|
HC PROTECTORS PIN WHITE
|
Facility
|
IP
|
$47.02
|
|
| Hospital Charge Code |
41602393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.27 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna Commercial |
$40.63
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cigna All Commercial |
$40.58
|
| Rate for Payer: CORVEL All Commercial |
$43.73
|
| Rate for Payer: Coventry All Commercial |
$41.38
|
| Rate for Payer: Encore All Commercial |
$43.28
|
| Rate for Payer: Frontpath All Commercial |
$43.26
|
| Rate for Payer: Humana ChoiceCare |
$40.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.32
|
| Rate for Payer: PHCS All Commercial |
$35.27
|
| Rate for Payer: PHP All Commercial |
$35.66
|
| Rate for Payer: Sagamore Health Network All Products |
$36.30
|
| Rate for Payer: Signature Care EPO |
$39.03
|
| Rate for Payer: Signature Care PPO |
$41.38
|
| Rate for Payer: United Healthcare Commercial |
$37.05
|
|
|
HC PROTEIN BF
|
Facility
|
IP
|
$123.94
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
63001184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$107.08
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cigna All Commercial |
$106.96
|
| Rate for Payer: CORVEL All Commercial |
$115.26
|
| Rate for Payer: Coventry All Commercial |
$109.07
|
| Rate for Payer: Encore All Commercial |
$114.09
|
| Rate for Payer: Frontpath All Commercial |
$114.02
|
| Rate for Payer: Humana ChoiceCare |
$107.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.55
|
| Rate for Payer: PHCS All Commercial |
$92.95
|
| Rate for Payer: PHP All Commercial |
$94.00
|
| Rate for Payer: Sagamore Health Network All Products |
$95.68
|
| Rate for Payer: Signature Care EPO |
$102.87
|
| Rate for Payer: Signature Care PPO |
$109.07
|
| Rate for Payer: United Healthcare Commercial |
$97.66
|
|
|
HC PROTEIN BF
|
Facility
|
OP
|
$123.94
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
63001184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$104.61
|
| Rate for Payer: Aetna Medicare |
$39.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.63
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Centivo All Commercial |
$67.42
|
| Rate for Payer: Cigna All Commercial |
$106.96
|
| Rate for Payer: CORVEL All Commercial |
$115.26
|
| Rate for Payer: Coventry All Commercial |
$109.07
|
| Rate for Payer: Encore All Commercial |
$114.09
|
| Rate for Payer: Frontpath All Commercial |
$114.02
|
| Rate for Payer: Humana ChoiceCare |
$107.05
|
| Rate for Payer: Humana Medicare |
$39.66
|
| Rate for Payer: Lucent All Commercial |
$67.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.55
|
| Rate for Payer: Managed Health Services Medicaid |
$4.00
|
| Rate for Payer: MDWise Medicaid |
$4.00
|
| Rate for Payer: PHCS All Commercial |
$92.95
|
| Rate for Payer: PHP All Commercial |
$94.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.34
|
| Rate for Payer: Sagamore Health Network All Products |
$95.68
|
| Rate for Payer: Signature Care EPO |
$102.87
|
| Rate for Payer: Signature Care PPO |
$109.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.35
|
| Rate for Payer: United Healthcare Commercial |
$97.66
|
| Rate for Payer: United Healthcare Medicare |
$39.66
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
|
OP
|
$330.99
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
63001741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$307.82 |
| Rate for Payer: Aetna Commercial |
$279.36
|
| Rate for Payer: Aetna Medicare |
$105.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$152.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$152.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.51
|
| Rate for Payer: Cash Price |
$198.59
|
| Rate for Payer: Cash Price |
$198.59
|
| Rate for Payer: Centivo All Commercial |
$180.06
|
| Rate for Payer: Cigna All Commercial |
$285.64
|
| Rate for Payer: CORVEL All Commercial |
$307.82
|
| Rate for Payer: Coventry All Commercial |
$291.27
|
| Rate for Payer: Encore All Commercial |
$304.68
|
| Rate for Payer: Frontpath All Commercial |
$304.51
|
| Rate for Payer: Humana ChoiceCare |
$285.88
|
| Rate for Payer: Humana Medicare |
$105.92
|
