|
HC CULTURE ROUTINE W/SUSCEPTIBILITY IF IND
|
Facility
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
|
|
HC CULTURE TYPING EA
|
Facility
IP
|
$76.87
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
63002009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.65 |
| Max. Negotiated Rate |
$71.49 |
| Rate for Payer: Aetna Commercial |
$66.41
|
| Rate for Payer: Cash Price |
$47.66
|
| Rate for Payer: Cigna All Commercial |
$66.34
|
| Rate for Payer: CORVEL All Commercial |
$71.49
|
| Rate for Payer: Coventry All Commercial |
$67.64
|
| Rate for Payer: Encore All Commercial |
$70.76
|
| Rate for Payer: Frontpath All Commercial |
$70.72
|
| Rate for Payer: Humana ChoiceCare |
$66.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.18
|
| Rate for Payer: PHCS All Commercial |
$57.65
|
| Rate for Payer: PHP All Commercial |
$58.30
|
| Rate for Payer: Sagamore Health Network All Products |
$59.34
|
| Rate for Payer: Signature Care EPO |
$63.80
|
| Rate for Payer: Signature Care PPO |
$67.64
|
| Rate for Payer: United Healthcare Commercial |
$60.57
|
|
|
HC CULTURE TYPING EA
|
Facility
OP
|
$76.87
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
63002009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$71.49 |
| Rate for Payer: Aetna Commercial |
$64.88
|
| Rate for Payer: Aetna Medicare |
$25.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.90
|
| Rate for Payer: Cash Price |
$47.66
|
| Rate for Payer: Cash Price |
$47.66
|
| Rate for Payer: Centivo All Commercial |
$39.20
|
| Rate for Payer: Cigna All Commercial |
$66.34
|
| Rate for Payer: CORVEL All Commercial |
$71.49
|
| Rate for Payer: Coventry All Commercial |
$67.64
|
| Rate for Payer: Encore All Commercial |
$70.76
|
| Rate for Payer: Frontpath All Commercial |
$70.72
|
| Rate for Payer: Humana ChoiceCare |
$66.39
|
| Rate for Payer: Humana Medicare |
$39.20
|
| Rate for Payer: Lucent All Commercial |
$39.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.57
|
| Rate for Payer: MDWise Medicaid |
$5.57
|
| Rate for Payer: PHCS All Commercial |
$57.65
|
| Rate for Payer: PHP All Commercial |
$58.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.98
|
| Rate for Payer: Sagamore Health Network All Products |
$59.34
|
| Rate for Payer: Signature Care EPO |
$63.80
|
| Rate for Payer: Signature Care PPO |
$67.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.34
|
| Rate for Payer: United Healthcare Commercial |
$60.57
|
| Rate for Payer: United Healthcare Medicare |
$25.37
|
|
|
HC CUSHION LUMBAR CONTOURED
|
Facility
IP
|
$139.65
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41602356
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$104.74 |
| Max. Negotiated Rate |
$129.87 |
| Rate for Payer: Aetna Commercial |
$120.66
|
| Rate for Payer: Cash Price |
$86.58
|
| Rate for Payer: Cigna All Commercial |
$120.52
|
| Rate for Payer: CORVEL All Commercial |
$129.87
|
| Rate for Payer: Coventry All Commercial |
$122.89
|
| Rate for Payer: Encore All Commercial |
$128.55
|
| Rate for Payer: Frontpath All Commercial |
$128.48
|
| Rate for Payer: Humana ChoiceCare |
$120.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.68
|
| Rate for Payer: PHCS All Commercial |
$104.74
|
| Rate for Payer: PHP All Commercial |
$105.91
|
| Rate for Payer: Sagamore Health Network All Products |
$107.81
|
| Rate for Payer: Signature Care EPO |
$115.91
|
| Rate for Payer: Signature Care PPO |
$122.89
|
| Rate for Payer: United Healthcare Commercial |
$110.04
|
|
|
HC CUSHION LUMBAR CONTOURED
|
Facility
OP
|
$139.65
|
|
|
Service Code
|
CPT E1399
|
| Hospital Charge Code |
41602356
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$129.87 |
| Rate for Payer: Aetna Commercial |
$117.86
|
| Rate for Payer: Aetna Medicare |
$46.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.69
|
| Rate for Payer: Cash Price |
$86.58
|
| Rate for Payer: Cash Price |
$86.58
|
| Rate for Payer: Centivo All Commercial |
$71.22
|
| Rate for Payer: Cigna All Commercial |
$120.52
|
| Rate for Payer: CORVEL All Commercial |
$129.87
|
| Rate for Payer: Coventry All Commercial |
$122.89
|
| Rate for Payer: Encore All Commercial |
$128.55
|
| Rate for Payer: Frontpath All Commercial |
$128.48
|
