|
HC CHOLINESTERASE-RBC
|
Facility
IP
|
$137.27
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
63001493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.95 |
| Max. Negotiated Rate |
$127.66 |
| Rate for Payer: Aetna Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$85.11
|
| Rate for Payer: Cigna All Commercial |
$118.47
|
| Rate for Payer: CORVEL All Commercial |
$127.66
|
| Rate for Payer: Coventry All Commercial |
$120.80
|
| Rate for Payer: Encore All Commercial |
$126.36
|
| Rate for Payer: Frontpath All Commercial |
$126.29
|
| Rate for Payer: Humana ChoiceCare |
$118.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.54
|
| Rate for Payer: PHCS All Commercial |
$102.95
|
| Rate for Payer: PHP All Commercial |
$104.11
|
| Rate for Payer: Sagamore Health Network All Products |
$105.97
|
| Rate for Payer: Signature Care EPO |
$113.94
|
| Rate for Payer: Signature Care PPO |
$120.80
|
| Rate for Payer: United Healthcare Commercial |
$108.17
|
|
|
HC CHOLINESTERASE-RBC
|
Facility
OP
|
$137.27
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
63001493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$127.66 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$45.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.83
|
| Rate for Payer: Cash Price |
$85.11
|
| Rate for Payer: Cash Price |
$85.11
|
| Rate for Payer: Centivo All Commercial |
$70.01
|
| Rate for Payer: Cigna All Commercial |
$118.47
|
| Rate for Payer: CORVEL All Commercial |
$127.66
|
| Rate for Payer: Coventry All Commercial |
$120.80
|
| Rate for Payer: Encore All Commercial |
$126.36
|
| Rate for Payer: Frontpath All Commercial |
$126.29
|
| Rate for Payer: Humana ChoiceCare |
$118.56
|
| Rate for Payer: Humana Medicare |
$70.01
|
| Rate for Payer: Lucent All Commercial |
$70.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.54
|
| Rate for Payer: Managed Health Services Medicaid |
$9.81
|
| Rate for Payer: MDWise Medicaid |
$9.81
|
| Rate for Payer: PHCS All Commercial |
$102.95
|
| Rate for Payer: PHP All Commercial |
$104.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.54
|
| Rate for Payer: Sagamore Health Network All Products |
$105.97
|
| Rate for Payer: Signature Care EPO |
$113.94
|
| Rate for Payer: Signature Care PPO |
$120.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.68
|
| Rate for Payer: United Healthcare Commercial |
$108.17
|
| Rate for Payer: United Healthcare Medicare |
$45.30
|
|
|
HC CHROMATIN(HISTONE)IGG AB
|
Facility
OP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$131.32
|
| Rate for Payer: Aetna Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.48
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Centivo All Commercial |
$79.35
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Humana Medicare |
$79.35
|
| Rate for Payer: Lucent All Commercial |
$79.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.68
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.25
|
| Rate for Payer: United Healthcare Commercial |
$122.61
|
| Rate for Payer: United Healthcare Medicare |
$51.34
|
|
|
HC CHROMATIN(HISTONE)IGG AB
|
Facility
IP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$134.43
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: United Healthcare Commercial |
$122.61
|
|
|
HC CHROMIUM SERUM
|
Facility
OP
|
$242.35
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
63001494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$225.39 |
| Rate for Payer: Aetna Commercial |
$204.55
|
| Rate for Payer: Aetna Medicare |
$79.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$139.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$151.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.97
|
| Rate for Payer: Cash Price |
$150.26
|
| Rate for Payer: Cash Price |
$150.26
|
| Rate for Payer: Centivo All Commercial |
