|
HC HER-2 (ERBB2) ANALYSIS BY FISH
|
Facility
OP
|
$1,298.12
|
|
|
Service Code
|
CPT 88374
|
| Hospital Charge Code |
63002136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$428.38 |
| Max. Negotiated Rate |
$1,207.25 |
| Rate for Payer: Aetna Commercial |
$1,095.62
|
| Rate for Payer: Aetna Medicare |
$428.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$428.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$745.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$811.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$716.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$492.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$471.22
|
| Rate for Payer: Cash Price |
$804.84
|
| Rate for Payer: Cash Price |
$804.84
|
| Rate for Payer: Centivo All Commercial |
$662.04
|
| 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: Humana Medicare |
$662.04
|
| Rate for Payer: Lucent All Commercial |
$662.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,168.31
|
| Rate for Payer: Managed Health Services Medicaid |
$716.12
|
| Rate for Payer: MDWise Medicaid |
$716.12
|
| Rate for Payer: PHCS All Commercial |
$973.59
|
| Rate for Payer: PHP All Commercial |
$984.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$506.27
|
| 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: Three Rivers Preferred All Commercial |
$1,103.40
|
| Rate for Payer: United Healthcare Commercial |
$1,022.92
|
| Rate for Payer: United Healthcare Medicare |
$428.38
|
|
|
HC HER-2/NEU-2 PROBE BY FISH
|
Facility
OP
|
$455.48
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
63002135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$150.31 |
| Max. Negotiated Rate |
$716.39 |
| Rate for Payer: Aetna Commercial |
$384.43
|
| Rate for Payer: Aetna Medicare |
$150.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$261.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$284.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$716.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.34
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Centivo All Commercial |
$232.30
|
| Rate for Payer: Cigna All Commercial |
$393.08
|
| Rate for Payer: CORVEL All Commercial |
$423.60
|
| Rate for Payer: Coventry All Commercial |
$400.82
|
| Rate for Payer: Encore All Commercial |
$419.27
|
| Rate for Payer: Frontpath All Commercial |
$419.04
|
| Rate for Payer: Humana ChoiceCare |
$393.40
|
| Rate for Payer: Humana Medicare |
$232.30
|
| Rate for Payer: Lucent All Commercial |
$232.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.93
|
| Rate for Payer: Managed Health Services Medicaid |
$716.39
|
| Rate for Payer: MDWise Medicaid |
$716.39
|
| Rate for Payer: PHCS All Commercial |
$341.61
|
| Rate for Payer: PHP All Commercial |
$345.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$177.64
|
| Rate for Payer: Sagamore Health Network All Products |
$351.63
|
| Rate for Payer: Signature Care EPO |
$378.05
|
| Rate for Payer: Signature Care PPO |
$400.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$387.16
|
| Rate for Payer: United Healthcare Commercial |
$358.92
|
| Rate for Payer: United Healthcare Medicare |
$150.31
|
|
|
HC HER-2/NEU-2 PROBE BY FISH
|
Facility
IP
|
$440.64
|
|
|
Service Code
|
CPT 88374
|
| Hospital Charge Code |
63002137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$330.48 |
| Max. Negotiated Rate |
$409.80 |
| Rate for Payer: Aetna Commercial |
$380.71
|
| Rate for Payer: Cash Price |
$273.20
|
| Rate for Payer: Cigna All Commercial |
$380.27
|
| Rate for Payer: CORVEL All Commercial |
$409.80
|
| Rate for Payer: Coventry All Commercial |
$387.76
|
| Rate for Payer: Encore All Commercial |
$405.61
|
| Rate for Payer: Frontpath All Commercial |
$405.39
|
| Rate for Payer: Humana ChoiceCare |
$380.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$396.58
|
| Rate for Payer: PHCS All Commercial |
$330.48
|
| Rate for Payer: PHP All Commercial |
$334.18
|
| Rate for Payer: Sagamore Health Network All Products |
$340.17
|