| Rate for Payer: Lucent All Commercial |
$180.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.89
|
| Rate for Payer: Managed Health Services Medicaid |
$13.84
|
| Rate for Payer: MDWise Medicaid |
$13.84
|
| Rate for Payer: PHCS All Commercial |
$248.24
|
| Rate for Payer: PHP All Commercial |
$251.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$129.09
|
| Rate for Payer: Sagamore Health Network All Products |
$255.52
|
| Rate for Payer: Signature Care EPO |
$274.72
|
| Rate for Payer: Signature Care PPO |
$291.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$281.34
|
| Rate for Payer: United Healthcare Commercial |
$260.82
|
| Rate for Payer: United Healthcare Medicare |
$105.92
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
|
IP
|
$330.99
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
63001741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$248.24 |
| Max. Negotiated Rate |
$307.82 |
| Rate for Payer: Aetna Commercial |
$285.98
|
| Rate for Payer: Cash Price |
$198.59
|
| Rate for Payer: Cigna All Commercial |
$285.64
|
| Rate for Payer: CORVEL All Commercial |
$307.82
|
| Rate for Payer: Coventry All Commercial |
$291.27
|
| Rate for Payer: Encore All Commercial |
$304.68
|
| Rate for Payer: Frontpath All Commercial |
$304.51
|
| Rate for Payer: Humana ChoiceCare |
$285.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.89
|
| Rate for Payer: PHCS All Commercial |
$248.24
|
| Rate for Payer: PHP All Commercial |
$251.02
|
| Rate for Payer: Sagamore Health Network All Products |
$255.52
|
| Rate for Payer: Signature Care EPO |
$274.72
|
| Rate for Payer: Signature Care PPO |
$291.27
|
| Rate for Payer: United Healthcare Commercial |
$260.82
|
|
|
HC PROTEIN C ANTIGEN AND PROTEIN S ANTIGEN PANEL
|
Facility
|
IP
|
$273.77
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
63044077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.33 |
| Max. Negotiated Rate |
$254.61 |
| Rate for Payer: Aetna Commercial |
$236.54
|
| Rate for Payer: Cash Price |
$164.26
|
| Rate for Payer: Cigna All Commercial |
$236.26
|
| Rate for Payer: CORVEL All Commercial |
$254.61
|
| Rate for Payer: Coventry All Commercial |
$240.92
|
| Rate for Payer: Encore All Commercial |
$252.01
|
| Rate for Payer: Frontpath All Commercial |
$251.87
|
| Rate for Payer: Humana ChoiceCare |
$236.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.39
|
| Rate for Payer: PHCS All Commercial |
$205.33
|
| Rate for Payer: PHP All Commercial |
$207.63
|
| Rate for Payer: Sagamore Health Network All Products |
$211.35
|
| Rate for Payer: Signature Care EPO |
$227.23
|
| Rate for Payer: Signature Care PPO |
$240.92
|
| Rate for Payer: United Healthcare Commercial |
$215.73
|
|
|
HC PROTEIN C ANTIGEN AND PROTEIN S ANTIGEN PANEL
|
Facility
|
OP
|
$273.77
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
63044077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$254.61 |
| Rate for Payer: Aetna Commercial |
$231.06
|
| Rate for Payer: Aetna Medicare |
$87.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$125.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.37
|
| Rate for Payer: Cash Price |
$164.26
|
| Rate for Payer: Cash Price |
$164.26
|
| Rate for Payer: Centivo All Commercial |
$148.93
|
| Rate for Payer: Cigna All Commercial |
$236.26
|
| Rate for Payer: CORVEL All Commercial |
$254.61
|
| Rate for Payer: Coventry All Commercial |
$240.92
|
| Rate for Payer: Encore All Commercial |
$252.01
|
| Rate for Payer: Frontpath All Commercial |
$251.87
|
| Rate for Payer: Humana ChoiceCare |
$236.46
|
| Rate for Payer: Humana Medicare |
$87.61
|
| Rate for Payer: Lucent All Commercial |
$148.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.39
|
| Rate for Payer: Managed Health Services Medicaid |
$12.01
|
| Rate for Payer: MDWise Medicaid |
$12.01
|
| Rate for Payer: PHCS All Commercial |
$205.33
|
| Rate for Payer: PHP All Commercial |
$207.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.77
|
| Rate for Payer: Sagamore Health Network All Products |
$211.35
|
| Rate for Payer: Signature Care EPO |
$227.23
|
| Rate for Payer: Signature Care PPO |
$240.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.70
