HC HEP A TOTAL AB
|
Facility
OP
|
$167.18
|
|
Service Code
|
CPT 86708
|
Hospital Charge Code |
63001956
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$12.39 |
Max. Negotiated Rate |
$155.48 |
Rate for Payer: Aetna Commercial |
$141.10
|
Rate for Payer: Aetna Medicare |
$55.17
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.17
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.01
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.50
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.39
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.44
|
Rate for Payer: CareSource Indiana of IN Medicare |
$60.69
|
Rate for Payer: Cash Price |
$103.65
|
Rate for Payer: Cash Price |
$103.65
|
Rate for Payer: Centivo All Commercial |
$85.26
|
Rate for Payer: Cigna All Commercial |
$144.27
|
Rate for Payer: CORVEL All Commercial |
$155.48
|
Rate for Payer: Coventry All Commercial |
$147.12
|
Rate for Payer: Encore All Commercial |
$153.89
|
Rate for Payer: Frontpath All Commercial |
$153.80
|
Rate for Payer: Humana ChoiceCare |
$144.39
|
Rate for Payer: Humana Medicare |
$85.26
|
Rate for Payer: Lucent All Commercial |
$85.26
|
Rate for Payer: Lutheran Preferred All Commercial |
$150.46
|
Rate for Payer: Managed Health Services Medicaid |
$12.39
|
Rate for Payer: MDWise Medicaid |
$12.39
|
Rate for Payer: PHCS All Commercial |
$125.38
|
Rate for Payer: PHP All Commercial |
$126.79
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$65.20
|
Rate for Payer: Sagamore Health Network All Products |
$129.06
|
Rate for Payer: Signature Care EPO |
$138.76
|
Rate for Payer: Signature Care PPO |
$147.12
|
Rate for Payer: Three Rivers Preferred All Commercial |
$142.10
|
Rate for Payer: United Healthcare Commercial |
$131.74
|
Rate for Payer: United Healthcare Medicare |
$55.17
|
|
HC HEP A TOTAL AB
|
Facility
IP
|
$167.18
|
|
Service Code
|
CPT 86708
|
Hospital Charge Code |
63001956
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$125.38 |
Max. Negotiated Rate |
$155.48 |
Rate for Payer: Aetna Commercial |
$144.44
|
Rate for Payer: Cash Price |
$103.65
|
Rate for Payer: Cigna All Commercial |
$144.27
|
Rate for Payer: CORVEL All Commercial |
$155.48
|
Rate for Payer: Coventry All Commercial |
$147.12
|
Rate for Payer: Encore All Commercial |
$153.89
|
Rate for Payer: Frontpath All Commercial |
$153.80
|
Rate for Payer: Humana ChoiceCare |
$144.39
|
Rate for Payer: Lutheran Preferred All Commercial |
$150.46
|
Rate for Payer: PHCS All Commercial |
$125.38
|
Rate for Payer: PHP All Commercial |
$126.79
|
Rate for Payer: Sagamore Health Network All Products |
$129.06
|
Rate for Payer: Signature Care EPO |
$138.76
|
Rate for Payer: Signature Care PPO |
$147.12
|
Rate for Payer: United Healthcare Commercial |
$131.74
|
|
HC HEP A TOTAL AB W/ IGM IF INDICATED
|
Facility
OP
|
$167.18
|
|
Service Code
|
CPT 86708
|
Hospital Charge Code |
63001957
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$12.39 |
Max. Negotiated Rate |
$155.48 |
Rate for Payer: Aetna Commercial |
$141.10
|
Rate for Payer: Aetna Medicare |
$55.17
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.17
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.01
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.50
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.39
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.44
|
Rate for Payer: CareSource Indiana of IN Medicare |
$60.69
|
Rate for Payer: Cash Price |
$103.65
|
Rate for Payer: Cash Price |
$103.65
|
Rate for Payer: Centivo All Commercial |
$85.26
|
Rate for Payer: Cigna All Commercial |
$144.27
|
Rate for Payer: CORVEL All Commercial |
$155.48
|
Rate for Payer: Coventry All Commercial |
$147.12
|
Rate for Payer: Encore All Commercial |
$153.89
|
Rate for Payer: Frontpath All Commercial |
$153.80
|
Rate for Payer: Humana ChoiceCare |
$144.39
|
Rate for Payer: Humana Medicare |
$85.26
|
Rate for Payer: Lucent All Commercial |
$85.26
|
Rate for Payer: Lutheran Preferred All Commercial |
$150.46
|
Rate for Payer: Managed Health Services Medicaid |
$12.39
|
Rate for Payer: MDWise Medicaid |
$12.39
|
Rate for Payer: PHCS All Commercial |
$125.38
|
Rate for Payer: PHP All Commercial |
$126.79
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$65.20
|
Rate for Payer: Sagamore Health Network All Products |
$129.06
|
Rate for Payer: Signature Care EPO |
$138.76
|