$123.60
|
| Rate for Payer: Cigna All Commercial |
$209.15
|
| Rate for Payer: CORVEL All Commercial |
$225.39
|
| Rate for Payer: Coventry All Commercial |
$213.27
|
| Rate for Payer: Encore All Commercial |
$223.09
|
| Rate for Payer: Frontpath All Commercial |
$222.96
|
| Rate for Payer: Humana ChoiceCare |
$209.32
|
| Rate for Payer: Humana Medicare |
$123.60
|
| Rate for Payer: Lucent All Commercial |
$123.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$218.12
|
| Rate for Payer: Managed Health Services Medicaid |
$20.28
|
| Rate for Payer: MDWise Medicaid |
$20.28
|
| Rate for Payer: PHCS All Commercial |
$181.76
|
| Rate for Payer: PHP All Commercial |
$183.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.52
|
| Rate for Payer: Sagamore Health Network All Products |
$187.10
|
| Rate for Payer: Signature Care EPO |
$201.15
|
| Rate for Payer: Signature Care PPO |
$213.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$206.00
|
| Rate for Payer: United Healthcare Commercial |
$190.97
|
| Rate for Payer: United Healthcare Medicare |
$79.98
|
|
|
HC CHROMIUM SERUM
|
Facility
IP
|
$242.35
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
63001494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.76 |
| Max. Negotiated Rate |
$225.39 |
| Rate for Payer: Aetna Commercial |
$209.39
|
| Rate for Payer: Cash Price |
$150.26
|
| Rate for Payer: Cigna All Commercial |
$209.15
|
| Rate for Payer: CORVEL All Commercial |
$225.39
|
| Rate for Payer: Coventry All Commercial |
$213.27
|
| Rate for Payer: Encore All Commercial |
$223.09
|
| Rate for Payer: Frontpath All Commercial |
$222.96
|
| Rate for Payer: Humana ChoiceCare |
$209.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$218.12
|
| Rate for Payer: PHCS All Commercial |
$181.76
|
| Rate for Payer: PHP All Commercial |
$183.80
|
| Rate for Payer: Sagamore Health Network All Products |
$187.10
|
| Rate for Payer: Signature Care EPO |
$201.15
|
| Rate for Payer: Signature Care PPO |
$213.27
|
| Rate for Payer: United Healthcare Commercial |
$190.97
|
|
|
HC CHROMO ANALY 15-20 C
|
Facility
OP
|
$506.47
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
63002079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$471.02 |
| Rate for Payer: Aetna Commercial |
$427.46
|
| Rate for Payer: Aetna Medicare |
$167.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$167.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$290.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$316.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$125.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.85
|
| Rate for Payer: Cash Price |
$314.01
|
| Rate for Payer: Cash Price |
$314.01
|
| Rate for Payer: Centivo All Commercial |
$258.30
|
| Rate for Payer: Cigna All Commercial |
$437.08
|
| Rate for Payer: CORVEL All Commercial |
$471.02
|
| Rate for Payer: Coventry All Commercial |
$445.69
|
| Rate for Payer: Encore All Commercial |
$466.21
|
| Rate for Payer: Frontpath All Commercial |
$465.95
|
| Rate for Payer: Humana ChoiceCare |
$437.44
|
| Rate for Payer: Humana Medicare |
$258.30
|
| Rate for Payer: Lucent All Commercial |
$258.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$455.82
|
| Rate for Payer: Managed Health Services Medicaid |
$125.49
|
| Rate for Payer: MDWise Medicaid |
$125.49
|
| Rate for Payer: PHCS All Commercial |
$379.85
|
| Rate for Payer: PHP All Commercial |
$384.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$197.52
|
| Rate for Payer: Sagamore Health Network All Products |
$391.00
|
| Rate for Payer: Signature Care EPO |
$420.37
|
| Rate for Payer: Signature Care PPO |
$445.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$430.50
|
| Rate for Payer: United Healthcare Commercial |
$399.10
|
| Rate for Payer: United Healthcare Medicare |
$167.14
|