|
| Rate for Payer: United Healthcare Commercial |
$215.73
|
| Rate for Payer: United Healthcare Medicare |
$87.61
|
|
|
HC PROTEIN C ANTIGEN AND PROTEIN S ANTIGEN PANEL-B
|
Facility
|
IP
|
$282.18
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
63044078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$211.63 |
| Max. Negotiated Rate |
$262.43 |
| Rate for Payer: Aetna Commercial |
$243.80
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cigna All Commercial |
$243.52
|
| Rate for Payer: CORVEL All Commercial |
$262.43
|
| Rate for Payer: Coventry All Commercial |
$248.32
|
| Rate for Payer: Encore All Commercial |
$259.75
|
| Rate for Payer: Frontpath All Commercial |
$259.61
|
| Rate for Payer: Humana ChoiceCare |
$243.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.96
|
| Rate for Payer: PHCS All Commercial |
$211.63
|
| Rate for Payer: PHP All Commercial |
$214.01
|
| Rate for Payer: Sagamore Health Network All Products |
$217.84
|
| Rate for Payer: Signature Care EPO |
$234.21
|
| Rate for Payer: Signature Care PPO |
$248.32
|
| Rate for Payer: United Healthcare Commercial |
$222.36
|
|
|
HC PROTEIN C ANTIGEN AND PROTEIN S ANTIGEN PANEL-B
|
Facility
|
OP
|
$282.18
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
63044078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$262.43 |
| Rate for Payer: Aetna Commercial |
$238.16
|
| Rate for Payer: Aetna Medicare |
$90.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$129.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.33
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Centivo All Commercial |
$153.51
|
| Rate for Payer: Cigna All Commercial |
$243.52
|
| Rate for Payer: CORVEL All Commercial |
$262.43
|
| Rate for Payer: Coventry All Commercial |
$248.32
|
| Rate for Payer: Encore All Commercial |
$259.75
|
| Rate for Payer: Frontpath All Commercial |
$259.61
|
| Rate for Payer: Humana ChoiceCare |
$243.72
|
| Rate for Payer: Humana Medicare |
$90.30
|
| Rate for Payer: Lucent All Commercial |
$153.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.96
|
| Rate for Payer: Managed Health Services Medicaid |
$11.61
|
| Rate for Payer: MDWise Medicaid |
$11.61
|
| Rate for Payer: PHCS All Commercial |
$211.63
|
| Rate for Payer: PHP All Commercial |
$214.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.05
|
| Rate for Payer: Sagamore Health Network All Products |
$217.84
|
| Rate for Payer: Signature Care EPO |
$234.21
|
| Rate for Payer: Signature Care PPO |
$248.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.85
|
| Rate for Payer: United Healthcare Commercial |
$222.36
|
| Rate for Payer: United Healthcare Medicare |
$90.30
|
|
|
HC PROTEIN S, FREE ANTIGEN
|
Facility
|
OP
|
$518.87
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
63001744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$482.55 |
| Rate for Payer: Aetna Commercial |
$437.93
|
| Rate for Payer: Aetna Medicare |
$166.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$160.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$238.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$190.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.64
|
| Rate for Payer: Cash Price |
$311.32
|
| Rate for Payer: Cash Price |
$311.32
|
| Rate for Payer: Centivo All Commercial |
$282.27
|
| Rate for Payer: Cigna All Commercial |
$447.78
|
| Rate for Payer: CORVEL All Commercial |
$482.55
|
| Rate for Payer: Coventry All Commercial |
$456.61
|
| Rate for Payer: Encore All Commercial |
$477.62
|
| Rate for Payer: Frontpath All Commercial |
$477.36
|
| Rate for Payer: Humana ChoiceCare |
$448.15
|
| Rate for Payer: Humana Medicare |
$166.04
|
| Rate for Payer: Lucent All Commercial |
$282.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.98
|
| Rate for Payer: Managed Health Services Medicaid |
$15.32
|
| Rate for Payer: MDWise Medicaid |
$15.32
|
| Rate for Payer: PHCS All Commercial |
$389.15
|
| Rate for Payer: PHP All Commercial |
$393.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.36
|
| Rate for Payer: Sagamore Health Network All Products |
$400.57
|
| Rate for Payer: Signature Care EPO |
$430.66
|