Rate for Payer: Signature Care PPO |
$147.12
|
Rate for Payer: Three Rivers Preferred All Commercial |
$142.10
|
Rate for Payer: United Healthcare Commercial |
$131.74
|
Rate for Payer: United Healthcare Medicare |
$55.17
|
|
HC HEP A TOTAL AB W/ IGM IF INDICATED
|
Facility
IP
|
$167.18
|
|
Service Code
|
CPT 86708
|
Hospital Charge Code |
63001957
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$125.38 |
Max. Negotiated Rate |
$155.48 |
Rate for Payer: Aetna Commercial |
$144.44
|
Rate for Payer: Cash Price |
$103.65
|
Rate for Payer: Cigna All Commercial |
$144.27
|
Rate for Payer: CORVEL All Commercial |
$155.48
|
Rate for Payer: Coventry All Commercial |
$147.12
|
Rate for Payer: Encore All Commercial |
$153.89
|
Rate for Payer: Frontpath All Commercial |
$153.80
|
Rate for Payer: Humana ChoiceCare |
$144.39
|
Rate for Payer: Lutheran Preferred All Commercial |
$150.46
|
Rate for Payer: PHCS All Commercial |
$125.38
|
Rate for Payer: PHP All Commercial |
$126.79
|
Rate for Payer: Sagamore Health Network All Products |
$129.06
|
Rate for Payer: Signature Care EPO |
$138.76
|
Rate for Payer: Signature Care PPO |
$147.12
|
Rate for Payer: United Healthcare Commercial |
$131.74
|
|
HC HEP B CORE IGM
|
Facility
IP
|
$163.56
|
|
Service Code
|
CPT 86705
|
Hospital Charge Code |
63001336
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$122.67 |
Max. Negotiated Rate |
$152.11 |
Rate for Payer: Aetna Commercial |
$141.31
|
Rate for Payer: Cash Price |
$101.41
|
Rate for Payer: Cigna All Commercial |
$141.15
|
Rate for Payer: CORVEL All Commercial |
$152.11
|
Rate for Payer: Coventry All Commercial |
$143.93
|
Rate for Payer: Encore All Commercial |
$150.55
|
Rate for Payer: Frontpath All Commercial |
$150.47
|
Rate for Payer: Humana ChoiceCare |
$141.26
|
Rate for Payer: Lutheran Preferred All Commercial |
$147.20
|
Rate for Payer: PHCS All Commercial |
$122.67
|
Rate for Payer: PHP All Commercial |
$124.04
|
Rate for Payer: Sagamore Health Network All Products |
$126.27
|
Rate for Payer: Signature Care EPO |
$135.75
|
Rate for Payer: Signature Care PPO |
$143.93
|
Rate for Payer: United Healthcare Commercial |
$128.88
|
|
HC HEP B CORE IGM
|
Facility
OP
|
$163.56
|
|
Service Code
|
CPT 86705
|
Hospital Charge Code |
63001336
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$11.77 |
Max. Negotiated Rate |
$152.11 |
Rate for Payer: Aetna Commercial |
$138.04
|
Rate for Payer: Aetna Medicare |
$53.97
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.97
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.17
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.17
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.77
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.07
|
Rate for Payer: CareSource Indiana of IN Medicare |
$59.37
|
Rate for Payer: Cash Price |
$101.41
|
Rate for Payer: Cash Price |
$101.41
|
Rate for Payer: Centivo All Commercial |
$83.41
|
Rate for Payer: Cigna All Commercial |
$141.15
|
Rate for Payer: CORVEL All Commercial |
$152.11
|
Rate for Payer: Coventry All Commercial |
$143.93
|
Rate for Payer: Encore All Commercial |
$150.55
|
Rate for Payer: Frontpath All Commercial |
$150.47
|
Rate for Payer: Humana ChoiceCare |
$141.26
|
Rate for Payer: Humana Medicare |
$83.41
|
Rate for Payer: Lucent All Commercial |
$83.41
|
Rate for Payer: Lutheran Preferred All Commercial |
$147.20
|
Rate for Payer: Managed Health Services Medicaid |
$11.77
|
Rate for Payer: MDWise Medicaid |
$11.77
|
Rate for Payer: PHCS All Commercial |
$122.67
|
Rate for Payer: PHP All Commercial |
$124.04
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$63.79
|
Rate for Payer: Sagamore Health Network All Products |
$126.27
|
Rate for Payer: Signature Care EPO |
$135.75
|
Rate for Payer: Signature Care PPO |
$143.93
|
Rate for Payer: Three Rivers Preferred All Commercial |
$139.02
|
Rate for Payer: United Healthcare Commercial |
$128.88
|
Rate for Payer: United Healthcare Medicare |
$53.97
|
|
HC HEP BE ANTIBODY
|
Facility
OP
|
$171.11
|
|
Service Code
|
CPT 86707
|
Hospital Charge Code |
63001955
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$6.32 |
Max. Negotiated Rate |
$159.13 |
Rate for Payer: Aetna Commercial |
$144.41
|
Rate for Payer: Aetna Medicare |
$56.46
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.46
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.27
