|
HC IMMUNOASSAY QUANT EA
|
Facility
IP
|
$211.67
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001603
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.75 |
| Max. Negotiated Rate |
$196.85 |
| Rate for Payer: Aetna Commercial |
$182.88
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cigna All Commercial |
$182.67
|
| Rate for Payer: CORVEL All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$186.27
|
| Rate for Payer: Encore All Commercial |
$194.84
|
| Rate for Payer: Frontpath All Commercial |
$194.74
|
| Rate for Payer: Humana ChoiceCare |
$182.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
| Rate for Payer: PHCS All Commercial |
$158.75
|
| Rate for Payer: PHP All Commercial |
$160.53
|
| Rate for Payer: Sagamore Health Network All Products |
$163.41
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.27
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
|
|
HC IMMUNOASSAY QUANT EA
|
Facility
IP
|
$301.48
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$226.11 |
| Max. Negotiated Rate |
$280.38 |
| Rate for Payer: Aetna Commercial |
$260.48
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cigna All Commercial |
$260.18
|
| Rate for Payer: CORVEL All Commercial |
$280.38
|
| Rate for Payer: Coventry All Commercial |
$265.30
|
| Rate for Payer: Encore All Commercial |
$277.51
|
| Rate for Payer: Frontpath All Commercial |
$277.36
|
| Rate for Payer: Humana ChoiceCare |
$260.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$271.33
|
| Rate for Payer: PHCS All Commercial |
$226.11
|
| Rate for Payer: PHP All Commercial |
$228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$232.74
|
| Rate for Payer: Signature Care EPO |
$250.23
|
| Rate for Payer: Signature Care PPO |
$265.30
|
| Rate for Payer: United Healthcare Commercial |
$237.57
|
|
|
HC IMMUNOASSAY QUANT EA
|
Facility
OP
|
$301.48
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$280.38 |
| Rate for Payer: Aetna Commercial |
$254.45
|
| Rate for Payer: Aetna Medicare |
$99.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$173.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$188.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.44
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Centivo All Commercial |
$153.76
|
| Rate for Payer: Cigna All Commercial |
$260.18
|
| Rate for Payer: CORVEL All Commercial |
$280.38
|
| Rate for Payer: Coventry All Commercial |
$265.30
|
| Rate for Payer: Encore All Commercial |
$277.51
|
| Rate for Payer: Frontpath All Commercial |
$277.36
|
| Rate for Payer: Humana ChoiceCare |
$260.39
|
| Rate for Payer: Humana Medicare |
$153.76
|
| Rate for Payer: Lucent All Commercial |
$153.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$271.33
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$226.11
|
| Rate for Payer: PHP All Commercial |
$228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$117.58
|
| Rate for Payer: Sagamore Health Network All Products |
$232.74
|
| Rate for Payer: Signature Care EPO |
$250.23
|
| Rate for Payer: Signature Care PPO |
$265.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$256.26
|
| Rate for Payer: United Healthcare Commercial |
$237.57
|
| Rate for Payer: United Healthcare Medicare |
$99.49
|
|
|
HC IMMUNOASSAY QUANT EA
|
Facility
OP
|
$211.67
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001603
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$196.85 |
| Rate for Payer: Aetna Commercial |
$178.65
|
| Rate for Payer: Aetna Medicare |
$69.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.84
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Centivo All Commercial |
$107.95
|
| Rate for Payer: Cigna All Commercial |
$182.67
|
| Rate for Payer: CORVEL All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$186.27
|
| Rate for Payer: Encore All Commercial |
$194.84
|
| Rate for Payer: Frontpath All Commercial |
$194.74
|
| Rate for Payer: Humana ChoiceCare |
$182.82
|
| Rate for Payer: Humana Medicare |
$107.95
|
| Rate for Payer: Lucent All Commercial |
$107.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$158.75
|
| Rate for Payer: PHP All Commercial |
$160.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.55
|
| Rate for Payer: Sagamore Health Network All Products |
