|
HC DILATOR 20F 20CM
|
Facility
OP
|
$93.59
|
|
| Hospital Charge Code |
41607438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$78.99
|
| Rate for Payer: Aetna Medicare |
$30.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.97
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Centivo All Commercial |
$47.73
|
| Rate for Payer: Cigna All Commercial |
$80.77
|
| Rate for Payer: CORVEL All Commercial |
$87.04
|
| Rate for Payer: Coventry All Commercial |
$82.36
|
| Rate for Payer: Encore All Commercial |
$86.15
|
| Rate for Payer: Frontpath All Commercial |
$86.10
|
| Rate for Payer: Humana ChoiceCare |
$80.83
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Lucent All Commercial |
$47.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.23
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$70.19
|
| Rate for Payer: PHP All Commercial |
$70.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.50
|
| Rate for Payer: Sagamore Health Network All Products |
$72.25
|
| Rate for Payer: Signature Care EPO |
$77.68
|
| Rate for Payer: Signature Care PPO |
$82.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.55
|
| Rate for Payer: United Healthcare Commercial |
$73.75
|
| Rate for Payer: United Healthcare Medicare |
$30.88
|
|
|
HC DILATOR 20F 20CM
|
Facility
IP
|
$93.59
|
|
| Hospital Charge Code |
41607438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.19 |
| Max. Negotiated Rate |
$87.04 |
| Rate for Payer: Aetna Commercial |
$80.86
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cigna All Commercial |
$80.77
|
| Rate for Payer: CORVEL All Commercial |
$87.04
|
| Rate for Payer: Coventry All Commercial |
$82.36
|
| Rate for Payer: Encore All Commercial |
$86.15
|
| Rate for Payer: Frontpath All Commercial |
$86.10
|
| Rate for Payer: Humana ChoiceCare |
$80.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.23
|
| Rate for Payer: PHCS All Commercial |
$70.19
|
| Rate for Payer: PHP All Commercial |
$70.98
|
| Rate for Payer: Sagamore Health Network All Products |
$72.25
|
| Rate for Payer: Signature Care EPO |
$77.68
|
| Rate for Payer: Signature Care PPO |
$82.36
|
| Rate for Payer: United Healthcare Commercial |
$73.75
|
|
|
HC DILATOR 8F 15CM
|
Facility
OP
|
$43.68
|
|
| Hospital Charge Code |
41607435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$36.87
|
| Rate for Payer: Aetna Medicare |
$14.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.86
|
| Rate for Payer: Cash Price |
$27.08
|
| Rate for Payer: Cash Price |
$27.08
|
| Rate for Payer: Centivo All Commercial |
$22.28
|
| Rate for Payer: Cigna All Commercial |
$37.70
|
| Rate for Payer: CORVEL All Commercial |
$40.62
|
| Rate for Payer: Coventry All Commercial |
$38.44
|
| Rate for Payer: Encore All Commercial |
$40.21
|
| Rate for Payer: Frontpath All Commercial |
$40.19
|
| Rate for Payer: Humana ChoiceCare |
$37.73
|
| Rate for Payer: Humana Medicare |
$22.28
|
| Rate for Payer: Lucent All Commercial |
$22.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.31
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$32.76
|
| Rate for Payer: PHP All Commercial |
$33.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.04
|
| Rate for Payer: Sagamore Health Network All Products |
$33.72
|
| Rate for Payer: Signature Care EPO |
$36.25
|
| Rate for Payer: Signature Care PPO |
$38.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.13
|
| Rate for Payer: United Healthcare Commercial |
$34.42
|
| Rate for Payer: United Healthcare Medicare |
$14.41
|
|
|
HC DILATOR 8F 15CM
|
Facility
IP
|
$43.68
|
|
| Hospital Charge Code |
41607435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$40.62 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Cash Price |
$27.08
|
| Rate for Payer: Cigna All Commercial |
$37.70
|
| Rate for Payer: CORVEL All Commercial |
