|
HC CUFF TOURNIQUET 34 IN
|
Facility
|
OP
|
$173.64
|
|
| Hospital Charge Code |
41601248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$161.49 |
| Rate for Payer: Aetna Commercial |
$146.55
|
| Rate for Payer: Aetna Medicare |
$55.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$99.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.12
|
| Rate for Payer: Cash Price |
$104.18
|
| Rate for Payer: Cash Price |
$104.18
|
| Rate for Payer: Centivo All Commercial |
$94.46
|
| Rate for Payer: Cigna All Commercial |
$149.85
|
| Rate for Payer: CORVEL All Commercial |
$161.49
|
| Rate for Payer: Coventry All Commercial |
$152.80
|
| Rate for Payer: Encore All Commercial |
$159.84
|
| Rate for Payer: Frontpath All Commercial |
$159.75
|
| Rate for Payer: Humana ChoiceCare |
$149.97
|
| Rate for Payer: Humana Medicare |
$55.56
|
| Rate for Payer: Lucent All Commercial |
$94.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.28
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$130.23
|
| Rate for Payer: PHP All Commercial |
$131.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.72
|
| Rate for Payer: Sagamore Health Network All Products |
$134.05
|
| Rate for Payer: Signature Care EPO |
$144.12
|
| Rate for Payer: Signature Care PPO |
$152.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.59
|
| Rate for Payer: United Healthcare Commercial |
$136.83
|
| Rate for Payer: United Healthcare Medicare |
$55.56
|
|
|
HC CUFF TOURNIQUET 34 IN
|
Facility
|
IP
|
$173.64
|
|
| Hospital Charge Code |
41601248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.23 |
| Max. Negotiated Rate |
$161.49 |
| Rate for Payer: Aetna Commercial |
$150.02
|
| Rate for Payer: Cash Price |
$104.18
|
| Rate for Payer: Cigna All Commercial |
$149.85
|
| Rate for Payer: CORVEL All Commercial |
$161.49
|
| Rate for Payer: Coventry All Commercial |
$152.80
|
| Rate for Payer: Encore All Commercial |
$159.84
|
| Rate for Payer: Frontpath All Commercial |
$159.75
|
| Rate for Payer: Humana ChoiceCare |
$149.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.28
|
| Rate for Payer: PHCS All Commercial |
$130.23
|
| Rate for Payer: PHP All Commercial |
$131.69
|
| Rate for Payer: Sagamore Health Network All Products |
$134.05
|
| Rate for Payer: Signature Care EPO |
$144.12
|
| Rate for Payer: Signature Care PPO |
$152.80
|
| Rate for Payer: United Healthcare Commercial |
$136.83
|
|
|
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 |
$130.94
|
| 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 ROUTINE W/SUSCEPTIBILITY IF IND
|
Facility
|
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$69.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.82
|
| Rate for Payer: Cash Price |
$130.94
|
| Rate for Payer: Cash Price |
$130.94
|
| Rate for Payer: Centivo All Commercial |
$118.72
|
| 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: Humana Medicare |
$69.84
|
| Rate for Payer: Lucent All Commercial |
$118.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| 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: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$69.84
|
|
|
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 |
$66.42
|
| Rate for Payer: Cash Price |
$46.12
|
| Rate for Payer: Cigna All Commercial |
$66.34
|
| Rate for Payer: CORVEL All Commercial |
$71.49
|
| Rate for Payer: Coventry All Commercial |
$67.65
|
| 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 |
$67.65
|
| 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 |
$24.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.06
|
| Rate for Payer: Cash Price |
$46.12
|
| Rate for Payer: Cash Price |
$46.12
|
| Rate for Payer: Centivo All Commercial |
$41.82
|
| Rate for Payer: Cigna All Commercial |
$66.34
|
| Rate for Payer: CORVEL All Commercial |
$71.49
|
| Rate for Payer: Coventry All Commercial |
$67.65
|
| 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 |
$24.60
|
| Rate for Payer: Lucent All Commercial |
$41.82
|
| 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 |
$67.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.34
|
| Rate for Payer: United Healthcare Commercial |
$60.57
|
| Rate for Payer: United Healthcare Medicare |
$24.60
|
|
|
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 |
$51.91 |
| Max. Negotiated Rate |
$155.72 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Aetna Medicare |
$53.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$76.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.94
|
| Rate for Payer: Cash Price |
$100.46
|
| Rate for Payer: Cash Price |
$100.46
|
| Rate for Payer: Centivo All Commercial |
$91.09
|
| 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 |
$154.04
|
| Rate for Payer: Humana ChoiceCare |
$144.62
|
| Rate for Payer: Humana Medicare |
$53.58
|
