|
HC FROZEN SECTION PATH EA ADDTL
|
Facility
IP
|
$121.82
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
63001262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$91.36 |
| Max. Negotiated Rate |
$113.29 |
| Rate for Payer: Aetna Commercial |
$105.25
|
| Rate for Payer: Cash Price |
$75.53
|
| Rate for Payer: Cigna All Commercial |
$105.13
|
| Rate for Payer: CORVEL All Commercial |
$113.29
|
| Rate for Payer: Coventry All Commercial |
$107.20
|
| Rate for Payer: Encore All Commercial |
$112.13
|
| Rate for Payer: Frontpath All Commercial |
$112.07
|
| Rate for Payer: Humana ChoiceCare |
$105.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.64
|
| Rate for Payer: PHCS All Commercial |
$91.36
|
| Rate for Payer: PHP All Commercial |
$92.39
|
| Rate for Payer: Sagamore Health Network All Products |
$94.04
|
| Rate for Payer: Signature Care EPO |
$101.11
|
| Rate for Payer: Signature Care PPO |
$107.20
|
| Rate for Payer: United Healthcare Commercial |
$95.99
|
|
|
HC FSH
|
Facility
OP
|
$173.91
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
63001159
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$146.78
|
| Rate for Payer: Aetna Medicare |
$57.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.13
|
| Rate for Payer: Cash Price |
$107.82
|
| Rate for Payer: Cash Price |
$107.82
|
| Rate for Payer: Centivo All Commercial |
$88.69
|
| Rate for Payer: Cigna All Commercial |
$150.08
|
| Rate for Payer: CORVEL All Commercial |
$161.74
|
| Rate for Payer: Coventry All Commercial |
$153.04
|
| Rate for Payer: Encore All Commercial |
$160.08
|
| Rate for Payer: Frontpath All Commercial |
$160.00
|
| Rate for Payer: Humana ChoiceCare |
$150.21
|
| Rate for Payer: Humana Medicare |
$88.69
|
| Rate for Payer: Lucent All Commercial |
$88.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.52
|
| Rate for Payer: Managed Health Services Medicaid |
$18.58
|
| Rate for Payer: MDWise Medicaid |
$18.58
|
| Rate for Payer: PHCS All Commercial |
$130.43
|
| Rate for Payer: PHP All Commercial |
$131.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.82
|
| Rate for Payer: Sagamore Health Network All Products |
$134.26
|
| Rate for Payer: Signature Care EPO |
$144.35
|
| Rate for Payer: Signature Care PPO |
$153.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.82
|
| Rate for Payer: United Healthcare Commercial |
$137.04
|
| Rate for Payer: United Healthcare Medicare |
$57.39
|
|
|
HC FSH
|
Facility
IP
|
$173.91
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
63001159
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$150.26
|
| Rate for Payer: Cash Price |
$107.82
|
| Rate for Payer: Cigna All Commercial |
$150.08
|
| Rate for Payer: CORVEL All Commercial |
$161.74
|
| Rate for Payer: Coventry All Commercial |
$153.04
|
| Rate for Payer: Encore All Commercial |
$160.08
|
| Rate for Payer: Frontpath All Commercial |
$160.00
|
| Rate for Payer: Humana ChoiceCare |
$150.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.52
|
| Rate for Payer: PHCS All Commercial |
$130.43
|
| Rate for Payer: PHP All Commercial |
$131.89
|
| Rate for Payer: Sagamore Health Network All Products |
$134.26
|
| Rate for Payer: Signature Care EPO |
$144.35
|
| Rate for Payer: Signature Care PPO |
$153.04
|
| Rate for Payer: United Healthcare Commercial |
$137.04
|
|
|
HC FUNGAL CULT-BLOOD
|
Facility
IP
|
$306.16
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
63001068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$229.62 |
| Max. Negotiated Rate |
$284.73 |
| Rate for Payer: Aetna Commercial |
$264.53
|
| Rate for Payer: Cash Price |
$189.82
|
| Rate for Payer: Cigna All Commercial |
$264.22
|
| Rate for Payer: CORVEL All Commercial |
$284.73
|
| Rate for Payer: Coventry All Commercial |
$269.42
|
| Rate for Payer: Encore All Commercial |
$281.82
|
| Rate for Payer: Frontpath All Commercial |
$281.67
|
| Rate for Payer: Humana ChoiceCare |
$264.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.55
|
| Rate for Payer: PHCS All Commercial |
$229.62
|
| Rate for Payer: PHP All Commercial |
$232.19
|
| Rate for Payer: Sagamore Health Network All Products |
$236.36
|
| Rate for Payer: Signature Care EPO |
$254.12
|
| Rate for Payer: Signature Care PPO |
$269.42
|
| Rate for Payer: United Healthcare Commercial |
$241.26
|
|
|
