|
HC HEP B CORE IGM
|
Facility
|
IP
|
$163.56
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
63001336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.67 |
| Max. Negotiated Rate |
$152.11 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Cash Price |
$98.14
|
| Rate for Payer: Cigna All Commercial |
$141.15
|
| Rate for Payer: CORVEL All Commercial |
$152.11
|
| Rate for Payer: Coventry All Commercial |
$143.93
|
| Rate for Payer: Encore All Commercial |
$150.56
|
| Rate for Payer: Frontpath All Commercial |
$150.48
|
| Rate for Payer: Humana ChoiceCare |
$141.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.20
|
| Rate for Payer: PHCS All Commercial |
$122.67
|
| Rate for Payer: PHP All Commercial |
$124.04
|
| Rate for Payer: Sagamore Health Network All Products |
$126.27
|
| Rate for Payer: Signature Care EPO |
$135.75
|
| Rate for Payer: Signature Care PPO |
$143.93
|
| Rate for Payer: United Healthcare Commercial |
$128.89
|
|
|
HC HEP BE ANTIBODY
|
Facility
|
OP
|
$171.11
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
63001955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna Commercial |
$144.42
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.23
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Centivo All Commercial |
$93.08
|
| Rate for Payer: Cigna All Commercial |
$147.67
|
| Rate for Payer: CORVEL All Commercial |
$159.13
|
| Rate for Payer: Coventry All Commercial |
$150.58
|
| Rate for Payer: Encore All Commercial |
$157.51
|
| Rate for Payer: Frontpath All Commercial |
$157.42
|
| Rate for Payer: Humana ChoiceCare |
$147.79
|
| Rate for Payer: Humana Medicare |
$54.76
|
| Rate for Payer: Lucent All Commercial |
$93.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.00
|
| Rate for Payer: Managed Health Services Medicaid |
$11.57
|
| Rate for Payer: MDWise Medicaid |
$11.57
|
| Rate for Payer: PHCS All Commercial |
$128.33
|
| Rate for Payer: PHP All Commercial |
$129.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.73
|
| Rate for Payer: Sagamore Health Network All Products |
$132.10
|
| Rate for Payer: Signature Care EPO |
$142.02
|
| Rate for Payer: Signature Care PPO |
$150.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.44
|
| Rate for Payer: United Healthcare Commercial |
$134.83
|
| Rate for Payer: United Healthcare Medicare |
$54.76
|
|
|
HC HEP BE ANTIBODY
|
Facility
|
IP
|
$171.11
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
63001955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cigna All Commercial |
$147.67
|
| Rate for Payer: CORVEL All Commercial |
$159.13
|
| Rate for Payer: Coventry All Commercial |
$150.58
|
| Rate for Payer: Encore All Commercial |
$157.51
|
| Rate for Payer: Frontpath All Commercial |
$157.42
|
| Rate for Payer: Humana ChoiceCare |
$147.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.00
|
| Rate for Payer: PHCS All Commercial |
$128.33
|
| Rate for Payer: PHP All Commercial |
$129.77
|
| Rate for Payer: Sagamore Health Network All Products |
$132.10
|
| Rate for Payer: Signature Care EPO |
$142.02
|
| Rate for Payer: Signature Care PPO |
$150.58
|
| Rate for Payer: United Healthcare Commercial |
$134.83
|
|
|
HC HEP BE ANTIGEN
|
Facility
|
OP
|
$140.25
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
63002030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$130.43 |
| Rate for Payer: Aetna Commercial |
$118.37
|
| Rate for Payer: Aetna Medicare |
$44.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$64.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.37
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Centivo All Commercial |
$76.30
|
| Rate for Payer: Cigna All Commercial |
$121.04
|
| Rate for Payer: CORVEL All Commercial |
$130.43
|
| Rate for Payer: Coventry All Commercial |
$123.42
|
| Rate for Payer: Encore All Commercial |
$129.10
|
| Rate for Payer: Frontpath All Commercial |
$129.03
|
| Rate for Payer: Humana ChoiceCare |
$121.13
|
| Rate for Payer: Humana Medicare |
$44.88
|
| Rate for Payer: Lucent All Commercial |
$76.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.22
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$105.19