| Rate for Payer: Lucent All Commercial |
$91.09
|
| 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 |
$129.26
|
| Rate for Payer: Signature Care EPO |
$138.98
|
| Rate for Payer: Signature Care PPO |
$147.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.32
|
| Rate for Payer: United Healthcare Commercial |
$131.94
|
| Rate for Payer: United Healthcare Medicare |
$53.58
|
|
|
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 |
$100.46
|
| 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 |
$154.04
|
| 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 |
$129.26
|
| Rate for Payer: Signature Care EPO |
$138.98
|
| Rate for Payer: Signature Care PPO |
$147.35
|
| Rate for Payer: United Healthcare Commercial |
$131.94
|
|
|
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 |
$55.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.68
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Centivo All Commercial |
$93.77
|
| 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 |
$55.16
|
| Rate for Payer: Lucent All Commercial |
$93.77
|
| 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 |
$55.16
|
|
|
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 |
$103.43
|
| 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 CYSTOGRAM
|
Facility
|
IP
|
$980.55
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
1614451
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$735.41 |
| Max. Negotiated Rate |
$911.91 |
| Rate for Payer: Aetna Commercial |
$847.20
|
| Rate for Payer: Cash Price |
$588.33
|
| 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 |
$902.60
|
| Rate for Payer: Frontpath All Commercial |
$902.11
|
| Rate for Payer: Humana ChoiceCare |
$846.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$882.50
|
| 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 |
$813.86
|
| Rate for Payer: Signature Care PPO |
$862.88
|
| Rate for Payer: United Healthcare Commercial |
$772.67
|
|
|
HC CYSTOGRAM
|
Facility
|
OP
|
$980.55
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
1614451
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$911.91 |
| Rate for Payer: Aetna Commercial |
$827.58
|
| Rate for Payer: Aetna Medicare |
$313.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$303.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$563.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$612.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$345.15
|
| Rate for Payer: Cash Price |
$588.33
|
| Rate for Payer: Cash Price |
$588.33
|
| Rate for Payer: Centivo All Commercial |
$533.42
|
| 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 |
$902.60
|
| Rate for Payer: Frontpath All Commercial |
$902.11
|
| Rate for Payer: Humana ChoiceCare |
$846.90
|
| Rate for Payer: Humana Medicare |
$313.78
|
| Rate for Payer: Lucent All Commercial |
$533.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$882.50
|
| Rate for Payer: Managed Health Services Medicaid |
$18.00
|
| Rate for Payer: MDWise Medicaid |
$18.00
|
| 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 |
$813.86
|
| Rate for Payer: Signature Care PPO |
$862.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$833.47
|
| Rate for Payer: United Healthcare Commercial |
$772.67
|
| Rate for Payer: United Healthcare Medicare |
$313.78
|
|
|
HC CYTOLOGY CELL BLOCK
|
Facility
|
OP
|
$337.65
|
|
|
Service Code
|
CPT 88305 59
|
| Hospital Charge Code |
63002170
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.12 |
| Max. Negotiated Rate |
$314.01 |
| Rate for Payer: Aetna Commercial |
$284.98
|
| Rate for Payer: Aetna Medicare |
$108.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$71.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$155.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$155.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$71.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.85
|
| Rate for Payer: Cash Price |
$202.59
|
| Rate for Payer: Cash Price |
$202.59
|
| Rate for Payer: Centivo All Commercial |
$183.68
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.01
|
| 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 |
$108.05
|
| Rate for Payer: Lucent All Commercial |
$183.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.88
|
| Rate for Payer: Managed Health Services Medicaid |
$71.12
|
| Rate for Payer: MDWise Medicaid |
$71.12
|
| 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 |
$108.05
|
|
|
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 |
$314.01 |
| Rate for Payer: Aetna Commercial |
$291.73
|
| Rate for Payer: Cash Price |
$202.59
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.01
|
| 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 |
$303.88
|
| 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 |
$317.75
|
| 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 |
