ChoiceCare |
$153.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.52
|
| Rate for Payer: PHCS All Commercial |
$132.94
|
| Rate for Payer: PHP All Commercial |
$134.43
|
| Rate for Payer: Sagamore Health Network All Products |
$136.84
|
| Rate for Payer: Signature Care EPO |
$147.12
|
| Rate for Payer: Signature Care PPO |
$155.98
|
| Rate for Payer: United Healthcare Commercial |
$139.67
|
|
|
HC CAP SCOPE DISTAL CF-H180AL
|
Facility
OP
|
$177.25
|
|
| Hospital Charge Code |
41603093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.49 |
| Max. Negotiated Rate |
$164.84 |
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna Medicare |
$58.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$101.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.34
|
| Rate for Payer: Cash Price |
$109.90
|
| Rate for Payer: Cash Price |
$109.90
|
| Rate for Payer: Centivo All Commercial |
$90.40
|
| Rate for Payer: Cigna All Commercial |
$152.97
|
| Rate for Payer: CORVEL All Commercial |
$164.84
|
| Rate for Payer: Coventry All Commercial |
$155.98
|
| Rate for Payer: Encore All Commercial |
$163.16
|
| Rate for Payer: Frontpath All Commercial |
$163.07
|
| Rate for Payer: Humana ChoiceCare |
$153.09
|
| Rate for Payer: Humana Medicare |
$90.40
|
| Rate for Payer: Lucent All Commercial |
$90.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.52
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$132.94
|
| Rate for Payer: PHP All Commercial |
$134.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.13
|
| Rate for Payer: Sagamore Health Network All Products |
$136.84
|
| Rate for Payer: Signature Care EPO |
$147.12
|
| Rate for Payer: Signature Care PPO |
$155.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$150.66
|
| Rate for Payer: United Healthcare Commercial |
$139.67
|
| Rate for Payer: United Healthcare Medicare |
$58.49
|
|