| Rate for Payer: Humana ChoiceCare |
$120.62
|
| Rate for Payer: Humana Medicare |
$71.22
|
| Rate for Payer: Lucent All Commercial |
$71.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.68
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$104.74
|
| Rate for Payer: PHP All Commercial |
$105.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.46
|
| Rate for Payer: Sagamore Health Network All Products |
$107.81
|
| Rate for Payer: Signature Care EPO |
$115.91
|
| Rate for Payer: Signature Care PPO |
$122.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.70
|
| Rate for Payer: United Healthcare Commercial |
$110.04
|
| Rate for Payer: United Healthcare Medicare |
$46.08
|
|
|
HC CUSTOM DRUG SCREEN W/QUANT IF INDICATED
|
Facility
OP
|
$167.44
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001388
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.26 |
| Max. Negotiated Rate |
$155.72 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Aetna Medicare |
$55.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.78
|
| Rate for Payer: Cash Price |
$103.82
|
| Rate for Payer: Cash Price |
$103.82
|
| Rate for Payer: Centivo All Commercial |
$85.40
|
| Rate for Payer: Cigna All Commercial |
$144.50
|
| Rate for Payer: CORVEL All Commercial |
$155.72
|
| Rate for Payer: Coventry All Commercial |
$147.35
|
| Rate for Payer: Encore All Commercial |
$154.13
|
| Rate for Payer: Frontpath All Commercial |
$154.05
|
| Rate for Payer: Humana ChoiceCare |
$144.62
|
| Rate for Payer: Humana Medicare |
$85.40
|
| Rate for Payer: Lucent All Commercial |
$85.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.70
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$125.58
|
| Rate for Payer: PHP All Commercial |
$126.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.30
|
| Rate for Payer: Sagamore Health Network All Products |
$129.27
|
| Rate for Payer: Signature Care EPO |
$138.98
|
| Rate for Payer: Signature Care PPO |
$147.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.33
|
| Rate for Payer: United Healthcare Commercial |
$131.95
|
| Rate for Payer: United Healthcare Medicare |
$55.26
|
|
|
HC CUSTOM DRUG SCREEN W/QUANT IF INDICATED
|
Facility
IP
|
$167.44
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001388
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$155.72 |
| Rate for Payer: Aetna Commercial |
$144.67
|
| Rate for Payer: Cash Price |
$103.82
|
| Rate for Payer: Cigna All Commercial |
$144.50
|
| Rate for Payer: CORVEL All Commercial |
$155.72
|
| Rate for Payer: Coventry All Commercial |
$147.35
|
| Rate for Payer: Encore All Commercial |
$154.13
|
| Rate for Payer: Frontpath All Commercial |
$154.05
|
| Rate for Payer: Humana ChoiceCare |
$144.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.70
|
| Rate for Payer: PHCS All Commercial |
$125.58
|
| Rate for Payer: PHP All Commercial |
$126.99
|
| Rate for Payer: Sagamore Health Network All Products |
$129.27
|
| Rate for Payer: Signature Care EPO |
$138.98
|
| Rate for Payer: Signature Care PPO |
$147.35
|
| Rate for Payer: United Healthcare Commercial |
$131.95
|
|
|
HC CYCLOSPORINE
|
Facility
OP
|
$172.38
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
63001034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$160.31 |
| Rate for Payer: Aetna Commercial |
$145.49
|
| Rate for Payer: Aetna Medicare |
$56.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.57
|
| Rate for Payer: Cash Price |
$106.88
|
| Rate for Payer: Cash Price |
$106.88
|
| Rate for Payer: Centivo All Commercial |
$87.91
|
| Rate for Payer: Cigna All Commercial |
$148.76
|
| Rate for Payer: CORVEL All Commercial |
$160.31
|
| Rate for Payer: Coventry All Commercial |
$151.69
|
| Rate for Payer: Encore All Commercial |
$158.68
|
| Rate for Payer: Frontpath All Commercial |
$158.59
|
| Rate for Payer: Humana ChoiceCare |
$148.88
|
| Rate for Payer: Humana Medicare |
$87.91
|
| Rate for Payer: Lucent All Commercial |
$87.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.14
|
| Rate for Payer: Managed Health Services Medicaid |
$18.05
|
| Rate for Payer: MDWise Medicaid |
$18.05
|
| Rate for Payer: PHCS All Commercial |
$129.28
|
| Rate for Payer: PHP All Commercial |