$487.21
|
| Rate for Payer: Humana ChoiceCare |
$457.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.62
|
| Rate for Payer: PHCS All Commercial |
$397.19
|
| Rate for Payer: PHP All Commercial |
$401.63
|
| 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 CYTOLOGY CELL BLOCK
|
Facility
|
OP
|
$529.58
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63002099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.12 |
| Max. Negotiated Rate |
$492.51 |
| Rate for Payer: Aetna Commercial |
$446.97
|
| Rate for Payer: Aetna Medicare |
$169.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$71.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$164.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$243.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$243.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$71.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.41
|
| Rate for Payer: Cash Price |
$317.75
|
| Rate for Payer: Cash Price |
$317.75
|
| Rate for Payer: Centivo All Commercial |
$288.09
|
| 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 |
$487.21
|
| Rate for Payer: Humana ChoiceCare |
$457.40
|
| Rate for Payer: Humana Medicare |
$169.47
|
| Rate for Payer: Lucent All Commercial |
$288.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.62
|
| Rate for Payer: Managed Health Services Medicaid |
$71.12
|
| Rate for Payer: MDWise Medicaid |
$71.12
|
| Rate for Payer: PHCS All Commercial |
$397.19
|
| Rate for Payer: PHP All Commercial |
$401.63
|
| 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 |
$450.14
|
| Rate for Payer: United Healthcare Commercial |
$417.31
|
| Rate for Payer: United Healthcare Medicare |
$169.47
|
|
|
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 |
$50.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.08
|
| Rate for Payer: Cash Price |
$95.59
|
| Rate for Payer: Cash Price |
$95.59
|
| Rate for Payer: Centivo All Commercial |
$86.67
|
| Rate for Payer: Cigna All Commercial |
$137.49
|
| Rate for Payer: CORVEL All Commercial |
$148.17
|
| Rate for Payer: Coventry All Commercial |
$140.20
|
| Rate for Payer: Encore All Commercial |
$146.65
|
| Rate for Payer: Frontpath All Commercial |
$146.57
|
| Rate for Payer: Humana ChoiceCare |
$137.60
|
| Rate for Payer: Humana Medicare |
$50.98
|
| Rate for Payer: Lucent All Commercial |
$86.67
|
| 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 |
$62.13
|
| Rate for Payer: Sagamore Health Network All Products |
$123.00
|
| Rate for Payer: Signature Care EPO |
$132.24
|
| Rate for Payer: Signature Care PPO |
$140.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.42
|
| Rate for Payer: United Healthcare Commercial |
$125.54
|
| Rate for Payer: United Healthcare Medicare |
$50.98
|
|
|
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 |
$137.65
|
| Rate for Payer: Cash Price |
$95.59
|
| Rate for Payer: Cigna All Commercial |
$137.49
|
| Rate for Payer: CORVEL All Commercial |
$148.17
|
| Rate for Payer: Coventry All Commercial |
$140.20
|
| Rate for Payer: Encore All Commercial |
$146.65
|
| Rate for Payer: Frontpath All Commercial |
$146.57
|
| Rate for Payer: Humana ChoiceCare |
$137.60
|
| 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 |
$140.20
|
| Rate for Payer: United Healthcare Commercial |
$125.54
|
|
|
HC CYTOMEGALOVIRUS IGM
|
Facility
|
OP
|
$185.13
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
63001278
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$172.17 |
| Rate for Payer: Aetna Commercial |
$156.25
|
| Rate for Payer: Aetna Medicare |
$59.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.17
|
| Rate for Payer: Cash Price |
$111.08
|
| Rate for Payer: Cash Price |
$111.08
|
| Rate for Payer: Centivo All Commercial |
$100.71
|
| 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 |
$59.24
|
| Rate for Payer: Lucent All Commercial |
$100.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.62
|
| Rate for Payer: Managed Health Services Medicaid |
$16.85
|
| Rate for Payer: MDWise Medicaid |
$16.85
|
| 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 |
$59.24
|
|
|
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 |
$111.08
|
| 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 CYTOMEG DNA-PCR QT
|
Facility
|
IP
|
$552.02
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
63001020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$414.01 |
| Max. Negotiated Rate |
$513.38 |
| Rate for Payer: Aetna Commercial |
$476.95
|
| Rate for Payer: Cash Price |
$331.21
|
| Rate for Payer: Cigna All Commercial |
$476.39
|
| Rate for Payer: CORVEL All Commercial |
$513.38
|
| Rate for Payer: Coventry All Commercial |
$485.78
|
| Rate for Payer: Encore All Commercial |
$508.13
|
| 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 |
$414.01
