|
HC CYTOMEG DNA-PCR QUAL
|
Facility
OP
|
$169.04
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
63002037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$157.21 |
| Rate for Payer: Aetna Commercial |
$142.67
|
| Rate for Payer: Aetna Medicare |
$55.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.36
|
| Rate for Payer: Cash Price |
$104.81
|
| Rate for Payer: Cash Price |
$104.81
|
| Rate for Payer: Centivo All Commercial |
$86.21
|
| Rate for Payer: Cigna All Commercial |
$145.89
|
| Rate for Payer: CORVEL All Commercial |
$157.21
|
| Rate for Payer: Coventry All Commercial |
$148.76
|
| Rate for Payer: Encore All Commercial |
$155.61
|
| Rate for Payer: Frontpath All Commercial |
$155.52
|
| Rate for Payer: Humana ChoiceCare |
$146.00
|
| Rate for Payer: Humana Medicare |
$86.21
|
| Rate for Payer: Lucent All Commercial |
$86.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.14
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$126.78
|
| Rate for Payer: PHP All Commercial |
$128.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.93
|
| Rate for Payer: Sagamore Health Network All Products |
$130.50
|
| Rate for Payer: Signature Care EPO |
$140.31
|
| Rate for Payer: Signature Care PPO |
$148.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.69
|
| Rate for Payer: United Healthcare Commercial |
$133.21
|
| Rate for Payer: United Healthcare Medicare |
$55.78
|
|
|
HC CYTOMEG DNA-PCR QUAL
|
Facility
IP
|
$169.04
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
63002037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.78 |
| Max. Negotiated Rate |
$157.21 |
| Rate for Payer: Aetna Commercial |
$146.05
|
| Rate for Payer: Cash Price |
$104.81
|
| Rate for Payer: Cigna All Commercial |
$145.89
|
| Rate for Payer: CORVEL All Commercial |
$157.21
|
| Rate for Payer: Coventry All Commercial |
$148.76
|
| Rate for Payer: Encore All Commercial |
$155.61
|
| Rate for Payer: Frontpath All Commercial |
$155.52
|
| Rate for Payer: Humana ChoiceCare |
$146.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.14
|
| Rate for Payer: PHCS All Commercial |
$126.78
|
| Rate for Payer: PHP All Commercial |
$128.20
|
| Rate for Payer: Sagamore Health Network All Products |
$130.50
|
| Rate for Payer: Signature Care EPO |
$140.31
|
| Rate for Payer: Signature Care PPO |
$148.76
|
| Rate for Payer: United Healthcare Commercial |
$133.21
|
|
|
HC CYTOPATH FNA-5 & SLIDES
|
Facility
OP
|
$148.84
|
|
|
Service Code
|
CPT 88162
|
| Hospital Charge Code |
63002064
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$160.56 |
| Rate for Payer: Aetna Commercial |
$125.62
|
| Rate for Payer: Aetna Medicare |
$49.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$160.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.03
|
| Rate for Payer: Cash Price |
$92.28
|
| Rate for Payer: Cash Price |
$92.28
|
| Rate for Payer: Centivo All Commercial |
$75.91
|
| Rate for Payer: Cigna All Commercial |
$128.45
|
| Rate for Payer: CORVEL All Commercial |
$138.42
|
| Rate for Payer: Coventry All Commercial |
$130.98
|
| Rate for Payer: Encore All Commercial |
$137.01
|
| Rate for Payer: Frontpath All Commercial |
$136.93
|
| Rate for Payer: Humana ChoiceCare |
$128.55
|
| Rate for Payer: Humana Medicare |
$75.91
|
| Rate for Payer: Lucent All Commercial |
$75.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.95
|
| Rate for Payer: Managed Health Services Medicaid |
$160.56
|
| Rate for Payer: MDWise Medicaid |
$160.56
|
| Rate for Payer: PHCS All Commercial |
$111.63
|
| Rate for Payer: PHP All Commercial |
$112.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.05
|
| Rate for Payer: Sagamore Health Network All Products |
$114.90
|
| Rate for Payer: Signature Care EPO |
$123.54
|
| Rate for Payer: Signature Care PPO |
$130.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.51
|
| Rate for Payer: United Healthcare Commercial |
$117.28
|
| Rate for Payer: United Healthcare Medicare |
$49.12
|
|
|
HC CYTOPATH FNA-5 & SLIDES
|
Facility
IP
|
$148.84
|
|
|
Service Code
|
CPT 88162
|
| Hospital Charge Code |
63002064
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.63 |