$130.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.23
|
| Rate for Payer: Sagamore Health Network All Products |
$133.08
|
| Rate for Payer: Signature Care EPO |
$143.08
|
| Rate for Payer: Signature Care PPO |
$151.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$146.52
|
| Rate for Payer: United Healthcare Commercial |
$135.84
|
| Rate for Payer: United Healthcare Medicare |
$56.89
|
|
|
HC CYCLOSPORINE
|
Facility
IP
|
$172.38
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
63001034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.28 |
| Max. Negotiated Rate |
$160.31 |
| Rate for Payer: Aetna Commercial |
$148.94
|
| Rate for Payer: Cash Price |
$106.88
|
| Rate for Payer: Cigna All Commercial |
$148.76
|
| Rate for Payer: CORVEL All Commercial |
$160.31
|
| Rate for Payer: Coventry All Commercial |
$151.69
|
| Rate for Payer: Encore All Commercial |
$158.68
|
| Rate for Payer: Frontpath All Commercial |
$158.59
|
| Rate for Payer: Humana ChoiceCare |
$148.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.14
|
| Rate for Payer: PHCS All Commercial |
$129.28
|
| Rate for Payer: PHP All Commercial |
$130.73
|
| Rate for Payer: Sagamore Health Network All Products |
$133.08
|
| Rate for Payer: Signature Care EPO |
$143.08
|
| Rate for Payer: Signature Care PPO |
$151.69
|
| Rate for Payer: United Healthcare Commercial |
$135.84
|
|
|
HC CYPASS EYE STENT
|
Facility
OP
|
$8,100.00
|
|
| Hospital Charge Code |
41604003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,533.00 |
| Rate for Payer: Aetna Commercial |
$6,836.40
|
| Rate for Payer: Aetna Medicare |
$2,673.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,673.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,651.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,063.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,073.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,940.30
|
| Rate for Payer: Cash Price |
$5,022.00
|
| Rate for Payer: Cash Price |
$5,022.00
|
| Rate for Payer: Centivo All Commercial |
$4,131.00
|
| Rate for Payer: Cigna All Commercial |
$6,990.30
|
| Rate for Payer: CORVEL All Commercial |
$7,533.00
|
| Rate for Payer: Coventry All Commercial |
$7,128.00
|
| Rate for Payer: Encore All Commercial |
$7,456.05
|
| Rate for Payer: Frontpath All Commercial |
$7,452.00
|
| Rate for Payer: Humana ChoiceCare |
$6,995.97
|
| Rate for Payer: Humana Medicare |
$4,131.00
|
| Rate for Payer: Lucent All Commercial |
$4,131.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,290.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,075.00
|
| Rate for Payer: PHP All Commercial |
$6,143.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,159.00
|
| Rate for Payer: Sagamore Health Network All Products |
$6,253.20
|
| Rate for Payer: Signature Care EPO |
$6,723.00
|
| Rate for Payer: Signature Care PPO |
$7,128.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,885.00
|
| Rate for Payer: United Healthcare Commercial |
$6,382.80
|
| Rate for Payer: United Healthcare Medicare |
$2,673.00
|
|
|
HC CYPASS EYE STENT
|
Facility
IP
|
$8,100.00
|
|
| Hospital Charge Code |
41604003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,075.00 |
| Max. Negotiated Rate |
$7,533.00 |
| Rate for Payer: Aetna Commercial |
$6,998.40
|
| Rate for Payer: Cash Price |
$5,022.00
|
| Rate for Payer: Cigna All Commercial |
$6,990.30
|
| Rate for Payer: CORVEL All Commercial |
$7,533.00
|
| Rate for Payer: Coventry All Commercial |
$7,128.00
|
| Rate for Payer: Encore All Commercial |
$7,456.05
|
| Rate for Payer: Frontpath All Commercial |
$7,452.00
|
| Rate for Payer: Humana ChoiceCare |
$6,995.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,290.00
|
| Rate for Payer: PHCS All Commercial |
$6,075.00
|
| Rate for Payer: PHP All Commercial |
$6,143.04
|
| Rate for Payer: Sagamore Health Network All Products |
$6,253.20
|
| Rate for Payer: Signature Care EPO |
$6,723.00
|
| Rate for Payer: Signature Care PPO |
$7,128.00
|
| Rate for Payer: United Healthcare Commercial |
$6,382.80
|
|
|
HC CYSTIC FIBROSIS CFTR PANEL
|
Facility
OP
|
$2,094.04
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
63001436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$556.60 |