|
|
HC CHROMO ANALY 15-20 C
|
Facility
IP
|
$506.47
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
63002079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$379.85 |
| Max. Negotiated Rate |
$471.02 |
| Rate for Payer: Aetna Commercial |
$437.59
|
| Rate for Payer: Cash Price |
$314.01
|
| Rate for Payer: Cigna All Commercial |
$437.08
|
| Rate for Payer: CORVEL All Commercial |
$471.02
|
| Rate for Payer: Coventry All Commercial |
$445.69
|
| Rate for Payer: Encore All Commercial |
$466.21
|
| Rate for Payer: Frontpath All Commercial |
$465.95
|
| Rate for Payer: Humana ChoiceCare |
$437.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$455.82
|
| Rate for Payer: PHCS All Commercial |
$379.85
|
| Rate for Payer: PHP All Commercial |
$384.11
|
| Rate for Payer: Sagamore Health Network All Products |
$391.00
|
| Rate for Payer: Signature Care EPO |
$420.37
|
| Rate for Payer: Signature Care PPO |
$445.69
|
| Rate for Payer: United Healthcare Commercial |
$399.10
|
|
|
HC CHROMO ANALY 5 ONCOLOGY CHARGE
|
Facility
IP
|
$640.94
|
|
|
Service Code
|
CPT 88261
|
| Hospital Charge Code |
63002078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$480.70 |
| Max. Negotiated Rate |
$596.07 |
| Rate for Payer: Aetna Commercial |
$553.77
|
| Rate for Payer: Cash Price |
$397.38
|
| Rate for Payer: Cigna All Commercial |
$553.13
|
| Rate for Payer: CORVEL All Commercial |
$596.07
|
| Rate for Payer: Coventry All Commercial |
$564.02
|
| Rate for Payer: Encore All Commercial |
$589.98
|
| Rate for Payer: Frontpath All Commercial |
$589.66
|
| Rate for Payer: Humana ChoiceCare |
$553.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.84
|
| Rate for Payer: PHCS All Commercial |
$480.70
|
| Rate for Payer: PHP All Commercial |
$486.09
|
| Rate for Payer: Sagamore Health Network All Products |
$494.80
|
| Rate for Payer: Signature Care EPO |
$531.98
|
| Rate for Payer: Signature Care PPO |
$564.02
|
| Rate for Payer: United Healthcare Commercial |
$505.06
|
|
|
HC CHROMO ANALY 5 ONCOLOGY CHARGE
|
Facility
OP
|
$640.94
|
|
|
Service Code
|
CPT 88261
|
| Hospital Charge Code |
63002078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$211.51 |
| Max. Negotiated Rate |
$596.07 |
| Rate for Payer: Aetna Commercial |
$540.95
|
| Rate for Payer: Aetna Medicare |
$211.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$211.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$368.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$400.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$240.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$243.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$232.66
|
| Rate for Payer: Cash Price |
$397.38
|
| Rate for Payer: Cash Price |
$397.38
|
| Rate for Payer: Centivo All Commercial |
$326.88
|
| Rate for Payer: Cigna All Commercial |
$553.13
|
| Rate for Payer: CORVEL All Commercial |
$596.07
|
| Rate for Payer: Coventry All Commercial |
$564.02
|
| Rate for Payer: Encore All Commercial |
$589.98
|
| Rate for Payer: Frontpath All Commercial |
$589.66
|
| Rate for Payer: Humana ChoiceCare |
$553.58
|
| Rate for Payer: Humana Medicare |
$326.88
|
| Rate for Payer: Lucent All Commercial |
$326.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.84
|
| Rate for Payer: Managed Health Services Medicaid |
$240.51
|
| Rate for Payer: MDWise Medicaid |
$240.51
|
| Rate for Payer: PHCS All Commercial |
$480.70
|
| Rate for Payer: PHP All Commercial |
$486.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.97
|
| Rate for Payer: Sagamore Health Network All Products |
$494.80
|
| Rate for Payer: Signature Care EPO |
$531.98
|
| Rate for Payer: Signature Care PPO |
$564.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$544.80
|
| Rate for Payer: United Healthcare Commercial |
$505.06
|
| Rate for Payer: United Healthcare Medicare |