| Max. Negotiated Rate |
$138.42 |
| Rate for Payer: Aetna Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$92.28
|
| Rate for Payer: Cigna All Commercial |
$128.45
|
| Rate for Payer: CORVEL All Commercial |
$138.42
|
| Rate for Payer: Coventry All Commercial |
$130.98
|
| Rate for Payer: Encore All Commercial |
$137.01
|
| Rate for Payer: Frontpath All Commercial |
$136.93
|
| Rate for Payer: Humana ChoiceCare |
$128.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.95
|
| Rate for Payer: PHCS All Commercial |
$111.63
|
| Rate for Payer: PHP All Commercial |
$112.88
|
| Rate for Payer: Sagamore Health Network All Products |
$114.90
|
| Rate for Payer: Signature Care EPO |
$123.54
|
| Rate for Payer: Signature Care PPO |
$130.98
|
| Rate for Payer: United Healthcare Commercial |
$117.28
|
|
|
HC CYTOPATHOLOGY, NON-GYN,CELL BLOCK-OP
|
Facility
IP
|
$493.15
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63002100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$369.86 |
| Max. Negotiated Rate |
$458.63 |
| Rate for Payer: Aetna Commercial |
$426.08
|
| Rate for Payer: Cash Price |
$305.75
|
| Rate for Payer: Cigna All Commercial |
$425.59
|
| Rate for Payer: CORVEL All Commercial |
$458.63
|
| Rate for Payer: Coventry All Commercial |
$433.97
|
| Rate for Payer: Encore All Commercial |
$453.94
|
| Rate for Payer: Frontpath All Commercial |
$453.70
|
| Rate for Payer: Humana ChoiceCare |
$425.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$443.83
|
| Rate for Payer: PHCS All Commercial |
$369.86
|
| Rate for Payer: PHP All Commercial |
$374.00
|
| Rate for Payer: Sagamore Health Network All Products |
$380.71
|
| Rate for Payer: Signature Care EPO |
$409.31
|
| Rate for Payer: Signature Care PPO |
$433.97
|
| Rate for Payer: United Healthcare Commercial |
$388.60
|
|
|
HC CYTOPATHOLOGY, NON-GYN,CELL BLOCK-OP
|
Facility
OP
|
$493.15
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63002100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$162.74 |
| Max. Negotiated Rate |
$458.63 |
| Rate for Payer: Aetna Commercial |
$416.22
|
| Rate for Payer: Aetna Medicare |
$162.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$162.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$283.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$308.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$277.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$187.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$179.01
|
| Rate for Payer: Cash Price |
$305.75
|
| Rate for Payer: Cash Price |
$305.75
|
| Rate for Payer: Centivo All Commercial |
$251.51
|
| Rate for Payer: Cigna All Commercial |
$425.59
|
| Rate for Payer: CORVEL All Commercial |
$458.63
|
| Rate for Payer: Coventry All Commercial |
$433.97
|
| Rate for Payer: Encore All Commercial |
$453.94
|
| Rate for Payer: Frontpath All Commercial |
$453.70
|
| Rate for Payer: Humana ChoiceCare |
$425.93
|
| Rate for Payer: Humana Medicare |
$251.51
|
| Rate for Payer: Lucent All Commercial |
$251.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$443.83
|
| Rate for Payer: Managed Health Services Medicaid |
$277.37
|
| Rate for Payer: MDWise Medicaid |
$277.37
|
| Rate for Payer: PHCS All Commercial |
$369.86
|
| Rate for Payer: PHP All Commercial |
$374.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$192.33
|
| Rate for Payer: Sagamore Health Network All Products |
$380.71
|
| Rate for Payer: Signature Care EPO |
$409.31
|
| Rate for Payer: Signature Care PPO |
$433.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$419.18
|
| Rate for Payer: United Healthcare Commercial |
$388.60
|
| Rate for Payer: United Healthcare Medicare |
$162.74
|
|
|
HC CYTOPATH PREP SMEARS/INTR
|
Facility
IP
|
$51.19
|
|
|
Service Code
|
CPT 88160
|
| Hospital Charge Code |
63002063
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$47.61 |
| Rate for Payer: Aetna Commercial |
$44.23
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cigna All Commercial |
$44.18
|
| Rate for Payer: CORVEL All Commercial |
$47.61
|
| Rate for Payer: Coventry All Commercial |
$45.05
|
| Rate for Payer: Encore All Commercial |