|
| Rate for Payer: PHP All Commercial |
$106.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.70
|
| Rate for Payer: Sagamore Health Network All Products |
$108.27
|
| Rate for Payer: Signature Care EPO |
$116.41
|
| Rate for Payer: Signature Care PPO |
$123.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.21
|
| Rate for Payer: United Healthcare Commercial |
$110.52
|
| Rate for Payer: United Healthcare Medicare |
$44.88
|
|
|
HC HEP BE ANTIGEN
|
Facility
|
IP
|
$140.25
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
63002030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.19 |
| Max. Negotiated Rate |
$130.43 |
| Rate for Payer: Aetna Commercial |
$121.18
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna All Commercial |
$121.04
|
| Rate for Payer: CORVEL All Commercial |
$130.43
|
| Rate for Payer: Coventry All Commercial |
$123.42
|
| Rate for Payer: Encore All Commercial |
$129.10
|
| Rate for Payer: Frontpath All Commercial |
$129.03
|
| Rate for Payer: Humana ChoiceCare |
$121.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.22
|
| Rate for Payer: PHCS All Commercial |
$105.19
|
| Rate for Payer: PHP All Commercial |
$106.37
|
| Rate for Payer: Sagamore Health Network All Products |
$108.27
|
| Rate for Payer: Signature Care EPO |
$116.41
|
| Rate for Payer: Signature Care PPO |
$123.42
|
| Rate for Payer: United Healthcare Commercial |
$110.52
|
|
|
HC HEP B SURFACE AB
|
Facility
|
OP
|
$154.84
|
|
|
Service Code
|
CPT G0499
|
| Hospital Charge Code |
63001215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$130.68
|
| Rate for Payer: Aetna Medicare |
$49.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$28.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$28.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.50
|
| Rate for Payer: Cash Price |
$92.90
|
| Rate for Payer: Cash Price |
$92.90
|
| Rate for Payer: Centivo All Commercial |
$84.23
|
| Rate for Payer: Cigna All Commercial |
$133.63
|
| Rate for Payer: CORVEL All Commercial |
$144.00
|
| Rate for Payer: Coventry All Commercial |
$136.26
|
| Rate for Payer: Encore All Commercial |
$142.53
|
| Rate for Payer: Frontpath All Commercial |
$142.45
|
| Rate for Payer: Humana ChoiceCare |
$133.74
|
| Rate for Payer: Humana Medicare |
$49.55
|
| Rate for Payer: Lucent All Commercial |
$84.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.36
|
| Rate for Payer: Managed Health Services Medicaid |
$28.27
|
| Rate for Payer: MDWise Medicaid |
$28.27
|
| Rate for Payer: PHCS All Commercial |
$116.13
|
| Rate for Payer: PHP All Commercial |
$117.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.39
|
| Rate for Payer: Sagamore Health Network All Products |
$119.54
|
| Rate for Payer: Signature Care EPO |
$128.52
|
| Rate for Payer: Signature Care PPO |
$136.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.61
|
| Rate for Payer: United Healthcare Commercial |
$122.01
|
| Rate for Payer: United Healthcare Medicare |
$49.55
|
|
|
HC HEP B SURFACE AB
|
Facility
|
OP
|
$154.84
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
63001215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$130.68
|
| Rate for Payer: Aetna Medicare |
$49.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.50
|
| Rate for Payer: Cash Price |
$92.90
|
| Rate for Payer: Cash Price |
$92.90
|
| Rate for Payer: Centivo All Commercial |
$84.23
|
| Rate for Payer: Cigna All Commercial |
$133.63
|
| Rate for Payer: CORVEL All Commercial |
$144.00
|
| Rate for Payer: Coventry All Commercial |
$136.26
|
| Rate for Payer: Encore All Commercial |
$142.53
|
| Rate for Payer: Frontpath All Commercial |
$142.45
|
| Rate for Payer: Humana ChoiceCare |
$133.74
|
| Rate for Payer: Humana Medicare |
$49.55
|
| Rate for Payer: Lucent All Commercial |
$84.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.36
|
| Rate for Payer: Managed Health Services Medicaid |
$10.74
|
| Rate for Payer: MDWise Medicaid |
$10.74
|
| Rate for Payer: PHCS All Commercial |
$116.13
|
| Rate for Payer: PHP All Commercial |
$117.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.39