$163.41
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.92
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
| Rate for Payer: United Healthcare Medicare |
$69.85
|
|
|
HC IMMUNOASSAY QUANT EA - IBD
|
Facility
IP
|
$218.15
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.61 |
| Max. Negotiated Rate |
$202.88 |
| Rate for Payer: Aetna Commercial |
$188.48
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cigna All Commercial |
$188.26
|
| Rate for Payer: CORVEL All Commercial |
$202.88
|
| Rate for Payer: Coventry All Commercial |
$191.97
|
| Rate for Payer: Encore All Commercial |
$200.80
|
| Rate for Payer: Frontpath All Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$188.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.33
|
| Rate for Payer: PHCS All Commercial |
$163.61
|
| Rate for Payer: PHP All Commercial |
$165.44
|
| Rate for Payer: Sagamore Health Network All Products |
$168.41
|
| Rate for Payer: Signature Care EPO |
$181.06
|
| Rate for Payer: Signature Care PPO |
$191.97
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
|
|
HC IMMUNOASSAY QUANT EA - IBD
|
Facility
OP
|
$218.15
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$202.88 |
| Rate for Payer: Aetna Commercial |
$184.12
|
| Rate for Payer: Aetna Medicare |
$71.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$125.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$136.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.19
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Cash Price |
$135.25
|
| Rate for Payer: Centivo All Commercial |
$111.26
|
| Rate for Payer: Cigna All Commercial |
$188.26
|
| Rate for Payer: CORVEL All Commercial |
$202.88
|
| Rate for Payer: Coventry All Commercial |
$191.97
|
| Rate for Payer: Encore All Commercial |
$200.80
|
| Rate for Payer: Frontpath All Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$188.41
|
| Rate for Payer: Humana Medicare |
$111.26
|
| Rate for Payer: Lucent All Commercial |
$111.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.33
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$163.61
|
| Rate for Payer: PHP All Commercial |
$165.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.08
|
| Rate for Payer: Sagamore Health Network All Products |
$168.41
|
| Rate for Payer: Signature Care EPO |
$181.06
|
| Rate for Payer: Signature Care PPO |
$191.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.43
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Medicare |
$71.99
|
|
|
HC IMMUNOFIXATION - CSF
|
Facility
IP
|
$233.89
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
63001903
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.41 |
| Max. Negotiated Rate |
$217.51 |
| Rate for Payer: Aetna Commercial |
$202.08
|
| Rate for Payer: Cash Price |
$145.01
|
| Rate for Payer: Cigna All Commercial |
$201.84
|
| Rate for Payer: CORVEL All Commercial |
$217.51
|
| Rate for Payer: Coventry All Commercial |
$205.82
|
| Rate for Payer: Encore All Commercial |
$215.29
|
| Rate for Payer: Frontpath All Commercial |
$215.18
|
| Rate for Payer: Humana ChoiceCare |
$202.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.50
|
| Rate for Payer: PHCS All Commercial |
$175.41
|
| Rate for Payer: PHP All Commercial |
$177.38
|
| Rate for Payer: Sagamore Health Network All Products |
$180.56
|
| Rate for Payer: Signature Care EPO |
$194.13
|
| Rate for Payer: Signature Care PPO |
$205.82
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
|
|
HC IMMUNOFIXATION - CSF
|
Facility
OP
|
$233.89
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
63001903
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$217.51 |
| Rate for Payer: Aetna Commercial |
$197.40
|
| Rate for Payer: Aetna Medicare |
$77.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$29.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.90
|
| Rate for Payer: Cash Price |
$145.01
|
| Rate for Payer: Cash Price |
$145.01
|
| Rate for Payer: Centivo All Commercial |
$119.28
|
| Rate for Payer: Cigna All Commercial |
$201.84
|
| Rate for Payer: CORVEL All Commercial |
$217.51
|
| Rate for Payer: Coventry All Commercial |
$205.82
|
| Rate for Payer: Encore All Commercial |
$215.29
|
| Rate for Payer: Frontpath All Commercial |
$215.18
|
| Rate for Payer: Humana ChoiceCare |
