|
HC CHLAMYDIA CULT
|
Facility
|
OP
|
$143.20
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
63002005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$133.18 |
| Rate for Payer: Aetna Commercial |
$120.86
|
| Rate for Payer: Aetna Medicare |
$45.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$65.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.41
|
| Rate for Payer: Cash Price |
$85.92
|
| Rate for Payer: Cash Price |
$85.92
|
| Rate for Payer: Centivo All Commercial |
$77.90
|
| Rate for Payer: Cigna All Commercial |
$123.58
|
| Rate for Payer: CORVEL All Commercial |
$133.18
|
| Rate for Payer: Coventry All Commercial |
$126.02
|
| Rate for Payer: Encore All Commercial |
$131.82
|
| Rate for Payer: Frontpath All Commercial |
$131.74
|
| Rate for Payer: Humana ChoiceCare |
$123.68
|
| Rate for Payer: Humana Medicare |
$45.82
|
| Rate for Payer: Lucent All Commercial |
$77.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.88
|
| Rate for Payer: Managed Health Services Medicaid |
$19.60
|
| Rate for Payer: MDWise Medicaid |
$19.60
|
| Rate for Payer: PHCS All Commercial |
$107.40
|
| Rate for Payer: PHP All Commercial |
$108.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.85
|
| Rate for Payer: Sagamore Health Network All Products |
$110.55
|
| Rate for Payer: Signature Care EPO |
$118.86
|
| Rate for Payer: Signature Care PPO |
$126.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.72
|
| Rate for Payer: United Healthcare Commercial |
$112.84
|
| Rate for Payer: United Healthcare Medicare |
$45.82
|
|
|
HC CHLAMYDIA CULT
|
Facility
|
IP
|
$143.20
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
63002005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$133.18 |
| Rate for Payer: Aetna Commercial |
$123.72
|
| Rate for Payer: Cash Price |
$85.92
|
| Rate for Payer: Cigna All Commercial |
$123.58
|
| Rate for Payer: CORVEL All Commercial |
$133.18
|
| Rate for Payer: Coventry All Commercial |
$126.02
|
| Rate for Payer: Encore All Commercial |
$131.82
|
| Rate for Payer: Frontpath All Commercial |
$131.74
|
| Rate for Payer: Humana ChoiceCare |
$123.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.88
|
| Rate for Payer: PHCS All Commercial |
$107.40
|
| Rate for Payer: PHP All Commercial |
$108.60
|
| Rate for Payer: Sagamore Health Network All Products |
$110.55
|
| Rate for Payer: Signature Care EPO |
$118.86
|
| Rate for Payer: Signature Care PPO |
$126.02
|
| Rate for Payer: United Healthcare Commercial |
$112.84
|
|
|
HC CHLAMYDIA DNA-URINE
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
63002035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$53.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.24
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Centivo All Commercial |
$91.56
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$53.86
|
| Rate for Payer: Lucent All Commercial |
$91.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$53.86
|
|
|
HC CHLAMYDIA DNA-URINE
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
63002035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC CHLORIDE 24U
|
Facility
|
OP
|
$58.77
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
63001490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$54.66 |
| Rate for Payer: Aetna Commercial |
$49.60
|
| Rate for Payer: Aetna Medicare |
$18.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.69
|
| Rate for Payer: Cash Price |
$35.26
|
| Rate for Payer: Cash Price |
$35.26
|
| Rate for Payer: Centivo All Commercial |
$31.97
|
| Rate for Payer: Cigna All Commercial |
$50.72
|
| Rate for Payer: CORVEL All Commercial |
$54.66
|
| Rate for Payer: Coventry All Commercial |
$51.72
|
| Rate for Payer: Encore All Commercial |
$54.10
|
| Rate for Payer: Frontpath All Commercial |
$54.07
|
| Rate for Payer: Humana ChoiceCare |
$50.76
|
| Rate for Payer: Humana Medicare |
$18.81
|
| Rate for Payer: Lucent All Commercial |
$31.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.89
|
| Rate for Payer: Managed Health Services Medicaid |
$5.75
|
| Rate for Payer: MDWise Medicaid |
$5.75
|
| Rate for Payer: PHCS All Commercial |
$44.08
|
| Rate for Payer: PHP All Commercial |
$44.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.92
|
| Rate for Payer: Sagamore Health Network All Products |
$45.37
|
| Rate for Payer: Signature Care EPO |
$48.78
|
| Rate for Payer: Signature Care PPO |