| Rate for Payer: Signature Care PPO |
$456.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.04
|
| Rate for Payer: United Healthcare Commercial |
$408.87
|
| Rate for Payer: United Healthcare Medicare |
$166.04
|
|
|
HC PROTEIN S, FREE ANTIGEN
|
Facility
|
IP
|
$518.87
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
63001744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$389.15 |
| Max. Negotiated Rate |
$482.55 |
| Rate for Payer: Aetna Commercial |
$448.30
|
| Rate for Payer: Cash Price |
$311.32
|
| Rate for Payer: Cigna All Commercial |
$447.78
|
| Rate for Payer: CORVEL All Commercial |
$482.55
|
| Rate for Payer: Coventry All Commercial |
$456.61
|
| Rate for Payer: Encore All Commercial |
$477.62
|
| Rate for Payer: Frontpath All Commercial |
$477.36
|
| Rate for Payer: Humana ChoiceCare |
$448.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.98
|
| Rate for Payer: PHCS All Commercial |
$389.15
|
| Rate for Payer: PHP All Commercial |
$393.51
|
| Rate for Payer: Sagamore Health Network All Products |
$400.57
|
| Rate for Payer: Signature Care EPO |
$430.66
|
| Rate for Payer: Signature Care PPO |
$456.61
|
| Rate for Payer: United Healthcare Commercial |
$408.87
|
|
|
HC PROTEIN S FUNCTIONAL
|
Facility
|
IP
|
$518.87
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
63001743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$389.15 |
| Max. Negotiated Rate |
$482.55 |
| Rate for Payer: Aetna Commercial |
$448.30
|
| Rate for Payer: Cash Price |
$311.32
|
| Rate for Payer: Cigna All Commercial |
$447.78
|
| Rate for Payer: CORVEL All Commercial |
$482.55
|
| Rate for Payer: Coventry All Commercial |
$456.61
|
| Rate for Payer: Encore All Commercial |
$477.62
|
| Rate for Payer: Frontpath All Commercial |
$477.36
|
| Rate for Payer: Humana ChoiceCare |
$448.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.98
|
| Rate for Payer: PHCS All Commercial |
$389.15
|
| Rate for Payer: PHP All Commercial |
$393.51
|
| Rate for Payer: Sagamore Health Network All Products |
$400.57
|
| Rate for Payer: Signature Care EPO |
$430.66
|
| Rate for Payer: Signature Care PPO |
$456.61
|
| Rate for Payer: United Healthcare Commercial |
$408.87
|
|
|
HC PROTEIN S FUNCTIONAL
|
Facility
|
OP
|
$518.87
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
63001743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$482.55 |
| Rate for Payer: Aetna Commercial |
$437.93
|
| Rate for Payer: Aetna Medicare |
$166.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$160.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$238.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$190.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.64
|
| Rate for Payer: Cash Price |
$311.32
|
| Rate for Payer: Cash Price |
$311.32
|
| Rate for Payer: Centivo All Commercial |
$282.27
|
| Rate for Payer: Cigna All Commercial |
$447.78
|
| Rate for Payer: CORVEL All Commercial |
$482.55
|
| Rate for Payer: Coventry All Commercial |
$456.61
|
| Rate for Payer: Encore All Commercial |
$477.62
|
| Rate for Payer: Frontpath All Commercial |
$477.36
|
| Rate for Payer: Humana ChoiceCare |
$448.15
|
| Rate for Payer: Humana Medicare |
$166.04
|
| Rate for Payer: Lucent All Commercial |
$282.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.98
|
| Rate for Payer: Managed Health Services Medicaid |
$15.32
|
| Rate for Payer: MDWise Medicaid |
$15.32
|
| Rate for Payer: PHCS All Commercial |
$389.15
|
| Rate for Payer: PHP All Commercial |
$393.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.36
|
| Rate for Payer: Sagamore Health Network All Products |
$400.57
|
| Rate for Payer: Signature Care EPO |
$430.66
|
| Rate for Payer: Signature Care PPO |
$456.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.04
|
| Rate for Payer: United Healthcare Commercial |
$408.87
|
| Rate for Payer: United Healthcare Medicare |
$166.04
|
|
|
HC PROTEIN S TOTAL
|
Facility
|
OP
|
$282.18
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
63001742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$262.43 |
| Rate for Payer: Aetna Commercial |
$238.16
|
| Rate for Payer: Aetna Medicare |