| Rate for Payer: Signature Care EPO |
$365.73
|
| Rate for Payer: Signature Care PPO |
$387.76
|
| Rate for Payer: United Healthcare Commercial |
$347.22
|
|
|
HC HER-2/NEU-2 PROBE BY FISH
|
Facility
IP
|
$455.48
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
63002135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$341.61 |
| Max. Negotiated Rate |
$423.60 |
| Rate for Payer: Aetna Commercial |
$393.54
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cigna All Commercial |
$393.08
|
| Rate for Payer: CORVEL All Commercial |
$423.60
|
| Rate for Payer: Coventry All Commercial |
$400.82
|
| Rate for Payer: Encore All Commercial |
$419.27
|
| Rate for Payer: Frontpath All Commercial |
$419.04
|
| Rate for Payer: Humana ChoiceCare |
$393.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.93
|
| Rate for Payer: PHCS All Commercial |
$341.61
|
| Rate for Payer: PHP All Commercial |
$345.44
|
| Rate for Payer: Sagamore Health Network All Products |
$351.63
|
| Rate for Payer: Signature Care EPO |
$378.05
|
| Rate for Payer: Signature Care PPO |
$400.82
|
| Rate for Payer: United Healthcare Commercial |
$358.92
|
|
|
HC HER-2/NEU-2 PROBE BY FISH
|
Facility
OP
|
$864.12
|
|
|
Service Code
|
CPT 88367
|
| Hospital Charge Code |
63002134
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$285.16 |
| Max. Negotiated Rate |
$803.63 |
| Rate for Payer: Aetna Commercial |
$729.32
|
| Rate for Payer: Aetna Medicare |
$285.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$285.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$496.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$540.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$716.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$327.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$313.68
|
| Rate for Payer: Cash Price |
$535.76
|
| Rate for Payer: Cash Price |
$535.76
|
| Rate for Payer: Centivo All Commercial |
$440.70
|
| Rate for Payer: Cigna All Commercial |
$745.74
|
| Rate for Payer: CORVEL All Commercial |
$803.63
|
| Rate for Payer: Coventry All Commercial |
$760.43
|
| Rate for Payer: Encore All Commercial |
$795.43
|
| Rate for Payer: Frontpath All Commercial |
$794.99
|
| Rate for Payer: Humana ChoiceCare |
$746.34
|
| Rate for Payer: Humana Medicare |
$440.70
|
| Rate for Payer: Lucent All Commercial |
$440.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$777.71
|
| Rate for Payer: Managed Health Services Medicaid |
$716.39
|
| Rate for Payer: MDWise Medicaid |
$716.39
|
| Rate for Payer: PHCS All Commercial |
$648.09
|
| Rate for Payer: PHP All Commercial |
$655.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.01
|
| Rate for Payer: Sagamore Health Network All Products |
$667.10
|
| Rate for Payer: Signature Care EPO |
$717.22
|
| Rate for Payer: Signature Care PPO |
$760.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$734.51
|
| Rate for Payer: United Healthcare Commercial |
$680.93
|
| Rate for Payer: United Healthcare Medicare |
$285.16
|
|
|
HC HER-2/NEU-2 PROBE BY FISH
|
Facility
OP
|
$440.64
|
|
|
Service Code
|
CPT 88374
|
| Hospital Charge Code |
63002137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.41 |
| Max. Negotiated Rate |
$716.12 |
| Rate for Payer: Aetna Commercial |
$371.90
|
| Rate for Payer: Aetna Medicare |
$145.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$253.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$275.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$716.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.95
|
| Rate for Payer: Cash Price |
$273.20
|
| Rate for Payer: Cash Price |
$273.20
|
| Rate for Payer: Centivo All Commercial |
$224.73
|
| Rate for Payer: Cigna All Commercial |
$380.27
|
| Rate for Payer: CORVEL All Commercial |
$409.80
|
| Rate for Payer: Coventry All Commercial |
$387.76
|
| Rate for Payer: Encore All Commercial |
$405.61
|
| Rate for Payer: Frontpath All Commercial |
$405.39
|
| Rate for Payer: Humana ChoiceCare |
$380.58
|
| Rate for Payer: Humana Medicare |