$51.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.95
|
| Rate for Payer: United Healthcare Commercial |
$46.31
|
| Rate for Payer: United Healthcare Medicare |
$18.81
|
|
|
HC CHLORIDE 24U
|
Facility
|
IP
|
$58.77
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
63001490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$54.66 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Cash Price |
$35.26
|
| Rate for Payer: Cigna All Commercial |
$50.72
|
| Rate for Payer: CORVEL All Commercial |
$54.66
|
| Rate for Payer: Coventry All Commercial |
$51.72
|
| Rate for Payer: Encore All Commercial |
$54.10
|
| Rate for Payer: Frontpath All Commercial |
$54.07
|
| Rate for Payer: Humana ChoiceCare |
$50.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.89
|
| Rate for Payer: PHCS All Commercial |
$44.08
|
| Rate for Payer: PHP All Commercial |
$44.57
|
| Rate for Payer: Sagamore Health Network All Products |
$45.37
|
| Rate for Payer: Signature Care EPO |
$48.78
|
| Rate for Payer: Signature Care PPO |
$51.72
|
| Rate for Payer: United Healthcare Commercial |
$46.31
|
|
|
HC CHLORIDE URINE
|
Facility
|
IP
|
$99.86
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
63001174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.89 |
| Max. Negotiated Rate |
$92.87 |
| Rate for Payer: Aetna Commercial |
$86.28
|
| Rate for Payer: Cash Price |
$59.92
|
| Rate for Payer: Cigna All Commercial |
$86.18
|
| Rate for Payer: CORVEL All Commercial |
$92.87
|
| Rate for Payer: Coventry All Commercial |
$87.88
|
| Rate for Payer: Encore All Commercial |
$91.92
|
| Rate for Payer: Frontpath All Commercial |
$91.87
|
| Rate for Payer: Humana ChoiceCare |
$86.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.87
|
| Rate for Payer: PHCS All Commercial |
$74.89
|
| Rate for Payer: PHP All Commercial |
$75.73
|
| Rate for Payer: Sagamore Health Network All Products |
$77.09
|
| Rate for Payer: Signature Care EPO |
$82.88
|
| Rate for Payer: Signature Care PPO |
$87.88
|
| Rate for Payer: United Healthcare Commercial |
$78.69
|
|
|
HC CHLORIDE URINE
|
Facility
|
OP
|
$99.86
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
63001174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$92.87 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.15
|
| Rate for Payer: Cash Price |
$59.92
|
| Rate for Payer: Cash Price |
$59.92
|
| Rate for Payer: Centivo All Commercial |
$54.32
|
| Rate for Payer: Cigna All Commercial |
$86.18
|
| Rate for Payer: CORVEL All Commercial |
$92.87
|
| Rate for Payer: Coventry All Commercial |
$87.88
|
| Rate for Payer: Encore All Commercial |
$91.92
|
| Rate for Payer: Frontpath All Commercial |
$91.87
|
| Rate for Payer: Humana ChoiceCare |
$86.25
|
| Rate for Payer: Humana Medicare |
$31.96
|
| Rate for Payer: Lucent All Commercial |
$54.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.87
|
| Rate for Payer: Managed Health Services Medicaid |
$5.75
|
| Rate for Payer: MDWise Medicaid |
$5.75
|
| Rate for Payer: PHCS All Commercial |
$74.89
|
| Rate for Payer: PHP All Commercial |
$75.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.95
|
| Rate for Payer: Sagamore Health Network All Products |
$77.09
|
| Rate for Payer: Signature Care EPO |
$82.88
|
| Rate for Payer: Signature Care PPO |
$87.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.88
|
| Rate for Payer: United Healthcare Commercial |
$78.69
|
| Rate for Payer: United Healthcare Medicare |
$31.96
|
|
|
HC CHOLESTEROL
|
Facility
|
IP
|
$57.22
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
63001093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$53.21 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.21
|
| Rate for Payer: Coventry All Commercial |
$50.35
|
| 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 |
$42.91
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Sagamore Health Network All Products |
$44.17
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.35
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
|
|
HC CHOLESTEROL
|
Facility
|
OP
|
$57.22
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
63001093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$53.21 |
| Rate for Payer: Aetna Commercial |
$48.29
|
| Rate for Payer: Aetna Medicare |
$18.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.14
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Centivo All Commercial |
$31.13