$47.12
|
| Rate for Payer: Frontpath All Commercial |
$47.10
|
| Rate for Payer: Humana ChoiceCare |
$44.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.07
|
| Rate for Payer: PHCS All Commercial |
$38.40
|
| Rate for Payer: PHP All Commercial |
$38.83
|
| Rate for Payer: Sagamore Health Network All Products |
$39.52
|
| Rate for Payer: Signature Care EPO |
$42.49
|
| Rate for Payer: Signature Care PPO |
$45.05
|
| Rate for Payer: United Healthcare Commercial |
$40.34
|
|
|
HC CYTOPATH PREP SMEARS/INTR
|
Facility
OP
|
$51.19
|
|
|
Service Code
|
CPT 88160
|
| Hospital Charge Code |
63002063
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$90.83 |
| Rate for Payer: Aetna Commercial |
$43.21
|
| Rate for Payer: Aetna Medicare |
$16.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$90.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.58
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Centivo All Commercial |
$26.11
|
| Rate for Payer: Cigna All Commercial |
$44.18
|
| Rate for Payer: CORVEL All Commercial |
$47.61
|
| Rate for Payer: Coventry All Commercial |
$45.05
|
| Rate for Payer: Encore All Commercial |
$47.12
|
| Rate for Payer: Frontpath All Commercial |
$47.10
|
| Rate for Payer: Humana ChoiceCare |
$44.22
|
| Rate for Payer: Humana Medicare |
$26.11
|
| Rate for Payer: Lucent All Commercial |
$26.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.07
|
| Rate for Payer: Managed Health Services Medicaid |
$90.83
|
| Rate for Payer: MDWise Medicaid |
$90.83
|
| Rate for Payer: PHCS All Commercial |
$38.40
|
| Rate for Payer: PHP All Commercial |
$38.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.97
|
| Rate for Payer: Sagamore Health Network All Products |
$39.52
|
| Rate for Payer: Signature Care EPO |
$42.49
|
| Rate for Payer: Signature Care PPO |
$45.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.51
|
| Rate for Payer: United Healthcare Commercial |
$40.34
|
| Rate for Payer: United Healthcare Medicare |
$16.89
|
|
|
HC CYTOPATH SMEAR AND INTERP
|
Facility
OP
|
$143.24
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
63002058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.27 |
| Max. Negotiated Rate |
$133.21 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Aetna Medicare |
$47.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$109.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.00
|
| Rate for Payer: Cash Price |
$88.81
|
| Rate for Payer: Cash Price |
$88.81
|
| Rate for Payer: Centivo All Commercial |
$73.05
|
| Rate for Payer: Cigna All Commercial |
$123.61
|
| Rate for Payer: CORVEL All Commercial |
$133.21
|
| Rate for Payer: Coventry All Commercial |
$126.05
|
| Rate for Payer: Encore All Commercial |
$131.85
|
| Rate for Payer: Frontpath All Commercial |
$131.78
|
| Rate for Payer: Humana ChoiceCare |
$123.72
|
| Rate for Payer: Humana Medicare |
$73.05
|
| Rate for Payer: Lucent All Commercial |
$73.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.91
|
| Rate for Payer: Managed Health Services Medicaid |
$109.04
|
| Rate for Payer: MDWise Medicaid |
$109.04
|
| Rate for Payer: PHCS All Commercial |
$107.43
|
| Rate for Payer: PHP All Commercial |
$108.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.86
|
| Rate for Payer: Sagamore Health Network All Products |
$110.58
|
| Rate for Payer: Signature Care EPO |
$118.89
|
| Rate for Payer: Signature Care PPO |
$126.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.75
|
| Rate for Payer: United Healthcare Commercial |
$112.87
|
| Rate for Payer: United Healthcare Medicare |
$47.27
|
|
|
HC CYTOPATH SMEAR AND INTERP
|
Facility
IP
|
$143.24
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
63002058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$107.43 |
| Max. Negotiated Rate |
$133.21 |
| Rate for Payer: Aetna Commercial |
$123.76
|
| Rate for Payer: Cash Price |
$88.81
|
| Rate for Payer: Cigna All Commercial |
$123.61
|
| Rate for Payer: CORVEL All Commercial |
$133.21
|
| Rate for Payer: Coventry All Commercial |
$126.05
|
| Rate for Payer: Encore All Commercial |
$131.85
|
| Rate for Payer: Frontpath All Commercial |
$131.78
|