$202.01
|
| Rate for Payer: Humana Medicare |
$119.28
|
| Rate for Payer: Lucent All Commercial |
$119.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.50
|
| Rate for Payer: Managed Health Services Medicaid |
$29.35
|
| Rate for Payer: MDWise Medicaid |
$29.35
|
| Rate for Payer: PHCS All Commercial |
$175.41
|
| Rate for Payer: PHP All Commercial |
$177.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.22
|
| Rate for Payer: Sagamore Health Network All Products |
$180.56
|
| Rate for Payer: Signature Care EPO |
$194.13
|
| Rate for Payer: Signature Care PPO |
$205.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.80
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
| Rate for Payer: United Healthcare Medicare |
$77.18
|
|
|
HC IMMUNOFIXATION CSF
|
Facility
OP
|
$233.89
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
63001904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$217.51 |
| Rate for Payer: Aetna Commercial |
$197.40
|
| Rate for Payer: Aetna Medicare |
$77.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$29.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.90
|
| Rate for Payer: Cash Price |
$145.01
|
| Rate for Payer: Cash Price |
$145.01
|
| Rate for Payer: Centivo All Commercial |
$119.28
|
| Rate for Payer: Cigna All Commercial |
$201.84
|
| Rate for Payer: CORVEL All Commercial |
$217.51
|
| Rate for Payer: Coventry All Commercial |
$205.82
|
| Rate for Payer: Encore All Commercial |
$215.29
|
| Rate for Payer: Frontpath All Commercial |
$215.18
|
| Rate for Payer: Humana ChoiceCare |
$202.01
|
| Rate for Payer: Humana Medicare |
$119.28
|
| Rate for Payer: Lucent All Commercial |
$119.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.50
|
| Rate for Payer: Managed Health Services Medicaid |
$29.35
|
| Rate for Payer: MDWise Medicaid |
$29.35
|
| Rate for Payer: PHCS All Commercial |
$175.41
|
| Rate for Payer: PHP All Commercial |
$177.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.22
|
| Rate for Payer: Sagamore Health Network All Products |
$180.56
|
| Rate for Payer: Signature Care EPO |
$194.13
|
| Rate for Payer: Signature Care PPO |
$205.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.80
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
| Rate for Payer: United Healthcare Medicare |
$77.18
|
|
|
HC IMMUNOFIXATION CSF
|
Facility
IP
|
$233.89
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
63001904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.41 |
| Max. Negotiated Rate |
$217.51 |
| Rate for Payer: Aetna Commercial |
$202.08
|
| Rate for Payer: Cash Price |
$145.01
|
| Rate for Payer: Cigna All Commercial |
$201.84
|
| Rate for Payer: CORVEL All Commercial |
$217.51
|
| Rate for Payer: Coventry All Commercial |
$205.82
|
| Rate for Payer: Encore All Commercial |
$215.29
|
| Rate for Payer: Frontpath All Commercial |
$215.18
|
| Rate for Payer: Humana ChoiceCare |
$202.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.50
|
| Rate for Payer: PHCS All Commercial |
$175.41
|
| Rate for Payer: PHP All Commercial |
$177.38
|
| Rate for Payer: Sagamore Health Network All Products |
$180.56
|
| Rate for Payer: Signature Care EPO |
$194.13
|
| Rate for Payer: Signature Care PPO |
$205.82
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
|
|
HC IMMUNOFIXATION SERUM
|
Facility
OP
|
$295.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
63001902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$274.35 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Medicare |
$97.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$169.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$184.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.09
|
| Rate for Payer: Cash Price |
$182.90
|
| Rate for Payer: Cash Price |
$182.90
|
| Rate for Payer: Centivo All Commercial |
$150.45
|
| Rate for Payer: Cigna All Commercial |
$254.59
|
| Rate for Payer: CORVEL All Commercial |
$274.35
|
| Rate for Payer: Coventry All Commercial |
$259.60
|
| Rate for Payer: Encore All Commercial |
$271.55
|
| Rate for Payer: Frontpath All Commercial |
$271.40
|
| Rate for Payer: Humana ChoiceCare |
$254.80
|
| Rate for Payer: Humana Medicare |
$150.45
|
| Rate for Payer: Lucent All Commercial |