|
| Rate for Payer: Sagamore Health Network All Products |
$119.54
|
| Rate for Payer: Signature Care EPO |
$128.52
|
| Rate for Payer: Signature Care PPO |
$136.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.61
|
| Rate for Payer: United Healthcare Commercial |
$122.01
|
| Rate for Payer: United Healthcare Medicare |
$49.55
|
|
|
HC HEP B SURFACE AB
|
Facility
|
IP
|
$154.84
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
63001215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.13 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$133.78
|
| Rate for Payer: Cash Price |
$92.90
|
| Rate for Payer: Cigna All Commercial |
$133.63
|
| Rate for Payer: CORVEL All Commercial |
$144.00
|
| Rate for Payer: Coventry All Commercial |
$136.26
|
| Rate for Payer: Encore All Commercial |
$142.53
|
| Rate for Payer: Frontpath All Commercial |
$142.45
|
| Rate for Payer: Humana ChoiceCare |
$133.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.36
|
| Rate for Payer: PHCS All Commercial |
$116.13
|
| Rate for Payer: PHP All Commercial |
$117.43
|
| Rate for Payer: Sagamore Health Network All Products |
$119.54
|
| Rate for Payer: Signature Care EPO |
$128.52
|
| Rate for Payer: Signature Care PPO |
$136.26
|
| Rate for Payer: United Healthcare Commercial |
$122.01
|
|
|
HC HEP B SURFACE AB
|
Facility
|
IP
|
$154.84
|
|
|
Service Code
|
CPT G0499
|
| Hospital Charge Code |
63001215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.13 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$133.78
|
| Rate for Payer: Cash Price |
$92.90
|
| Rate for Payer: Cigna All Commercial |
$133.63
|
| Rate for Payer: CORVEL All Commercial |
$144.00
|
| Rate for Payer: Coventry All Commercial |
$136.26
|
| Rate for Payer: Encore All Commercial |
$142.53
|
| Rate for Payer: Frontpath All Commercial |
$142.45
|
| Rate for Payer: Humana ChoiceCare |
$133.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.36
|
| Rate for Payer: PHCS All Commercial |
$116.13
|
| Rate for Payer: PHP All Commercial |
$117.43
|
| Rate for Payer: Sagamore Health Network All Products |
$119.54
|
| Rate for Payer: Signature Care EPO |
$128.52
|
| Rate for Payer: Signature Care PPO |
$136.26
|
| Rate for Payer: United Healthcare Commercial |
$122.01
|
|
|
HC HEP B VIRAL DNA
|
Facility
|
OP
|
$471.24
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
63002039
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$438.25 |
| Rate for Payer: Aetna Commercial |
$397.73
|
| Rate for Payer: Aetna Medicare |
$150.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$216.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$216.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.88
|
| Rate for Payer: Cash Price |
$282.74
|
| Rate for Payer: Cash Price |
$282.74
|
| Rate for Payer: Centivo All Commercial |
$256.35
|
| Rate for Payer: Cigna All Commercial |
$406.68
|
| Rate for Payer: CORVEL All Commercial |
$438.25
|
| Rate for Payer: Coventry All Commercial |
$414.69
|
| Rate for Payer: Encore All Commercial |
$433.78
|
| Rate for Payer: Frontpath All Commercial |
$433.54
|
| Rate for Payer: Humana ChoiceCare |
$407.01
|
| Rate for Payer: Humana Medicare |
$150.80
|
| Rate for Payer: Lucent All Commercial |
$256.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.12
|
| Rate for Payer: Managed Health Services Medicaid |
$42.84
|
| Rate for Payer: MDWise Medicaid |
$42.84
|
| Rate for Payer: PHCS All Commercial |
$353.43
|
| Rate for Payer: PHP All Commercial |
$357.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$183.78
|
| Rate for Payer: Sagamore Health Network All Products |
$363.80
|
| Rate for Payer: Signature Care EPO |
$391.13
|
| Rate for Payer: Signature Care PPO |
$414.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.55
|
| Rate for Payer: United Healthcare Commercial |
$371.34
|
| Rate for Payer: United Healthcare Medicare |
$150.80
|
|
|
HC HEP B VIRAL DNA
|
Facility
|
IP
|
$471.24
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
63002039
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$353.43 |
| Max. Negotiated Rate |
$438.25 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: Cash Price |