| Rate for Payer: Humana ChoiceCare |
$123.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.91
|
| Rate for Payer: PHCS All Commercial |
$107.43
|
| Rate for Payer: PHP All Commercial |
$108.63
|
| Rate for Payer: Sagamore Health Network All Products |
$110.58
|
| Rate for Payer: Signature Care EPO |
$118.89
|
| Rate for Payer: Signature Care PPO |
$126.05
|
| Rate for Payer: United Healthcare Commercial |
$112.87
|
|
|
HC CYTOSPIN PATH W/INTERP
|
Facility
OP
|
$175.47
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
63002059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.91 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Aetna Commercial |
$148.10
|
| Rate for Payer: Aetna Medicare |
$57.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$112.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.70
|
| Rate for Payer: Cash Price |
$108.79
|
| Rate for Payer: Cash Price |
$108.79
|
| Rate for Payer: Centivo All Commercial |
$89.49
|
| Rate for Payer: Cigna All Commercial |
$151.43
|
| Rate for Payer: CORVEL All Commercial |
$163.19
|
| Rate for Payer: Coventry All Commercial |
$154.41
|
| Rate for Payer: Encore All Commercial |
$161.52
|
| Rate for Payer: Frontpath All Commercial |
$161.43
|
| Rate for Payer: Humana ChoiceCare |
$151.55
|
| Rate for Payer: Humana Medicare |
$89.49
|
| Rate for Payer: Lucent All Commercial |
$89.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.92
|
| Rate for Payer: Managed Health Services Medicaid |
$112.09
|
| Rate for Payer: MDWise Medicaid |
$112.09
|
| Rate for Payer: PHCS All Commercial |
$131.60
|
| Rate for Payer: PHP All Commercial |
$133.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.43
|
| Rate for Payer: Sagamore Health Network All Products |
$135.46
|
| Rate for Payer: Signature Care EPO |
$145.64
|
| Rate for Payer: Signature Care PPO |
$154.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$149.15
|
| Rate for Payer: United Healthcare Commercial |
$138.27
|
| Rate for Payer: United Healthcare Medicare |
$57.91
|
|
|
HC CYTOSPIN PATH W/INTERP
|
Facility
IP
|
$175.47
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
63002059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Aetna Commercial |
$151.61
|
| Rate for Payer: Cash Price |
$108.79
|
| Rate for Payer: Cigna All Commercial |
$151.43
|
| Rate for Payer: CORVEL All Commercial |
$163.19
|
| Rate for Payer: Coventry All Commercial |
$154.41
|
| Rate for Payer: Encore All Commercial |
$161.52
|
| Rate for Payer: Frontpath All Commercial |
$161.43
|
| Rate for Payer: Humana ChoiceCare |
$151.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.92
|
| Rate for Payer: PHCS All Commercial |
$131.60
|
| Rate for Payer: PHP All Commercial |
$133.08
|
| Rate for Payer: Sagamore Health Network All Products |
$135.46
|
| Rate for Payer: Signature Care EPO |
$145.64
|
| Rate for Payer: Signature Care PPO |
$154.41
|
| Rate for Payer: United Healthcare Commercial |
$138.27
|
|
|
HC D-DIMER QUANT
|
Facility
OP
|
$238.99
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
63001347
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$222.26 |
| Rate for Payer: Aetna Commercial |
$201.70
|
| Rate for Payer: Aetna Medicare |
$78.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$109.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.75
|
| Rate for Payer: Cash Price |
$148.17
|
| Rate for Payer: Cash Price |
$148.17
|
| Rate for Payer: Centivo All Commercial |
$121.88
|
| Rate for Payer: Cigna All Commercial |
$206.24
|
| Rate for Payer: CORVEL All Commercial |
$222.26
|
| Rate for Payer: Coventry All Commercial |
$210.31
|
| Rate for Payer: Encore All Commercial |
$219.99
|
| Rate for Payer: Frontpath All Commercial |
$219.87
|
| Rate for Payer: Humana ChoiceCare |
$206.41
|
| Rate for Payer: Humana Medicare |
$121.88
|
| Rate for Payer: Lucent All Commercial |
$121.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.09
|
| Rate for Payer: Managed Health Services Medicaid |
$10.18
|
| Rate for Payer: MDWise Medicaid |
$10.18
|
| Rate for Payer: PHCS All Commercial |
$179.24
|
| Rate for Payer: PHP All Commercial |
$181.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.20