| Max. Negotiated Rate |
$1,947.46 |
| Rate for Payer: Aetna Commercial |
$1,767.37
|
| Rate for Payer: Aetna Medicare |
$691.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$691.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,202.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,308.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$556.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$794.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$760.14
|
| Rate for Payer: Cash Price |
$1,298.31
|
| Rate for Payer: Cash Price |
$1,298.31
|
| Rate for Payer: Centivo All Commercial |
$1,067.96
|
| Rate for Payer: Cigna All Commercial |
$1,807.16
|
| Rate for Payer: CORVEL All Commercial |
$1,947.46
|
| Rate for Payer: Coventry All Commercial |
$1,842.75
|
| Rate for Payer: Encore All Commercial |
$1,927.56
|
| Rate for Payer: Frontpath All Commercial |
$1,926.52
|
| Rate for Payer: Humana ChoiceCare |
$1,808.62
|
| Rate for Payer: Humana Medicare |
$1,067.96
|
| Rate for Payer: Lucent All Commercial |
$1,067.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,884.64
|
| Rate for Payer: Managed Health Services Medicaid |
$556.60
|
| Rate for Payer: MDWise Medicaid |
$556.60
|
| Rate for Payer: PHCS All Commercial |
$1,570.53
|
| Rate for Payer: PHP All Commercial |
$1,588.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$816.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,616.60
|
| Rate for Payer: Signature Care EPO |
$1,738.05
|
| Rate for Payer: Signature Care PPO |
$1,842.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,779.93
|
| Rate for Payer: United Healthcare Commercial |
$1,650.10
|
| Rate for Payer: United Healthcare Medicare |
$691.03
|
|
|
HC CYSTIC FIBROSIS CFTR PANEL
|
Facility
IP
|
$2,094.04
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
63001436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,570.53 |
| Max. Negotiated Rate |
$1,947.46 |
| Rate for Payer: Aetna Commercial |
$1,809.25
|
| Rate for Payer: Cash Price |
$1,298.31
|
| Rate for Payer: Cigna All Commercial |
$1,807.16
|
| Rate for Payer: CORVEL All Commercial |
$1,947.46
|
| Rate for Payer: Coventry All Commercial |
$1,842.75
|
| Rate for Payer: Encore All Commercial |
$1,927.56
|
| Rate for Payer: Frontpath All Commercial |
$1,926.52
|
| Rate for Payer: Humana ChoiceCare |
$1,808.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,884.64
|
| Rate for Payer: PHCS All Commercial |
$1,570.53
|
| Rate for Payer: PHP All Commercial |
$1,588.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,616.60
|
| Rate for Payer: Signature Care EPO |
$1,738.05
|
| Rate for Payer: Signature Care PPO |
$1,842.75
|
| Rate for Payer: United Healthcare Commercial |
$1,650.10
|
|
|
HC CYSTOGRAM
|
Facility
OP
|
$980.55
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
01614451
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$911.91 |
| Rate for Payer: Aetna Commercial |
$827.58
|
| Rate for Payer: Aetna Medicare |
$323.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$323.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$563.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$612.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$70.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$372.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$355.94
|
| Rate for Payer: Cash Price |
$607.94
|
| Rate for Payer: Cash Price |
$607.94
|
| Rate for Payer: Centivo All Commercial |
$500.08
|
| Rate for Payer: Cigna All Commercial |
$846.21
|
| Rate for Payer: CORVEL All Commercial |
$911.91
|
| Rate for Payer: Coventry All Commercial |
$862.88
|
| Rate for Payer: Encore All Commercial |
$902.59
|
| Rate for Payer: Frontpath All Commercial |
$902.10
|
| Rate for Payer: Humana ChoiceCare |
$846.90
|
| Rate for Payer: Humana Medicare |
$500.08
|
| Rate for Payer: Lucent All Commercial |
$500.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$882.49
|
| Rate for Payer: Managed Health Services Medicaid |
$70.20
|
| Rate for Payer: MDWise Medicaid |
$70.20
|
| Rate for Payer: PHCS All Commercial |
$735.41
|
| Rate for Payer: PHP All Commercial |
$743.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$382.41
|