$282.74
|
| Rate for Payer: Cigna All Commercial |
$406.68
|
| Rate for Payer: CORVEL All Commercial |
$438.25
|
| Rate for Payer: Coventry All Commercial |
$414.69
|
| Rate for Payer: Encore All Commercial |
$433.78
|
| Rate for Payer: Frontpath All Commercial |
$433.54
|
| Rate for Payer: Humana ChoiceCare |
$407.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.12
|
| Rate for Payer: PHCS All Commercial |
$353.43
|
| Rate for Payer: PHP All Commercial |
$357.39
|
| Rate for Payer: Sagamore Health Network All Products |
$363.80
|
| Rate for Payer: Signature Care EPO |
$391.13
|
| Rate for Payer: Signature Care PPO |
$414.69
|
| Rate for Payer: United Healthcare Commercial |
$371.34
|
|
|
HC HEP C GENOTYPE PCR
|
Facility
|
IP
|
$1,113.02
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
63002056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$834.76 |
| Max. Negotiated Rate |
$1,035.11 |
| Rate for Payer: Aetna Commercial |
$961.65
|
| Rate for Payer: Cash Price |
$667.81
|
| Rate for Payer: Cigna All Commercial |
$960.54
|
| Rate for Payer: CORVEL All Commercial |
$1,035.11
|
| Rate for Payer: Coventry All Commercial |
$979.46
|
| Rate for Payer: Encore All Commercial |
$1,024.53
|
| Rate for Payer: Frontpath All Commercial |
$1,023.98
|
| Rate for Payer: Humana ChoiceCare |
$961.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,001.72
|
| Rate for Payer: PHCS All Commercial |
$834.76
|
| Rate for Payer: PHP All Commercial |
$844.11
|
| Rate for Payer: Sagamore Health Network All Products |
$859.25
|
| Rate for Payer: Signature Care EPO |
$923.81
|
| Rate for Payer: Signature Care PPO |
$979.46
|
| Rate for Payer: United Healthcare Commercial |
$877.06
|
|
|
HC HEP C GENOTYPE PCR
|
Facility
|
OP
|
$1,113.02
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
63002056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$1,035.11 |
| Rate for Payer: Aetna Commercial |
$939.39
|
| Rate for Payer: Aetna Medicare |
$356.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$257.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$345.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$511.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$511.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$257.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$409.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$391.78
|
| Rate for Payer: Cash Price |
$667.81
|
| Rate for Payer: Cash Price |
$667.81
|
| Rate for Payer: Centivo All Commercial |
$605.48
|
| Rate for Payer: Cigna All Commercial |
$960.54
|
| Rate for Payer: CORVEL All Commercial |
$1,035.11
|
| Rate for Payer: Coventry All Commercial |
$979.46
|
| Rate for Payer: Encore All Commercial |
$1,024.53
|
| Rate for Payer: Frontpath All Commercial |
$1,023.98
|
| Rate for Payer: Humana ChoiceCare |
$961.32
|
| Rate for Payer: Humana Medicare |
$356.17
|
| Rate for Payer: Lucent All Commercial |
$605.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,001.72
|
| Rate for Payer: Managed Health Services Medicaid |
$257.45
|
| Rate for Payer: MDWise Medicaid |
$257.45
|
| Rate for Payer: PHCS All Commercial |
$834.76
|
| Rate for Payer: PHP All Commercial |
$844.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.08
|
| Rate for Payer: Sagamore Health Network All Products |
$859.25
|
| Rate for Payer: Signature Care EPO |
$923.81
|
| Rate for Payer: Signature Care PPO |
$979.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$946.07
|
| Rate for Payer: United Healthcare Commercial |
$877.06
|
| Rate for Payer: United Healthcare Medicare |
$356.17
|
|
|
HC HEP C GENOTYPE PCR REFLEX
|
Facility
|
OP
|
$1,355.96
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
63002057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$1,261.04 |
| Rate for Payer: Aetna Commercial |
$1,144.43
|
| Rate for Payer: Aetna Medicare |
$433.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$257.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$420.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$623.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$257.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$498.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$477.30