$224.73
|
| Rate for Payer: Lucent All Commercial |
$224.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$396.58
|
| Rate for Payer: Managed Health Services Medicaid |
$716.12
|
| Rate for Payer: MDWise Medicaid |
$716.12
|
| Rate for Payer: PHCS All Commercial |
$330.48
|
| Rate for Payer: PHP All Commercial |
$334.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.85
|
| Rate for Payer: Sagamore Health Network All Products |
$340.17
|
| Rate for Payer: Signature Care EPO |
$365.73
|
| Rate for Payer: Signature Care PPO |
$387.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$374.54
|
| Rate for Payer: United Healthcare Commercial |
$347.22
|
| Rate for Payer: United Healthcare Medicare |
$145.41
|
|
|
HC HER-2/NEU-2 PROBE BY FISH
|
Facility
IP
|
$864.12
|
|
|
Service Code
|
CPT 88367
|
| Hospital Charge Code |
63002134
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$648.09 |
| Max. Negotiated Rate |
$803.63 |
| Rate for Payer: Aetna Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$535.76
|
| Rate for Payer: Cigna All Commercial |
$745.74
|
| Rate for Payer: CORVEL All Commercial |
$803.63
|
| Rate for Payer: Coventry All Commercial |
$760.43
|
| Rate for Payer: Encore All Commercial |
$795.43
|
| Rate for Payer: Frontpath All Commercial |
$794.99
|
| Rate for Payer: Humana ChoiceCare |
$746.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$777.71
|
| Rate for Payer: PHCS All Commercial |
$648.09
|
| Rate for Payer: PHP All Commercial |
$655.35
|
| Rate for Payer: Sagamore Health Network All Products |
$667.10
|
| Rate for Payer: Signature Care EPO |
$717.22
|
| Rate for Payer: Signature Care PPO |
$760.43
|
| Rate for Payer: United Healthcare Commercial |
$680.93
|
|
|
HC HERCEPT MORPH ANALYSIS
|
Facility
OP
|
$476.11
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
63002129
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$157.11 |
| Max. Negotiated Rate |
$716.39 |
| Rate for Payer: Aetna Commercial |
$401.83
|
| Rate for Payer: Aetna Medicare |
$157.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$273.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$297.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$716.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.83
|
| Rate for Payer: Cash Price |
$295.19
|
| Rate for Payer: Cash Price |
$295.19
|
| Rate for Payer: Centivo All Commercial |
$242.81
|
| Rate for Payer: Cigna All Commercial |
$410.88
|
| Rate for Payer: CORVEL All Commercial |
$442.78
|
| Rate for Payer: Coventry All Commercial |
$418.97
|
| Rate for Payer: Encore All Commercial |
$438.26
|
| Rate for Payer: Frontpath All Commercial |
$438.02
|
| Rate for Payer: Humana ChoiceCare |
$411.21
|
| Rate for Payer: Humana Medicare |
$242.81
|
| Rate for Payer: Lucent All Commercial |
$242.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.49
|
| Rate for Payer: Managed Health Services Medicaid |
$716.39
|
| Rate for Payer: MDWise Medicaid |
$716.39
|
| Rate for Payer: PHCS All Commercial |
$357.08
|
| Rate for Payer: PHP All Commercial |
$361.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.68
|
| Rate for Payer: Sagamore Health Network All Products |
$367.55
|
| Rate for Payer: Signature Care EPO |
$395.17
|
| Rate for Payer: Signature Care PPO |
$418.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$404.69
|
| Rate for Payer: United Healthcare Commercial |
$375.17
|
| Rate for Payer: United Healthcare Medicare |
$157.11
|
|
|
HC HERCEPT MORPH ANALYSIS
|
Facility
IP
|
$476.11
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
63002129
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$357.08 |
| Max. Negotiated Rate |
$442.78 |
| Rate for Payer: Aetna Commercial |
$411.36
|
| Rate for Payer: Cash Price |
$295.19
|
| Rate for Payer: Cigna All Commercial |
$410.88
|
| Rate for Payer: CORVEL All Commercial |
$442.78
|
| Rate for Payer: Coventry All Commercial |
$418.97
|
| Rate for Payer: Encore All Commercial |
$438.26
|
| Rate for Payer: Frontpath All Commercial |
$438.02
|