| Rate for Payer: Sagamore Health Network All Products |
$756.98
|
| Rate for Payer: Signature Care EPO |
$813.85
|
| Rate for Payer: Signature Care PPO |
$862.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$833.46
|
| Rate for Payer: United Healthcare Commercial |
$772.67
|
| Rate for Payer: United Healthcare Medicare |
$323.58
|
|
|
HC CYSTOGRAM
|
Facility
IP
|
$980.55
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
01614451
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$735.41 |
| Max. Negotiated Rate |
$911.91 |
| Rate for Payer: Aetna Commercial |
$847.19
|
| Rate for Payer: Cash Price |
$607.94
|
| Rate for Payer: Cigna All Commercial |
$846.21
|
| Rate for Payer: CORVEL All Commercial |
$911.91
|
| Rate for Payer: Coventry All Commercial |
$862.88
|
| Rate for Payer: Encore All Commercial |
$902.59
|
| Rate for Payer: Frontpath All Commercial |
$902.10
|
| Rate for Payer: Humana ChoiceCare |
$846.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$882.49
|
| Rate for Payer: PHCS All Commercial |
$735.41
|
| Rate for Payer: PHP All Commercial |
$743.65
|
| Rate for Payer: Sagamore Health Network All Products |
$756.98
|
| Rate for Payer: Signature Care EPO |
$813.85
|
| Rate for Payer: Signature Care PPO |
$862.88
|
| Rate for Payer: United Healthcare Commercial |
$772.67
|
|
|
HC CYTOLOGY CELL BLOCK
|
Facility
OP
|
$337.65
|
|
|
Service Code
|
CPT 88305 59
|
| Hospital Charge Code |
63002170
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.42 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$284.98
|
| Rate for Payer: Aetna Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.57
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Centivo All Commercial |
$172.20
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Humana Medicare |
$172.20
|
| Rate for Payer: Lucent All Commercial |
$172.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.68
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.00
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
| Rate for Payer: United Healthcare Medicare |
$111.42
|
|
|
HC CYTOLOGY CELL BLOCK
|
Facility
OP
|
$529.58
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63002099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$492.51 |
| Rate for Payer: Aetna Commercial |
$446.97
|
| Rate for Payer: Aetna Medicare |
$174.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$174.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$304.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$331.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$277.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.24
|
| Rate for Payer: Cash Price |
$328.34
|
| Rate for Payer: Cash Price |
$328.34
|
| Rate for Payer: Centivo All Commercial |
$270.09
|
| Rate for Payer: Cigna All Commercial |
$457.03
|
| Rate for Payer: CORVEL All Commercial |
$492.51
|
| Rate for Payer: Coventry All Commercial |
$466.03
|
| Rate for Payer: Encore All Commercial |
$487.48
|
| Rate for Payer: Frontpath All Commercial |
$487.22
|
| Rate for Payer: Humana ChoiceCare |
$457.40
|
| Rate for Payer: Humana Medicare |
$270.09
|
| Rate for Payer: Lucent All Commercial |
$270.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.63
|
| Rate for Payer: Managed Health Services Medicaid |
$277.37
|
| Rate for Payer: MDWise Medicaid |
$277.37
|
| Rate for Payer: PHCS All Commercial |
$397.19
|
| Rate for Payer: PHP All Commercial |
$401.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.54
|
| Rate for Payer: Sagamore Health Network All Products |
$408.84
|
| Rate for Payer: Signature Care EPO |
$439.55
|
| Rate for Payer: Signature Care PPO |
$466.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$450.15
|
| Rate for Payer: United Healthcare Commercial |
$417.31
|
| Rate for Payer: United Healthcare Medicare |
$174.76
|
|
|
HC CYTOLOGY CELL BLOCK
|
Facility
IP
|
$337.65
|
|
|
Service Code
|
CPT 88305 59
|
| Hospital Charge Code |
63002170
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$253.24 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$291.73
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
|
|
HC CYTOLOGY CELL BLOCK
|
Facility
IP
|
$529.58