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.96
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.32
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.93
|
Rate for Payer: CareSource Indiana of IN Medicare |
$62.11
|
Rate for Payer: Cash Price |
$106.09
|
Rate for Payer: Cash Price |
$106.09
|
Rate for Payer: Centivo All Commercial |
$87.26
|
Rate for Payer: Cigna All Commercial |
$147.66
|
Rate for Payer: CORVEL All Commercial |
$159.13
|
Rate for Payer: Coventry All Commercial |
$150.57
|
Rate for Payer: Encore All Commercial |
$157.50
|
Rate for Payer: Frontpath All Commercial |
$157.42
|
Rate for Payer: Humana ChoiceCare |
$147.78
|
Rate for Payer: Humana Medicare |
$87.26
|
Rate for Payer: Lucent All Commercial |
$87.26
|
Rate for Payer: Lutheran Preferred All Commercial |
$153.99
|
Rate for Payer: Managed Health Services Medicaid |
$6.32
|
Rate for Payer: MDWise Medicaid |
$6.32
|
Rate for Payer: PHCS All Commercial |
$128.33
|
Rate for Payer: PHP All Commercial |
$129.77
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$66.73
|
Rate for Payer: Sagamore Health Network All Products |
$132.09
|
Rate for Payer: Signature Care EPO |
$142.02
|
Rate for Payer: Signature Care PPO |
$150.57
|
Rate for Payer: Three Rivers Preferred All Commercial |
$145.44
|
Rate for Payer: United Healthcare Commercial |
$134.83
|
Rate for Payer: United Healthcare Medicare |
$56.46
|
|
HC HEP BE ANTIBODY
|
Facility
IP
|
$171.11
|
|
Service Code
|
CPT 86707
|
Hospital Charge Code |
63001955
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$128.33 |
Max. Negotiated Rate |
$159.13 |
Rate for Payer: Aetna Commercial |
$147.83
|
Rate for Payer: Cash Price |
$106.09
|
Rate for Payer: Cigna All Commercial |
$147.66
|
Rate for Payer: CORVEL All Commercial |
$159.13
|
Rate for Payer: Coventry All Commercial |
$150.57
|
Rate for Payer: Encore All Commercial |
$157.50
|
Rate for Payer: Frontpath All Commercial |
$157.42
|
Rate for Payer: Humana ChoiceCare |
$147.78
|
Rate for Payer: Lutheran Preferred All Commercial |
$153.99
|
Rate for Payer: PHCS All Commercial |
$128.33
|
Rate for Payer: PHP All Commercial |
$129.77
|
Rate for Payer: Sagamore Health Network All Products |
$132.09
|
Rate for Payer: Signature Care EPO |
$142.02
|
Rate for Payer: Signature Care PPO |
$150.57
|
Rate for Payer: United Healthcare Commercial |
$134.83
|
|
HC HEP BE ANTIGEN
|
Facility
OP
|
$140.25
|
|
Service Code
|
CPT 87350
|
Hospital Charge Code |
63002030
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$11.53 |
Max. Negotiated Rate |
$130.43 |
Rate for Payer: Aetna Commercial |
$118.37
|
Rate for Payer: Aetna Medicare |
$46.28
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.28
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.55
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.67
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.22
|
Rate for Payer: CareSource Indiana of IN Medicare |
$50.91
|
Rate for Payer: Cash Price |
$86.96
|
Rate for Payer: Cash Price |
$86.96
|
Rate for Payer: Centivo All Commercial |
$71.53
|
Rate for Payer: Cigna All Commercial |
$121.04
|
Rate for Payer: CORVEL All Commercial |
$130.43
|
Rate for Payer: Coventry All Commercial |
$123.42
|
Rate for Payer: Encore All Commercial |
$129.10
|
Rate for Payer: Frontpath All Commercial |
$129.03
|
Rate for Payer: Humana ChoiceCare |
$121.13
|
Rate for Payer: Humana Medicare |
$71.53
|
Rate for Payer: Lucent All Commercial |
$71.53
|
Rate for Payer: Lutheran Preferred All Commercial |
$126.22
|
Rate for Payer: Managed Health Services Medicaid |
$11.53
|
Rate for Payer: MDWise Medicaid |
$11.53
|
Rate for Payer: PHCS All Commercial |
$105.19
|
Rate for Payer: PHP All Commercial |
$106.37
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$54.70
|
Rate for Payer: Sagamore Health Network All Products |
$108.27
|
Rate for Payer: Signature Care EPO |
$116.41
|
Rate for Payer: Signature Care PPO |
$123.42
|
Rate for Payer: Three Rivers Preferred All Commercial |
$119.21
|
Rate for Payer: United Healthcare Commercial |
$110.52
|
Rate for Payer: United Healthcare Medicare |
$46.28
|
|
HC HEP BE ANTIGEN
|
Facility
IP
|
$140.25
|
|
Service Code
|
CPT 87350
|
Hospital Charge Code |
63002030
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$105.19 |
Max. Negotiated Rate |
$130.43 |
Rate for Payer: Aetna Commercial |
$121.18
|
Rate for Payer: Cash Price |
$86.96