$150.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$265.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.34
|
| Rate for Payer: MDWise Medicaid |
$22.34
|
| Rate for Payer: PHCS All Commercial |
$221.25
|
| Rate for Payer: PHP All Commercial |
$223.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.05
|
| Rate for Payer: Sagamore Health Network All Products |
$227.74
|
| Rate for Payer: Signature Care EPO |
$244.85
|
| Rate for Payer: Signature Care PPO |
$259.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$250.75
|
| Rate for Payer: United Healthcare Commercial |
$232.46
|
| Rate for Payer: United Healthcare Medicare |
$97.35
|
|
|
HC IMMUNOFIXATION SERUM
|
Facility
IP
|
$295.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
63001902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$274.35 |
| Rate for Payer: Aetna Commercial |
$254.88
|
| Rate for Payer: Cash Price |
$182.90
|
| Rate for Payer: Cigna All Commercial |
$254.59
|
| Rate for Payer: CORVEL All Commercial |
$274.35
|
| Rate for Payer: Coventry All Commercial |
$259.60
|
| Rate for Payer: Encore All Commercial |
$271.55
|
| Rate for Payer: Frontpath All Commercial |
$271.40
|
| Rate for Payer: Humana ChoiceCare |
$254.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$265.50
|
| Rate for Payer: PHCS All Commercial |
$221.25
|
| Rate for Payer: PHP All Commercial |
$223.73
|
| Rate for Payer: Sagamore Health Network All Products |
$227.74
|
| Rate for Payer: Signature Care EPO |
$244.85
|
| Rate for Payer: Signature Care PPO |
$259.60
|
| Rate for Payer: United Healthcare Commercial |
$232.46
|
|
|
HC IMMUNOFIXATION URINE
|
Facility
OP
|
$295.09
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
63001208
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$274.43 |
| Rate for Payer: Aetna Commercial |
$249.05
|
| Rate for Payer: Aetna Medicare |
$97.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$184.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$29.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.12
|
| Rate for Payer: Cash Price |
$182.95
|
| Rate for Payer: Cash Price |
$182.95
|
| Rate for Payer: Centivo All Commercial |
$150.49
|
| Rate for Payer: Cigna All Commercial |
$254.66
|
| Rate for Payer: CORVEL All Commercial |
$274.43
|
| Rate for Payer: Coventry All Commercial |
$259.68
|
| Rate for Payer: Encore All Commercial |
$271.63
|
| Rate for Payer: Frontpath All Commercial |
$271.48
|
| Rate for Payer: Humana ChoiceCare |
$254.87
|
| Rate for Payer: Humana Medicare |
$150.49
|
| Rate for Payer: Lucent All Commercial |
$150.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$265.58
|
| Rate for Payer: Managed Health Services Medicaid |
$29.35
|
| Rate for Payer: MDWise Medicaid |
$29.35
|
| Rate for Payer: PHCS All Commercial |
$221.31
|
| Rate for Payer: PHP All Commercial |
$223.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.08
|
| Rate for Payer: Sagamore Health Network All Products |
$227.81
|
| Rate for Payer: Signature Care EPO |
$244.92
|
| Rate for Payer: Signature Care PPO |
$259.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$250.82
|
| Rate for Payer: United Healthcare Commercial |
$232.53
|
| Rate for Payer: United Healthcare Medicare |
$97.38
|
|
|
HC IMMUNOFIXATION URINE
|
Facility
IP
|
$295.09
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
63001208
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$274.43 |
| Rate for Payer: Aetna Commercial |
$254.95
|
| Rate for Payer: Cash Price |
$182.95
|
| Rate for Payer: Cigna All Commercial |
$254.66
|
| Rate for Payer: CORVEL All Commercial |
$274.43
|
| Rate for Payer: Coventry All Commercial |
$259.68
|
| Rate for Payer: Encore All Commercial |
$271.63
|
| Rate for Payer: Frontpath All Commercial |
$271.48
|
| Rate for Payer: Humana ChoiceCare |
$254.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$265.58
|
| Rate for Payer: PHCS All Commercial |
$221.31
|
| Rate for Payer: PHP All Commercial |
$223.79
|
| Rate for Payer: Sagamore Health Network All Products |
$227.81
|
| Rate for Payer: Signature Care EPO |
$244.92
|
| Rate for Payer: Signature Care PPO |
$259.68
|
| Rate for Payer: United Healthcare Commercial |
$232.53
|
|
|
HC IMMUNOFLUORO PATH STUDY EA AB
|
Facility
IP
|
$247.38
