|
HC HISTOPLASMA CAP AG
|
Facility
IP
|
$532.95
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
63001019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$399.71 |
| Max. Negotiated Rate |
$495.64 |
| Rate for Payer: Aetna Commercial |
$460.47
|
| Rate for Payer: Cash Price |
$330.43
|
| Rate for Payer: Cigna All Commercial |
$459.94
|
| Rate for Payer: CORVEL All Commercial |
$495.64
|
| Rate for Payer: Coventry All Commercial |
$469.00
|
| Rate for Payer: Encore All Commercial |
$490.58
|
| Rate for Payer: Frontpath All Commercial |
$490.31
|
| Rate for Payer: Humana ChoiceCare |
$460.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$479.66
|
| Rate for Payer: PHCS All Commercial |
$399.71
|
| Rate for Payer: PHP All Commercial |
$404.19
|
| Rate for Payer: Sagamore Health Network All Products |
$411.44
|
| Rate for Payer: Signature Care EPO |
$442.35
|
| Rate for Payer: Signature Care PPO |
$469.00
|
| Rate for Payer: United Healthcare Commercial |
$419.96
|
|
|
HC HISTOPLASMA GALACTOMANNAN ANTIGEN EIA, SERUM
|
Facility
OP
|
$137.70
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
63044049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$116.22
|
| Rate for Payer: Aetna Medicare |
$45.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.99
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Centivo All Commercial |
$70.23
|
| Rate for Payer: Cigna All Commercial |
$118.84
|
| Rate for Payer: CORVEL All Commercial |
$128.06
|
| Rate for Payer: Coventry All Commercial |
$121.18
|
| Rate for Payer: Encore All Commercial |
$126.75
|
| Rate for Payer: Frontpath All Commercial |
$126.68
|
| Rate for Payer: Humana ChoiceCare |
$118.93
|
| Rate for Payer: Humana Medicare |
$70.23
|
| Rate for Payer: Lucent All Commercial |
$70.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.93
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$103.28
|
| Rate for Payer: PHP All Commercial |
$104.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.70
|
| Rate for Payer: Sagamore Health Network All Products |
$106.30
|
| Rate for Payer: Signature Care EPO |
$114.29
|
| Rate for Payer: Signature Care PPO |
$121.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.04
|
| Rate for Payer: United Healthcare Commercial |
$108.51
|
| Rate for Payer: United Healthcare Medicare |
$45.44
|
|
|
HC HISTOPLASMA GALACTOMANNAN ANTIGEN EIA, SERUM
|
Facility
IP
|
$137.70
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
63044049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.28 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$118.97
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Cigna All Commercial |
$118.84
|
| Rate for Payer: CORVEL All Commercial |
$128.06
|
| Rate for Payer: Coventry All Commercial |
$121.18
|
| Rate for Payer: Encore All Commercial |
$126.75
|
| Rate for Payer: Frontpath All Commercial |
$126.68
|
| Rate for Payer: Humana ChoiceCare |
$118.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.93
|
| Rate for Payer: PHCS All Commercial |
$103.28
|
| Rate for Payer: PHP All Commercial |
$104.43
|
| Rate for Payer: Sagamore Health Network All Products |
$106.30
|
| Rate for Payer: Signature Care EPO |
$114.29
|
| Rate for Payer: Signature Care PPO |
$121.18
|
| Rate for Payer: United Healthcare Commercial |
$108.51
|
|
|
HC HISTOPLASMA MYCELIA AB-CF/ID
|
Facility
IP
|
$111.64
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$103.82 |
| Rate for Payer: Aetna Commercial |
$96.46
|
| Rate for Payer: Cash Price |
$69.22
|
| Rate for Payer: Cigna All Commercial |
$96.34
|
| Rate for Payer: CORVEL All Commercial |
$103.82
|
| Rate for Payer: Coventry All Commercial |
$98.24
|
| Rate for Payer: Encore All Commercial |
$102.76
|
| Rate for Payer: Frontpath All Commercial |