|
Rate for Payer: Cigna All Commercial |
$121.04
|
Rate for Payer: CORVEL All Commercial |
$130.43
|
Rate for Payer: Coventry All Commercial |
$123.42
|
Rate for Payer: Encore All Commercial |
$129.10
|
Rate for Payer: Frontpath All Commercial |
$129.03
|
Rate for Payer: Humana ChoiceCare |
$121.13
|
Rate for Payer: Lutheran Preferred All Commercial |
$126.22
|
Rate for Payer: PHCS All Commercial |
$105.19
|
Rate for Payer: PHP All Commercial |
$106.37
|
Rate for Payer: Sagamore Health Network All Products |
$108.27
|
Rate for Payer: Signature Care EPO |
$116.41
|
Rate for Payer: Signature Care PPO |
$123.42
|
Rate for Payer: United Healthcare Commercial |
$110.52
|
|
HC HEP B SURFACE AB
|
Facility
IP
|
$154.84
|
|
Service Code
|
CPT G0499
|
Hospital Charge Code |
63001215
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$116.13 |
Max. Negotiated Rate |
$144.00 |
Rate for Payer: Aetna Commercial |
$133.78
|
Rate for Payer: Cash Price |
$96.00
|
Rate for Payer: Cigna All Commercial |
$133.62
|
Rate for Payer: CORVEL All Commercial |
$144.00
|
Rate for Payer: Coventry All Commercial |
$136.26
|
Rate for Payer: Encore All Commercial |
$142.53
|
Rate for Payer: Frontpath All Commercial |
$142.45
|
Rate for Payer: Humana ChoiceCare |
$133.73
|
Rate for Payer: Lutheran Preferred All Commercial |
$139.35
|
Rate for Payer: PHCS All Commercial |
$116.13
|
Rate for Payer: PHP All Commercial |
$117.43
|
Rate for Payer: Sagamore Health Network All Products |
$119.53
|
Rate for Payer: Signature Care EPO |
$128.51
|
Rate for Payer: Signature Care PPO |
$136.26
|
Rate for Payer: United Healthcare Commercial |
$122.01
|
|
HC HEP B SURFACE AB
|
Facility
OP
|
$154.84
|
|
Service Code
|
CPT G0499
|
Hospital Charge Code |
63001215
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$28.27 |
Max. Negotiated Rate |
$144.00 |
Rate for Payer: Aetna Commercial |
$130.68
|
Rate for Payer: Aetna Medicare |
$51.10
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.10
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$88.92
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$96.79
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$28.27
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.76
|
Rate for Payer: CareSource Indiana of IN Medicare |
$56.21
|
Rate for Payer: Cash Price |
$96.00
|
Rate for Payer: Cash Price |
$96.00
|
Rate for Payer: Centivo All Commercial |
$78.97
|
Rate for Payer: Cigna All Commercial |
$133.62
|
Rate for Payer: CORVEL All Commercial |
$144.00
|
Rate for Payer: Coventry All Commercial |
$136.26
|
Rate for Payer: Encore All Commercial |
$142.53
|
Rate for Payer: Frontpath All Commercial |
$142.45
|
Rate for Payer: Humana ChoiceCare |
$133.73
|
Rate for Payer: Humana Medicare |
$78.97
|
Rate for Payer: Lucent All Commercial |
$78.97
|
Rate for Payer: Lutheran Preferred All Commercial |
$139.35
|
Rate for Payer: Managed Health Services Medicaid |
$28.27
|
Rate for Payer: MDWise Medicaid |
$28.27
|
Rate for Payer: PHCS All Commercial |
$116.13
|
Rate for Payer: PHP All Commercial |
$117.43
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$60.39
|
Rate for Payer: Sagamore Health Network All Products |
$119.53
|
Rate for Payer: Signature Care EPO |
$128.51
|
Rate for Payer: Signature Care PPO |
$136.26
|
Rate for Payer: Three Rivers Preferred All Commercial |
$131.61
|
Rate for Payer: United Healthcare Commercial |
$122.01
|
Rate for Payer: United Healthcare Medicare |
$51.10
|
|
HC HEP B VIRAL DNA
|
Facility
OP
|
$471.24
|
|
Service Code
|
CPT 87517
|
Hospital Charge Code |
63002039
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$42.84 |
Max. Negotiated Rate |
$438.25 |
Rate for Payer: Aetna Commercial |
$397.73
|
Rate for Payer: Aetna Medicare |
$155.51
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$155.51
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$270.63
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.57
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$42.84
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$178.84
|
Rate for Payer: CareSource Indiana of IN Medicare |
$171.06
|
Rate for Payer: Cash Price |
$292.17
|
Rate for Payer: Cash Price |
$292.17
|
Rate for Payer: Centivo All Commercial |
$240.33
|
Rate for Payer: Cigna All Commercial |
$406.68
|
Rate for Payer: CORVEL All Commercial |
$438.25
|
Rate for Payer: Coventry All Commercial |
$414.69
