|
HC IMMUN ADMIN EA ADD
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1689116
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
|
|
HC IMMUN ADMIN EA ADD
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1689116
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.31
|
| Rate for Payer: Cash Price |
$55.08
|
| Rate for Payer: Centivo All Commercial |
$49.94
|
| Rate for Payer: Cigna All Commercial |
$79.22
|
| Rate for Payer: CORVEL All Commercial |
$85.37
|
| Rate for Payer: Coventry All Commercial |
$80.78
|
| Rate for Payer: Encore All Commercial |
$84.50
|
| Rate for Payer: Frontpath All Commercial |
$84.46
|
| Rate for Payer: Humana ChoiceCare |
$79.29
|
| Rate for Payer: Humana Medicare |
$29.38
|
| Rate for Payer: Lucent All Commercial |
$49.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.62
|
| Rate for Payer: PHCS All Commercial |
$68.85
|
| Rate for Payer: PHP All Commercial |
$69.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.80
|
| Rate for Payer: Sagamore Health Network All Products |
$70.87
|
| Rate for Payer: Signature Care EPO |
$76.19
|
| Rate for Payer: Signature Care PPO |
$80.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.03
|
| Rate for Payer: United Healthcare Commercial |
$72.34
|
| Rate for Payer: United Healthcare Medicare |
$29.38
|
|
|
HC IMMUNE ADMIN ORAL/NASAL 1 VACCINE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
520473
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna Commercial |
$17.28
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna All Commercial |
$17.26
|
| Rate for Payer: CORVEL All Commercial |
$18.60
|
| Rate for Payer: Coventry All Commercial |
$17.60
|
| Rate for Payer: Encore All Commercial |
$18.41
|
| Rate for Payer: Frontpath All Commercial |
$18.40
|
| Rate for Payer: Humana ChoiceCare |
$17.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.00
|
| Rate for Payer: PHCS All Commercial |
$15.00
|
| Rate for Payer: PHP All Commercial |
$15.17
|
| Rate for Payer: Sagamore Health Network All Products |
$15.44
|
| Rate for Payer: Signature Care EPO |
$16.60
|
| Rate for Payer: Signature Care PPO |
$17.60
|
| Rate for Payer: United Healthcare Commercial |
$15.76
|
|
|
HC IMMUNE ADMIN ORAL/NASAL 1 VACCINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
520473
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna Commercial |
$16.88
|
| Rate for Payer: Aetna Medicare |
$6.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.04
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Centivo All Commercial |
$10.88
|
| Rate for Payer: Cigna All Commercial |
$17.26
|
| Rate for Payer: CORVEL All Commercial |
$18.60
|
| Rate for Payer: Coventry All Commercial |
$17.60
|
| Rate for Payer: Encore All Commercial |
$18.41
|
| Rate for Payer: Frontpath All Commercial |
$18.40
|
| Rate for Payer: Humana ChoiceCare |
$17.27
|
| Rate for Payer: Humana Medicare |
$6.40
|
| Rate for Payer: Lucent All Commercial |
$10.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.00
|
| Rate for Payer: PHCS All Commercial |
$15.00
|
| Rate for Payer: PHP All Commercial |
$15.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.80
|
| Rate for Payer: Sagamore Health Network All Products |
$15.44
|
| Rate for Payer: Signature Care EPO |
$16.60
|
| Rate for Payer: Signature Care PPO |
$17.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.00
|
| Rate for Payer: United Healthcare Commercial |
$15.76
|
| Rate for Payer: United Healthcare Medicare |
$6.40
|
|
|
HC IMMUNE ADMIN ORAL/NASAL ADDL
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
520474
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna Commercial |
$18.33
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: Cigna All Commercial |
$18.31
|
| Rate for Payer: CORVEL All Commercial |
$19.73
|
| Rate for Payer: Coventry All Commercial |
$18.67
|
| Rate for Payer: Encore All Commercial |
$19.53
|
| Rate for Payer: Frontpath All Commercial |
$19.52
|
| Rate for Payer: Humana ChoiceCare |
$18.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.10
|
| Rate for Payer: PHCS All Commercial |
$15.91
|
| Rate for Payer: PHP All Commercial |
$16.09
|
| Rate for Payer: Sagamore Health Network All Products |
$16.38
|
| Rate for Payer: Signature Care EPO |
$17.61
|
| Rate for Payer: Signature Care PPO |
$18.67
|
| Rate for Payer: United Healthcare Commercial |
$16.72
|
|
|
HC IMMUNE ADMIN ORAL/NASAL ADDL
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
520474
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna Medicare |
$6.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.47
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: Centivo All Commercial |
$11.54
|
| Rate for Payer: Cigna All Commercial |
$18.31
|
| Rate for Payer: CORVEL All Commercial |
$19.73
|
| Rate for Payer: Coventry All Commercial |
$18.67
|
| Rate for Payer: Encore All Commercial |
$19.53
|
| Rate for Payer: Frontpath All Commercial |
$19.52
|
| Rate for Payer: Humana ChoiceCare |
$18.33
|
| Rate for Payer: Humana Medicare |
$6.79
|
| Rate for Payer: Lucent All Commercial |
$11.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.10
|
| Rate for Payer: PHCS All Commercial |
$15.91
|
| Rate for Payer: PHP All Commercial |