|
| Rate for Payer: Sagamore Health Network All Products |
$184.50
|
| Rate for Payer: Signature Care EPO |
$198.36
|
| Rate for Payer: Signature Care PPO |
$210.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$203.14
|
| Rate for Payer: United Healthcare Commercial |
$188.32
|
| Rate for Payer: United Healthcare Medicare |
$78.87
|
|
|
HC D-DIMER QUANT
|
Facility
IP
|
$238.99
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
63001347
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.24 |
| Max. Negotiated Rate |
$222.26 |
| Rate for Payer: Aetna Commercial |
$206.48
|
| Rate for Payer: Cash Price |
$148.17
|
| Rate for Payer: Cigna All Commercial |
$206.24
|
| Rate for Payer: CORVEL All Commercial |
$222.26
|
| Rate for Payer: Coventry All Commercial |
$210.31
|
| Rate for Payer: Encore All Commercial |
$219.99
|
| Rate for Payer: Frontpath All Commercial |
$219.87
|
| Rate for Payer: Humana ChoiceCare |
$206.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.09
|
| Rate for Payer: PHCS All Commercial |
$179.24
|
| Rate for Payer: PHP All Commercial |
$181.25
|
| Rate for Payer: Sagamore Health Network All Products |
$184.50
|
| Rate for Payer: Signature Care EPO |
$198.36
|
| Rate for Payer: Signature Care PPO |
$210.31
|
| Rate for Payer: United Healthcare Commercial |
$188.32
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE, MUSCLE, =20 SQ CM
|
Facility
IP
|
$1,065.08
|
|
| Hospital Charge Code |
01685522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$798.81 |
| Max. Negotiated Rate |
$990.53 |
| Rate for Payer: Aetna Commercial |
$920.23
|
| Rate for Payer: Cash Price |
$660.35
|
| Rate for Payer: Cigna All Commercial |
$919.17
|
| Rate for Payer: CORVEL All Commercial |
$990.53
|
| Rate for Payer: Coventry All Commercial |
$937.27
|
| Rate for Payer: Encore All Commercial |
$980.41
|
| Rate for Payer: Frontpath All Commercial |
$979.88
|
| Rate for Payer: Humana ChoiceCare |
$919.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$958.58
|
| Rate for Payer: PHCS All Commercial |
$798.81
|
| Rate for Payer: PHP All Commercial |
$807.76
|
| Rate for Payer: Sagamore Health Network All Products |
$822.24
|
| Rate for Payer: Signature Care EPO |
$884.02
|
| Rate for Payer: Signature Care PPO |
$937.27
|
| Rate for Payer: United Healthcare Commercial |
$839.29
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE, MUSCLE, =20 SQ CM
|
Facility
OP
|
$1,065.08
|
|
| Hospital Charge Code |
01685522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$990.53 |
| Rate for Payer: Aetna Commercial |
$898.93
|
| Rate for Payer: Aetna Medicare |
$351.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$351.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$611.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$665.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$159.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$404.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$386.63
|
| Rate for Payer: Cash Price |
$660.35
|
| Rate for Payer: Cash Price |
$660.35
|
| Rate for Payer: Centivo All Commercial |
$543.19
|
| Rate for Payer: Cigna All Commercial |
$919.17
|
| Rate for Payer: CORVEL All Commercial |
$990.53
|
| Rate for Payer: Coventry All Commercial |
$937.27
|
| Rate for Payer: Encore All Commercial |
$980.41
|
| Rate for Payer: Frontpath All Commercial |
$979.88
|
| Rate for Payer: Humana ChoiceCare |
$919.91
|
| Rate for Payer: Humana Medicare |
$543.19
|
| Rate for Payer: Lucent All Commercial |
$543.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$958.58
|
| Rate for Payer: Managed Health Services Medicaid |
$159.12
|
| Rate for Payer: MDWise Medicaid |
$159.12
|
| Rate for Payer: PHCS All Commercial |
$798.81
|
| Rate for Payer: PHP All Commercial |
$807.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$415.38
|
| Rate for Payer: Sagamore Health Network All Products |
$822.24
|
| Rate for Payer: Signature Care EPO |
$884.02
|
| Rate for Payer: Signature Care PPO |
$937.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$905.32
|
| Rate for Payer: United Healthcare Commercial |
$839.29
|