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63002099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$397.19 |
| Max. Negotiated Rate |
$492.51 |
| Rate for Payer: Aetna Commercial |
$457.56
|
| Rate for Payer: Cash Price |
$328.34
|
| Rate for Payer: Cigna All Commercial |
$457.03
|
| Rate for Payer: CORVEL All Commercial |
$492.51
|
| Rate for Payer: Coventry All Commercial |
$466.03
|
| Rate for Payer: Encore All Commercial |
$487.48
|
| Rate for Payer: Frontpath All Commercial |
$487.22
|
| Rate for Payer: Humana ChoiceCare |
$457.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.63
|
| Rate for Payer: PHCS All Commercial |
$397.19
|
| Rate for Payer: PHP All Commercial |
$401.64
|
| Rate for Payer: Sagamore Health Network All Products |
$408.84
|
| Rate for Payer: Signature Care EPO |
$439.55
|
| Rate for Payer: Signature Care PPO |
$466.03
|
| Rate for Payer: United Healthcare Commercial |
$417.31
|
|
|
HC CYTOMEGALOVIRUS IGG
|
Facility
OP
|
$159.32
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
63001283
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$148.17 |
| Rate for Payer: Aetna Commercial |
$134.47
|
| Rate for Payer: Aetna Medicare |
$52.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.83
|
| Rate for Payer: Cash Price |
$98.78
|
| Rate for Payer: Cash Price |
$98.78
|
| Rate for Payer: Centivo All Commercial |
$81.26
|
| Rate for Payer: Cigna All Commercial |
$137.50
|
| Rate for Payer: CORVEL All Commercial |
$148.17
|
| Rate for Payer: Coventry All Commercial |
$140.21
|
| Rate for Payer: Encore All Commercial |
$146.66
|
| Rate for Payer: Frontpath All Commercial |
$146.58
|
| Rate for Payer: Humana ChoiceCare |
$137.61
|
| Rate for Payer: Humana Medicare |
$81.26
|
| Rate for Payer: Lucent All Commercial |
$81.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.39
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$119.49
|
| Rate for Payer: PHP All Commercial |
$120.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.14
|
| Rate for Payer: Sagamore Health Network All Products |
$123.00
|
| Rate for Payer: Signature Care EPO |
$132.24
|
| Rate for Payer: Signature Care PPO |
$140.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.43
|
| Rate for Payer: United Healthcare Commercial |
$125.55
|
| Rate for Payer: United Healthcare Medicare |
$52.58
|
|
|
HC CYTOMEGALOVIRUS IGG
|
Facility
IP
|
$159.32
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
63001283
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.49 |
| Max. Negotiated Rate |
$148.17 |
| Rate for Payer: Aetna Commercial |
$137.66
|
| Rate for Payer: Cash Price |
$98.78
|
| Rate for Payer: Cigna All Commercial |
$137.50
|
| Rate for Payer: CORVEL All Commercial |
$148.17
|
| Rate for Payer: Coventry All Commercial |
$140.21
|
| Rate for Payer: Encore All Commercial |
$146.66
|
| Rate for Payer: Frontpath All Commercial |
$146.58
|
| Rate for Payer: Humana ChoiceCare |
$137.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.39
|
| Rate for Payer: PHCS All Commercial |
$119.49
|
| Rate for Payer: PHP All Commercial |
$120.83
|
| Rate for Payer: Sagamore Health Network All Products |
$123.00
|
| Rate for Payer: Signature Care EPO |
$132.24
|
| Rate for Payer: Signature Care PPO |
$140.21
|
| Rate for Payer: United Healthcare Commercial |
$125.55
|
|
|
HC CYTOMEGALOVIRUS IGM
|
Facility
IP
|
$185.13
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
63001278
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.85 |
| Max. Negotiated Rate |
$172.17 |
| Rate for Payer: Aetna Commercial |
$159.95
|
| Rate for Payer: Cash Price |
$114.78
|
| Rate for Payer: Cigna All Commercial |
$159.77
|
| Rate for Payer: CORVEL All Commercial |
$172.17
|
| Rate for Payer: Coventry All Commercial |
$162.91
|
| Rate for Payer: Encore All Commercial |
$170.41
|
| Rate for Payer: Frontpath All Commercial |
$170.32
|
| Rate for Payer: Humana ChoiceCare |
$159.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.62
|
| Rate for Payer: PHCS All Commercial |
$138.85
|
| Rate for Payer: PHP All Commercial |
$140.40
|
| Rate for Payer: Sagamore Health Network All Products |
$142.92
|
| Rate for Payer: Signature Care EPO |
$153.66
|
| Rate for Payer: Signature Care PPO |
$162.91
|