$40.62
|
| Rate for Payer: Coventry All Commercial |
$38.44
|
| Rate for Payer: Encore All Commercial |
$40.21
|
| Rate for Payer: Frontpath All Commercial |
$40.19
|
| Rate for Payer: Humana ChoiceCare |
$37.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.31
|
| Rate for Payer: PHCS All Commercial |
$32.76
|
| Rate for Payer: PHP All Commercial |
$33.13
|
| Rate for Payer: Sagamore Health Network All Products |
$33.72
|
| Rate for Payer: Signature Care EPO |
$36.25
|
| Rate for Payer: Signature Care PPO |
$38.44
|
| Rate for Payer: United Healthcare Commercial |
$34.42
|
|
|
HC DILATOR NOTTINGHAM
|
Facility
OP
|
$149.24
|
|
| Hospital Charge Code |
41601861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.25 |
| Max. Negotiated Rate |
$138.79 |
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: Aetna Medicare |
$49.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.17
|
| Rate for Payer: Cash Price |
$92.53
|
| Rate for Payer: Cash Price |
$92.53
|
| Rate for Payer: Centivo All Commercial |
$76.11
|
| Rate for Payer: Cigna All Commercial |
$128.79
|
| Rate for Payer: CORVEL All Commercial |
$138.79
|
| Rate for Payer: Coventry All Commercial |
$131.33
|
| Rate for Payer: Encore All Commercial |
$137.38
|
| Rate for Payer: Frontpath All Commercial |
$137.30
|
| Rate for Payer: Humana ChoiceCare |
$128.90
|
| Rate for Payer: Humana Medicare |
$76.11
|
| Rate for Payer: Lucent All Commercial |
$76.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$111.93
|
| Rate for Payer: PHP All Commercial |
$113.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.20
|
| Rate for Payer: Sagamore Health Network All Products |
$115.21
|
| Rate for Payer: Signature Care EPO |
$123.87
|
| Rate for Payer: Signature Care PPO |
$131.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.85
|
| Rate for Payer: United Healthcare Commercial |
$117.60
|
| Rate for Payer: United Healthcare Medicare |
$49.25
|
|
|
HC DILATOR NOTTINGHAM
|
Facility
IP
|
$149.24
|
|
| Hospital Charge Code |
41601861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$138.79 |
| Rate for Payer: Aetna Commercial |
$128.94
|
| Rate for Payer: Cash Price |
$92.53
|
| Rate for Payer: Cigna All Commercial |
$128.79
|
| Rate for Payer: CORVEL All Commercial |
$138.79
|
| Rate for Payer: Coventry All Commercial |
$131.33
|
| Rate for Payer: Encore All Commercial |
$137.38
|
| Rate for Payer: Frontpath All Commercial |
$137.30
|
| Rate for Payer: Humana ChoiceCare |
$128.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.32
|
| Rate for Payer: PHCS All Commercial |
$111.93
|
| Rate for Payer: PHP All Commercial |
$113.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.21
|
| Rate for Payer: Signature Care EPO |
$123.87
|
| Rate for Payer: Signature Care PPO |
$131.33
|
| Rate for Payer: United Healthcare Commercial |
$117.60
|
|
|
HC DIPHTHERIA IGG AB
|
Facility
OP
|
$420.55
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63001035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$391.11 |
| Rate for Payer: Aetna Commercial |
$354.94
|
| Rate for Payer: Aetna Medicare |
$138.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.66
|
| Rate for Payer: Cash Price |
$260.74
|
| Rate for Payer: Cash Price |
$260.74
|
| Rate for Payer: Centivo All Commercial |
$214.48
|
| Rate for Payer: Cigna All Commercial |
$362.93
|
| Rate for Payer: CORVEL All Commercial |
$391.11
|
| Rate for Payer: Coventry All Commercial |
$370.08
|
| Rate for Payer: Encore All Commercial |
$387.11
|
| Rate for Payer: Frontpath All Commercial |
$386.90
|
| Rate for Payer: Humana ChoiceCare |
$363.23
|
| Rate for Payer: Humana Medicare |
$214.48
|
| Rate for Payer: Lucent All Commercial |
$214.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.49
|
| Rate for Payer: Managed Health Services Medicaid |