$102.71
|
| Rate for Payer: Humana ChoiceCare |
$96.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.48
|
| Rate for Payer: PHCS All Commercial |
$83.73
|
| Rate for Payer: PHP All Commercial |
$84.67
|
| Rate for Payer: Sagamore Health Network All Products |
$86.19
|
| Rate for Payer: Signature Care EPO |
$92.66
|
| Rate for Payer: Signature Care PPO |
$98.24
|
| Rate for Payer: United Healthcare Commercial |
$87.97
|
|
|
HC HISTOPLASMA MYCELIA AB-CF/ID
|
Facility
OP
|
$111.64
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$103.82 |
| Rate for Payer: Aetna Commercial |
$94.22
|
| Rate for Payer: Aetna Medicare |
$36.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.52
|
| Rate for Payer: Cash Price |
$69.22
|
| Rate for Payer: Cash Price |
$69.22
|
| Rate for Payer: Centivo All Commercial |
$56.94
|
| Rate for Payer: Cigna All Commercial |
$96.34
|
| Rate for Payer: CORVEL All Commercial |
$103.82
|
| Rate for Payer: Coventry All Commercial |
$98.24
|
| Rate for Payer: Encore All Commercial |
$102.76
|
| Rate for Payer: Frontpath All Commercial |
$102.71
|
| Rate for Payer: Humana ChoiceCare |
$96.42
|
| Rate for Payer: Humana Medicare |
$56.94
|
| Rate for Payer: Lucent All Commercial |
$56.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.48
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$83.73
|
| Rate for Payer: PHP All Commercial |
$84.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.54
|
| Rate for Payer: Sagamore Health Network All Products |
$86.19
|
| Rate for Payer: Signature Care EPO |
$92.66
|
| Rate for Payer: Signature Care PPO |
$98.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.89
|
| Rate for Payer: United Healthcare Commercial |
$87.97
|
| Rate for Payer: United Healthcare Medicare |
$36.84
|
|
|
HC HISTOPLASMA YEAST AB - CF
|
Facility
IP
|
$111.64
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001951
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$103.82 |
| Rate for Payer: Aetna Commercial |
$96.46
|
| Rate for Payer: Cash Price |
$69.22
|
| Rate for Payer: Cigna All Commercial |
$96.34
|
| Rate for Payer: CORVEL All Commercial |
$103.82
|
| Rate for Payer: Coventry All Commercial |
$98.24
|
| Rate for Payer: Encore All Commercial |
$102.76
|
| Rate for Payer: Frontpath All Commercial |
$102.71
|
| Rate for Payer: Humana ChoiceCare |
$96.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.48
|
| Rate for Payer: PHCS All Commercial |
$83.73
|
| Rate for Payer: PHP All Commercial |
$84.67
|
| Rate for Payer: Sagamore Health Network All Products |
$86.19
|
| Rate for Payer: Signature Care EPO |
$92.66
|
| Rate for Payer: Signature Care PPO |
$98.24
|
| Rate for Payer: United Healthcare Commercial |
$87.97
|
|
|
HC HISTOPLASMA YEAST AB - CF
|
Facility
OP
|
$111.64
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001951
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$103.82 |
| Rate for Payer: Aetna Commercial |
$94.22
|
| Rate for Payer: Aetna Medicare |
$36.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.52
|
| Rate for Payer: Cash Price |
$69.22
|
| Rate for Payer: Cash Price |
$69.22
|
| Rate for Payer: Centivo All Commercial |
$56.94
|
| Rate for Payer: Cigna All Commercial |
$96.34
|
| Rate for Payer: CORVEL All Commercial |
$103.82
|
| Rate for Payer: Coventry All Commercial |
$98.24
|
| Rate for Payer: Encore All Commercial |
$102.76
|
| Rate for Payer: Frontpath All Commercial |
$102.71
|
| Rate for Payer: Humana ChoiceCare |
$96.42
|
| Rate for Payer: Humana Medicare |
$56.94
|
| Rate for Payer: Lucent All Commercial |
$56.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.48
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$83.73
|
| Rate for Payer: PHP All Commercial |
$84.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.54