$211.51
|
|
|
HC CHROMO ANALY TISSUE CHARGE
|
Facility
OP
|
$61.06
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
63002076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$86.50 |
| Rate for Payer: United Healthcare Medicare |
$20.15
|
| Rate for Payer: Aetna Commercial |
$51.53
|
| Rate for Payer: Aetna Medicare |
$20.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$86.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.16
|
| Rate for Payer: Cash Price |
$37.86
|
| Rate for Payer: Cash Price |
$37.86
|
| Rate for Payer: Centivo All Commercial |
$31.14
|
| Rate for Payer: Cigna All Commercial |
$52.69
|
| Rate for Payer: CORVEL All Commercial |
$56.78
|
| Rate for Payer: Coventry All Commercial |
$53.73
|
| Rate for Payer: Encore All Commercial |
$56.20
|
| Rate for Payer: Frontpath All Commercial |
$56.17
|
| Rate for Payer: Humana ChoiceCare |
$52.74
|
| Rate for Payer: Humana Medicare |
$31.14
|
| Rate for Payer: Lucent All Commercial |
$31.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.95
|
| Rate for Payer: Managed Health Services Medicaid |
$86.50
|
| Rate for Payer: MDWise Medicaid |
$86.50
|
| Rate for Payer: PHCS All Commercial |
$45.79
|
| Rate for Payer: PHP All Commercial |
$46.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.81
|
| Rate for Payer: Sagamore Health Network All Products |
$47.14
|
| Rate for Payer: Signature Care EPO |
$50.68
|
| Rate for Payer: Signature Care PPO |
$53.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.90
|
| Rate for Payer: United Healthcare Commercial |
$48.11
|
|
|
HC CHROMO ANALY TISSUE CHARGE
|
Facility
IP
|
$61.06
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
63002076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$56.78 |
| Rate for Payer: Aetna Commercial |
$52.75
|
| Rate for Payer: Cash Price |
$37.86
|
| Rate for Payer: Cigna All Commercial |
$52.69
|
| Rate for Payer: CORVEL All Commercial |
$56.78
|
| Rate for Payer: Coventry All Commercial |
$53.73
|
| Rate for Payer: Encore All Commercial |
$56.20
|
| Rate for Payer: Frontpath All Commercial |
$56.17
|
| Rate for Payer: Humana ChoiceCare |
$52.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.95
|
| Rate for Payer: PHCS All Commercial |
$45.79
|
| Rate for Payer: PHP All Commercial |
$46.31
|
| Rate for Payer: Sagamore Health Network All Products |
$47.14
|
| Rate for Payer: Signature Care EPO |
$50.68
|
| Rate for Payer: Signature Care PPO |
$53.73
|
| Rate for Payer: United Healthcare Commercial |
$48.11
|
|
|
HC CHROMOGRANIN A
|
Facility
IP
|
$99.45
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
63044032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.59 |
| Max. Negotiated Rate |
$92.49 |
| Rate for Payer: Aetna Commercial |
$85.92
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Cigna All Commercial |
$85.83
|
| Rate for Payer: CORVEL All Commercial |
$92.49
|
| Rate for Payer: Coventry All Commercial |
$87.52
|
| Rate for Payer: Encore All Commercial |
$91.54
|
| Rate for Payer: Frontpath All Commercial |
$91.49
|
| Rate for Payer: Humana ChoiceCare |
$85.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.50
|
| Rate for Payer: PHCS All Commercial |
$74.59
|
| Rate for Payer: PHP All Commercial |
$75.42
|
| Rate for Payer: Sagamore Health Network All Products |
$76.78
|
| Rate for Payer: Signature Care EPO |
$82.54
|
| Rate for Payer: Signature Care PPO |
$87.52
|
| Rate for Payer: United Healthcare Commercial |
$78.37
|
|
|
HC CHROMOGRANIN A
|
Facility
OP
|
$255.26
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
63001898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$237.39 |
| Rate for Payer: Aetna Commercial |
$215.44
|
| Rate for Payer: Aetna Medicare |
$84.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$146.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.66