$14.99
|
| Rate for Payer: MDWise Medicaid |
$14.99
|
| Rate for Payer: PHCS All Commercial |
$315.41
|
| Rate for Payer: PHP All Commercial |
$318.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.01
|
| Rate for Payer: Sagamore Health Network All Products |
$324.66
|
| Rate for Payer: Signature Care EPO |
$349.05
|
| Rate for Payer: Signature Care PPO |
$370.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.46
|
| Rate for Payer: United Healthcare Commercial |
$331.39
|
| Rate for Payer: United Healthcare Medicare |
$138.78
|
|
|
HC DIPHTHERIA IGG AB
|
Facility
IP
|
$420.55
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
63001035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.41 |
| Max. Negotiated Rate |
$391.11 |
| Rate for Payer: Aetna Commercial |
$363.35
|
| Rate for Payer: Cash Price |
$260.74
|
| Rate for Payer: Cigna All Commercial |
$362.93
|
| Rate for Payer: CORVEL All Commercial |
$391.11
|
| Rate for Payer: Coventry All Commercial |
$370.08
|
| Rate for Payer: Encore All Commercial |
$387.11
|
| Rate for Payer: Frontpath All Commercial |
$386.90
|
| Rate for Payer: Humana ChoiceCare |
$363.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.49
|
| Rate for Payer: PHCS All Commercial |
$315.41
|
| Rate for Payer: PHP All Commercial |
$318.94
|
| Rate for Payer: Sagamore Health Network All Products |
$324.66
|
| Rate for Payer: Signature Care EPO |
$349.05
|
| Rate for Payer: Signature Care PPO |
$370.08
|
| Rate for Payer: United Healthcare Commercial |
$331.39
|
|
|
HC DIRECT ANTIGLOBULIN TEST
|
Facility
OP
|
$99.31
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
63001983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$83.82
|
| Rate for Payer: Aetna Medicare |
$32.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.05
|
| Rate for Payer: Cash Price |
$61.57
|
| Rate for Payer: Cash Price |
$61.57
|
| Rate for Payer: Centivo All Commercial |
$50.65
|
| Rate for Payer: Cigna All Commercial |
$85.70
|
| Rate for Payer: CORVEL All Commercial |
$92.36
|
| Rate for Payer: Coventry All Commercial |
$87.39
|
| Rate for Payer: Encore All Commercial |
$91.41
|
| Rate for Payer: Frontpath All Commercial |
$91.36
|
| Rate for Payer: Humana ChoiceCare |
$85.77
|
| Rate for Payer: Humana Medicare |
$50.65
|
| Rate for Payer: Lucent All Commercial |
$50.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.38
|
| Rate for Payer: Managed Health Services Medicaid |
$5.39
|
| Rate for Payer: MDWise Medicaid |
$5.39
|
| Rate for Payer: PHCS All Commercial |
$74.48
|
| Rate for Payer: PHP All Commercial |
$75.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.73
|
| Rate for Payer: Sagamore Health Network All Products |
$76.67
|
| Rate for Payer: Signature Care EPO |
$82.42
|
| Rate for Payer: Signature Care PPO |
$87.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.41
|
| Rate for Payer: United Healthcare Commercial |
$78.25
|
| Rate for Payer: United Healthcare Medicare |
$32.77
|
|
|
HC DIRECT ANTIGLOBULIN TEST
|
Facility
IP
|
$99.31
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
63001983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$85.80
|
| Rate for Payer: Cash Price |
$61.57
|
| Rate for Payer: Cigna All Commercial |
$85.70
|
| Rate for Payer: CORVEL All Commercial |
$92.36
|
| Rate for Payer: Coventry All Commercial |
$87.39
|
| Rate for Payer: Encore All Commercial |
$91.41
|
| Rate for Payer: Frontpath All Commercial |
$91.36
|
| Rate for Payer: Humana ChoiceCare |
$85.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.38
|
| Rate for Payer: PHCS All Commercial |
$74.48
|
| Rate for Payer: PHP All Commercial |
$75.31
|
| Rate for Payer: Sagamore Health Network All Products |
$76.67
|
| Rate for Payer: Signature Care EPO |
$82.42
|
| Rate for Payer: Signature Care PPO |
$87.39