|
Rate for Payer: Encore All Commercial |
$433.78
|
Rate for Payer: Frontpath All Commercial |
$433.54
|
Rate for Payer: Humana ChoiceCare |
$407.01
|
Rate for Payer: Humana Medicare |
$240.33
|
Rate for Payer: Lucent All Commercial |
$240.33
|
Rate for Payer: Lutheran Preferred All Commercial |
$424.12
|
Rate for Payer: Managed Health Services Medicaid |
$42.84
|
Rate for Payer: MDWise Medicaid |
$42.84
|
Rate for Payer: PHCS All Commercial |
$353.43
|
Rate for Payer: PHP All Commercial |
$357.39
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$183.78
|
Rate for Payer: Sagamore Health Network All Products |
$363.80
|
Rate for Payer: Signature Care EPO |
$391.13
|
Rate for Payer: Signature Care PPO |
$414.69
|
Rate for Payer: Three Rivers Preferred All Commercial |
$400.55
|
Rate for Payer: United Healthcare Commercial |
$371.34
|
Rate for Payer: United Healthcare Medicare |
$155.51
|
|
HC HEP B VIRAL DNA
|
Facility
IP
|
$471.24
|
|
Service Code
|
CPT 87517
|
Hospital Charge Code |
63002039
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$353.43 |
Max. Negotiated Rate |
$438.25 |
Rate for Payer: Aetna Commercial |
$407.15
|
Rate for Payer: Cash Price |
$292.17
|
Rate for Payer: Cigna All Commercial |
$406.68
|
Rate for Payer: CORVEL All Commercial |
$438.25
|
Rate for Payer: Coventry All Commercial |
$414.69
|
Rate for Payer: Encore All Commercial |
$433.78
|
Rate for Payer: Frontpath All Commercial |
$433.54
|
Rate for Payer: Humana ChoiceCare |
$407.01
|
Rate for Payer: Lutheran Preferred All Commercial |
$424.12
|
Rate for Payer: PHCS All Commercial |
$353.43
|
Rate for Payer: PHP All Commercial |
$357.39
|
Rate for Payer: Sagamore Health Network All Products |
$363.80
|
Rate for Payer: Signature Care EPO |
$391.13
|
Rate for Payer: Signature Care PPO |
$414.69
|
Rate for Payer: United Healthcare Commercial |
$371.34
|
|
HC HEP C GENOTYPE PCR
|
Facility
OP
|
$1,113.02
|
|
Service Code
|
CPT 87902
|
Hospital Charge Code |
63002056
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$257.45 |
Max. Negotiated Rate |
$1,035.11 |
Rate for Payer: Aetna Commercial |
$939.39
|
Rate for Payer: Aetna Medicare |
$367.30
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.30
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$639.21
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$695.75
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$257.45
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$422.39
|
Rate for Payer: CareSource Indiana of IN Medicare |
$404.03
|
Rate for Payer: Cash Price |
$690.08
|
Rate for Payer: Cash Price |
$690.08
|
Rate for Payer: Centivo All Commercial |
$567.64
|
Rate for Payer: Cigna All Commercial |
$960.54
|
Rate for Payer: CORVEL All Commercial |
$1,035.11
|
Rate for Payer: Coventry All Commercial |
$979.46
|
Rate for Payer: Encore All Commercial |
$1,024.54
|
Rate for Payer: Frontpath All Commercial |
$1,023.98
|
Rate for Payer: Humana ChoiceCare |
$961.32
|
Rate for Payer: Humana Medicare |
$567.64
|
Rate for Payer: Lucent All Commercial |
$567.64
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,001.72
|
Rate for Payer: Managed Health Services Medicaid |
$257.45
|
Rate for Payer: MDWise Medicaid |
$257.45
|
Rate for Payer: PHCS All Commercial |
$834.77
|
Rate for Payer: PHP All Commercial |
$844.12
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$434.08
|
Rate for Payer: Sagamore Health Network All Products |
$859.25
|
Rate for Payer: Signature Care EPO |
$923.81
|
Rate for Payer: Signature Care PPO |
$979.46
|
Rate for Payer: Three Rivers Preferred All Commercial |
$946.07
|
Rate for Payer: United Healthcare Commercial |
$877.06
|
Rate for Payer: United Healthcare Medicare |
$367.30
|
|
HC HEP C GENOTYPE PCR
|
Facility
IP
|
$1,113.02
|
|
Service Code
|
CPT 87902
|
Hospital Charge Code |
63002056
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$834.77 |
Max. Negotiated Rate |
$1,035.11 |
Rate for Payer: Aetna Commercial |
$961.65
|
Rate for Payer: Cash Price |
$690.08
|
Rate for Payer: Cigna All Commercial |
$960.54
|
Rate for Payer: CORVEL All Commercial |
$1,035.11
|
Rate for Payer: Coventry All Commercial |
$979.46
|
Rate for Payer: Encore All Commercial |
$1,024.54
|
Rate for Payer: Frontpath All Commercial |
$1,023.98
|
Rate for Payer: Humana ChoiceCare |
$961.32
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,001.72
|