| Rate for Payer: Humana ChoiceCare |
$411.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.49
|
| Rate for Payer: PHCS All Commercial |
$357.08
|
| Rate for Payer: PHP All Commercial |
$361.08
|
| Rate for Payer: Sagamore Health Network All Products |
$367.55
|
| Rate for Payer: Signature Care EPO |
$395.17
|
| Rate for Payer: Signature Care PPO |
$418.97
|
| Rate for Payer: United Healthcare Commercial |
$375.17
|
|
|
HC HERPES 6(HHV6) IGG
|
Facility
OP
|
$165.16
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
63001977
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$139.39
|
| Rate for Payer: Aetna Medicare |
$54.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.95
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Centivo All Commercial |
$84.23
|
| Rate for Payer: Cigna All Commercial |
$142.53
|
| Rate for Payer: CORVEL All Commercial |
$153.60
|
| Rate for Payer: Coventry All Commercial |
$145.34
|
| Rate for Payer: Encore All Commercial |
$152.03
|
| Rate for Payer: Frontpath All Commercial |
$151.95
|
| Rate for Payer: Humana ChoiceCare |
$142.65
|
| Rate for Payer: Humana Medicare |
$84.23
|
| Rate for Payer: Lucent All Commercial |
$84.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.64
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: MDWise Medicaid |
$12.88
|
| Rate for Payer: PHCS All Commercial |
$123.87
|
| Rate for Payer: PHP All Commercial |
$125.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.41
|
| Rate for Payer: Sagamore Health Network All Products |
$127.50
|
| Rate for Payer: Signature Care EPO |
$137.08
|
| Rate for Payer: Signature Care PPO |
$145.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.38
|
| Rate for Payer: United Healthcare Commercial |
$130.14
|
| Rate for Payer: United Healthcare Medicare |
$54.50
|
|
|
HC HERPES 6(HHV6) IGG
|
Facility
IP
|
$165.16
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
63001977
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$142.70
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cigna All Commercial |
$142.53
|
| Rate for Payer: CORVEL All Commercial |
$153.60
|
| Rate for Payer: Coventry All Commercial |
$145.34
|
| Rate for Payer: Encore All Commercial |
$152.03
|
| Rate for Payer: Frontpath All Commercial |
$151.95
|
| Rate for Payer: Humana ChoiceCare |
$142.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.64
|
| Rate for Payer: PHCS All Commercial |
$123.87
|
| Rate for Payer: PHP All Commercial |
$125.26
|
| Rate for Payer: Sagamore Health Network All Products |
$127.50
|
| Rate for Payer: Signature Care EPO |
$137.08
|
| Rate for Payer: Signature Care PPO |
$145.34
|
| Rate for Payer: United Healthcare Commercial |
$130.14
|
|
|
HC HERPES 6(HHV6) IGM
|
Facility
OP
|
$277.13
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
63001978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$257.73 |
| Rate for Payer: Aetna Commercial |
$233.90
|
| Rate for Payer: Aetna Medicare |
$91.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$159.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$173.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$105.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.60
|
| Rate for Payer: Cash Price |
$171.82
|
| Rate for Payer: Cash Price |
$171.82
|
| Rate for Payer: Centivo All Commercial |
$141.34
|
| Rate for Payer: Cigna All Commercial |
$239.17
|
| Rate for Payer: CORVEL All Commercial |
$257.73
|
| Rate for Payer: Coventry All Commercial |
$243.88
|
| Rate for Payer: Encore All Commercial |
$255.10
|
| Rate for Payer: Frontpath All Commercial |
$254.96
|
| Rate for Payer: Humana ChoiceCare |
$239.36
|
| Rate for Payer: Humana Medicare |
$141.34
|
| Rate for Payer: Lucent All Commercial |
$141.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.42
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: MDWise Medicaid |
$12.88
|
| Rate for Payer: PHCS All Commercial |
$207.85
|
| Rate for Payer: PHP All Commercial |
$210.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.08
|