|
| Rate for Payer: United Healthcare Commercial |
$78.25
|
|
|
HC DISOPYRAMIDE
|
Facility
OP
|
$189.16
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
63001382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$159.65
|
| Rate for Payer: Aetna Medicare |
$62.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.66
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Centivo All Commercial |
$96.47
|
| Rate for Payer: Cigna All Commercial |
$163.24
|
| Rate for Payer: CORVEL All Commercial |
$175.92
|
| Rate for Payer: Coventry All Commercial |
$166.46
|
| Rate for Payer: Encore All Commercial |
$174.12
|
| Rate for Payer: Frontpath All Commercial |
$174.03
|
| Rate for Payer: Humana ChoiceCare |
$163.38
|
| Rate for Payer: Humana Medicare |
$96.47
|
| Rate for Payer: Lucent All Commercial |
$96.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: Managed Health Services Medicaid |
$18.64
|
| Rate for Payer: MDWise Medicaid |
$18.64
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.77
|
| Rate for Payer: Sagamore Health Network All Products |
$146.03
|
| Rate for Payer: Signature Care EPO |
$157.00
|
| Rate for Payer: Signature Care PPO |
$166.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.79
|
| Rate for Payer: United Healthcare Commercial |
$149.06
|
| Rate for Payer: United Healthcare Medicare |
$62.42
|
|
|
HC DISOPYRAMIDE
|
Facility
IP
|
$189.16
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
63001382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.87 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$163.43
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Cigna All Commercial |
$163.24
|
| Rate for Payer: CORVEL All Commercial |
$175.92
|
| Rate for Payer: Coventry All Commercial |
$166.46
|
| Rate for Payer: Encore All Commercial |
$174.12
|
| Rate for Payer: Frontpath All Commercial |
$174.03
|
| Rate for Payer: Humana ChoiceCare |
$163.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.24
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Sagamore Health Network All Products |
$146.03
|
| Rate for Payer: Signature Care EPO |
$157.00
|
| Rate for Payer: Signature Care PPO |
$166.46
|
| Rate for Payer: United Healthcare Commercial |
$149.06
|
|
|
HC DNA ANTIBODY TITER
|
Facility
IP
|
$194.36
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.77 |
| Max. Negotiated Rate |
$180.76 |
| Rate for Payer: Aetna Commercial |
$167.93
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.76
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
|
|
HC DNA ANTIBODY TITER
|
Facility
OP
|
$194.36
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$180.76 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$64.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.55
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Centivo All Commercial |
$99.12
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.76
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Humana Medicare |
$99.12
|
| Rate for Payer: Lucent All Commercial |
$99.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.80
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.21
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
| Rate for Payer: United Healthcare Medicare |
$64.14
|
|
|
HC DNA BLOOD DRAW
|
Facility
OP
|
$72.96
|
|
| Hospital Charge Code |
63002211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$67.85 |
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Aetna Medicare |
$24.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.48
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Centivo All Commercial |
$37.21
|
| Rate for Payer: Cigna All Commercial |
$62.96
|
| Rate for Payer: CORVEL All Commercial |
$67.85
|
| Rate for Payer: Coventry All Commercial |
$64.21
|
| Rate for Payer: Encore All Commercial |
$67.16
|