|
| Rate for Payer: Sagamore Health Network All Products |
$86.19
|
| Rate for Payer: Signature Care EPO |
$92.66
|
| Rate for Payer: Signature Care PPO |
$98.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.89
|
| Rate for Payer: United Healthcare Commercial |
$87.97
|
| Rate for Payer: United Healthcare Medicare |
$36.84
|
|
|
HC HIV-1 GENOTYPE - DNA OR RNA
|
Facility
IP
|
$986.04
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
63001038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$739.53 |
| Max. Negotiated Rate |
$917.02 |
| Rate for Payer: Aetna Commercial |
$851.94
|
| Rate for Payer: Cash Price |
$611.35
|
| Rate for Payer: Cigna All Commercial |
$850.96
|
| Rate for Payer: CORVEL All Commercial |
$917.02
|
| Rate for Payer: Coventry All Commercial |
$867.72
|
| Rate for Payer: Encore All Commercial |
$907.65
|
| Rate for Payer: Frontpath All Commercial |
$907.16
|
| Rate for Payer: Humana ChoiceCare |
$851.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$887.44
|
| Rate for Payer: PHCS All Commercial |
$739.53
|
| Rate for Payer: PHP All Commercial |
$747.82
|
| Rate for Payer: Sagamore Health Network All Products |
$761.23
|
| Rate for Payer: Signature Care EPO |
$818.42
|
| Rate for Payer: Signature Care PPO |
$867.72
|
| Rate for Payer: United Healthcare Commercial |
$777.00
|
|
|
HC HIV-1 GENOTYPE - DNA OR RNA
|
Facility
OP
|
$986.04
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
63001038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$917.02 |
| Rate for Payer: Aetna Commercial |
$832.22
|
| Rate for Payer: Aetna Medicare |
$325.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$566.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$616.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$257.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$374.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$357.93
|
| Rate for Payer: Cash Price |
$611.35
|
| Rate for Payer: Cash Price |
$611.35
|
| Rate for Payer: Centivo All Commercial |
$502.88
|
| Rate for Payer: Cigna All Commercial |
$850.96
|
| Rate for Payer: CORVEL All Commercial |
$917.02
|
| Rate for Payer: Coventry All Commercial |
$867.72
|
| Rate for Payer: Encore All Commercial |
$907.65
|
| Rate for Payer: Frontpath All Commercial |
$907.16
|
| Rate for Payer: Humana ChoiceCare |
$851.65
|
| Rate for Payer: Humana Medicare |
$502.88
|
| Rate for Payer: Lucent All Commercial |
$502.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$887.44
|
| Rate for Payer: Managed Health Services Medicaid |
$257.45
|
| Rate for Payer: MDWise Medicaid |
$257.45
|
| Rate for Payer: PHCS All Commercial |
$739.53
|
| Rate for Payer: PHP All Commercial |
$747.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$384.56
|
| Rate for Payer: Sagamore Health Network All Products |
$761.23
|
| Rate for Payer: Signature Care EPO |
$818.42
|
| Rate for Payer: Signature Care PPO |
$867.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$838.14
|
| Rate for Payer: United Healthcare Commercial |
$777.00
|
| Rate for Payer: United Healthcare Medicare |
$325.39
|
|
|
HC HIV-1 & HIV-2 AB SCREEN
|
Facility
IP
|
$131.24
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
63001289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.43 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$113.39
|
| Rate for Payer: Cash Price |
$81.37
|
| Rate for Payer: Cigna All Commercial |
$113.26
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.49
|
| Rate for Payer: Encore All Commercial |
$120.81
|
| Rate for Payer: Frontpath All Commercial |
$120.74
|
| Rate for Payer: Humana ChoiceCare |
$113.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: PHCS All Commercial |
$98.43
|
| Rate for Payer: PHP All Commercial |