$90.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$129.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.33
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Centivo All Commercial |
$153.51
|
| Rate for Payer: Cigna All Commercial |
$243.52
|
| Rate for Payer: CORVEL All Commercial |
$262.43
|
| Rate for Payer: Coventry All Commercial |
$248.32
|
| Rate for Payer: Encore All Commercial |
$259.75
|
| Rate for Payer: Frontpath All Commercial |
$259.61
|
| Rate for Payer: Humana ChoiceCare |
$243.72
|
| Rate for Payer: Humana Medicare |
$90.30
|
| Rate for Payer: Lucent All Commercial |
$153.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.96
|
| Rate for Payer: Managed Health Services Medicaid |
$11.61
|
| Rate for Payer: MDWise Medicaid |
$11.61
|
| Rate for Payer: PHCS All Commercial |
$211.63
|
| Rate for Payer: PHP All Commercial |
$214.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.05
|
| Rate for Payer: Sagamore Health Network All Products |
$217.84
|
| Rate for Payer: Signature Care EPO |
$234.21
|
| Rate for Payer: Signature Care PPO |
$248.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.85
|
| Rate for Payer: United Healthcare Commercial |
$222.36
|
| Rate for Payer: United Healthcare Medicare |
$90.30
|
|
|
HC PROTEIN S TOTAL
|
Facility
|
IP
|
$282.18
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
63001742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$211.63 |
| Max. Negotiated Rate |
$262.43 |
| Rate for Payer: Aetna Commercial |
$243.80
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cigna All Commercial |
$243.52
|
| Rate for Payer: CORVEL All Commercial |
$262.43
|
| Rate for Payer: Coventry All Commercial |
$248.32
|
| Rate for Payer: Encore All Commercial |
$259.75
|
| Rate for Payer: Frontpath All Commercial |
$259.61
|
| Rate for Payer: Humana ChoiceCare |
$243.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.96
|
| Rate for Payer: PHCS All Commercial |
$211.63
|
| Rate for Payer: PHP All Commercial |
$214.01
|
| Rate for Payer: Sagamore Health Network All Products |
$217.84
|
| Rate for Payer: Signature Care EPO |
$234.21
|
| Rate for Payer: Signature Care PPO |
$248.32
|
| Rate for Payer: United Healthcare Commercial |
$222.36
|
|
|
HC PROTEIN TOTAL-24HR
|
Facility
|
IP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Cigna All Commercial |
$74.13
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.59
|
| Rate for Payer: Encore All Commercial |
$79.07
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: PHCS All Commercial |
$64.42
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Sagamore Health Network All Products |
$66.31
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.59
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
|
|
HC PROTEIN TOTAL-24HR
|
Facility
|
OP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$72.50
|
| Rate for Payer: Aetna Medicare |
$27.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$39.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.24
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Centivo All Commercial |
$46.73
|
| Rate for Payer: Cigna All Commercial |
$74.13
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.59
|
| Rate for Payer: Encore All Commercial |
$79.07
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.19
|
| Rate for Payer: Humana Medicare |
$27.49
|
| Rate for Payer: Lucent All Commercial |
$46.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: Managed Health Services Medicaid |
$3.67
|
| Rate for Payer: MDWise Medicaid |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$64.42
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.50
|
| Rate for Payer: Sagamore Health Network All Products |
$66.31
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.02
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
| Rate for Payer: United Healthcare Medicare |
$27.49
|
|
|
HC PROTEIN URINE
|
Facility
|
IP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Cigna All Commercial |
$74.13
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.59
|
| Rate for Payer: Encore All Commercial |
$79.07
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: PHCS All Commercial |
$64.42