| Rate for Payer: United Healthcare Commercial |
$145.88
|
|
|
HC CYTOMEGALOVIRUS IGM
|
Facility
OP
|
$185.13
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
63001278
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$172.17 |
| Rate for Payer: Aetna Commercial |
$156.25
|
| Rate for Payer: Aetna Medicare |
$61.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.20
|
| Rate for Payer: Cash Price |
$114.78
|
| Rate for Payer: Cash Price |
$114.78
|
| Rate for Payer: Centivo All Commercial |
$94.42
|
| Rate for Payer: Cigna All Commercial |
$159.77
|
| Rate for Payer: CORVEL All Commercial |
$172.17
|
| Rate for Payer: Coventry All Commercial |
$162.91
|
| Rate for Payer: Encore All Commercial |
$170.41
|
| Rate for Payer: Frontpath All Commercial |
$170.32
|
| Rate for Payer: Humana ChoiceCare |
$159.90
|
| Rate for Payer: Humana Medicare |
$94.42
|
| Rate for Payer: Lucent All Commercial |
$94.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.62
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$138.85
|
| Rate for Payer: PHP All Commercial |
$140.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.20
|
| Rate for Payer: Sagamore Health Network All Products |
$142.92
|
| Rate for Payer: Signature Care EPO |
$153.66
|
| Rate for Payer: Signature Care PPO |
$162.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$157.36
|
| Rate for Payer: United Healthcare Commercial |
$145.88
|
| Rate for Payer: United Healthcare Medicare |
$61.09
|
|
|
HC CYTOMEG DNA-PCR QT
|
Facility
OP
|
$552.02
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
63001020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$513.38 |
| Rate for Payer: Aetna Commercial |
$465.91
|
| Rate for Payer: Aetna Medicare |
$182.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$182.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$253.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$253.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$209.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$200.38
|
| Rate for Payer: Cash Price |
$342.26
|
| Rate for Payer: Cash Price |
$342.26
|
| Rate for Payer: Centivo All Commercial |
$281.53
|
| Rate for Payer: Cigna All Commercial |
$476.40
|
| Rate for Payer: CORVEL All Commercial |
$513.38
|
| Rate for Payer: Coventry All Commercial |
$485.78
|
| Rate for Payer: Encore All Commercial |
$508.14
|
| Rate for Payer: Frontpath All Commercial |
$507.86
|
| Rate for Payer: Humana ChoiceCare |
$476.78
|
| Rate for Payer: Humana Medicare |
$281.53
|
| Rate for Payer: Lucent All Commercial |
$281.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$496.82
|
| Rate for Payer: Managed Health Services Medicaid |
$42.84
|
| Rate for Payer: MDWise Medicaid |
$42.84
|
| Rate for Payer: PHCS All Commercial |
$414.02
|
| Rate for Payer: PHP All Commercial |
$418.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$215.29
|
| Rate for Payer: Sagamore Health Network All Products |
$426.16
|
| Rate for Payer: Signature Care EPO |
$458.18
|
| Rate for Payer: Signature Care PPO |
$485.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$469.22
|
| Rate for Payer: United Healthcare Commercial |
$434.99
|
| Rate for Payer: United Healthcare Medicare |
$182.17
|
|
|
HC CYTOMEG DNA-PCR QT
|
Facility
IP
|
$552.02
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
63001020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$414.02 |
| Max. Negotiated Rate |
$513.38 |
| Rate for Payer: Aetna Commercial |
$476.95
|
| Rate for Payer: Cash Price |
$342.26
|
| Rate for Payer: Cigna All Commercial |
$476.40
|
| Rate for Payer: CORVEL All Commercial |
$513.38
|
| Rate for Payer: Coventry All Commercial |
$485.78
|
| Rate for Payer: Encore All Commercial |
$508.14
|
| Rate for Payer: Frontpath All Commercial |
$507.86
|
| Rate for Payer: Humana ChoiceCare |
$476.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$496.82
|
| Rate for Payer: PHCS All Commercial |
$414.02
|
| Rate for Payer: PHP All Commercial |
$418.66
|
| Rate for Payer: Sagamore Health Network All Products |
$426.16
|
| Rate for Payer: Signature Care EPO |
$458.18
|
| Rate for Payer: Signature Care PPO |
$485.78
|
| Rate for Payer: United Healthcare Commercial |
$434.99
|
|