Rate for Payer: PHCS All Commercial |
$834.77
|
Rate for Payer: PHP All Commercial |
$844.12
|
Rate for Payer: Sagamore Health Network All Products |
$859.25
|
Rate for Payer: Signature Care EPO |
$923.81
|
Rate for Payer: Signature Care PPO |
$979.46
|
Rate for Payer: United Healthcare Commercial |
$877.06
|
|
HC HEP C GENOTYPE PCR REFLEX
|
Facility
IP
|
$1,355.96
|
|
Service Code
|
CPT 87902
|
Hospital Charge Code |
63002057
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$1,016.97 |
Max. Negotiated Rate |
$1,261.04 |
Rate for Payer: Aetna Commercial |
$1,171.55
|
Rate for Payer: Cash Price |
$840.69
|
Rate for Payer: Cigna All Commercial |
$1,170.19
|
Rate for Payer: CORVEL All Commercial |
$1,261.04
|
Rate for Payer: Coventry All Commercial |
$1,193.24
|
Rate for Payer: Encore All Commercial |
$1,248.16
|
Rate for Payer: Frontpath All Commercial |
$1,247.48
|
Rate for Payer: Humana ChoiceCare |
$1,171.14
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,220.36
|
Rate for Payer: PHCS All Commercial |
$1,016.97
|
Rate for Payer: PHP All Commercial |
$1,028.36
|
Rate for Payer: Sagamore Health Network All Products |
$1,046.80
|
Rate for Payer: Signature Care EPO |
$1,125.44
|
Rate for Payer: Signature Care PPO |
$1,193.24
|
Rate for Payer: United Healthcare Commercial |
$1,068.49
|
|
HC HEP C GENOTYPE PCR REFLEX
|
Facility
OP
|
$1,355.96
|
|
Service Code
|
CPT 87902
|
Hospital Charge Code |
63002057
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$257.45 |
Max. Negotiated Rate |
$1,261.04 |
Rate for Payer: Aetna Commercial |
$1,144.43
|
Rate for Payer: Aetna Medicare |
$447.47
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$447.47
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$778.73
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$847.61
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$257.45
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$514.59
|
Rate for Payer: CareSource Indiana of IN Medicare |
$492.21
|
Rate for Payer: Cash Price |
$840.69
|
Rate for Payer: Cash Price |
$840.69
|
Rate for Payer: Centivo All Commercial |
$691.54
|
Rate for Payer: Cigna All Commercial |
$1,170.19
|
Rate for Payer: CORVEL All Commercial |
$1,261.04
|
Rate for Payer: Coventry All Commercial |
$1,193.24
|
Rate for Payer: Encore All Commercial |
$1,248.16
|
Rate for Payer: Frontpath All Commercial |
$1,247.48
|
Rate for Payer: Humana ChoiceCare |
$1,171.14
|
Rate for Payer: Humana Medicare |
$691.54
|
Rate for Payer: Lucent All Commercial |
$691.54
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,220.36
|
Rate for Payer: Managed Health Services Medicaid |
$257.45
|
Rate for Payer: MDWise Medicaid |
$257.45
|
Rate for Payer: PHCS All Commercial |
$1,016.97
|
Rate for Payer: PHP All Commercial |
$1,028.36
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$528.82
|
Rate for Payer: Sagamore Health Network All Products |
$1,046.80
|
Rate for Payer: Signature Care EPO |
$1,125.44
|
Rate for Payer: Signature Care PPO |
$1,193.24
|
Rate for Payer: Three Rivers Preferred All Commercial |
$1,152.56
|
Rate for Payer: United Healthcare Commercial |
$1,068.49
|
Rate for Payer: United Healthcare Medicare |
$447.47
|
|
HC HEP C RNA PCR QL
|
Facility
IP
|
$607.00
|
|
Service Code
|
CPT 87521
|
Hospital Charge Code |
63002040
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$455.25 |
Max. Negotiated Rate |
$564.51 |
Rate for Payer: Aetna Commercial |
$524.45
|
Rate for Payer: Cash Price |
$376.34
|
Rate for Payer: Cigna All Commercial |
$523.84
|
Rate for Payer: CORVEL All Commercial |
$564.51
|
Rate for Payer: Coventry All Commercial |
$534.16
|
Rate for Payer: Encore All Commercial |
$558.75
|
Rate for Payer: Frontpath All Commercial |
$558.44
|
Rate for Payer: Humana ChoiceCare |
$524.27
|
Rate for Payer: Lutheran Preferred All Commercial |
$546.30
|
Rate for Payer: PHCS All Commercial |
$455.25
|
Rate for Payer: PHP All Commercial |
$460.35
|
Rate for Payer: Sagamore Health Network All Products |
$468.61
|
Rate for Payer: Signature Care EPO |
$503.81
|
Rate for Payer: Signature Care PPO |
$534.16
|
Rate for Payer: United Healthcare Commercial |
$478.32
|
|
HC HEP C RNA PCR QL
|
Facility
OP
|
$607.00
|
|
Service Code
|
CPT 87521
|
Hospital Charge Code |
63002040
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$35.09 |
Max. Negotiated Rate |
$564.51 |
Rate for Payer: Aetna Commercial |