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Sagamore Health Network All Products |
$66.31
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.59
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
|
|
HC PROTEIN URINE
|
Facility
|
OP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$72.50
|
| Rate for Payer: Aetna Medicare |
$27.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$39.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.24
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Centivo All Commercial |
$46.73
|
| Rate for Payer: Cigna All Commercial |
$74.13
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.59
|
| Rate for Payer: Encore All Commercial |
$79.07
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.19
|
| Rate for Payer: Humana Medicare |
$27.49
|
| Rate for Payer: Lucent All Commercial |
$46.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: Managed Health Services Medicaid |
$3.67
|
| Rate for Payer: MDWise Medicaid |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$64.42
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.50
|
| Rate for Payer: Sagamore Health Network All Products |
$66.31
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.02
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
| Rate for Payer: United Healthcare Medicare |
$27.49
|
|
|
HC PROTEIN URINE 24HR
|
Facility
|
OP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$72.50
|
| Rate for Payer: Aetna Medicare |
$27.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$39.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.24
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Centivo All Commercial |
$46.73
|
| Rate for Payer: Cigna All Commercial |
$74.13
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.59
|
| Rate for Payer: Encore All Commercial |
$79.07
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.19
|
| Rate for Payer: Humana Medicare |
$27.49
|
| Rate for Payer: Lucent All Commercial |
$46.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: Managed Health Services Medicaid |
$3.67
|
| Rate for Payer: MDWise Medicaid |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$64.42
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.50
|
| Rate for Payer: Sagamore Health Network All Products |
$66.31
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.02
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
| Rate for Payer: United Healthcare Medicare |
$27.49
|
|
|
HC PROTEIN URINE 24HR
|
Facility
|
IP
|
$85.90
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
63001669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: Cash Price |
$51.54
|
| Rate for Payer: Cigna All Commercial |
$74.13
|
| Rate for Payer: CORVEL All Commercial |
$79.89
|
| Rate for Payer: Coventry All Commercial |
$75.59
|
| Rate for Payer: Encore All Commercial |
$79.07
|
| Rate for Payer: Frontpath All Commercial |
$79.03
|
| Rate for Payer: Humana ChoiceCare |
$74.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.31
|
| Rate for Payer: PHCS All Commercial |
$64.42
|
| Rate for Payer: PHP All Commercial |
$65.15
|
| Rate for Payer: Sagamore Health Network All Products |
$66.31
|
| Rate for Payer: Signature Care EPO |
$71.30
|
| Rate for Payer: Signature Care PPO |
$75.59
|
| Rate for Payer: United Healthcare Commercial |
$67.69
|
|
|
HC PROTHROMBIN
|
Facility
|
IP
|
$51.11
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
63001272
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Aetna Commercial |
$44.16
|
| Rate for Payer: Cash Price |
$30.67
|
| Rate for Payer: Cigna All Commercial |
$44.11
|
| Rate for Payer: CORVEL All Commercial |
$47.53
|
| Rate for Payer: Coventry All Commercial |
$44.98
|
| Rate for Payer: Encore All Commercial |
$47.05
|
| Rate for Payer: Frontpath All Commercial |
$47.02
|
| Rate for Payer: Humana ChoiceCare |
$44.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.00
|
| Rate for Payer: PHCS All Commercial |
$38.33
|
| Rate for Payer: PHP All Commercial |
$38.76
|
| Rate for Payer: Sagamore Health Network All Products |
$39.46
|
| Rate for Payer: Signature Care EPO |
$42.42
|
| Rate for Payer: Signature Care PPO |
$44.98