$99.53
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.93
|
| Rate for Payer: Signature Care PPO |
$115.49
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
|
|
HC HIV-1 & HIV-2 AB SCREEN
|
Facility
OP
|
$131.24
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
63001289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$110.77
|
| Rate for Payer: Aetna Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.64
|
| Rate for Payer: Cash Price |
$81.37
|
| Rate for Payer: Cash Price |
$81.37
|
| Rate for Payer: Centivo All Commercial |
$66.93
|
| Rate for Payer: Cigna All Commercial |
$113.26
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.49
|
| Rate for Payer: Encore All Commercial |
$120.81
|
| Rate for Payer: Frontpath All Commercial |
$120.74
|
| Rate for Payer: Humana ChoiceCare |
$113.35
|
| Rate for Payer: Humana Medicare |
$66.93
|
| Rate for Payer: Lucent All Commercial |
$66.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: Managed Health Services Medicaid |
$24.08
|
| Rate for Payer: MDWise Medicaid |
$24.08
|
| Rate for Payer: PHCS All Commercial |
$98.43
|
| Rate for Payer: PHP All Commercial |
$99.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.18
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.93
|
| Rate for Payer: Signature Care PPO |
$115.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.56
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
|
|
HC HIV-1 & HIV-2 AB SCREEN - MC
|
Facility
IP
|
$112.46
|
|
|
Service Code
|
CPT G0432
|
| Hospital Charge Code |
63002209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.34 |
| Max. Negotiated Rate |
$104.58 |
| Rate for Payer: Aetna Commercial |
$97.16
|
| Rate for Payer: Cash Price |
$69.72
|
| Rate for Payer: Cigna All Commercial |
$97.05
|
| Rate for Payer: CORVEL All Commercial |
$104.58
|
| Rate for Payer: Coventry All Commercial |
$98.96
|
| Rate for Payer: Encore All Commercial |
$103.51
|
| Rate for Payer: Frontpath All Commercial |
$103.46
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.21
|
| Rate for Payer: PHCS All Commercial |
$84.34
|
| Rate for Payer: PHP All Commercial |
$85.29
|
| Rate for Payer: Sagamore Health Network All Products |
$86.82
|
| Rate for Payer: Signature Care EPO |
$93.34
|
| Rate for Payer: Signature Care PPO |
$98.96
|
| Rate for Payer: United Healthcare Commercial |
$88.61
|
|
|
HC HIV-1 & HIV-2 AB SCREEN - MC
|
Facility
OP
|
$112.46
|
|
|
Service Code
|
CPT G0432
|
| Hospital Charge Code |
63002209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$104.58 |
| Rate for Payer: Aetna Commercial |
$94.91
|
| Rate for Payer: Aetna Medicare |
$37.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.82
|
| Rate for Payer: Cash Price |
$69.72
|
| Rate for Payer: Centivo All Commercial |
$57.35
|
| Rate for Payer: Cigna All Commercial |
$97.05
|
| Rate for Payer: CORVEL All Commercial |
$104.58
|
| Rate for Payer: Coventry All Commercial |
$98.96
|
| Rate for Payer: Encore All Commercial |
$103.51
|
| Rate for Payer: Frontpath All Commercial |
$103.46
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Humana Medicare |
$57.35
|
| Rate for Payer: Lucent All Commercial |
$57.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.21
|
| Rate for Payer: PHCS All Commercial |
$84.34
|
| Rate for Payer: PHP All Commercial |
$85.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.86
|
| Rate for Payer: Sagamore Health Network All Products |
$86.82
|
| Rate for Payer: Signature Care EPO |
$93.34
|
| Rate for Payer: Signature Care PPO |
$98.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.59
|
| Rate for Payer: United Healthcare Commercial |
$88.61
|
| Rate for Payer: United Healthcare Medicare |
$37.11
|
|
|
HC HIV-1 & HIV-2 AB SCREEN W/WB IF IND.
