|
HC PHOSPHATIDYLGLYCEROL IGG
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001593
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC PHOSPHATIDYLGLYCEROL IGG
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001593
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC PHOSPHATIDYLGLYCEROL IGM
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001594
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC PHOSPHATIDYLGLYCEROL IGM
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001594
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC PHOSPHATIDYLINOSITOL IGA
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC PHOSPHATIDYLINOSITOL IGA
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC PHOSPHATIDYLINOSITOL IGG
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001596
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC PHOSPHATIDYLINOSITOL IGG
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001596
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC PHOSPHATIDYLINOSITOL IGM
|
Facility
OP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.07
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Centivo All Commercial |
$66.13
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Humana Medicare |
$66.13
|
| Rate for Payer: Lucent All Commercial |
$66.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.57
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$42.79
|
|
|
HC PHOSPHATIDYLINOSITOL IGM
|
Facility
IP
|
$129.67
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna All Commercial |
$111.91
|
| Rate for Payer: CORVEL All Commercial |
$120.60
|
| Rate for Payer: Coventry All Commercial |
$114.11
|
| Rate for Payer: Encore All Commercial |
$119.36
|
| Rate for Payer: Frontpath All Commercial |
$119.30
|
| Rate for Payer: Humana ChoiceCare |
$112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.71
|
| Rate for Payer: PHCS All Commercial |
$97.25
|
| Rate for Payer: PHP All Commercial |
$98.34
|
| Rate for Payer: Sagamore Health Network All Products |
$100.11
|
| Rate for Payer: Signature Care EPO |
$107.63
|
| Rate for Payer: Signature Care PPO |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
|
|
HC PHOSPHATIDYLSERINE IGA
|
Facility
OP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$136.98
|
| Rate for Payer: Aetna Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.92
|
| Rate for Payer: Cash Price |
$100.63
|
| Rate for Payer: Cash Price |
$100.63
|
| Rate for Payer: Centivo All Commercial |
$82.77
|
| Rate for Payer: Cigna All Commercial |
$140.07
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.83
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Humana Medicare |
$82.77
|
| Rate for Payer: Lucent All Commercial |
$82.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: Managed Health Services Medicaid |
$16.07
|
| Rate for Payer: MDWise Medicaid |
$16.07
|
| Rate for Payer: PHCS All Commercial |
$121.73
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.30
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.96
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$53.56
|
|
|
HC PHOSPHATIDYLSERINE IGA
|
Facility
IP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$140.23
|
| Rate for Payer: Cash Price |
$100.63
|
| Rate for Payer: Cigna All Commercial |
$140.07
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.83
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: PHCS All Commercial |
$121.73
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.83
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
|
|
HC PHOSPHATIDYLSERINE IGG
|
Facility
IP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$140.23
|
| Rate for Payer: Cash Price |
$100.63
|
| Rate for Payer: Cigna All Commercial |
$140.07
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.83
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: PHCS All Commercial |
$121.73
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.83
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
|
|
HC PHOSPHATIDYLSERINE IGG
|
Facility
OP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$136.98
|
| Rate for Payer: Aetna Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.92
|
| Rate for Payer: Cash Price |
$100.63
|
| Rate for Payer: Cash Price |
$100.63
|
| Rate for Payer: Centivo All Commercial |
$82.77
|
| Rate for Payer: Cigna All Commercial |
$140.07
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.83
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Humana Medicare |
$82.77
|
| Rate for Payer: Lucent All Commercial |
$82.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: Managed Health Services Medicaid |
$16.07
|
| Rate for Payer: MDWise Medicaid |
$16.07
|
| Rate for Payer: PHCS All Commercial |
$121.73
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.30
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.96
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$53.56
|
|
|
HC PHOSPHATIDYLSERINE IGM
|
Facility
IP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$140.23
|
| Rate for Payer: Cash Price |
$100.63
|
| Rate for Payer: Cigna All Commercial |
$140.07
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.83
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: PHCS All Commercial |
$121.73
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.83
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
|
|