$16.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.28
|
| Rate for Payer: Sagamore Health Network All Products |
$16.38
|
| Rate for Payer: Signature Care EPO |
$17.61
|
| Rate for Payer: Signature Care PPO |
$18.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.04
|
| Rate for Payer: United Healthcare Commercial |
$16.72
|
| Rate for Payer: United Healthcare Medicare |
$6.79
|
|
|
HC IMMUNIZATION ADMIN- 1 VAC
|
Facility
|
IP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1689115
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
|
|
HC IMMUNIZATION ADMIN- 1 VAC
|
Facility
|
OP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1689115
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Centivo All Commercial |
$51.75
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Humana Medicare |
$30.44
|
| Rate for Payer: Lucent All Commercial |
$51.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.10
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$30.44
|
|
|
HC IMMUNOASSAY QT NOS
|
Facility
|
OP
|
$163.95
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$152.47 |
| Rate for Payer: Aetna Commercial |
$138.37
|
| Rate for Payer: Aetna Medicare |
$52.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.71
|
| Rate for Payer: Cash Price |
$98.37
|
| Rate for Payer: Cash Price |
$98.37
|
| Rate for Payer: Centivo All Commercial |
$89.19
|
| Rate for Payer: Cigna All Commercial |
$141.49
|
| Rate for Payer: CORVEL All Commercial |
$152.47
|
| Rate for Payer: Coventry All Commercial |
$144.28
|
| Rate for Payer: Encore All Commercial |
$150.92
|
| Rate for Payer: Frontpath All Commercial |
$150.83
|
| Rate for Payer: Humana ChoiceCare |
$141.60
|
| Rate for Payer: Humana Medicare |
$52.46
|
| Rate for Payer: Lucent All Commercial |
$89.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.56
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$122.96
|
| Rate for Payer: PHP All Commercial |
$124.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.94
|
| Rate for Payer: Sagamore Health Network All Products |
$126.57
|
| Rate for Payer: Signature Care EPO |
$136.08
|
| Rate for Payer: Signature Care PPO |
$144.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.36
|
| Rate for Payer: United Healthcare Commercial |
$129.19
|
| Rate for Payer: United Healthcare Medicare |
$52.46
|
|
|
HC IMMUNOASSAY QT NOS
|
Facility
|
IP
|
$163.95
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.96 |
| Max. Negotiated Rate |
$152.47 |
| Rate for Payer: Aetna Commercial |
$141.65
|
| Rate for Payer: Cash Price |
$98.37
|
| Rate for Payer: Cigna All Commercial |
$141.49
|
| Rate for Payer: CORVEL All Commercial |
$152.47
|
| Rate for Payer: Coventry All Commercial |
$144.28
|
| Rate for Payer: Encore All Commercial |
$150.92
|
| Rate for Payer: Frontpath All Commercial |
$150.83
|
| Rate for Payer: Humana ChoiceCare |
$141.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.56
|
| Rate for Payer: PHCS All Commercial |
$122.96
|
| Rate for Payer: PHP All Commercial |
$124.34
|
| Rate for Payer: Sagamore Health Network All Products |
$126.57
|
| Rate for Payer: Signature Care EPO |
$136.08
|
| Rate for Payer: Signature Care PPO |
$144.28
|
| Rate for Payer: United Healthcare Commercial |
$129.19
|
|
|
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 |
$67.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.51
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Centivo All Commercial |
$115.15
|
| 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 |
$67.73
|
| Rate for Payer: Lucent All Commercial |
$115.15
|
| 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 |
$67.73
|
|
|
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 |
$180.89
|
| 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 |
$96.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$93.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$138.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$138.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.12
|
| Rate for Payer: Cash Price |
$180.89
|
| Rate for Payer: Cash Price |
$180.89
|
| Rate for Payer: Centivo All Commercial |
$164.01
|
| 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 |
$96.47
|
| Rate for Payer: Lucent All Commercial |
$164.01
|
| 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 |
$96.47
|
|
|
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 |
$127.00
|
| 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 - 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 |
$69.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.79
|
| Rate for Payer: Cash Price |
$130.89
|
| Rate for Payer: Cash Price |
$130.89
|
| Rate for Payer: Centivo All Commercial |
$118.67
|
| 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 |
$200.81
|
| Rate for Payer: Frontpath All Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$188.42
|
| Rate for Payer: Humana Medicare |
$69.81
|
| Rate for Payer: Lucent All Commercial |
$118.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.34
|
| 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 |
$69.81
|
|
|
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 |
$130.89
|
| 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 |
$200.81
|