|
| Rate for Payer: Cash Price |
$158.26
|
| Rate for Payer: Cash Price |
$158.26
|
| Rate for Payer: Centivo All Commercial |
$130.18
|
| Rate for Payer: Cigna All Commercial |
$220.29
|
| Rate for Payer: CORVEL All Commercial |
$237.39
|
| Rate for Payer: Coventry All Commercial |
$224.62
|
| Rate for Payer: Encore All Commercial |
$234.96
|
| Rate for Payer: Frontpath All Commercial |
$234.83
|
| Rate for Payer: Humana ChoiceCare |
$220.46
|
| Rate for Payer: Humana Medicare |
$130.18
|
| Rate for Payer: Lucent All Commercial |
$130.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.73
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$191.44
|
| Rate for Payer: PHP All Commercial |
$193.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.55
|
| Rate for Payer: Sagamore Health Network All Products |
$197.06
|
| Rate for Payer: Signature Care EPO |
$211.86
|
| Rate for Payer: Signature Care PPO |
$224.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$216.97
|
| Rate for Payer: United Healthcare Commercial |
$201.14
|
| Rate for Payer: United Healthcare Medicare |
$84.23
|
|
|
HC CHROMOGRANIN A
|
Facility
IP
|
$255.26
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
63001898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.44 |
| Max. Negotiated Rate |
$237.39 |
| Rate for Payer: Aetna Commercial |
$220.54
|
| Rate for Payer: Cash Price |
$158.26
|
| Rate for Payer: Cigna All Commercial |
$220.29
|
| Rate for Payer: CORVEL All Commercial |
$237.39
|
| Rate for Payer: Coventry All Commercial |
$224.62
|
| Rate for Payer: Encore All Commercial |
$234.96
|
| Rate for Payer: Frontpath All Commercial |
$234.83
|
| Rate for Payer: Humana ChoiceCare |
$220.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.73
|
| Rate for Payer: PHCS All Commercial |
$191.44
|
| Rate for Payer: PHP All Commercial |
$193.59
|
| Rate for Payer: Sagamore Health Network All Products |
$197.06
|
| Rate for Payer: Signature Care EPO |
$211.86
|
| Rate for Payer: Signature Care PPO |
$224.62
|
| Rate for Payer: United Healthcare Commercial |
$201.14
|
|
|
HC CHROMOGRANIN A
|
Facility
OP
|
$99.45
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
63044032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$92.49 |
| Rate for Payer: Aetna Commercial |
$83.94
|
| Rate for Payer: Aetna Medicare |
$32.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.10
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Centivo All Commercial |
$50.72
|
| Rate for Payer: Cigna All Commercial |
$85.83
|
| Rate for Payer: CORVEL All Commercial |
$92.49
|
| Rate for Payer: Coventry All Commercial |
$87.52
|
| Rate for Payer: Encore All Commercial |
$91.54
|
| Rate for Payer: Frontpath All Commercial |
$91.49
|
| Rate for Payer: Humana ChoiceCare |
$85.89
|
| Rate for Payer: Humana Medicare |
$50.72
|
| Rate for Payer: Lucent All Commercial |
$50.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.50
|
| Rate for Payer: Managed Health Services Medicaid |
$20.81
|
| Rate for Payer: MDWise Medicaid |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$74.59
|
| Rate for Payer: PHP All Commercial |
$75.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.79
|
| Rate for Payer: Sagamore Health Network All Products |
$76.78
|
| Rate for Payer: Signature Care EPO |
$82.54
|
| Rate for Payer: Signature Care PPO |
$87.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.53
|
| Rate for Payer: United Healthcare Commercial |
$78.37
|
| Rate for Payer: United Healthcare Medicare |
$32.82
|
|
|
HC CHROMO HYBRID 10-30C
|
Facility
OP
|
$379.47
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
63002087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$352.91 |
| Rate for Payer: Aetna Commercial |
$320.27
|
| Rate for Payer: Aetna Medicare |