HC FUNGAL CULT-BLOOD
|
Facility
OP
|
$306.16
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
63001068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$284.73 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Medicare |
$101.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.14
|
| Rate for Payer: Cash Price |
$189.82
|
| Rate for Payer: Cash Price |
$189.82
|
| Rate for Payer: Centivo All Commercial |
$156.14
|
| Rate for Payer: Cigna All Commercial |
$264.22
|
| Rate for Payer: CORVEL All Commercial |
$284.73
|
| Rate for Payer: Coventry All Commercial |
$269.42
|
| Rate for Payer: Encore All Commercial |
$281.82
|
| Rate for Payer: Frontpath All Commercial |
$281.67
|
| Rate for Payer: Humana ChoiceCare |
$264.43
|
| Rate for Payer: Humana Medicare |
$156.14
|
| Rate for Payer: Lucent All Commercial |
$156.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.55
|
| Rate for Payer: Managed Health Services Medicaid |
$12.27
|
| Rate for Payer: MDWise Medicaid |
$12.27
|
| Rate for Payer: PHCS All Commercial |
$229.62
|
| Rate for Payer: PHP All Commercial |
$232.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.40
|
| Rate for Payer: Sagamore Health Network All Products |
$236.36
|
| Rate for Payer: Signature Care EPO |
$254.12
|
| Rate for Payer: Signature Care PPO |
$269.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.24
|
| Rate for Payer: United Healthcare Commercial |
$241.26
|
| Rate for Payer: United Healthcare Medicare |
$101.03
|
|
|
HC FUNGAL CULT-OTHER
|
Facility
IP
|
$214.30
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
63001070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.73 |
| Max. Negotiated Rate |
$199.30 |
| Rate for Payer: Aetna Commercial |
$185.16
|
| Rate for Payer: Cash Price |
$132.87
|
| Rate for Payer: Cigna All Commercial |
$184.94
|
| Rate for Payer: CORVEL All Commercial |
$199.30
|
| Rate for Payer: Coventry All Commercial |
$188.59
|
| Rate for Payer: Encore All Commercial |
$197.26
|
| Rate for Payer: Frontpath All Commercial |
$197.16
|
| Rate for Payer: Humana ChoiceCare |
$185.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.87
|
| Rate for Payer: PHCS All Commercial |
$160.73
|
| Rate for Payer: PHP All Commercial |
$162.53
|
| Rate for Payer: Sagamore Health Network All Products |
$165.44
|
| Rate for Payer: Signature Care EPO |
$177.87
|
| Rate for Payer: Signature Care PPO |
$188.59
|
| Rate for Payer: United Healthcare Commercial |
$168.87
|
|
|
HC FUNGAL CULT-OTHER
|
Facility
OP
|
$214.30
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
63001070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$199.30 |
| Rate for Payer: Aetna Commercial |
$180.87
|
| Rate for Payer: Aetna Medicare |
$70.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$123.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.79
|
| Rate for Payer: Cash Price |
$132.87
|
| Rate for Payer: Cash Price |
$132.87
|
| Rate for Payer: Centivo All Commercial |
$109.29
|
| Rate for Payer: Cigna All Commercial |
$184.94
|
| Rate for Payer: CORVEL All Commercial |
$199.30
|
| Rate for Payer: Coventry All Commercial |
$188.59
|
| Rate for Payer: Encore All Commercial |
$197.26
|
| Rate for Payer: Frontpath All Commercial |
$197.16
|
| Rate for Payer: Humana ChoiceCare |
$185.09
|
| Rate for Payer: Humana Medicare |
$109.29
|
| Rate for Payer: Lucent All Commercial |
$109.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.87
|
| Rate for Payer: Managed Health Services Medicaid |
$8.41
|
| Rate for Payer: MDWise Medicaid |
$8.41
|
| Rate for Payer: PHCS All Commercial |
$160.73
|
| Rate for Payer: PHP All Commercial |
$162.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.58
|
| Rate for Payer: Sagamore Health Network All Products |
$165.44
|
| Rate for Payer: Signature Care EPO |
$177.87
|
| Rate for Payer: Signature Care PPO |
$188.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.16
|
| Rate for Payer: United Healthcare Commercial |
$168.87
|
| Rate for Payer: United Healthcare Medicare |
$70.72
|
|
|
HC FUNGAL CULT-SKIN, HAIR OR NAILS
|
Facility
IP
|
$115.52
|
|
|
Service Code
|
CPT 87101
|
| Hospital Charge Code |
63001071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.64 |
| Max. Negotiated Rate |
$107.43 |
| Rate for Payer: Aetna Commercial |
$99.80
|