| Rate for Payer: Frontpath All Commercial |
$67.12
|
| Rate for Payer: Humana ChoiceCare |
$63.02
|
| Rate for Payer: Humana Medicare |
$37.21
|
| Rate for Payer: Lucent All Commercial |
$37.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.66
|
| Rate for Payer: PHCS All Commercial |
$54.72
|
| Rate for Payer: PHP All Commercial |
$55.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.45
|
| Rate for Payer: Sagamore Health Network All Products |
$56.33
|
| Rate for Payer: Signature Care EPO |
$60.56
|
| Rate for Payer: Signature Care PPO |
$64.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.02
|
| Rate for Payer: United Healthcare Commercial |
$57.49
|
| Rate for Payer: United Healthcare Medicare |
$24.08
|
|
|
HC DNA BLOOD DRAW
|
Facility
IP
|
$72.96
|
|
| Hospital Charge Code |
63002211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$67.85 |
| Rate for Payer: Aetna Commercial |
$63.04
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Cigna All Commercial |
$62.96
|
| Rate for Payer: CORVEL All Commercial |
$67.85
|
| Rate for Payer: Coventry All Commercial |
$64.21
|
| Rate for Payer: Encore All Commercial |
$67.16
|
| Rate for Payer: Frontpath All Commercial |
$67.12
|
| Rate for Payer: Humana ChoiceCare |
$63.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.66
|
| Rate for Payer: PHCS All Commercial |
$54.72
|
| Rate for Payer: PHP All Commercial |
$55.33
|
| Rate for Payer: Sagamore Health Network All Products |
$56.33
|
| Rate for Payer: Signature Care EPO |
$60.56
|
| Rate for Payer: Signature Care PPO |
$64.21
|
| Rate for Payer: United Healthcare Commercial |
$57.49
|
|
|
HC DNA DOUBLE STRANDED AB
|
Facility
OP
|
$72.58
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
63001286
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$61.26
|
| Rate for Payer: Aetna Medicare |
$23.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.35
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Centivo All Commercial |
$37.02
|
| Rate for Payer: Cigna All Commercial |
$62.64
|
| Rate for Payer: CORVEL All Commercial |
$67.50
|
| Rate for Payer: Coventry All Commercial |
$63.87
|
| Rate for Payer: Encore All Commercial |
$66.81
|
| Rate for Payer: Frontpath All Commercial |
$66.78
|
| Rate for Payer: Humana ChoiceCare |
$62.69
|
| Rate for Payer: Humana Medicare |
$37.02
|
| Rate for Payer: Lucent All Commercial |
$37.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.32
|
| Rate for Payer: Managed Health Services Medicaid |
$13.74
|
| Rate for Payer: MDWise Medicaid |
$13.74
|
| Rate for Payer: PHCS All Commercial |
$54.44
|
| Rate for Payer: PHP All Commercial |
$55.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.31
|
| Rate for Payer: Sagamore Health Network All Products |
$56.03
|
| Rate for Payer: Signature Care EPO |
$60.24
|
| Rate for Payer: Signature Care PPO |
$63.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.70
|
| Rate for Payer: United Healthcare Commercial |
$57.20
|
| Rate for Payer: United Healthcare Medicare |
$23.95
|
|
|
HC DNA DOUBLE STRANDED AB
|
Facility
IP
|
$72.58
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
63001286
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna All Commercial |
$62.64
|
| Rate for Payer: CORVEL All Commercial |
$67.50
|
| Rate for Payer: Coventry All Commercial |
$63.87
|
| Rate for Payer: Encore All Commercial |
$66.81
|
| Rate for Payer: Frontpath All Commercial |
$66.78
|
| Rate for Payer: Humana ChoiceCare |
$62.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.32
|
| Rate for Payer: PHCS All Commercial |
$54.44
|
| Rate for Payer: PHP All Commercial |
$55.05
|
| Rate for Payer: Sagamore Health Network All Products |
$56.03
|
| Rate for Payer: Signature Care EPO |
$60.24
|
| Rate for Payer: Signature Care PPO |
$63.87
|