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
63002125
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$185.54 |
| Max. Negotiated Rate |
$230.06 |
| Rate for Payer: Aetna Commercial |
$213.74
|
| Rate for Payer: Cash Price |
$153.38
|
| Rate for Payer: Cigna All Commercial |
$213.49
|
| Rate for Payer: CORVEL All Commercial |
$230.06
|
| Rate for Payer: Coventry All Commercial |
$217.69
|
| Rate for Payer: Encore All Commercial |
$227.71
|
| Rate for Payer: Frontpath All Commercial |
$227.59
|
| Rate for Payer: Humana ChoiceCare |
$213.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$222.64
|
| Rate for Payer: PHCS All Commercial |
$185.54
|
| Rate for Payer: PHP All Commercial |
$187.61
|
| Rate for Payer: Sagamore Health Network All Products |
$190.98
|
| Rate for Payer: Signature Care EPO |
$205.33
|
| Rate for Payer: Signature Care PPO |
$217.69
|
| Rate for Payer: United Healthcare Commercial |
$194.94
|
|
|
HC IMMUNOFLUORO PATH STUDY EA AB
|
Facility
OP
|
$247.38
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
63002125
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$816.74 |
| Rate for Payer: Aetna Commercial |
$208.79
|
| Rate for Payer: Aetna Medicare |
$81.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$142.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$816.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.80
|
| Rate for Payer: Cash Price |
$153.38
|
| Rate for Payer: Cash Price |
$153.38
|
| Rate for Payer: Centivo All Commercial |
$126.16
|
| Rate for Payer: Cigna All Commercial |
$213.49
|
| Rate for Payer: CORVEL All Commercial |
$230.06
|
| Rate for Payer: Coventry All Commercial |
$217.69
|
| Rate for Payer: Encore All Commercial |
$227.71
|
| Rate for Payer: Frontpath All Commercial |
$227.59
|
| Rate for Payer: Humana ChoiceCare |
$213.66
|
| Rate for Payer: Humana Medicare |
$126.16
|
| Rate for Payer: Lucent All Commercial |
$126.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$222.64
|
| Rate for Payer: Managed Health Services Medicaid |
$816.74
|
| Rate for Payer: MDWise Medicaid |
$816.74
|
| Rate for Payer: PHCS All Commercial |
$185.54
|
| Rate for Payer: PHP All Commercial |
$187.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.48
|
| Rate for Payer: Sagamore Health Network All Products |
$190.98
|
| Rate for Payer: Signature Care EPO |
$205.33
|
| Rate for Payer: Signature Care PPO |
$217.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$210.27
|
| Rate for Payer: United Healthcare Commercial |
$194.94
|
| Rate for Payer: United Healthcare Medicare |
$81.64
|
|
|
HC IMMUNO MULTIPLE STEP
|
Facility
OP
|
$102.74
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001584
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna Commercial |
$86.72
|
| Rate for Payer: Aetna Medicare |
$33.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.30
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Centivo All Commercial |
$52.40
|
| Rate for Payer: Cigna All Commercial |
$88.67
|
| Rate for Payer: CORVEL All Commercial |
$95.55
|
| Rate for Payer: Coventry All Commercial |
$90.42
|
| Rate for Payer: Encore All Commercial |
$94.58
|
| Rate for Payer: Frontpath All Commercial |
$94.53
|
| Rate for Payer: Humana ChoiceCare |
$88.74
|
| Rate for Payer: Humana Medicare |
$52.40
|
| Rate for Payer: Lucent All Commercial |
$52.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.47
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$77.06
|
| Rate for Payer: PHP All Commercial |
$77.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.07
|
| Rate for Payer: Sagamore Health Network All Products |
$79.32
|
| Rate for Payer: Signature Care EPO |
$85.28
|
| Rate for Payer: Signature Care PPO |
$90.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.33
|
| Rate for Payer: United Healthcare Commercial |
$80.96
|
| Rate for Payer: United Healthcare Medicare |
$33.91
|
|
|
HC IMMUNO MULTIPLE STEP
|
Facility
IP
|
$102.74
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001584
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Cigna All Commercial |
$88.67
|
| Rate for Payer: Aetna Commercial |
$88.77
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: CORVEL All Commercial |
$95.55
|
| Rate for Payer: Coventry All Commercial |
$90.42
|