$125.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$217.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$237.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$34.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.75
|
| Rate for Payer: Cash Price |
$235.27
|
| Rate for Payer: Cash Price |
$235.27
|
| Rate for Payer: Centivo All Commercial |
$193.53
|
| Rate for Payer: Cigna All Commercial |
$327.48
|
| Rate for Payer: CORVEL All Commercial |
$352.91
|
| Rate for Payer: Coventry All Commercial |
$333.93
|
| Rate for Payer: Encore All Commercial |
$349.30
|
| Rate for Payer: Frontpath All Commercial |
$349.11
|
| Rate for Payer: Humana ChoiceCare |
$327.75
|
| Rate for Payer: Humana Medicare |
$193.53
|
| Rate for Payer: Lucent All Commercial |
$193.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$341.52
|
| Rate for Payer: Managed Health Services Medicaid |
$34.81
|
| Rate for Payer: MDWise Medicaid |
$34.81
|
| Rate for Payer: PHCS All Commercial |
$284.60
|
| Rate for Payer: PHP All Commercial |
$287.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.99
|
| Rate for Payer: Sagamore Health Network All Products |
$292.95
|
| Rate for Payer: Signature Care EPO |
$314.96
|
| Rate for Payer: Signature Care PPO |
$333.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$322.55
|
| Rate for Payer: United Healthcare Commercial |
$299.02
|
| Rate for Payer: United Healthcare Medicare |
$125.23
|
|
|
HC CHROMO HYBRID 10-30C
|
Facility
IP
|
$379.47
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
63002087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$284.60 |
| Max. Negotiated Rate |
$352.91 |
| Rate for Payer: Aetna Commercial |
$327.86
|
| Rate for Payer: Cash Price |
$235.27
|
| Rate for Payer: Cigna All Commercial |
$327.48
|
| Rate for Payer: CORVEL All Commercial |
$352.91
|
| Rate for Payer: Coventry All Commercial |
$333.93
|
| Rate for Payer: Encore All Commercial |
$349.30
|
| Rate for Payer: Frontpath All Commercial |
$349.11
|
| Rate for Payer: Humana ChoiceCare |
$327.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$341.52
|
| Rate for Payer: PHCS All Commercial |
$284.60
|
| Rate for Payer: PHP All Commercial |
$287.79
|
| Rate for Payer: Sagamore Health Network All Products |
$292.95
|
| Rate for Payer: Signature Care EPO |
$314.96
|
| Rate for Payer: Signature Care PPO |
$333.93
|
| Rate for Payer: United Healthcare Commercial |
$299.02
|
|
|
HC CHROMO HYBRID 3-5CEL
|
Facility
IP
|
$80.94
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
63002084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$75.27 |
| Rate for Payer: Aetna Commercial |
$69.93
|
| Rate for Payer: Cash Price |
$50.18
|
| Rate for Payer: Cigna All Commercial |
$69.85
|
| Rate for Payer: CORVEL All Commercial |
$75.27
|
| Rate for Payer: Coventry All Commercial |
$71.22
|
| Rate for Payer: Encore All Commercial |
$74.50
|
| Rate for Payer: Frontpath All Commercial |
$74.46
|
| Rate for Payer: Humana ChoiceCare |
$69.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.84
|
| Rate for Payer: PHCS All Commercial |
$60.70
|
| Rate for Payer: PHP All Commercial |
$61.38
|
| Rate for Payer: Sagamore Health Network All Products |
$62.48
|
| Rate for Payer: Signature Care EPO |
$67.18
|
| Rate for Payer: Signature Care PPO |
$71.22
|
| Rate for Payer: United Healthcare Commercial |
$63.78
|
|
|
HC CHROMO HYBRID 3-5CEL
|
Facility
OP
|
$80.94
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
63002084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.71 |
| Max. Negotiated Rate |
$75.27 |
| Rate for Payer: Aetna Commercial |
$68.31
|
| Rate for Payer: Aetna Medicare |
$26.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$36.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.38
|
| Rate for Payer: Cash Price |
$50.18
|
| Rate for Payer: Cash Price |