|
| Rate for Payer: Cash Price |
$813.58
|
| Rate for Payer: Cash Price |
$813.58
|
| Rate for Payer: Centivo All Commercial |
$737.64
|
| Rate for Payer: Cigna All Commercial |
$1,170.19
|
| Rate for Payer: CORVEL All Commercial |
$1,261.04
|
| Rate for Payer: Coventry All Commercial |
$1,193.24
|
| Rate for Payer: Encore All Commercial |
$1,248.16
|
| Rate for Payer: Frontpath All Commercial |
$1,247.48
|
| Rate for Payer: Humana ChoiceCare |
$1,171.14
|
| Rate for Payer: Humana Medicare |
$433.91
|
| Rate for Payer: Lucent All Commercial |
$737.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,220.36
|
| Rate for Payer: Managed Health Services Medicaid |
$257.45
|
| Rate for Payer: MDWise Medicaid |
$257.45
|
| Rate for Payer: PHCS All Commercial |
$1,016.97
|
| Rate for Payer: PHP All Commercial |
$1,028.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$528.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1,046.80
|
| Rate for Payer: Signature Care EPO |
$1,125.45
|
| Rate for Payer: Signature Care PPO |
$1,193.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,152.57
|
| Rate for Payer: United Healthcare Commercial |
$1,068.50
|
| Rate for Payer: United Healthcare Medicare |
$433.91
|
|
|
HC HEP C GENOTYPE PCR REFLEX
|
Facility
|
IP
|
$1,355.96
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
63002057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,016.97 |
| Max. Negotiated Rate |
$1,261.04 |
| Rate for Payer: Aetna Commercial |
$1,171.55
|
| Rate for Payer: Cash Price |
$813.58
|
| Rate for Payer: Cigna All Commercial |
$1,170.19
|
| Rate for Payer: CORVEL All Commercial |
$1,261.04
|
| Rate for Payer: Coventry All Commercial |
$1,193.24
|
| Rate for Payer: Encore All Commercial |
$1,248.16
|
| Rate for Payer: Frontpath All Commercial |
$1,247.48
|
| Rate for Payer: Humana ChoiceCare |
$1,171.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,220.36
|
| Rate for Payer: PHCS All Commercial |
$1,016.97
|
| Rate for Payer: PHP All Commercial |
$1,028.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,046.80
|
| Rate for Payer: Signature Care EPO |
$1,125.45
|
| Rate for Payer: Signature Care PPO |
$1,193.24
|
| Rate for Payer: United Healthcare Commercial |
$1,068.50
|
|
|
HC HEP C RNA PCR QT
|
Facility
|
OP
|
$645.15
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
63002041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$599.99 |
| Rate for Payer: Aetna Commercial |
$544.51
|
| Rate for Payer: Aetna Medicare |
$206.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$200.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$296.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$296.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.09
|
| Rate for Payer: Cash Price |
$387.09
|
| Rate for Payer: Cash Price |
$387.09
|
| Rate for Payer: Centivo All Commercial |
$350.96
|
| Rate for Payer: Cigna All Commercial |
$556.76
|
| Rate for Payer: CORVEL All Commercial |
$599.99
|
| Rate for Payer: Coventry All Commercial |
$567.73
|
| Rate for Payer: Encore All Commercial |
$593.86
|
| Rate for Payer: Frontpath All Commercial |
$593.54
|
| Rate for Payer: Humana ChoiceCare |
$557.22
|
| Rate for Payer: Humana Medicare |
$206.45
|
| Rate for Payer: Lucent All Commercial |
$350.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$580.63
|
| Rate for Payer: Managed Health Services Medicaid |
$42.84
|
| Rate for Payer: MDWise Medicaid |
$42.84
|
| Rate for Payer: PHCS All Commercial |
$483.86
|
| Rate for Payer: PHP All Commercial |
$489.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$251.61
|
| Rate for Payer: Sagamore Health Network All Products |
$498.06
|
| Rate for Payer: Signature Care EPO |
$535.47
|
| Rate for Payer: Signature Care PPO |
$567.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$548.38
|
| Rate for Payer: United Healthcare Commercial |
$508.38
|
| Rate for Payer: United Healthcare Medicare |
$206.45
|
|
|
HC HEP C RNA PCR QT
|
Facility
|
IP
|
$645.15
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