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.21
|
| Rate for Payer: Coventry All Commercial |
$50.35
|
| 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 |
$18.31
|
| Rate for Payer: Lucent All Commercial |
$31.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: Managed Health Services Medicaid |
$4.35
|
| Rate for Payer: MDWise Medicaid |
$4.35
|
| Rate for Payer: PHCS All Commercial |
$42.91
|
| 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 |
$44.17
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
| Rate for Payer: United Healthcare Medicare |
$18.31
|
|
|
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 |
$49.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.77
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Centivo All Commercial |
$84.64
|
| 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 |
$49.79
|
| Rate for Payer: Lucent All Commercial |
$84.64
|
| 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 |
$122.60
|
| Rate for Payer: United Healthcare Medicare |
$49.79
|
|
|
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 |
$93.35
|
| 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: 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 |
$122.60
|
|
|
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 |
$145.41
|
| 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 |
$223.08
|
| 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 |
$187.09
|
| 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 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 |
$204.54
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.31
|
| Rate for Payer: Cash Price |
$145.41
|
| Rate for Payer: Cash Price |
$145.41
|
| Rate for Payer: Centivo All Commercial |
$131.84
|
| 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 |
$223.08
|
| Rate for Payer: Frontpath All Commercial |
$222.96
|
| Rate for Payer: Humana ChoiceCare |
$209.32
|
| Rate for Payer: Humana Medicare |
$77.55
|
| Rate for Payer: Lucent All Commercial |
$131.84
|
| 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 |
$187.09
|
| 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 |
$77.55
|
|
|
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 |
$384.56
|
| Rate for Payer: Cigna All Commercial |
$553.13
|
| Rate for Payer: CORVEL All Commercial |
$596.07
|
| Rate for Payer: Coventry All Commercial |
$564.03
|
| Rate for Payer: Encore All Commercial |
$589.99
|
| Rate for Payer: Frontpath All Commercial |
$589.66
|
| Rate for Payer: Humana ChoiceCare |
$553.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.85
|
| Rate for Payer: PHCS All Commercial |
$480.70
|
| Rate for Payer: PHP All Commercial |
$486.09
|
| Rate for Payer: Sagamore Health Network All Products |
$494.81
|
| Rate for Payer: Signature Care EPO |
$531.98
|
| Rate for Payer: Signature Care PPO |
$564.03
|
| 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 |
$198.69 |
| Max. Negotiated Rate |
$596.07 |
| Rate for Payer: Aetna Commercial |
$540.95
|
| Rate for Payer: Aetna Medicare |
$205.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$264.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$198.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$294.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$264.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$235.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$225.61
|
| Rate for Payer: Cash Price |
$384.56
|
| Rate for Payer: Cash Price |
$384.56
|
| Rate for Payer: Centivo All Commercial |
$348.67
|
| Rate for Payer: Cigna All Commercial |
$553.13
|
| Rate for Payer: CORVEL All Commercial |
$596.07
|
| Rate for Payer: Coventry All Commercial |
$564.03
|
| Rate for Payer: Encore All Commercial |
$589.99
|
| Rate for Payer: Frontpath All Commercial |
$589.66
|
| Rate for Payer: Humana ChoiceCare |
$553.58
|
| Rate for Payer: Humana Medicare |
$205.10
|
| Rate for Payer: Lucent All Commercial |
$348.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.85
|
| Rate for Payer: Managed Health Services Medicaid |
$264.34
|
| Rate for Payer: MDWise Medicaid |
$264.34
|
| 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 |
$494.81
|
| Rate for Payer: Signature Care EPO |
$531.98
|
| Rate for Payer: Signature Care PPO |
$564.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$544.80
|
| Rate for Payer: United Healthcare Commercial |
$505.06
|
| Rate for Payer: United Healthcare Medicare |
$205.10