|
Facility
IP
|
$108.44
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
63001290
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.33 |
| Max. Negotiated Rate |
$100.85 |
| Rate for Payer: Aetna Commercial |
$93.69
|
| Rate for Payer: Cash Price |
$67.23
|
| Rate for Payer: Cigna All Commercial |
$93.58
|
| Rate for Payer: CORVEL All Commercial |
$100.85
|
| Rate for Payer: Coventry All Commercial |
$95.42
|
| Rate for Payer: Encore All Commercial |
$99.82
|
| Rate for Payer: Frontpath All Commercial |
$99.76
|
| Rate for Payer: Humana ChoiceCare |
$93.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.59
|
| Rate for Payer: PHCS All Commercial |
$81.33
|
| Rate for Payer: PHP All Commercial |
$82.24
|
| Rate for Payer: Sagamore Health Network All Products |
$83.71
|
| Rate for Payer: Signature Care EPO |
$90.00
|
| Rate for Payer: Signature Care PPO |
$95.42
|
| Rate for Payer: United Healthcare Commercial |
$85.45
|
|
|
HC HIV-1 & HIV-2 AB SCREEN W/WB IF IND.
|
Facility
OP
|
$108.44
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
63001290
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$100.85 |
| Rate for Payer: Aetna Commercial |
$91.52
|
| Rate for Payer: Aetna Medicare |
$35.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.36
|
| Rate for Payer: Cash Price |
$67.23
|
| Rate for Payer: Cash Price |
$67.23
|
| Rate for Payer: Centivo All Commercial |
$55.30
|
| Rate for Payer: Cigna All Commercial |
$93.58
|
| Rate for Payer: CORVEL All Commercial |
$100.85
|
| Rate for Payer: Coventry All Commercial |
$95.42
|
| Rate for Payer: Encore All Commercial |
$99.82
|
| Rate for Payer: Frontpath All Commercial |
$99.76
|
| Rate for Payer: Humana ChoiceCare |
$93.66
|
| Rate for Payer: Humana Medicare |
$55.30
|
| Rate for Payer: Lucent All Commercial |
$55.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.59
|
| Rate for Payer: Managed Health Services Medicaid |
$13.71
|
| Rate for Payer: MDWise Medicaid |
$13.71
|
| Rate for Payer: PHCS All Commercial |
$81.33
|
| Rate for Payer: PHP All Commercial |
$82.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.29
|
| Rate for Payer: Sagamore Health Network All Products |
$83.71
|
| Rate for Payer: Signature Care EPO |
$90.00
|
| Rate for Payer: Signature Care PPO |
$95.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.17
|
| Rate for Payer: United Healthcare Commercial |
$85.45
|
| Rate for Payer: United Healthcare Medicare |
$35.78
|
|
|
HC HIV-1/HIV-2 SINGLE RESULT
|
Facility
IP
|
$136.32
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
63001953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$126.78 |
| Rate for Payer: Aetna Commercial |
$117.78
|
| Rate for Payer: Cash Price |
$84.52
|
| Rate for Payer: Cigna All Commercial |
$117.65
|
| Rate for Payer: CORVEL All Commercial |
$126.78
|
| Rate for Payer: Coventry All Commercial |
$119.96
|
| Rate for Payer: Encore All Commercial |
$125.49
|
| Rate for Payer: Frontpath All Commercial |
$125.42
|
| Rate for Payer: Humana ChoiceCare |
$117.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.69
|
| Rate for Payer: PHCS All Commercial |
$102.24
|
| Rate for Payer: PHP All Commercial |
$103.39
|
| Rate for Payer: Sagamore Health Network All Products |
$105.24
|
| Rate for Payer: Signature Care EPO |
$113.15
|
| Rate for Payer: Signature Care PPO |
$119.96
|
| Rate for Payer: United Healthcare Commercial |
$107.42
|
|
|
HC HIV-1/HIV-2 SINGLE RESULT
|
Facility
OP
|
$136.32
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
63001953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$126.78 |
| Rate for Payer: Aetna Commercial |
$115.06
|
| Rate for Payer: Aetna Medicare |
$44.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.49
|
| Rate for Payer: Cash Price |
$84.52
|
| Rate for Payer: Cash Price |