| Rate for Payer: Sagamore Health Network All Products |
$213.95
|
| Rate for Payer: Signature Care EPO |
$230.02
|
| Rate for Payer: Signature Care PPO |
$243.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$235.56
|
| Rate for Payer: United Healthcare Commercial |
$218.38
|
| Rate for Payer: United Healthcare Medicare |
$91.45
|
|
|
HC HERPES 6(HHV6) IGM
|
Facility
IP
|
$277.13
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
63001978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$207.85 |
| Max. Negotiated Rate |
$257.73 |
| Rate for Payer: Aetna Commercial |
$239.44
|
| Rate for Payer: Cash Price |
$171.82
|
| Rate for Payer: Cigna All Commercial |
$239.17
|
| Rate for Payer: CORVEL All Commercial |
$257.73
|
| Rate for Payer: Coventry All Commercial |
$243.88
|
| Rate for Payer: Encore All Commercial |
$255.10
|
| Rate for Payer: Frontpath All Commercial |
$254.96
|
| Rate for Payer: Humana ChoiceCare |
$239.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.42
|
| Rate for Payer: PHCS All Commercial |
$207.85
|
| Rate for Payer: PHP All Commercial |
$210.18
|
| Rate for Payer: Sagamore Health Network All Products |
$213.95
|
| Rate for Payer: Signature Care EPO |
$230.02
|
| Rate for Payer: Signature Care PPO |
$243.88
|
| Rate for Payer: United Healthcare Commercial |
$218.38
|
|
|
HC HERPES 6(HHV6) IGM REFLEX TITER
|
Facility
OP
|
$169.76
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
63001979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$157.88 |
| Rate for Payer: Aetna Commercial |
$143.28
|
| Rate for Payer: Aetna Medicare |
$56.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.62
|
| Rate for Payer: Cash Price |
$105.25
|
| Rate for Payer: Cash Price |
$105.25
|
| Rate for Payer: Centivo All Commercial |
$86.58
|
| Rate for Payer: Cigna All Commercial |
$146.50
|
| Rate for Payer: CORVEL All Commercial |
$157.88
|
| Rate for Payer: Coventry All Commercial |
$149.39
|
| Rate for Payer: Encore All Commercial |
$156.26
|
| Rate for Payer: Frontpath All Commercial |
$156.18
|
| Rate for Payer: Humana ChoiceCare |
$146.62
|
| Rate for Payer: Humana Medicare |
$86.58
|
| Rate for Payer: Lucent All Commercial |
$86.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.78
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: MDWise Medicaid |
$12.88
|
| Rate for Payer: PHCS All Commercial |
$127.32
|
| Rate for Payer: PHP All Commercial |
$128.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.21
|
| Rate for Payer: Sagamore Health Network All Products |
$131.05
|
| Rate for Payer: Signature Care EPO |
$140.90
|
| Rate for Payer: Signature Care PPO |
$149.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144.29
|
| Rate for Payer: United Healthcare Commercial |
$133.77
|
| Rate for Payer: United Healthcare Medicare |
$56.02
|
|
|
HC HERPES 6(HHV6) IGM REFLEX TITER
|
Facility
IP
|
$169.76
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
63001979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.32 |
| Max. Negotiated Rate |
$157.88 |
| Rate for Payer: Aetna Commercial |
$146.67
|
| Rate for Payer: Cash Price |
$105.25
|
| Rate for Payer: Cigna All Commercial |
$146.50
|
| Rate for Payer: CORVEL All Commercial |
$157.88
|
| Rate for Payer: Coventry All Commercial |
$149.39
|
| Rate for Payer: Encore All Commercial |
$156.26
|
| Rate for Payer: Frontpath All Commercial |
$156.18
|
| Rate for Payer: Humana ChoiceCare |
$146.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.78
|
| Rate for Payer: PHCS All Commercial |
$127.32
|
| Rate for Payer: PHP All Commercial |
$128.74
|
| Rate for Payer: Sagamore Health Network All Products |
$131.05
|
| Rate for Payer: Signature Care EPO |
$140.90
|
| Rate for Payer: Signature Care PPO |
$149.39
|
| Rate for Payer: United Healthcare Commercial |
$133.77
|
|
|
HC HERPES CULTURE
|
Facility
IP
|
$240.67
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.50 |
| Max. Negotiated Rate |
$223.82 |
| Rate for Payer: Aetna Commercial |
$207.94