|
|
|
HC CHROMO ANALY TISSUE CHARGE
|
Facility
|
IP
|
$61.06
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
63002076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$56.79 |
| Rate for Payer: Aetna Commercial |
$52.76
|
| Rate for Payer: Cash Price |
$36.64
|
| Rate for Payer: Cigna All Commercial |
$52.69
|
| Rate for Payer: CORVEL All Commercial |
$56.79
|
| Rate for Payer: Coventry All Commercial |
$53.73
|
| Rate for Payer: Encore All Commercial |
$56.21
|
| Rate for Payer: Frontpath All Commercial |
$56.18
|
| Rate for Payer: Humana ChoiceCare |
$52.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.95
|
| Rate for Payer: PHCS All Commercial |
$45.80
|
| 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 |
$48.12
|
|
|
HC CHROMO ANALY TISSUE CHARGE
|
Facility
|
OP
|
$61.06
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
63002076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$143.75 |
| Rate for Payer: Aetna Commercial |
$51.53
|
| Rate for Payer: Aetna Medicare |
$19.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$143.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.49
|
| Rate for Payer: Cash Price |
$36.64
|
| Rate for Payer: Cash Price |
$36.64
|
| Rate for Payer: Centivo All Commercial |
$33.22
|
| Rate for Payer: Cigna All Commercial |
$52.69
|
| Rate for Payer: CORVEL All Commercial |
$56.79
|
| Rate for Payer: Coventry All Commercial |
$53.73
|
| Rate for Payer: Encore All Commercial |
$56.21
|
| Rate for Payer: Frontpath All Commercial |
$56.18
|
| Rate for Payer: Humana ChoiceCare |
$52.74
|
| Rate for Payer: Humana Medicare |
$19.54
|
| Rate for Payer: Lucent All Commercial |
$33.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.95
|
| Rate for Payer: Managed Health Services Medicaid |
$143.75
|
| Rate for Payer: MDWise Medicaid |
$143.75
|
| Rate for Payer: PHCS All Commercial |
$45.80
|
| 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 |
$48.12
|
| Rate for Payer: United Healthcare Medicare |
$19.54
|
|
|
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 |
$81.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.85
|
| Rate for Payer: Cash Price |
$153.16
|
| Rate for Payer: Cash Price |
$153.16
|
| Rate for Payer: Centivo All Commercial |
$138.86
|
| Rate for Payer: Cigna All Commercial |
$220.29
|
| Rate for Payer: CORVEL All Commercial |
$237.39
|
| Rate for Payer: Coventry All Commercial |
$224.63
|
| Rate for Payer: Encore All Commercial |
$234.97
|
| Rate for Payer: Frontpath All Commercial |
$234.84
|
| Rate for Payer: Humana ChoiceCare |
$220.47
|
| Rate for Payer: Humana Medicare |
$81.68
|
| Rate for Payer: Lucent All Commercial |
$138.86
|
| 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 |
$211.87
|
| Rate for Payer: Signature Care PPO |
$224.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$216.97
|
| Rate for Payer: United Healthcare Commercial |
$201.14
|
| Rate for Payer: United Healthcare Medicare |
$81.68
|
|
|
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 |
$153.16
|
| Rate for Payer: Cigna All Commercial |
$220.29
|
| Rate for Payer: CORVEL All Commercial |
$237.39
|
| Rate for Payer: Coventry All Commercial |
$224.63
|
| Rate for Payer: Encore All Commercial |
$234.97
|
| Rate for Payer: Frontpath All Commercial |
$234.84
|
| Rate for Payer: Humana ChoiceCare |
$220.47
|
| 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 |
$211.87
|
| Rate for Payer: Signature Care PPO |
$224.63
|
| Rate for Payer: United Healthcare Commercial |
$201.14
|
|
|
HC CHROMOSOMAL MICROARRAY ANALYSIS
|
Facility
|
OP
|
$3,280.05
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
63001437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,016.82 |
| Max. Negotiated Rate |
$3,050.45 |
| Rate for Payer: Aetna Commercial |
$2,768.36
|
| Rate for Payer: Aetna Medicare |
$1,049.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,160.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,016.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,507.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,507.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,160.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,207.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,154.58
|
| Rate for Payer: Cash Price |
$1,968.03
|
| Rate for Payer: Cash Price |
$1,968.03
|
| Rate for Payer: Centivo All Commercial |
$1,784.35
|
| Rate for Payer: Cigna All Commercial |