| Rate for Payer: United Healthcare Commercial |
$57.20
|
|
|
HC DNA DOUBLE STRANDED AB EIA
|
Facility
OP
|
$57.22
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
63001873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$48.30
|
| Rate for Payer: Aetna Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.77
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Centivo All Commercial |
$29.18
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Humana Medicare |
$29.18
|
| Rate for Payer: Lucent All Commercial |
$29.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: Managed Health Services Medicaid |
$13.74
|
| Rate for Payer: MDWise Medicaid |
$13.74
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.32
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
| Rate for Payer: United Healthcare Medicare |
$18.88
|
|
|
HC DNA DOUBLE STRANDED AB EIA
|
Facility
IP
|
$57.22
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
63001873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
|
|
HC DNA PLOIDY IMAGE CONFIRM
|
Facility
IP
|
$449.77
|
|
|
Service Code
|
CPT 88358
|
| Hospital Charge Code |
63002126
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$337.33 |
| Max. Negotiated Rate |
$418.29 |
| Rate for Payer: Aetna Commercial |
$388.60
|
| Rate for Payer: Cash Price |
$278.86
|
| Rate for Payer: Cigna All Commercial |
$388.15
|
| Rate for Payer: CORVEL All Commercial |
$418.29
|
| Rate for Payer: Coventry All Commercial |
$395.80
|
| Rate for Payer: Encore All Commercial |
$414.01
|
| Rate for Payer: Frontpath All Commercial |
$413.79
|
| Rate for Payer: Humana ChoiceCare |
$388.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$404.79
|
| Rate for Payer: PHCS All Commercial |
$337.33
|
| Rate for Payer: PHP All Commercial |
$341.10
|
| Rate for Payer: Sagamore Health Network All Products |
$347.22
|
| Rate for Payer: Signature Care EPO |
$373.31
|
| Rate for Payer: Signature Care PPO |
$395.80
|
| Rate for Payer: United Healthcare Commercial |
$354.42
|
|
|
HC DNA PLOIDY IMAGE CONFIRM
|
Facility
OP
|
$449.77
|
|
|
Service Code
|
CPT 88358
|
| Hospital Charge Code |
63002126
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$457.39 |
| Rate for Payer: Aetna Commercial |
$379.61
|
| Rate for Payer: Aetna Medicare |
$148.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$258.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$281.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$457.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.27
|
| Rate for Payer: Cash Price |
$278.86
|
| Rate for Payer: Cash Price |
$278.86
|
| Rate for Payer: Centivo All Commercial |
$229.38
|
| Rate for Payer: Cigna All Commercial |
$388.15
|
| Rate for Payer: CORVEL All Commercial |
$418.29
|
| Rate for Payer: Coventry All Commercial |
$395.80
|
| Rate for Payer: Encore All Commercial |
$414.01
|
| Rate for Payer: Frontpath All Commercial |
$413.79
|
| Rate for Payer: Humana ChoiceCare |
$388.47
|
| Rate for Payer: Humana Medicare |
$229.38
|
| Rate for Payer: Lucent All Commercial |
$229.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$404.79
|
| Rate for Payer: Managed Health Services Medicaid |
$457.39
|
| Rate for Payer: MDWise Medicaid |
$457.39
|
| Rate for Payer: PHCS All Commercial |
$337.33
|
| Rate for Payer: PHP All Commercial |
$341.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.41
|
| Rate for Payer: Sagamore Health Network All Products |
$347.22
|
| Rate for Payer: Signature Care EPO |
$373.31
|
| Rate for Payer: Signature Care PPO |
$395.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$382.30
|
| Rate for Payer: United Healthcare Commercial |
$354.42
|
| Rate for Payer: United Healthcare Medicare |
$148.42
|
|
|
HC DNA PLOIDY SOLID TUMOR
|
Facility
OP
|
$97.69
|
|
|
Service Code
|
CPT 88358
|
| Hospital Charge Code |