HC PHOSPHATIDYLSERINE IGM
|
Facility
OP
|
$162.30
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
63001868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: Aetna Commercial |
$136.98
|
| Rate for Payer: Aetna Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.92
|
| Rate for Payer: Cash Price |
$100.63
|
| Rate for Payer: Cash Price |
$100.63
|
| Rate for Payer: Centivo All Commercial |
$82.77
|
| Rate for Payer: Cigna All Commercial |
$140.07
|
| Rate for Payer: CORVEL All Commercial |
$150.94
|
| Rate for Payer: Coventry All Commercial |
$142.83
|
| Rate for Payer: Encore All Commercial |
$149.40
|
| Rate for Payer: Frontpath All Commercial |
$149.32
|
| Rate for Payer: Humana ChoiceCare |
$140.18
|
| Rate for Payer: Humana Medicare |
$82.77
|
| Rate for Payer: Lucent All Commercial |
$82.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.07
|
| Rate for Payer: Managed Health Services Medicaid |
$16.07
|
| Rate for Payer: MDWise Medicaid |
$16.07
|
| Rate for Payer: PHCS All Commercial |
$121.73
|
| Rate for Payer: PHP All Commercial |
$123.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.30
|
| Rate for Payer: Sagamore Health Network All Products |
$125.30
|
| Rate for Payer: Signature Care EPO |
$134.71
|
| Rate for Payer: Signature Care PPO |
$142.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.96
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$53.56
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR AUTOANTIBODIES, IGG
|
Facility
OP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63044074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.44
|
| Rate for Payer: Aetna Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.50
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Centivo All Commercial |
$66.74
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$66.74
|
| Rate for Payer: Lucent All Commercial |
$66.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.03
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
| Rate for Payer: United Healthcare Medicare |
$43.18
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR AUTOANTIBODIES, IGG
|
Facility
IP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63044074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
|
|
HC PHOSPHORUS
|
Facility
IP
|
$47.12
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
63001100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Aetna Commercial |
$40.72
|
| Rate for Payer: Cash Price |
$29.22
|
| Rate for Payer: Cigna All Commercial |
$40.67
|
| Rate for Payer: CORVEL All Commercial |
$43.83
|
| Rate for Payer: Coventry All Commercial |
$41.47
|
| Rate for Payer: Encore All Commercial |
$43.38
|
| Rate for Payer: Frontpath All Commercial |
$43.35
|
| Rate for Payer: Humana ChoiceCare |
$40.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.41
|
| Rate for Payer: PHCS All Commercial |
$35.34
|
| Rate for Payer: PHP All Commercial |
$35.74
|
| Rate for Payer: Sagamore Health Network All Products |
$36.38
|
| Rate for Payer: Signature Care EPO |
$39.11
|
| Rate for Payer: Signature Care PPO |
$41.47
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
|
|
HC PHOSPHORUS
|
Facility
OP
|
$47.12
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
63001100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Aetna Commercial |
$39.77
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.11
|
| Rate for Payer: Cash Price |
$29.22
|
| Rate for Payer: Cash Price |
$29.22
|
| Rate for Payer: Centivo All Commercial |
$24.03
|
| Rate for Payer: Cigna All Commercial |
$40.67
|
| Rate for Payer: CORVEL All Commercial |
$43.83
|
| Rate for Payer: Coventry All Commercial |
$41.47
|
| Rate for Payer: Encore All Commercial |
$43.38
|
| Rate for Payer: Frontpath All Commercial |
$43.35
|
| Rate for Payer: Humana ChoiceCare |
$40.70
|
| Rate for Payer: Humana Medicare |
$24.03
|
| Rate for Payer: Lucent All Commercial |
$24.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.41
|
| Rate for Payer: Managed Health Services Medicaid |
$4.74
|
| Rate for Payer: MDWise Medicaid |
$4.74
|
| Rate for Payer: PHCS All Commercial |
$35.34
|
| Rate for Payer: PHP All Commercial |
$35.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.38
|
| Rate for Payer: Sagamore Health Network All Products |
$36.38
|
| Rate for Payer: Signature Care EPO |
$39.11
|
| Rate for Payer: Signature Care PPO |
$41.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.06
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
| Rate for Payer: United Healthcare Medicare |
$15.55
|
|
|
HC PHOSPHORUS 24H URINE
|
Facility
IP
|
$78.54
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
63001658
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$73.04 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cigna All Commercial |
$67.78
|
| Rate for Payer: CORVEL All Commercial |
$73.04
|
| Rate for Payer: Coventry All Commercial |
$69.12
|
| Rate for Payer: Encore All Commercial |
$72.30
|
| Rate for Payer: Frontpath All Commercial |
$72.26
|
| Rate for Payer: Humana ChoiceCare |
$67.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.69
|
| Rate for Payer: PHCS All Commercial |
$58.90
|
| Rate for Payer: PHP All Commercial |
$59.56
|
| Rate for Payer: Sagamore Health Network All Products |
$60.63
|
| Rate for Payer: Signature Care EPO |
$65.19
|
| Rate for Payer: Signature Care PPO |
$69.12
|