$512.31
|
Rate for Payer: Aetna Medicare |
$200.31
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$200.31
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$348.60
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$379.44
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.36
|
Rate for Payer: CareSource Indiana of IN Medicare |
$220.34
|
Rate for Payer: Cash Price |
$376.34
|
Rate for Payer: Cash Price |
$376.34
|
Rate for Payer: Centivo All Commercial |
$309.57
|
Rate for Payer: Cigna All Commercial |
$523.84
|
Rate for Payer: CORVEL All Commercial |
$564.51
|
Rate for Payer: Coventry All Commercial |
$534.16
|
Rate for Payer: Encore All Commercial |
$558.75
|
Rate for Payer: Frontpath All Commercial |
$558.44
|
Rate for Payer: Humana ChoiceCare |
$524.27
|
Rate for Payer: Humana Medicare |
$309.57
|
Rate for Payer: Lucent All Commercial |
$309.57
|
Rate for Payer: Lutheran Preferred All Commercial |
$546.30
|
Rate for Payer: Managed Health Services Medicaid |
$35.09
|
Rate for Payer: MDWise Medicaid |
$35.09
|
Rate for Payer: PHCS All Commercial |
$455.25
|
Rate for Payer: PHP All Commercial |
$460.35
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$236.73
|
Rate for Payer: Sagamore Health Network All Products |
$468.61
|
Rate for Payer: Signature Care EPO |
$503.81
|
Rate for Payer: Signature Care PPO |
$534.16
|
Rate for Payer: Three Rivers Preferred All Commercial |
$515.95
|
Rate for Payer: United Healthcare Commercial |
$478.32
|
Rate for Payer: United Healthcare Medicare |
$200.31
|
|
HC HEP C RNA PCR QT
|
Facility
OP
|
$645.15
|
|
Service Code
|
CPT 87522
|
Hospital Charge Code |
63002041
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$42.84 |
Max. Negotiated Rate |
$599.99 |
Rate for Payer: Aetna Commercial |
$544.51
|
Rate for Payer: Aetna Medicare |
$212.90
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$212.90
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$296.51
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$296.51
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$42.84
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$244.83
|
Rate for Payer: CareSource Indiana of IN Medicare |
$234.19
|
Rate for Payer: Cash Price |
$399.99
|
Rate for Payer: Cash Price |
$399.99
|
Rate for Payer: Centivo All Commercial |
$329.03
|
Rate for Payer: Cigna All Commercial |
$556.76
|
Rate for Payer: CORVEL All Commercial |
$599.99
|
Rate for Payer: Coventry All Commercial |
$567.73
|
Rate for Payer: Encore All Commercial |
$593.86
|
Rate for Payer: Frontpath All Commercial |
$593.54
|
Rate for Payer: Humana ChoiceCare |
$557.22
|
Rate for Payer: Humana Medicare |
$329.03
|
Rate for Payer: Lucent All Commercial |
$329.03
|
Rate for Payer: Lutheran Preferred All Commercial |
$580.64
|
Rate for Payer: Managed Health Services Medicaid |
$42.84
|
Rate for Payer: MDWise Medicaid |
$42.84
|
Rate for Payer: PHCS All Commercial |
$483.86
|
Rate for Payer: PHP All Commercial |
$489.28
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$251.61
|
Rate for Payer: Sagamore Health Network All Products |
$498.06
|
Rate for Payer: Signature Care EPO |
$535.47
|
Rate for Payer: Signature Care PPO |
$567.73
|
Rate for Payer: Three Rivers Preferred All Commercial |
$548.38
|
Rate for Payer: United Healthcare Commercial |
$508.38
|
Rate for Payer: United Healthcare Medicare |
$212.90
|
|
HC HEP C RNA PCR QT
|
Facility
IP
|
$645.15
|
|
Service Code
|
CPT 87522
|
Hospital Charge Code |
63002041
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$483.86 |
Max. Negotiated Rate |
$599.99 |
Rate for Payer: Aetna Commercial |
$557.41
|
Rate for Payer: Cash Price |
$399.99
|
Rate for Payer: Cigna All Commercial |
$556.76
|
Rate for Payer: CORVEL All Commercial |
$599.99
|
Rate for Payer: Coventry All Commercial |
$567.73
|
Rate for Payer: Encore All Commercial |
$593.86
|
Rate for Payer: Frontpath All Commercial |
$593.54
|
Rate for Payer: Humana ChoiceCare |
$557.22
|
Rate for Payer: Lutheran Preferred All Commercial |
$580.64
|
Rate for Payer: PHCS All Commercial |
$483.86
|
Rate for Payer: PHP All Commercial |
$489.28
|
Rate for Payer: Sagamore Health Network All Products |
$498.06
|
Rate for Payer: Signature Care EPO |
$535.47
|
Rate for Payer: Signature Care PPO |
$567.73
|
Rate for Payer: United Healthcare Commercial |
$508.38
|
|
HC HEP C RNA PCR QT W/ GENOTYPE IF IND.