63002127
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$457.39 |
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: Aetna Medicare |
$32.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$457.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.46
|
| Rate for Payer: Cash Price |
$60.57
|
| Rate for Payer: Cash Price |
$60.57
|
| Rate for Payer: Centivo All Commercial |
$49.82
|
| Rate for Payer: Cigna All Commercial |
$84.30
|
| Rate for Payer: CORVEL All Commercial |
$90.85
|
| Rate for Payer: Coventry All Commercial |
$85.96
|
| Rate for Payer: Encore All Commercial |
$89.92
|
| Rate for Payer: Frontpath All Commercial |
$89.87
|
| Rate for Payer: Humana ChoiceCare |
$84.37
|
| Rate for Payer: Humana Medicare |
$49.82
|
| Rate for Payer: Lucent All Commercial |
$49.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.92
|
| Rate for Payer: Managed Health Services Medicaid |
$457.39
|
| Rate for Payer: MDWise Medicaid |
$457.39
|
| Rate for Payer: PHCS All Commercial |
$73.26
|
| Rate for Payer: PHP All Commercial |
$74.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.10
|
| Rate for Payer: Sagamore Health Network All Products |
$75.41
|
| Rate for Payer: Signature Care EPO |
$81.08
|
| Rate for Payer: Signature Care PPO |
$85.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.03
|
| Rate for Payer: United Healthcare Commercial |
$76.98
|
| Rate for Payer: United Healthcare Medicare |
$32.24
|
|
|
HC DNA PLOIDY SOLID TUMOR
|
Facility
IP
|
$97.69
|
|
|
Service Code
|
CPT 88358
|
| Hospital Charge Code |
63002127
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$73.26 |
| Max. Negotiated Rate |
$90.85 |
| Rate for Payer: Aetna Commercial |
$84.40
|
| Rate for Payer: Cash Price |
$60.57
|
| Rate for Payer: Cigna All Commercial |
$84.30
|
| Rate for Payer: CORVEL All Commercial |
$90.85
|
| Rate for Payer: Coventry All Commercial |
$85.96
|
| Rate for Payer: Encore All Commercial |
$89.92
|
| Rate for Payer: Frontpath All Commercial |
$89.87
|
| Rate for Payer: Humana ChoiceCare |
$84.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.92
|
| Rate for Payer: PHCS All Commercial |
$73.26
|
| Rate for Payer: PHP All Commercial |
$74.08
|
| Rate for Payer: Sagamore Health Network All Products |
$75.41
|
| Rate for Payer: Signature Care EPO |
$81.08
|
| Rate for Payer: Signature Care PPO |
$85.96
|
| Rate for Payer: United Healthcare Commercial |
$76.98
|
|
|
HC DNASE-B ANTIBODY
|
Facility
OP
|
$111.75
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
63001872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$103.93 |
| Rate for Payer: Aetna Commercial |
$94.32
|
| Rate for Payer: Aetna Medicare |
$36.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.57
|
| Rate for Payer: Cash Price |
$69.29
|
| Rate for Payer: Cash Price |
$69.29
|
| Rate for Payer: Centivo All Commercial |
$56.99
|
| Rate for Payer: Cigna All Commercial |
$96.44
|
| Rate for Payer: CORVEL All Commercial |
$103.93
|
| Rate for Payer: Coventry All Commercial |
$98.34
|
| Rate for Payer: Encore All Commercial |
$102.87
|
| Rate for Payer: Frontpath All Commercial |
$102.81
|
| Rate for Payer: Humana ChoiceCare |
$96.52
|
| Rate for Payer: Humana Medicare |
$56.99
|
| Rate for Payer: Lucent All Commercial |
$56.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.58
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$83.81
|
| Rate for Payer: PHP All Commercial |
$84.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.58
|
| Rate for Payer: Sagamore Health Network All Products |
$86.27
|
| Rate for Payer: Signature Care EPO |
$92.75
|
| Rate for Payer: Signature Care PPO |
$98.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.99
|
| Rate for Payer: United Healthcare Commercial |
$88.06
|
| Rate for Payer: United Healthcare Medicare |
$36.88
|
|