$84.52
|
| Rate for Payer: Centivo All Commercial |
$69.52
|
| Rate for Payer: Cigna All Commercial |
$117.65
|
| Rate for Payer: CORVEL All Commercial |
$126.78
|
| Rate for Payer: Coventry All Commercial |
$119.96
|
| Rate for Payer: Encore All Commercial |
$125.49
|
| Rate for Payer: Frontpath All Commercial |
$125.42
|
| Rate for Payer: Humana ChoiceCare |
$117.74
|
| Rate for Payer: Humana Medicare |
$69.52
|
| Rate for Payer: Lucent All Commercial |
$69.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.69
|
| Rate for Payer: Managed Health Services Medicaid |
$13.71
|
| Rate for Payer: MDWise Medicaid |
$13.71
|
| Rate for Payer: PHCS All Commercial |
$102.24
|
| Rate for Payer: PHP All Commercial |
$103.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.17
|
| Rate for Payer: Sagamore Health Network All Products |
$105.24
|
| Rate for Payer: Signature Care EPO |
$113.15
|
| Rate for Payer: Signature Care PPO |
$119.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115.87
|
| Rate for Payer: United Healthcare Commercial |
$107.42
|
| Rate for Payer: United Healthcare Medicare |
$44.99
|
|
|
HC HIV-1 RNA QT
|
Facility
OP
|
$682.66
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
63002043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$634.87 |
| Rate for Payer: Aetna Commercial |
$576.16
|
| Rate for Payer: Aetna Medicare |
$225.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$225.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$313.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$313.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$85.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$259.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$247.80
|
| Rate for Payer: Cash Price |
$423.25
|
| Rate for Payer: Cash Price |
$423.25
|
| Rate for Payer: Centivo All Commercial |
$348.15
|
| Rate for Payer: Cigna All Commercial |
$589.13
|
| Rate for Payer: CORVEL All Commercial |
$634.87
|
| Rate for Payer: Coventry All Commercial |
$600.74
|
| Rate for Payer: Encore All Commercial |
$628.38
|
| Rate for Payer: Frontpath All Commercial |
$628.04
|
| Rate for Payer: Humana ChoiceCare |
$589.61
|
| Rate for Payer: Humana Medicare |
$348.15
|
| Rate for Payer: Lucent All Commercial |
$348.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$614.39
|
| Rate for Payer: Managed Health Services Medicaid |
$85.10
|
| Rate for Payer: MDWise Medicaid |
$85.10
|
| Rate for Payer: PHCS All Commercial |
$511.99
|
| Rate for Payer: PHP All Commercial |
$517.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$266.24
|
| Rate for Payer: Sagamore Health Network All Products |
$527.01
|
| Rate for Payer: Signature Care EPO |
$566.60
|
| Rate for Payer: Signature Care PPO |
$600.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$580.26
|
| Rate for Payer: United Healthcare Commercial |
$537.93
|
| Rate for Payer: United Healthcare Medicare |
$225.28
|
|
|
HC HIV-1 RNA QT
|
Facility
IP
|
$682.66
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
63002043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$511.99 |
| Max. Negotiated Rate |
$634.87 |
| Rate for Payer: Aetna Commercial |
$589.81
|
| Rate for Payer: Cash Price |
$423.25
|
| Rate for Payer: Cigna All Commercial |
$589.13
|
| Rate for Payer: CORVEL All Commercial |
$634.87
|
| Rate for Payer: Coventry All Commercial |
$600.74
|
| Rate for Payer: Encore All Commercial |
$628.38
|
| Rate for Payer: Frontpath All Commercial |
$628.04
|
| Rate for Payer: Humana ChoiceCare |
$589.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$614.39
|
| Rate for Payer: PHCS All Commercial |
$511.99
|
| Rate for Payer: PHP All Commercial |
$517.73
|
| Rate for Payer: Sagamore Health Network All Products |
$527.01
|
| Rate for Payer: Signature Care EPO |
$566.60
|