| Rate for Payer: United Healthcare Medicare |
$351.48
|
|
|
HC DEBRIDE NAIL 1-5
|
Facility
OP
|
$131.07
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
01681720
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$190.59 |
| Rate for Payer: Aetna Commercial |
$110.62
|
| Rate for Payer: Aetna Medicare |
$43.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$190.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.58
|
| Rate for Payer: Cash Price |
$81.26
|
| Rate for Payer: Cash Price |
$81.26
|
| Rate for Payer: Centivo All Commercial |
$66.85
|
| Rate for Payer: Cigna All Commercial |
$113.11
|
| Rate for Payer: CORVEL All Commercial |
$121.90
|
| Rate for Payer: Coventry All Commercial |
$115.34
|
| Rate for Payer: Encore All Commercial |
$120.65
|
| Rate for Payer: Frontpath All Commercial |
$120.58
|
| Rate for Payer: Humana ChoiceCare |
$113.21
|
| Rate for Payer: Humana Medicare |
$66.85
|
| Rate for Payer: Lucent All Commercial |
$66.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.96
|
| Rate for Payer: Managed Health Services Medicaid |
$190.59
|
| Rate for Payer: MDWise Medicaid |
$190.59
|
| Rate for Payer: PHCS All Commercial |
$98.30
|
| Rate for Payer: PHP All Commercial |
$99.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.12
|
| Rate for Payer: Sagamore Health Network All Products |
$101.19
|
| Rate for Payer: Signature Care EPO |
$108.79
|
| Rate for Payer: Signature Care PPO |
$115.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.41
|
| Rate for Payer: United Healthcare Commercial |
$103.28
|
| Rate for Payer: United Healthcare Medicare |
$43.25
|
|
|
HC DEBRIDE NAIL 1-5
|
Facility
IP
|
$131.07
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
01681720
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.30 |
| Max. Negotiated Rate |
$121.90 |
| Rate for Payer: Aetna Commercial |
$113.24
|
| Rate for Payer: Cash Price |
$81.26
|
| Rate for Payer: Cigna All Commercial |
$113.11
|
| Rate for Payer: CORVEL All Commercial |
$121.90
|
| Rate for Payer: Coventry All Commercial |
$115.34
|
| Rate for Payer: Encore All Commercial |
$120.65
|
| Rate for Payer: Frontpath All Commercial |
$120.58
|
| Rate for Payer: Humana ChoiceCare |
$113.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.96
|
| Rate for Payer: PHCS All Commercial |
$98.30
|
| Rate for Payer: PHP All Commercial |
$99.40
|
| Rate for Payer: Sagamore Health Network All Products |
$101.19
|
| Rate for Payer: Signature Care EPO |
$108.79
|
| Rate for Payer: Signature Care PPO |
$115.34
|
| Rate for Payer: United Healthcare Commercial |
$103.28
|
|
|
HC DEBRIDE NAIL 6 OR MORE
|
Facility
IP
|
$130.05
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
01681721
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$120.95 |
| Rate for Payer: Aetna Commercial |
$112.36
|
| Rate for Payer: Cash Price |
$80.63
|
| Rate for Payer: Cigna All Commercial |
$112.23
|
| Rate for Payer: CORVEL All Commercial |
$120.95
|
| Rate for Payer: Coventry All Commercial |
$114.44
|
| Rate for Payer: Encore All Commercial |
$119.71
|
| Rate for Payer: Frontpath All Commercial |
$119.65
|
| Rate for Payer: Humana ChoiceCare |
$112.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.04
|
| Rate for Payer: PHCS All Commercial |
$97.54
|
| Rate for Payer: PHP All Commercial |
$98.63
|
| Rate for Payer: Sagamore Health Network All Products |
$100.40
|
| Rate for Payer: Signature Care EPO |
$107.94
|
| Rate for Payer: Signature Care PPO |
$114.44
|
| Rate for Payer: United Healthcare Commercial |
$102.48
|
|
|
HC DEBRIDE NAIL 6 OR MORE
|
Facility
OP
|
$130.05
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
01681721
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$285.87 |
| Rate for Payer: Aetna Commercial |
$109.76
|
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$74.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.21
|
| Rate for Payer: Cash Price |
$80.63
|
| Rate for Payer: Cash Price |
$80.63
|
| Rate for Payer: Centivo All Commercial |
$66.33
|
| Rate for Payer: Cigna All Commercial |
$112.23
|
| Rate for Payer: CORVEL All Commercial |
$120.95
|
| Rate for Payer: Coventry All Commercial |