$50.18
|
| Rate for Payer: Centivo All Commercial |
$41.28
|
| Rate for Payer: Cigna All Commercial |
$69.85
|
| Rate for Payer: CORVEL All Commercial |
$75.27
|
| Rate for Payer: Coventry All Commercial |
$71.22
|
| Rate for Payer: Encore All Commercial |
$74.50
|
| Rate for Payer: Frontpath All Commercial |
$74.46
|
| Rate for Payer: Humana ChoiceCare |
$69.91
|
| Rate for Payer: Humana Medicare |
$41.28
|
| Rate for Payer: Lucent All Commercial |
$41.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.84
|
| Rate for Payer: Managed Health Services Medicaid |
$36.44
|
| Rate for Payer: MDWise Medicaid |
$36.44
|
| Rate for Payer: PHCS All Commercial |
$60.70
|
| Rate for Payer: PHP All Commercial |
$61.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.57
|
| Rate for Payer: Sagamore Health Network All Products |
$62.48
|
| Rate for Payer: Signature Care EPO |
$67.18
|
| Rate for Payer: Signature Care PPO |
$71.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.80
|
| Rate for Payer: United Healthcare Commercial |
$63.78
|
| Rate for Payer: United Healthcare Medicare |
$26.71
|
|
|
HC CHROMOSOMAL MICROARRAY ANALYSIS
|
Facility
IP
|
$3,280.05
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
63001437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2,460.04 |
| Max. Negotiated Rate |
$3,050.45 |
| Rate for Payer: Aetna Commercial |
$2,833.97
|
| Rate for Payer: Cash Price |
$2,033.63
|
| Rate for Payer: Cigna All Commercial |
$2,830.69
|
| Rate for Payer: CORVEL All Commercial |
$3,050.45
|
| Rate for Payer: Coventry All Commercial |
$2,886.45
|
| Rate for Payer: Encore All Commercial |
$3,019.29
|
| Rate for Payer: Frontpath All Commercial |
$3,017.65
|
| Rate for Payer: Humana ChoiceCare |
$2,832.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,952.05
|
| Rate for Payer: PHCS All Commercial |
$2,460.04
|
| Rate for Payer: PHP All Commercial |
$2,487.59
|
| Rate for Payer: Sagamore Health Network All Products |
$2,532.20
|
| Rate for Payer: Signature Care EPO |
$2,722.45
|
| Rate for Payer: Signature Care PPO |
$2,886.45
|
| Rate for Payer: United Healthcare Commercial |
$2,584.68
|
|
|
HC CHROMOSOMAL MICROARRAY ANALYSIS
|
Facility
OP
|
$3,280.05
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
63001437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,082.42 |
| Max. Negotiated Rate |
$3,050.45 |
| Rate for Payer: Aetna Commercial |
$2,768.37
|
| Rate for Payer: Aetna Medicare |
$1,082.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,082.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,883.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,050.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,160.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,244.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,190.66
|
| Rate for Payer: Cash Price |
$2,033.63
|
| Rate for Payer: Cash Price |
$2,033.63
|
| Rate for Payer: Centivo All Commercial |
$1,672.83
|
| Rate for Payer: Cigna All Commercial |
$2,830.69
|
| Rate for Payer: CORVEL All Commercial |
$3,050.45
|
| Rate for Payer: Coventry All Commercial |
$2,886.45
|
| Rate for Payer: Encore All Commercial |
$3,019.29
|
| Rate for Payer: Frontpath All Commercial |
$3,017.65
|
| Rate for Payer: Humana ChoiceCare |
$2,832.98
|
| Rate for Payer: Humana Medicare |
$1,672.83
|
| Rate for Payer: Lucent All Commercial |
$1,672.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,952.05
|
| Rate for Payer: Managed Health Services Medicaid |
$1,160.00
|
| Rate for Payer: MDWise Medicaid |
$1,160.00
|
| Rate for Payer: PHCS All Commercial |
$2,460.04
|
| Rate for Payer: PHP All Commercial |
$2,487.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,279.22
|
| Rate for Payer: Sagamore Health Network All Products |
$2,532.20
|
| Rate for Payer: Signature Care EPO |
$2,722.45
|