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cigna All Commercial |
$207.70
|
| Rate for Payer: CORVEL All Commercial |
$223.82
|
| Rate for Payer: Coventry All Commercial |
$211.79
|
| Rate for Payer: Encore All Commercial |
$221.54
|
| Rate for Payer: Frontpath All Commercial |
$221.42
|
| Rate for Payer: Humana ChoiceCare |
$207.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.60
|
| Rate for Payer: PHCS All Commercial |
$180.50
|
| Rate for Payer: PHP All Commercial |
$182.52
|
| Rate for Payer: Sagamore Health Network All Products |
$185.80
|
| Rate for Payer: Signature Care EPO |
$199.76
|
| Rate for Payer: Signature Care PPO |
$211.79
|
| Rate for Payer: United Healthcare Commercial |
$189.65
|
|
|
HC HERPES CULTURE
|
Facility
OP
|
$240.67
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.29 |
| Max. Negotiated Rate |
$223.82 |
| Rate for Payer: Aetna Commercial |
$203.12
|
| Rate for Payer: Aetna Medicare |
$79.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$138.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.36
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Centivo All Commercial |
$122.74
|
| Rate for Payer: Cigna All Commercial |
$207.70
|
| Rate for Payer: CORVEL All Commercial |
$223.82
|
| Rate for Payer: Coventry All Commercial |
$211.79
|
| Rate for Payer: Encore All Commercial |
$221.54
|
| Rate for Payer: Frontpath All Commercial |
$221.42
|
| Rate for Payer: Humana ChoiceCare |
$207.87
|
| Rate for Payer: Humana Medicare |
$122.74
|
| Rate for Payer: Lucent All Commercial |
$122.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.60
|
| Rate for Payer: Managed Health Services Medicaid |
$24.29
|
| Rate for Payer: MDWise Medicaid |
$24.29
|
| Rate for Payer: PHCS All Commercial |
$180.50
|
| Rate for Payer: PHP All Commercial |
$182.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.86
|
| Rate for Payer: Sagamore Health Network All Products |
$185.80
|
| Rate for Payer: Signature Care EPO |
$199.76
|
| Rate for Payer: Signature Care PPO |
$211.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$204.57
|
| Rate for Payer: United Healthcare Commercial |
$189.65
|
| Rate for Payer: United Healthcare Medicare |
$79.42
|
|
|
HC HERPES CULTURE W/TYPING IF IND
|
Facility
IP
|
$497.68
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$373.26 |
| Max. Negotiated Rate |
$462.84 |
| Rate for Payer: Aetna Commercial |
$429.99
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cigna All Commercial |
$429.50
|
| Rate for Payer: CORVEL All Commercial |
$462.84
|
| Rate for Payer: Coventry All Commercial |
$437.96
|
| Rate for Payer: Encore All Commercial |
$458.11
|
| Rate for Payer: Frontpath All Commercial |
$457.86
|
| Rate for Payer: Humana ChoiceCare |
$429.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.91
|
| Rate for Payer: PHCS All Commercial |
$373.26
|
| Rate for Payer: PHP All Commercial |
$377.44
|
| Rate for Payer: Sagamore Health Network All Products |
$384.21
|
| Rate for Payer: Signature Care EPO |
$413.07
|
| Rate for Payer: Signature Care PPO |
$437.96
|
| Rate for Payer: United Healthcare Commercial |
$392.17
|
|
|
HC HERPES CULTURE W/TYPING IF IND
|
Facility
OP
|
$497.68
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
63002020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.29 |
| Max. Negotiated Rate |
$462.84 |
| Rate for Payer: Aetna Commercial |
$420.04
|
| Rate for Payer: Aetna Medicare |
$164.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$164.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$285.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$311.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.66
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Centivo All Commercial |
$253.82
|
| Rate for Payer: Cigna All Commercial |
$429.50
|
| Rate for Payer: CORVEL All Commercial |
$462.84
|
| Rate for Payer: Coventry All Commercial |
$437.96
|
| Rate for Payer: Encore All Commercial |
$458.11
|
| Rate for Payer: Frontpath All Commercial |
$457.86
|
| Rate for Payer: Humana ChoiceCare |