63002041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$483.86 |
| Max. Negotiated Rate |
$599.99 |
| Rate for Payer: Aetna Commercial |
$557.41
|
| Rate for Payer: Cash Price |
$387.09
|
| Rate for Payer: Cigna All Commercial |
$556.76
|
| Rate for Payer: CORVEL All Commercial |
$599.99
|
| Rate for Payer: Coventry All Commercial |
$567.73
|
| Rate for Payer: Encore All Commercial |
$593.86
|
| Rate for Payer: Frontpath All Commercial |
$593.54
|
| Rate for Payer: Humana ChoiceCare |
$557.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$580.63
|
| Rate for Payer: PHCS All Commercial |
$483.86
|
| Rate for Payer: PHP All Commercial |
$489.28
|
| Rate for Payer: Sagamore Health Network All Products |
$498.06
|
| Rate for Payer: Signature Care EPO |
$535.47
|
| Rate for Payer: Signature Care PPO |
$567.73
|
| Rate for Payer: United Healthcare Commercial |
$508.38
|
|
|
HC HEP C RNA PCR QT W/ GENOTYPE IF IND.
|
Facility
|
IP
|
$645.15
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
63002042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$483.86 |
| Max. Negotiated Rate |
$599.99 |
| Rate for Payer: Aetna Commercial |
$557.41
|
| Rate for Payer: Cash Price |
$387.09
|
| Rate for Payer: Cigna All Commercial |
$556.76
|
| Rate for Payer: CORVEL All Commercial |
$599.99
|
| Rate for Payer: Coventry All Commercial |
$567.73
|
| Rate for Payer: Encore All Commercial |
$593.86
|
| Rate for Payer: Frontpath All Commercial |
$593.54
|
| Rate for Payer: Humana ChoiceCare |
$557.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$580.63
|
| Rate for Payer: PHCS All Commercial |
$483.86
|
| Rate for Payer: PHP All Commercial |
$489.28
|
| Rate for Payer: Sagamore Health Network All Products |
$498.06
|
| Rate for Payer: Signature Care EPO |
$535.47
|
| Rate for Payer: Signature Care PPO |
$567.73
|
| Rate for Payer: United Healthcare Commercial |
$508.38
|
|
|
HC HEP C RNA PCR QT W/ GENOTYPE IF IND.
|
Facility
|
OP
|
$645.15
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
63002042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$599.99 |
| Rate for Payer: Aetna Commercial |
$544.51
|
| Rate for Payer: Aetna Medicare |
$206.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$200.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$296.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$296.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.09
|
| Rate for Payer: Cash Price |
$387.09
|
| Rate for Payer: Cash Price |
$387.09
|
| Rate for Payer: Centivo All Commercial |
$350.96
|
| Rate for Payer: Cigna All Commercial |
$556.76
|
| Rate for Payer: CORVEL All Commercial |
$599.99
|
| Rate for Payer: Coventry All Commercial |
$567.73
|
| Rate for Payer: Encore All Commercial |
$593.86
|
| Rate for Payer: Frontpath All Commercial |
$593.54
|
| Rate for Payer: Humana ChoiceCare |
$557.22
|
| Rate for Payer: Humana Medicare |
$206.45
|
| Rate for Payer: Lucent All Commercial |
$350.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$580.63
|
| Rate for Payer: Managed Health Services Medicaid |
$42.84
|
| Rate for Payer: MDWise Medicaid |
$42.84
|
| Rate for Payer: PHCS All Commercial |
$483.86
|
| Rate for Payer: PHP All Commercial |
$489.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$251.61
|
| Rate for Payer: Sagamore Health Network All Products |
$498.06
|
| Rate for Payer: Signature Care EPO |
$535.47
|
| Rate for Payer: Signature Care PPO |
$567.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$548.38
|
| Rate for Payer: United Healthcare Commercial |
$508.38
|
| Rate for Payer: United Healthcare Medicare |
$206.45
|
|
|
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 |
$183.69 |
| Max. Negotiated Rate |
$803.63 |
| Rate for Payer: Aetna Commercial |
$729.32
|
| Rate for Payer: Aetna Medicare |
$276.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$183.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$267.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$397.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$397.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$183.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$318.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$304.17