| Rate for Payer: Signature Care PPO |
$600.74
|
| Rate for Payer: United Healthcare Commercial |
$537.93
|
|
|
HC HLA B27
|
Facility
OP
|
$325.38
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
63001981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$302.60 |
| Rate for Payer: Aetna Commercial |
$274.62
|
| Rate for Payer: Aetna Medicare |
$107.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$186.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$203.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.11
|
| Rate for Payer: Cash Price |
$201.74
|
| Rate for Payer: Cash Price |
$201.74
|
| Rate for Payer: Centivo All Commercial |
$165.94
|
| Rate for Payer: Cigna All Commercial |
$280.80
|
| Rate for Payer: CORVEL All Commercial |
$302.60
|
| Rate for Payer: Coventry All Commercial |
$286.33
|
| Rate for Payer: Encore All Commercial |
$299.51
|
| Rate for Payer: Frontpath All Commercial |
$299.35
|
| Rate for Payer: Humana ChoiceCare |
$281.03
|
| Rate for Payer: Humana Medicare |
$165.94
|
| Rate for Payer: Lucent All Commercial |
$165.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$292.84
|
| Rate for Payer: Managed Health Services Medicaid |
$25.81
|
| Rate for Payer: MDWise Medicaid |
$25.81
|
| Rate for Payer: PHCS All Commercial |
$244.04
|
| Rate for Payer: PHP All Commercial |
$246.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.90
|
| Rate for Payer: Sagamore Health Network All Products |
$251.19
|
| Rate for Payer: Signature Care EPO |
$270.07
|
| Rate for Payer: Signature Care PPO |
$286.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$276.57
|
| Rate for Payer: United Healthcare Commercial |
$256.40
|
| Rate for Payer: United Healthcare Medicare |
$107.38
|
|
|
HC HLA B27
|
Facility
IP
|
$325.38
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
63001981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$302.60 |
| Rate for Payer: Aetna Commercial |
$281.13
|
| Rate for Payer: Cash Price |
$201.74
|
| Rate for Payer: Cigna All Commercial |
$280.80
|
| Rate for Payer: CORVEL All Commercial |
$302.60
|
| Rate for Payer: Coventry All Commercial |
$286.33
|
| Rate for Payer: Encore All Commercial |
$299.51
|
| Rate for Payer: Frontpath All Commercial |
$299.35
|
| Rate for Payer: Humana ChoiceCare |
$281.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$292.84
|
| Rate for Payer: PHCS All Commercial |
$244.04
|
| Rate for Payer: PHP All Commercial |
$246.77
|
| Rate for Payer: Sagamore Health Network All Products |
$251.19
|
| Rate for Payer: Signature Care EPO |
$270.07
|
| Rate for Payer: Signature Care PPO |
$286.33
|
| Rate for Payer: United Healthcare Commercial |
$256.40
|
|
|
HC HLA-B27 CONFIRMATION-PCR
|
Facility
IP
|
$576.97
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
63001443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$432.73 |
| Max. Negotiated Rate |
$536.59 |
| Rate for Payer: Aetna Commercial |
$498.50
|
| Rate for Payer: Cash Price |
$357.72
|
| Rate for Payer: Cigna All Commercial |
$497.93
|
| Rate for Payer: CORVEL All Commercial |
$536.59
|
| Rate for Payer: Coventry All Commercial |
$507.74
|
| Rate for Payer: Encore All Commercial |
$531.10
|
| Rate for Payer: Frontpath All Commercial |
$530.82
|
| Rate for Payer: Humana ChoiceCare |
$498.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.28
|
| Rate for Payer: PHCS All Commercial |
$432.73
|
| Rate for Payer: PHP All Commercial |
$437.58
|
| Rate for Payer: Sagamore Health Network All Products |
$445.42
|
| Rate for Payer: Signature Care EPO |
$478.89
|
| Rate for Payer: Signature Care PPO |
$507.74
|
| Rate for Payer: United Healthcare Commercial |
$454.65
|
|
|
HC HLA-B27 CONFIRMATION-PCR
|
Facility
OP
|
$576.97
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