$429.84
|
| Rate for Payer: Humana Medicare |
$253.82
|
| Rate for Payer: Lucent All Commercial |
$253.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.91
|
| Rate for Payer: Managed Health Services Medicaid |
$24.29
|
| Rate for Payer: MDWise Medicaid |
$24.29
|
| Rate for Payer: PHCS All Commercial |
$373.26
|
| Rate for Payer: PHP All Commercial |
$377.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$194.09
|
| Rate for Payer: Sagamore Health Network All Products |
$384.21
|
| Rate for Payer: Signature Care EPO |
$413.07
|
| Rate for Payer: Signature Care PPO |
$437.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$423.03
|
| Rate for Payer: United Healthcare Commercial |
$392.17
|
| Rate for Payer: United Healthcare Medicare |
$164.23
|
|
|
HC HERPESELECT 1 IGG
|
Facility
IP
|
$144.36
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
63001944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.27 |
| Max. Negotiated Rate |
$134.26 |
| Rate for Payer: Aetna Commercial |
$124.73
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna All Commercial |
$124.58
|
| Rate for Payer: CORVEL All Commercial |
$134.26
|
| Rate for Payer: Coventry All Commercial |
$127.04
|
| Rate for Payer: Encore All Commercial |
$132.88
|
| Rate for Payer: Frontpath All Commercial |
$132.81
|
| Rate for Payer: Humana ChoiceCare |
$124.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.92
|
| Rate for Payer: PHCS All Commercial |
$108.27
|
| Rate for Payer: PHP All Commercial |
$109.48
|
| Rate for Payer: Sagamore Health Network All Products |
$111.45
|
| Rate for Payer: Signature Care EPO |
$119.82
|
| Rate for Payer: Signature Care PPO |
$127.04
|
| Rate for Payer: United Healthcare Commercial |
$113.76
|
|
|
HC HERPESELECT 1 IGG
|
Facility
OP
|
$144.36
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
63001944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$134.26 |
| Rate for Payer: Aetna Commercial |
$121.84
|
| Rate for Payer: Aetna Medicare |
$47.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.40
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Centivo All Commercial |
$73.62
|
| Rate for Payer: Cigna All Commercial |
$124.58
|
| Rate for Payer: CORVEL All Commercial |
$134.26
|
| Rate for Payer: Coventry All Commercial |
$127.04
|
| Rate for Payer: Encore All Commercial |
$132.88
|
| Rate for Payer: Frontpath All Commercial |
$132.81
|
| Rate for Payer: Humana ChoiceCare |
$124.68
|
| Rate for Payer: Humana Medicare |
$73.62
|
| Rate for Payer: Lucent All Commercial |
$73.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.92
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: MDWise Medicaid |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$108.27
|
| Rate for Payer: PHP All Commercial |
$109.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.30
|
| Rate for Payer: Sagamore Health Network All Products |
$111.45
|
| Rate for Payer: Signature Care EPO |
$119.82
|
| Rate for Payer: Signature Care PPO |
$127.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.71
|
| Rate for Payer: United Healthcare Commercial |
$113.76
|
| Rate for Payer: United Healthcare Medicare |
$47.64
|
|
|
HC HERPESELECT 2 IGG
|
Facility
IP
|
$149.23
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
63001947
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.92 |
| Max. Negotiated Rate |
$138.78 |
| Rate for Payer: Aetna Commercial |
$128.93
|
| Rate for Payer: Cash Price |
$92.52
|
| Rate for Payer: Cigna All Commercial |
$128.78
|
| Rate for Payer: CORVEL All Commercial |
$138.78
|
| Rate for Payer: Coventry All Commercial |
$131.32
|
| Rate for Payer: Encore All Commercial |
$137.36
|
| Rate for Payer: Frontpath All Commercial |
$137.29
|
| Rate for Payer: Humana ChoiceCare |
$128.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.30
|
| Rate for Payer: PHCS All Commercial |
$111.92
|
| Rate for Payer: PHP All Commercial |
$113.17
|
| Rate for Payer: Sagamore Health Network All Products |
$115.20
|
| Rate for Payer: Signature Care EPO |