|
Facility
IP
|
$645.15
|
|
Service Code
|
CPT 87522
|
Hospital Charge Code |
63002042
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$483.86 |
Max. Negotiated Rate |
$599.99 |
Rate for Payer: Aetna Commercial |
$557.41
|
Rate for Payer: Cash Price |
$399.99
|
Rate for Payer: Cigna All Commercial |
$556.76
|
Rate for Payer: CORVEL All Commercial |
$599.99
|
Rate for Payer: Coventry All Commercial |
$567.73
|
Rate for Payer: Encore All Commercial |
$593.86
|
Rate for Payer: Frontpath All Commercial |
$593.54
|
Rate for Payer: Humana ChoiceCare |
$557.22
|
Rate for Payer: Lutheran Preferred All Commercial |
$580.64
|
Rate for Payer: PHCS All Commercial |
$483.86
|
Rate for Payer: PHP All Commercial |
$489.28
|
Rate for Payer: Sagamore Health Network All Products |
$498.06
|
Rate for Payer: Signature Care EPO |
$535.47
|
Rate for Payer: Signature Care PPO |
$567.73
|
Rate for Payer: United Healthcare Commercial |
$508.38
|
|
HC HEP C RNA PCR QT W/ GENOTYPE IF IND.
|
Facility
OP
|
$645.15
|
|
Service Code
|
CPT 87522
|
Hospital Charge Code |
63002042
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$42.84 |
Max. Negotiated Rate |
$599.99 |
Rate for Payer: Aetna Commercial |
$544.51
|
Rate for Payer: Aetna Medicare |
$212.90
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$212.90
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$296.51
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$296.51
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$42.84
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$244.83
|
Rate for Payer: CareSource Indiana of IN Medicare |
$234.19
|
Rate for Payer: Cash Price |
$399.99
|
Rate for Payer: Cash Price |
$399.99
|
Rate for Payer: Centivo All Commercial |
$329.03
|
Rate for Payer: Cigna All Commercial |
$556.76
|
Rate for Payer: CORVEL All Commercial |
$599.99
|
Rate for Payer: Coventry All Commercial |
$567.73
|
Rate for Payer: Encore All Commercial |
$593.86
|
Rate for Payer: Frontpath All Commercial |
$593.54
|
Rate for Payer: Humana ChoiceCare |
$557.22
|
Rate for Payer: Humana Medicare |
$329.03
|
Rate for Payer: Lucent All Commercial |
$329.03
|
Rate for Payer: Lutheran Preferred All Commercial |
$580.64
|
Rate for Payer: Managed Health Services Medicaid |
$42.84
|
Rate for Payer: MDWise Medicaid |
$42.84
|
Rate for Payer: PHCS All Commercial |
$483.86
|
Rate for Payer: PHP All Commercial |
$489.28
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$251.61
|
Rate for Payer: Sagamore Health Network All Products |
$498.06
|
Rate for Payer: Signature Care EPO |
$535.47
|
Rate for Payer: Signature Care PPO |
$567.73
|
Rate for Payer: Three Rivers Preferred All Commercial |
$548.38
|
Rate for Payer: United Healthcare Commercial |
$508.38
|
Rate for Payer: United Healthcare Medicare |
$212.90
|
|
HC HER-2 (ERBB2) ANALYSIS BY FISH
|
Facility
IP
|
$1,298.12
|
|
Service Code
|
CPT 88374
|
Hospital Charge Code |
63002136
|
Hospital Revenue Code
|
310
|
Min. Negotiated Rate |
$973.59 |
Max. Negotiated Rate |
$1,207.25 |
Rate for Payer: Aetna Commercial |
$1,121.58
|
Rate for Payer: Cash Price |
$804.84
|
Rate for Payer: Cigna All Commercial |
$1,120.28
|
Rate for Payer: CORVEL All Commercial |
$1,207.25
|
Rate for Payer: Coventry All Commercial |
$1,142.35
|
Rate for Payer: Encore All Commercial |
$1,194.92
|
Rate for Payer: Frontpath All Commercial |
$1,194.27
|
Rate for Payer: Humana ChoiceCare |
$1,121.19
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,168.31
|
Rate for Payer: PHCS All Commercial |
$973.59
|
Rate for Payer: PHP All Commercial |
$984.50
|
Rate for Payer: Sagamore Health Network All Products |
$1,002.15
|
Rate for Payer: Signature Care EPO |
$1,077.44
|
Rate for Payer: Signature Care PPO |
$1,142.35
|
Rate for Payer: United Healthcare Commercial |
$1,022.92
|
|