| Rate for Payer: Frontpath All Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$188.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.34
|
| 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 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 |
$94.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$22.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$135.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.84
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Centivo All Commercial |
$160.48
|
| 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 |
$254.79
|
| Rate for Payer: Humana Medicare |
$94.40
|
| Rate for Payer: Lucent All Commercial |
$160.48
|
| 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 |
$94.40
|
|
|
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 |
$177.00
|
| 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 |
$254.79
|
| 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 |
$249.06
|
| Rate for Payer: Aetna Medicare |
$94.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$29.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$135.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$29.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.87
|
| Rate for Payer: Cash Price |
$177.05
|
| Rate for Payer: Cash Price |
$177.05
|
| Rate for Payer: Centivo All Commercial |
$160.53
|
| 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 |
$94.43
|
| Rate for Payer: Lucent All Commercial |
$160.53
|
| 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 |
$221.32
|
| Rate for Payer: PHP All Commercial |
$223.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.09
|
| 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 |
$250.83
|
| Rate for Payer: United Healthcare Commercial |
$232.53
|
| Rate for Payer: United Healthcare Medicare |
$94.43
|
|
|
HC IMMUNOFIXATION URINE
|
Facility
|
IP
|
$295.09
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
63001208
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$221.32 |
| Max. Negotiated Rate |
$274.43 |
| Rate for Payer: Aetna Commercial |
$254.96
|
| Rate for Payer: Cash Price |
$177.05
|
| 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 |
$221.32
|
| Rate for Payer: PHP All Commercial |
$223.80
|
| 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 |
$185.53 |
| Max. Negotiated Rate |
$230.06 |
| Rate for Payer: Aetna Commercial |
$213.74
|
| Rate for Payer: Cash Price |
$148.43
|
| 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 |
$185.53
|
| 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 |
$76.69 |
| Max. Negotiated Rate |
$230.06 |
| Rate for Payer: Aetna Commercial |
$208.79
|
| Rate for Payer: Aetna Medicare |
$79.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$209.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$113.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$209.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.08
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Centivo All Commercial |
$134.57
|
| 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 |
$79.16
|
| Rate for Payer: Lucent All Commercial |
$134.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$222.64
|
| Rate for Payer: Managed Health Services Medicaid |
$209.42
|
| Rate for Payer: MDWise Medicaid |
$209.42
|
| Rate for Payer: PHCS All Commercial |
$185.53
|
| 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 |
$79.16
|
|
|
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: Aetna Commercial |
$88.77
|
| Rate for Payer: Cash Price |
$61.64
|
| Rate for Payer: Cigna All Commercial |
$88.66
|
| Rate for Payer: CORVEL All Commercial |
$95.55
|
| Rate for Payer: Coventry All Commercial |
$90.41
|
| Rate for Payer: Encore All Commercial |
$94.57
|
| Rate for Payer: Frontpath All Commercial |
$94.52
|
| 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 |
$85.27
|
| Rate for Payer: Signature Care PPO |
$90.41
|
| Rate for Payer: United Healthcare Commercial |
$80.96
|
|
|
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 |
$120.59 |
| Rate for Payer: Aetna Commercial |
$112.03
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.59
|
| 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 |
$116.70
|
| 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
|
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 |
$86.71
|
| Rate for Payer: Aetna Medicare |
$32.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.16
|
| Rate for Payer: Cash Price |
$61.64
|
| Rate for Payer: Cash Price |
$61.64
|
| Rate for Payer: Centivo All Commercial |
$55.89
|
| Rate for Payer: Cigna All Commercial |
$88.66
|
| Rate for Payer: CORVEL All Commercial |
$95.55
|
| Rate for Payer: Coventry All Commercial |
$90.41
|
| Rate for Payer: Encore All Commercial |
$94.57
|
| Rate for Payer: Frontpath All Commercial |
$94.52
|
| Rate for Payer: Humana ChoiceCare |
$88.74
|
| Rate for Payer: Humana Medicare |
$32.88
|
| Rate for Payer: Lucent All Commercial |
$55.89
|
| 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 |
$85.27
|
| Rate for Payer: Signature Care PPO |
$90.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.33
|
| Rate for Payer: United Healthcare Commercial |
$80.96
|
| Rate for Payer: United Healthcare Medicare |
$32.88
|
|