$114.44
|
| Rate for Payer: Encore All Commercial |
$119.71
|
| Rate for Payer: Frontpath All Commercial |
$119.65
|
| Rate for Payer: Humana ChoiceCare |
$112.32
|
| Rate for Payer: Humana Medicare |
$66.33
|
| Rate for Payer: Lucent All Commercial |
$66.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.04
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$97.54
|
| Rate for Payer: PHP All Commercial |
$98.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.72
|
| Rate for Payer: Sagamore Health Network All Products |
$100.40
|
| Rate for Payer: Signature Care EPO |
$107.94
|
| Rate for Payer: Signature Care PPO |
$114.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.54
|
| Rate for Payer: United Healthcare Commercial |
$102.48
|
| Rate for Payer: United Healthcare Medicare |
$42.92
|
|
|
HC DEBRIDE-SHARP<20 SQCM-15 MIN
|
Facility
OP
|
$178.50
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
01727597
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.80
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Centivo All Commercial |
$91.04
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Humana Medicare |
$91.04
|
| Rate for Payer: Lucent All Commercial |
$91.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.72
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
| Rate for Payer: United Healthcare Medicare |
$58.90
|
|
|
HC DEBRIDE-SHARP<20 SQCM-15 MIN
|
Facility
IP
|
$178.50
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
01727597
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
|
|
HC DEBRIDE-SHARP<20 SQCM-30 MIN
|
Facility
IP
|
$425.43
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
01728597
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$319.07 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$367.57
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
|
|
HC DEBRIDE-SHARP<20 SQCM-30 MIN
|
Facility
OP
|
$425.43
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
01728597
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$140.39 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$359.06
|
| Rate for Payer: Aetna Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$244.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.43
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Centivo All Commercial |
$216.97
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Humana Medicare |
$216.97
|
| Rate for Payer: Lucent All Commercial |
$216.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.92
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$361.62
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
| Rate for Payer: United Healthcare Medicare |
$140.39
|
|
|
HC DEBRIDE-SHARP<20 SQCM-45 MIN-PT
|
Facility
OP
|
$425.43
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
01729597
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$140.39 |
| Max. Negotiated Rate |
$395.65 |
| Rate for Payer: Aetna Commercial |
$359.06
|
| Rate for Payer: Aetna Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$244.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.43
|
| Rate for Payer: Cash Price |
$263.77
|
| Rate for Payer: Centivo All Commercial |
$216.97
|
| Rate for Payer: Cigna All Commercial |
$367.15
|
| Rate for Payer: CORVEL All Commercial |
$395.65
|
| Rate for Payer: Coventry All Commercial |
$374.38
|
| Rate for Payer: Encore All Commercial |
$391.61
|
| Rate for Payer: Frontpath All Commercial |
$391.40
|
| Rate for Payer: Humana ChoiceCare |
$367.45
|
| Rate for Payer: Humana Medicare |
$216.97
|
| Rate for Payer: Lucent All Commercial |
$216.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$382.89
|
| Rate for Payer: PHCS All Commercial |
$319.07
|
| Rate for Payer: PHP All Commercial |
$322.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.92
|
| Rate for Payer: Sagamore Health Network All Products |
$328.43
|
| Rate for Payer: Signature Care EPO |
$353.11
|
| Rate for Payer: Signature Care PPO |
$374.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$361.62
|
| Rate for Payer: United Healthcare Commercial |
$335.24
|
| Rate for Payer: United Healthcare Medicare |
$140.39
|
|