|
| Rate for Payer: Cash Price |
$518.47
|
| Rate for Payer: Cash Price |
$518.47
|
| Rate for Payer: Centivo All Commercial |
$470.08
|
| 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 |
$795.42
|
| Rate for Payer: Frontpath All Commercial |
$794.99
|
| Rate for Payer: Humana ChoiceCare |
$746.34
|
| Rate for Payer: Humana Medicare |
$276.52
|
| Rate for Payer: Lucent All Commercial |
$470.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$777.71
|
| Rate for Payer: Managed Health Services Medicaid |
$183.69
|
| Rate for Payer: MDWise Medicaid |
$183.69
|
| 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 |
$734.50
|
| Rate for Payer: United Healthcare Commercial |
$680.93
|
| Rate for Payer: United Healthcare Medicare |
$276.52
|
|
|
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 |
$518.47
|
| 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 |
$795.42
|
| 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
|
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 |
$285.67
|
| Rate for Payer: Cigna All Commercial |
$410.88
|
| Rate for Payer: CORVEL All Commercial |
$442.78
|
| Rate for Payer: Coventry All Commercial |
$418.98
|
| Rate for Payer: Encore All Commercial |
$438.26
|
| Rate for Payer: Frontpath All Commercial |
$438.02
|
| Rate for Payer: Humana ChoiceCare |
$411.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.50
|
| Rate for Payer: PHCS All Commercial |
$357.08
|
| Rate for Payer: PHP All Commercial |
$361.08
|
| Rate for Payer: Sagamore Health Network All Products |
$367.56
|
| Rate for Payer: Signature Care EPO |
$395.17
|
| Rate for Payer: Signature Care PPO |
$418.98
|
| Rate for Payer: United Healthcare Commercial |
$375.17
|
|
|
HC HERCEPT MORPH ANALYSIS
|
Facility
|
OP
|
$476.11
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
63002129
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$147.59 |
| Max. Negotiated Rate |
$442.78 |
| Rate for Payer: Aetna Commercial |
$401.84
|
| Rate for Payer: Aetna Medicare |
$152.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$183.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$218.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$183.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.59
|
| Rate for Payer: Cash Price |
$285.67
|
| Rate for Payer: Cash Price |
$285.67
|
| Rate for Payer: Centivo All Commercial |
$259.00
|
| Rate for Payer: Cigna All Commercial |
$410.88
|
| Rate for Payer: CORVEL All Commercial |
$442.78
|
| Rate for Payer: Coventry All Commercial |
$418.98
|
| Rate for Payer: Encore All Commercial |
$438.26
|
| Rate for Payer: Frontpath All Commercial |
$438.02
|
| Rate for Payer: Humana ChoiceCare |
$411.22
|
| Rate for Payer: Humana Medicare |
$152.36
|
| Rate for Payer: Lucent All Commercial |
$259.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.50
|
| Rate for Payer: Managed Health Services Medicaid |
$183.69
|
| Rate for Payer: MDWise Medicaid |
$183.69
|
| 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 |
$367.56
|
| Rate for Payer: Signature Care EPO |
$395.17
|
| Rate for Payer: Signature Care PPO |
$418.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$404.69
|
| Rate for Payer: United Healthcare Commercial |
$375.17
|
| Rate for Payer: United Healthcare Medicare |
$152.36
|
|
|
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 |
$99.10
|
| 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 |
$130.15
|
|
|
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 |
$139.40
|
| Rate for Payer: Aetna Medicare |
$52.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.14
|
| Rate for Payer: Cash Price |
$99.10
|
| Rate for Payer: Cash Price |
$99.10
|
| Rate for Payer: Centivo All Commercial |
$89.85
|
| 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 |
$52.85
|
| Rate for Payer: Lucent All Commercial |
$89.85
|
| 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 |
$140.39
|
| Rate for Payer: United Healthcare Commercial |
$130.15
|
| Rate for Payer: United Healthcare Medicare |
$52.85
|
|