$123.86
|
| Rate for Payer: Signature Care PPO |
$131.32
|
| Rate for Payer: United Healthcare Commercial |
$117.59
|
|
|
HC HERPESELECT 2 IGG
|
Facility
OP
|
$149.23
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
63001947
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$138.78 |
| Rate for Payer: Aetna Commercial |
$125.95
|
| Rate for Payer: Aetna Medicare |
$49.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.17
|
| Rate for Payer: Cash Price |
$92.52
|
| Rate for Payer: Cash Price |
$92.52
|
| Rate for Payer: Centivo All Commercial |
$76.11
|
| Rate for Payer: Cigna All Commercial |
$128.78
|
| Rate for Payer: CORVEL All Commercial |
$138.78
|
| Rate for Payer: Coventry All Commercial |
$131.32
|
| Rate for Payer: Encore All Commercial |
$137.36
|
| Rate for Payer: Frontpath All Commercial |
$137.29
|
| Rate for Payer: Humana ChoiceCare |
$128.89
|
| Rate for Payer: Humana Medicare |
$76.11
|
| Rate for Payer: Lucent All Commercial |
$76.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.30
|
| Rate for Payer: Managed Health Services Medicaid |
$19.35
|
| Rate for Payer: MDWise Medicaid |
$19.35
|
| Rate for Payer: PHCS All Commercial |
$111.92
|
| Rate for Payer: PHP All Commercial |
$113.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.20
|
| Rate for Payer: Sagamore Health Network All Products |
$115.20
|
| Rate for Payer: Signature Care EPO |
$123.86
|
| Rate for Payer: Signature Care PPO |
$131.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.84
|
| Rate for Payer: United Healthcare Commercial |
$117.59
|
| Rate for Payer: United Healthcare Medicare |
$49.24
|
|
|
HC HERPES IGM AB
|
Facility
IP
|
$171.57
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
63001943
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.68 |
| Max. Negotiated Rate |
$159.56 |
| Rate for Payer: Aetna Commercial |
$148.24
|
| Rate for Payer: Cash Price |
$106.38
|
| Rate for Payer: Cigna All Commercial |
$148.07
|
| Rate for Payer: CORVEL All Commercial |
$159.56
|
| Rate for Payer: Coventry All Commercial |
$150.99
|
| Rate for Payer: Encore All Commercial |
$157.93
|
| Rate for Payer: Frontpath All Commercial |
$157.85
|
| Rate for Payer: Humana ChoiceCare |
$148.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.42
|
| Rate for Payer: PHCS All Commercial |
$128.68
|
| Rate for Payer: PHP All Commercial |
$130.12
|
| Rate for Payer: Sagamore Health Network All Products |
$132.46
|
| Rate for Payer: Signature Care EPO |
$142.41
|
| Rate for Payer: Signature Care PPO |
$150.99
|
| Rate for Payer: United Healthcare Commercial |
$135.20
|
|
|
HC HERPES IGM AB
|
Facility
OP
|
$171.57
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
63001943
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$159.56 |
| Rate for Payer: Aetna Commercial |
$144.81
|
| Rate for Payer: Aetna Medicare |
$56.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.28
|
| Rate for Payer: Cash Price |
$106.38
|
| Rate for Payer: Cash Price |
$106.38
|
| Rate for Payer: Centivo All Commercial |
$87.50
|
| Rate for Payer: Cigna All Commercial |
$148.07
|
| Rate for Payer: CORVEL All Commercial |
$159.56
|
| Rate for Payer: Coventry All Commercial |
$150.99
|
| Rate for Payer: Encore All Commercial |
$157.93
|
| Rate for Payer: Frontpath All Commercial |
$157.85
|
| Rate for Payer: Humana ChoiceCare |
$148.19
|
| Rate for Payer: Humana Medicare |
$87.50
|
| Rate for Payer: Lucent All Commercial |
$87.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.42
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$128.68
|
| Rate for Payer: PHP All Commercial |
$130.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.91
|
| Rate for Payer: Sagamore Health Network All Products |
$132.46
|
| Rate for Payer: Signature Care EPO |
$142.41
|
| Rate for Payer: Signature Care PPO |
$150.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.84
|
| Rate for Payer: United Healthcare Commercial |
$135.20
|
| Rate for Payer: United Healthcare Medicare |
$56.62
|
|