| Rate for Payer: United Healthcare Commercial |
$61.89
|
|
|
HC PHOSPHORUS 24H URINE
|
Facility
OP
|
$78.54
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
63001658
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$73.04 |
| Rate for Payer: Aetna Commercial |
$66.29
|
| Rate for Payer: Aetna Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.51
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Centivo All Commercial |
$40.06
|
| Rate for Payer: Cigna All Commercial |
$67.78
|
| Rate for Payer: CORVEL All Commercial |
$73.04
|
| Rate for Payer: Coventry All Commercial |
$69.12
|
| Rate for Payer: Encore All Commercial |
$72.30
|
| Rate for Payer: Frontpath All Commercial |
$72.26
|
| Rate for Payer: Humana ChoiceCare |
$67.83
|
| Rate for Payer: Humana Medicare |
$40.06
|
| Rate for Payer: Lucent All Commercial |
$40.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.69
|
| Rate for Payer: Managed Health Services Medicaid |
$5.78
|
| Rate for Payer: MDWise Medicaid |
$5.78
|
| Rate for Payer: PHCS All Commercial |
$58.90
|
| Rate for Payer: PHP All Commercial |
$59.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.63
|
| Rate for Payer: Sagamore Health Network All Products |
$60.63
|
| Rate for Payer: Signature Care EPO |
$65.19
|
| Rate for Payer: Signature Care PPO |
$69.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.76
|
| Rate for Payer: United Healthcare Commercial |
$61.89
|
| Rate for Payer: United Healthcare Medicare |
$25.92
|
|
|
HC PHOSPHORUS UR
|
Facility
OP
|
$67.44
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
63001163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$62.72 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna Medicare |
$22.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.48
|
| Rate for Payer: Cash Price |
$41.81
|
| Rate for Payer: Cash Price |
$41.81
|
| Rate for Payer: Centivo All Commercial |
$34.40
|
| Rate for Payer: Cigna All Commercial |
$58.20
|
| Rate for Payer: CORVEL All Commercial |
$62.72
|
| Rate for Payer: Coventry All Commercial |
$59.35
|
| Rate for Payer: Encore All Commercial |
$62.08
|
| Rate for Payer: Frontpath All Commercial |
$62.05
|
| Rate for Payer: Humana ChoiceCare |
$58.25
|
| Rate for Payer: Humana Medicare |
$34.40
|
| Rate for Payer: Lucent All Commercial |
$34.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.70
|
| Rate for Payer: Managed Health Services Medicaid |
$5.78
|
| Rate for Payer: MDWise Medicaid |
$5.78
|
| Rate for Payer: PHCS All Commercial |
$50.58
|
| Rate for Payer: PHP All Commercial |
$51.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.30
|
| Rate for Payer: Sagamore Health Network All Products |
$52.07
|
| Rate for Payer: Signature Care EPO |
$55.98
|
| Rate for Payer: Signature Care PPO |
$59.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$57.33
|
| Rate for Payer: United Healthcare Commercial |
$53.14
|
| Rate for Payer: United Healthcare Medicare |
$22.26
|
|
|
HC PHOSPHORUS UR
|
Facility
IP
|
$67.44
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
63001163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.58 |
| Max. Negotiated Rate |
$62.72 |
| Rate for Payer: Aetna Commercial |
$58.27
|
| Rate for Payer: Cash Price |
$41.81
|
| Rate for Payer: Cigna All Commercial |
$58.20
|
| Rate for Payer: CORVEL All Commercial |
$62.72
|
| Rate for Payer: Coventry All Commercial |
$59.35
|
| Rate for Payer: Encore All Commercial |
$62.08
|
| Rate for Payer: Frontpath All Commercial |
$62.05
|
| Rate for Payer: Humana ChoiceCare |
$58.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.70
|
| Rate for Payer: PHCS All Commercial |
$50.58
|
| Rate for Payer: PHP All Commercial |
$51.15
|
| Rate for Payer: Sagamore Health Network All Products |
$52.07
|
| Rate for Payer: Signature Care EPO |
$55.98
|
| Rate for Payer: Signature Care PPO |
$59.35
|
| Rate for Payer: United Healthcare Commercial |
$53.14
|
|
|
HC PH STOOL
|
Facility
OP
|
$60.18
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
63001222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$55.97 |
| Rate for Payer: Aetna Commercial |
$50.79
|
| Rate for Payer: Aetna Medicare |
$19.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.85
|
| Rate for Payer: Cash Price |
$37.31
|
| Rate for Payer: Cash Price |
$37.31
|
| Rate for Payer: Centivo All Commercial |
$30.69
|
| Rate for Payer: Cigna All Commercial |
$51.94
|
| Rate for Payer: CORVEL All Commercial |
$55.97
|
| Rate for Payer: Coventry All Commercial |
$52.96
|
| Rate for Payer: Encore All Commercial |
$55.40
|
| Rate for Payer: Frontpath All Commercial |
$55.37
|
| Rate for Payer: Humana ChoiceCare |
$51.98
|
| Rate for Payer: Humana Medicare |
$30.69
|
| Rate for Payer: Lucent All Commercial |
$30.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.16
|
| Rate for Payer: Managed Health Services Medicaid |
$3.58
|
| Rate for Payer: MDWise Medicaid |
$3.58
|
| Rate for Payer: PHCS All Commercial |
$45.14
|
| Rate for Payer: PHP All Commercial |
$45.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.47
|
| Rate for Payer: Sagamore Health Network All Products |
$46.46
|
| Rate for Payer: Signature Care EPO |
$49.95
|
| Rate for Payer: Signature Care PPO |
$52.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.15
|
| Rate for Payer: United Healthcare Commercial |
$47.42
|
| Rate for Payer: United Healthcare Medicare |
$19.86
|
|