| Rate for Payer: Encore All Commercial |
$94.58
|
| Rate for Payer: Frontpath All Commercial |
$94.53
|
| Rate for Payer: Humana ChoiceCare |
$88.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.47
|
| Rate for Payer: PHCS All Commercial |
$77.06
|
| Rate for Payer: PHP All Commercial |
$77.92
|
| Rate for Payer: Sagamore Health Network All Products |
$79.32
|
| Rate for Payer: Signature Care EPO |
$85.28
|
| Rate for Payer: Signature Care PPO |
$90.42
|
| Rate for Payer: United Healthcare Commercial |
$80.96
|
|
|
HC IMMUNO MULTIPLE STEP
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC IMMUNO MULTIPLE STEP
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC IMMUNO MULTIPLE STEP - EA
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001585
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC IMMUNO MULTIPLE STEP - EA
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001585
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC IMMUNO NONANTBY GI DISTRESS CH
|
Facility
IP
|
$105.57
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001586
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.18 |
| Max. Negotiated Rate |
$98.18 |
| Rate for Payer: Aetna Commercial |
$91.21
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Cigna All Commercial |
$91.11
|
| Rate for Payer: CORVEL All Commercial |
$98.18
|
| Rate for Payer: Coventry All Commercial |
$92.90
|
| Rate for Payer: Encore All Commercial |
$97.18
|
| Rate for Payer: Frontpath All Commercial |
$97.12
|
| Rate for Payer: Humana ChoiceCare |
$91.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.01
|
| Rate for Payer: PHCS All Commercial |
$79.18
|
| Rate for Payer: PHP All Commercial |
$80.06
|
| Rate for Payer: Sagamore Health Network All Products |
$81.50
|
| Rate for Payer: Signature Care EPO |
$87.62
|
| Rate for Payer: Signature Care PPO |
$92.90
|
| Rate for Payer: United Healthcare Commercial |
$83.19
|
|
|
HC IMMUNO NONANTBY GI DISTRESS CH
|
Facility
OP
|
$105.57
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001586
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$98.18 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: Aetna Medicare |
$34.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.32
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Centivo All Commercial |
$53.84
|
| Rate for Payer: Cigna All Commercial |
$91.11
|
| Rate for Payer: CORVEL All Commercial |
$98.18
|
| Rate for Payer: Coventry All Commercial |
$92.90
|
| Rate for Payer: Encore All Commercial |
$97.18
|
| Rate for Payer: Frontpath All Commercial |
$97.12
|
| Rate for Payer: Humana ChoiceCare |
$91.18
|
| Rate for Payer: Humana Medicare |
$53.84
|
| Rate for Payer: Lucent All Commercial |
$53.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.01
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$79.18
|
| Rate for Payer: PHP All Commercial |
$80.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.17
|
| Rate for Payer: Sagamore Health Network All Products |
$81.50
|
| Rate for Payer: Signature Care EPO |
$87.62
|
| Rate for Payer: Signature Care PPO |
$92.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.73
|
| Rate for Payer: United Healthcare Commercial |
$83.19
|
| Rate for Payer: United Healthcare Medicare |
$34.84
|
|
|
HC IMMUNOPEROXIDASE EA AB
|
Facility
IP
|
$483.99
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
63001271
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$362.99 |
| Max. Negotiated Rate |
$450.11 |
| Rate for Payer: Aetna Commercial |
$418.17
|
| Rate for Payer: Cash Price |
$300.07
|
| Rate for Payer: Cigna All Commercial |
$417.68
|
| Rate for Payer: CORVEL All Commercial |
$450.11
|
| Rate for Payer: Coventry All Commercial |
$425.91
|
| Rate for Payer: Encore All Commercial |
$445.51
|
| Rate for Payer: Frontpath All Commercial |
$445.27
|
| Rate for Payer: Humana ChoiceCare |
$418.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$435.59
|
| Rate for Payer: PHCS All Commercial |
$362.99
|
| Rate for Payer: PHP All Commercial |
$367.06
|
| Rate for Payer: Sagamore Health Network All Products |
$373.64
|
| Rate for Payer: Signature Care EPO |
$401.71
|
| Rate for Payer: Signature Care PPO |
$425.91
|
| Rate for Payer: United Healthcare Commercial |
$381.38
|
|