| Rate for Payer: Signature Care PPO |
$2,886.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,788.05
|
| Rate for Payer: United Healthcare Commercial |
$2,584.68
|
| Rate for Payer: United Healthcare Medicare |
$1,082.42
|
|
|
HC CHROMOSOME ADDL KARY
|
Facility
OP
|
$252.45
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
63002091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$234.78 |
| Rate for Payer: Aetna Commercial |
$213.07
|
| Rate for Payer: Aetna Medicare |
$83.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$157.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$33.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.64
|
| Rate for Payer: Cash Price |
$156.52
|
| Rate for Payer: Cash Price |
$156.52
|
| Rate for Payer: Centivo All Commercial |
$128.75
|
| Rate for Payer: Cigna All Commercial |
$217.86
|
| Rate for Payer: CORVEL All Commercial |
$234.78
|
| Rate for Payer: Coventry All Commercial |
$222.16
|
| Rate for Payer: Encore All Commercial |
$232.38
|
| Rate for Payer: Frontpath All Commercial |
$232.25
|
| Rate for Payer: Humana ChoiceCare |
$218.04
|
| Rate for Payer: Humana Medicare |
$128.75
|
| Rate for Payer: Lucent All Commercial |
$128.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.20
|
| Rate for Payer: Managed Health Services Medicaid |
$33.47
|
| Rate for Payer: MDWise Medicaid |
$33.47
|
| Rate for Payer: PHCS All Commercial |
$189.34
|
| Rate for Payer: PHP All Commercial |
$191.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.46
|
| Rate for Payer: Sagamore Health Network All Products |
$194.89
|
| Rate for Payer: Signature Care EPO |
$209.53
|
| Rate for Payer: Signature Care PPO |
$222.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$214.58
|
| Rate for Payer: United Healthcare Commercial |
$198.93
|
| Rate for Payer: United Healthcare Medicare |
$83.31
|
|
|
HC CHROMOSOME ADDL KARY
|
Facility
IP
|
$252.45
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
63002091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.34 |
| Max. Negotiated Rate |
$234.78 |
| Rate for Payer: Aetna Commercial |
$218.12
|
| Rate for Payer: Cash Price |
$156.52
|
| Rate for Payer: Cigna All Commercial |
$217.86
|
| Rate for Payer: CORVEL All Commercial |
$234.78
|
| Rate for Payer: Coventry All Commercial |
$222.16
|
| Rate for Payer: Encore All Commercial |
$232.38
|
| Rate for Payer: Frontpath All Commercial |
$232.25
|
| Rate for Payer: Humana ChoiceCare |
$218.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.20
|
| Rate for Payer: PHCS All Commercial |
$189.34
|
| Rate for Payer: PHP All Commercial |
$191.46
|
| Rate for Payer: Sagamore Health Network All Products |
$194.89
|
| Rate for Payer: Signature Care EPO |
$209.53
|
| Rate for Payer: Signature Care PPO |
$222.16
|
| Rate for Payer: United Healthcare Commercial |
$198.93
|
|
|
HC CHROMOSOME COUNT ADDITIONAL CHARGE
|
Facility
IP
|
$72.37
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
63002093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.28 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Aetna Commercial |
$62.53
|
| Rate for Payer: Cash Price |
$44.87
|
| Rate for Payer: Cigna All Commercial |
$62.45
|
| Rate for Payer: CORVEL All Commercial |
$67.30
|
| Rate for Payer: Coventry All Commercial |
$63.68
|
| Rate for Payer: Encore All Commercial |
$66.62
|
| Rate for Payer: Frontpath All Commercial |
$66.58
|
| Rate for Payer: Humana ChoiceCare |
$62.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.13
|
| Rate for Payer: PHCS All Commercial |
$54.28
|
| Rate for Payer: PHP All Commercial |
$54.88
|
| Rate for Payer: Sagamore Health Network All Products |
$55.87
|
| Rate for Payer: Signature Care EPO |
$60.07
|
| Rate for Payer: Signature Care PPO |
$63.68
|
| Rate for Payer: United Healthcare Commercial |
$57.03
|
|