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
|
|
HC PROTHROMBIN
|
Facility
|
OP
|
$51.11
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
63001272
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna Medicare |
$16.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.99
|
| Rate for Payer: Cash Price |
$30.67
|
| Rate for Payer: Cash Price |
$30.67
|
| Rate for Payer: Centivo All Commercial |
$27.80
|
| Rate for Payer: Cigna All Commercial |
$44.11
|
| Rate for Payer: CORVEL All Commercial |
$47.53
|
| Rate for Payer: Coventry All Commercial |
$44.98
|
| Rate for Payer: Encore All Commercial |
$47.05
|
| Rate for Payer: Frontpath All Commercial |
$47.02
|
| Rate for Payer: Humana ChoiceCare |
$44.14
|
| Rate for Payer: Humana Medicare |
$16.36
|
| Rate for Payer: Lucent All Commercial |
$27.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.00
|
| Rate for Payer: Managed Health Services Medicaid |
$4.29
|
| Rate for Payer: MDWise Medicaid |
$4.29
|
| Rate for Payer: PHCS All Commercial |
$38.33
|
| Rate for Payer: PHP All Commercial |
$38.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.93
|
| Rate for Payer: Sagamore Health Network All Products |
$39.46
|
| Rate for Payer: Signature Care EPO |
$42.42
|
| Rate for Payer: Signature Care PPO |
$44.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.44
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
| Rate for Payer: United Healthcare Medicare |
$16.36
|
|
|
HC PROTHROMBIN 20210 GENE MUTATION
|
Facility
|
IP
|
$415.38
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
63001144
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$311.54 |
| Max. Negotiated Rate |
$386.30 |
| Rate for Payer: Aetna Commercial |
$358.89
|
| Rate for Payer: Cash Price |
$249.23
|
| Rate for Payer: Cigna All Commercial |
$358.47
|
| Rate for Payer: CORVEL All Commercial |
$386.30
|
| Rate for Payer: Coventry All Commercial |
$365.53
|
| Rate for Payer: Encore All Commercial |
$382.36
|
| Rate for Payer: Frontpath All Commercial |
$382.15
|
| Rate for Payer: Humana ChoiceCare |
$358.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.84
|
| Rate for Payer: PHCS All Commercial |
$311.54
|
| Rate for Payer: PHP All Commercial |
$315.02
|
| Rate for Payer: Sagamore Health Network All Products |
$320.67
|
| Rate for Payer: Signature Care EPO |
$344.77
|
| Rate for Payer: Signature Care PPO |
$365.53
|
| Rate for Payer: United Healthcare Commercial |
$327.32
|
|
|
HC PROTHROMBIN 20210 GENE MUTATION
|
Facility
|
OP
|
$415.38
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
63001144
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.69 |
| Max. Negotiated Rate |
$386.30 |
| Rate for Payer: Aetna Commercial |
$350.58
|
| Rate for Payer: Aetna Medicare |
$132.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$190.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$190.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$65.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.21
|
| Rate for Payer: Cash Price |
$249.23
|
| Rate for Payer: Cash Price |
$249.23
|
| Rate for Payer: Centivo All Commercial |
$225.97
|
| Rate for Payer: Cigna All Commercial |
$358.47
|
| Rate for Payer: CORVEL All Commercial |
$386.30
|
| Rate for Payer: Coventry All Commercial |
$365.53
|
| Rate for Payer: Encore All Commercial |
$382.36
|
| Rate for Payer: Frontpath All Commercial |
$382.15
|
| Rate for Payer: Humana ChoiceCare |
$358.76
|
| Rate for Payer: Humana Medicare |
$132.92
|
| Rate for Payer: Lucent All Commercial |
$225.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.84
|
| Rate for Payer: Managed Health Services Medicaid |
$65.69
|
| Rate for Payer: MDWise Medicaid |
$65.69
|
| Rate for Payer: PHCS All Commercial |
$311.54
|
| Rate for Payer: PHP All Commercial |
$315.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.00
|
| Rate for Payer: Sagamore Health Network All Products |
$320.67
|
| Rate for Payer: Signature Care EPO |
$344.77
|
| Rate for Payer: Signature Care PPO |
$365.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.07
|
| Rate for Payer: United Healthcare Commercial |
$327.32
|
| Rate for Payer: United Healthcare Medicare |
$132.92
|
|