63001443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$536.59 |
| Rate for Payer: Aetna Commercial |
$486.97
|
| Rate for Payer: Aetna Medicare |
$190.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$190.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$331.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$360.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$218.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$209.44
|
| Rate for Payer: Cash Price |
$357.72
|
| Rate for Payer: Centivo All Commercial |
$294.26
|
| Rate for Payer: Cigna All Commercial |
$497.93
|
| Rate for Payer: CORVEL All Commercial |
$536.59
|
| Rate for Payer: Coventry All Commercial |
$507.74
|
| Rate for Payer: Encore All Commercial |
$531.10
|
| Rate for Payer: Frontpath All Commercial |
$530.82
|
| Rate for Payer: Humana ChoiceCare |
$498.33
|
| Rate for Payer: Humana Medicare |
$294.26
|
| Rate for Payer: Lucent All Commercial |
$294.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.28
|
| Rate for Payer: PHCS All Commercial |
$432.73
|
| Rate for Payer: PHP All Commercial |
$437.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$225.02
|
| Rate for Payer: Sagamore Health Network All Products |
$445.42
|
| Rate for Payer: Signature Care EPO |
$478.89
|
| Rate for Payer: Signature Care PPO |
$507.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$490.43
|
| Rate for Payer: United Healthcare Commercial |
$454.65
|
| Rate for Payer: United Healthcare Medicare |
$190.40
|
|
|
HC HLA-DQ TYPING CHARGE
|
Facility
IP
|
$159.06
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
63001444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.29 |
| Max. Negotiated Rate |
$147.92 |
| Rate for Payer: Aetna Commercial |
$137.43
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Cigna All Commercial |
$137.27
|
| Rate for Payer: CORVEL All Commercial |
$147.92
|
| Rate for Payer: Coventry All Commercial |
$139.97
|
| Rate for Payer: Encore All Commercial |
$146.41
|
| Rate for Payer: Frontpath All Commercial |
$146.33
|
| Rate for Payer: Humana ChoiceCare |
$137.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.15
|
| Rate for Payer: PHCS All Commercial |
$119.29
|
| Rate for Payer: PHP All Commercial |
$120.63
|
| Rate for Payer: Sagamore Health Network All Products |
$122.79
|
| Rate for Payer: Signature Care EPO |
$132.02
|
| Rate for Payer: Signature Care PPO |
$139.97
|
| Rate for Payer: United Healthcare Commercial |
$125.34
|
|
|
HC HLA-DQ TYPING CHARGE
|
Facility
OP
|
$159.06
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
63001444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$147.92 |
| Rate for Payer: Aetna Commercial |
$134.25
|
| Rate for Payer: Aetna Medicare |
$52.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.74
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Centivo All Commercial |
$81.12
|
| Rate for Payer: Cigna All Commercial |
$137.27
|
| Rate for Payer: CORVEL All Commercial |
$147.92
|
| Rate for Payer: Coventry All Commercial |
$139.97
|
| Rate for Payer: Encore All Commercial |
$146.41
|
| Rate for Payer: Frontpath All Commercial |
$146.33
|
| Rate for Payer: Humana ChoiceCare |
$137.38
|
| Rate for Payer: Humana Medicare |
$81.12
|
| Rate for Payer: Lucent All Commercial |
$81.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.15
|
| Rate for Payer: PHCS All Commercial |
$119.29
|
| Rate for Payer: PHP All Commercial |
$120.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.03
|
| Rate for Payer: Sagamore Health Network All Products |
$122.79
|
| Rate for Payer: Signature Care EPO |
$132.02
|
| Rate for Payer: Signature Care PPO |
$139.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.20
|
| Rate for Payer: United Healthcare Commercial |
$125.34
|
| Rate for Payer: United Healthcare Medicare |
$52.49
|
|