$2,830.68
|
| Rate for Payer: CORVEL All Commercial |
$3,050.45
|
| Rate for Payer: Coventry All Commercial |
$2,886.44
|
| 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 |
$1,049.62
|
| Rate for Payer: Lucent All Commercial |
$1,784.35
|
| 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 |
$2,722.44
|
| Rate for Payer: Signature Care PPO |
$2,886.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,788.04
|
| Rate for Payer: United Healthcare Commercial |
$2,584.68
|
| Rate for Payer: United Healthcare Medicare |
$1,049.62
|
|
|
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 |
$2,833.96
|
| Rate for Payer: Cash Price |
$1,968.03
|
| Rate for Payer: Cigna All Commercial |
$2,830.68
|
| Rate for Payer: CORVEL All Commercial |
$3,050.45
|
| Rate for Payer: Coventry All Commercial |
$2,886.44
|
| 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 |
$2,722.44
|
| Rate for Payer: Signature Care PPO |
$2,886.44
|
| Rate for Payer: United Healthcare Commercial |
$2,584.68
|
|
|
HC CHROMOSOME KARYOTYPE STUDY CHARGE
|
Facility
|
IP
|
$93.05
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
63002092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$86.54 |
| Rate for Payer: Aetna Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cigna All Commercial |
$80.30
|
| Rate for Payer: CORVEL All Commercial |
$86.54
|
| Rate for Payer: Coventry All Commercial |
$81.88
|
| Rate for Payer: Encore All Commercial |
$85.65
|
| Rate for Payer: Frontpath All Commercial |
$85.61
|
| Rate for Payer: Humana ChoiceCare |
$80.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.75
|
| Rate for Payer: PHCS All Commercial |
$69.79
|
| Rate for Payer: PHP All Commercial |
$70.57
|
| Rate for Payer: Sagamore Health Network All Products |
$71.83
|
| Rate for Payer: Signature Care EPO |
$77.23
|
| Rate for Payer: Signature Care PPO |
$81.88
|
| Rate for Payer: United Healthcare Commercial |
$73.32
|
|
|
HC CHROMOSOME KARYOTYPE STUDY CHARGE
|
Facility
|
OP
|
$93.05
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
63002092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.85 |
| Max. Negotiated Rate |
$86.54 |
| Rate for Payer: Aetna Commercial |
$78.53
|
| Rate for Payer: Aetna Medicare |
$29.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$33.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.75
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Centivo All Commercial |
$50.62
|
| Rate for Payer: Cigna All Commercial |
$80.30
|
| Rate for Payer: CORVEL All Commercial |
$86.54
|
| Rate for Payer: Coventry All Commercial |
$81.88
|
| Rate for Payer: Encore All Commercial |
$85.65
|
| Rate for Payer: Frontpath All Commercial |
$85.61
|
| Rate for Payer: Humana ChoiceCare |
$80.37
|
| Rate for Payer: Humana Medicare |
$29.78
|
| Rate for Payer: Lucent All Commercial |
$50.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.75
|
| Rate for Payer: Managed Health Services Medicaid |
$33.47
|
| Rate for Payer: MDWise Medicaid |
$33.47
|
| Rate for Payer: PHCS All Commercial |
$69.79
|
| Rate for Payer: PHP All Commercial |
$70.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.29
|
| Rate for Payer: Sagamore Health Network All Products |
$71.83
|
| Rate for Payer: Signature Care EPO |
$77.23
|
| Rate for Payer: Signature Care PPO |
$81.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.09
|
| Rate for Payer: United Healthcare Commercial |
$73.32
|
| Rate for Payer: United Healthcare Medicare |
$29.78
|
|
|
HC CIRCUMCISION ROUTINE
|
Facility
|
IP
|
$1,060.80
|
|
| Hospital Charge Code |
1023230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$986.54 |
| Rate for Payer: Aetna Commercial |
$916.53
|
| Rate for Payer: Cash Price |
$636.48
|
| Rate for Payer: Cigna All Commercial |
$915.47
|
| Rate for Payer: CORVEL All Commercial |
$986.54
|
| Rate for Payer: Coventry All Commercial |
$933.50
|
| Rate for Payer: Encore All Commercial |
$976.47
|
| Rate for Payer: Frontpath All Commercial |
$975.94
|
| Rate for Payer: Humana ChoiceCare |
$916.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$954.72
|
| Rate for Payer: PHCS All Commercial |
$795.60
|
| Rate for Payer: PHP All Commercial |
$804.51
|
| Rate for Payer: Sagamore Health Network All Products |
$818.94
|
| Rate for Payer: Signature Care EPO |
$880.46
|
| Rate for Payer: Signature Care PPO |
$933.50
|
| Rate for Payer: United Healthcare Commercial |
$835.91
|
|