|
| Rate for Payer: PHP All Commercial |
$418.65
|
| 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
|
|
|
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 |
$465.90
|
| Rate for Payer: Aetna Medicare |
$176.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$171.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$253.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$253.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$203.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$194.31
|
| Rate for Payer: Cash Price |
$331.21
|
| Rate for Payer: Cash Price |
$331.21
|
| Rate for Payer: Centivo All Commercial |
$300.30
|
| Rate for Payer: Cigna All Commercial |
$476.39
|
| Rate for Payer: CORVEL All Commercial |
$513.38
|
| Rate for Payer: Coventry All Commercial |
$485.78
|
| Rate for Payer: Encore All Commercial |
$508.13
|
| Rate for Payer: Frontpath All Commercial |
$507.86
|
| Rate for Payer: Humana ChoiceCare |
$476.78
|
| Rate for Payer: Humana Medicare |
$176.65
|
| Rate for Payer: Lucent All Commercial |
$300.30
|
| 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 |
$414.01
|
| Rate for Payer: PHP All Commercial |
$418.65
|
| 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 |
$176.65
|
|
|
HC CYTOSPIN PATH W/INTERP
|
Facility
|
OP
|
$175.47
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
63002059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.74 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Aetna Commercial |
$148.10
|
| Rate for Payer: Aetna Medicare |
$56.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$28.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$80.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$28.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.77
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Centivo All Commercial |
$95.46
|
| Rate for Payer: Cigna All Commercial |
$151.43
|
| Rate for Payer: CORVEL All Commercial |
$163.19
|
| Rate for Payer: Coventry All Commercial |
$154.41
|
| Rate for Payer: Encore All Commercial |
$161.52
|
| Rate for Payer: Frontpath All Commercial |
$161.43
|
| Rate for Payer: Humana ChoiceCare |
$151.55
|
| Rate for Payer: Humana Medicare |
$56.15
|
| Rate for Payer: Lucent All Commercial |
$95.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.92
|
| Rate for Payer: Managed Health Services Medicaid |
$28.74
|
| Rate for Payer: MDWise Medicaid |
$28.74
|
| Rate for Payer: PHCS All Commercial |
$131.60
|
| Rate for Payer: PHP All Commercial |
$133.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.43
|
| Rate for Payer: Sagamore Health Network All Products |
$135.46
|
| Rate for Payer: Signature Care EPO |
$145.64
|
| Rate for Payer: Signature Care PPO |
$154.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$149.15
|
| Rate for Payer: United Healthcare Commercial |
$138.27
|
| Rate for Payer: United Healthcare Medicare |
$56.15
|
|
|
HC CYTOSPIN PATH W/INTERP
|
Facility
|
IP
|
$175.47
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
63002059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Aetna Commercial |
$151.61
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cigna All Commercial |
$151.43
|
| Rate for Payer: CORVEL All Commercial |
$163.19
|
| Rate for Payer: Coventry All Commercial |
$154.41
|
| Rate for Payer: Encore All Commercial |
$161.52
|
| Rate for Payer: Frontpath All Commercial |
$161.43
|
| Rate for Payer: Humana ChoiceCare |
$151.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.92
|
| Rate for Payer: PHCS All Commercial |
$131.60
|
| Rate for Payer: PHP All Commercial |
$133.08
|
| Rate for Payer: Sagamore Health Network All Products |
$135.46
|
| Rate for Payer: Signature Care EPO |
$145.64
|
| Rate for Payer: Signature Care PPO |
$154.41
|
| Rate for Payer: United Healthcare Commercial |
$138.27
|
|
|
HC D-DIMER QUANT
|
Facility
|
IP
|
$238.99
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
63001347
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.24 |
| Max. Negotiated Rate |
$222.26 |
| Rate for Payer: Aetna Commercial |
$206.49
|
| Rate for Payer: Cash Price |
$143.39
|
| Rate for Payer: Cigna All Commercial |
$206.25
|
| Rate for Payer: CORVEL All Commercial |
$222.26
|
| Rate for Payer: Coventry All Commercial |
$210.31
|
| Rate for Payer: Encore All Commercial |
$219.99
|
| Rate for Payer: Frontpath All Commercial |
$219.87
|
| Rate for Payer: Humana ChoiceCare |
$206.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.09
|
| Rate for Payer: PHCS All Commercial |
$179.24
|
| Rate for Payer: PHP All Commercial |
$181.25
|
| Rate for Payer: Sagamore Health Network All Products |
$184.50
|
| Rate for Payer: Signature Care EPO |
$198.36
|
| Rate for Payer: Signature Care PPO |
$210.31
|
| Rate for Payer: United Healthcare Commercial |
$188.32
|
|