| Rate for Payer: Cash Price |
$71.62
|
| Rate for Payer: Cigna All Commercial |
$99.69
|
| Rate for Payer: CORVEL All Commercial |
$107.43
|
| Rate for Payer: Coventry All Commercial |
$101.65
|
| Rate for Payer: Encore All Commercial |
$106.33
|
| Rate for Payer: Frontpath All Commercial |
$106.27
|
| Rate for Payer: Humana ChoiceCare |
$99.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.96
|
| Rate for Payer: PHCS All Commercial |
$86.64
|
| Rate for Payer: PHP All Commercial |
$87.61
|
| Rate for Payer: Sagamore Health Network All Products |
$89.18
|
| Rate for Payer: Signature Care EPO |
$95.88
|
| Rate for Payer: Signature Care PPO |
$101.65
|
| Rate for Payer: United Healthcare Commercial |
$91.03
|
|
|
HC FUNGAL CULT-SKIN, HAIR OR NAILS
|
Facility
OP
|
$115.52
|
|
|
Service Code
|
CPT 87101
|
| Hospital Charge Code |
63001071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$107.43 |
| Rate for Payer: Aetna Commercial |
$97.49
|
| Rate for Payer: Aetna Medicare |
$38.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.93
|
| Rate for Payer: Cash Price |
$71.62
|
| Rate for Payer: Cash Price |
$71.62
|
| Rate for Payer: Centivo All Commercial |
$58.91
|
| Rate for Payer: Cigna All Commercial |
$99.69
|
| Rate for Payer: CORVEL All Commercial |
$107.43
|
| Rate for Payer: Coventry All Commercial |
$101.65
|
| Rate for Payer: Encore All Commercial |
$106.33
|
| Rate for Payer: Frontpath All Commercial |
$106.27
|
| Rate for Payer: Humana ChoiceCare |
$99.77
|
| Rate for Payer: Humana Medicare |
$58.91
|
| Rate for Payer: Lucent All Commercial |
$58.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.96
|
| Rate for Payer: Managed Health Services Medicaid |
$7.71
|
| Rate for Payer: MDWise Medicaid |
$7.71
|
| Rate for Payer: PHCS All Commercial |
$86.64
|
| Rate for Payer: PHP All Commercial |
$87.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.05
|
| Rate for Payer: Sagamore Health Network All Products |
$89.18
|
| Rate for Payer: Signature Care EPO |
$95.88
|
| Rate for Payer: Signature Care PPO |
$101.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.19
|
| Rate for Payer: United Healthcare Commercial |
$91.03
|
| Rate for Payer: United Healthcare Medicare |
$38.12
|
|
|
HC FUNGAL NES, IMMUNOASSAY
|
Facility
OP
|
$40.36
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
63001941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$34.07
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.65
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Centivo All Commercial |
$20.58
|
| Rate for Payer: Cigna All Commercial |
$34.83
|
| Rate for Payer: CORVEL All Commercial |
$37.54
|
| Rate for Payer: Coventry All Commercial |
$35.52
|
| Rate for Payer: Encore All Commercial |
$37.15
|
| Rate for Payer: Frontpath All Commercial |
$37.13
|
| Rate for Payer: Humana ChoiceCare |
$34.86
|
| Rate for Payer: Humana Medicare |
$20.58
|
| Rate for Payer: Lucent All Commercial |
$20.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.33
|
| Rate for Payer: Managed Health Services Medicaid |
$12.25
|
| Rate for Payer: MDWise Medicaid |
$12.25
|
| Rate for Payer: PHCS All Commercial |
$30.27
|
| Rate for Payer: PHP All Commercial |
$30.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.74
|
| Rate for Payer: Sagamore Health Network All Products |
$31.16
|
| Rate for Payer: Signature Care EPO |
$33.50
|
| Rate for Payer: Signature Care PPO |
$35.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.31
|
| Rate for Payer: United Healthcare Commercial |
$31.80
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
|
|
HC FUNGAL NES, IMMUNOASSAY
|
Facility
IP
|
$40.36
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
63001941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.27 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$34.87
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cigna All Commercial |
$34.83
|
| Rate for Payer: CORVEL All Commercial |
$37.54
|
| Rate for Payer: Coventry All Commercial |
$35.52
|
| Rate for Payer: Encore All Commercial |
$37.15
|
| Rate for Payer: Frontpath All Commercial |
$37.13
|
| Rate for Payer: Humana ChoiceCare |
$34.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.33
|
| Rate for Payer: PHCS All Commercial |
$30.27
|
| Rate for Payer: PHP All Commercial |
$30.61
|
| Rate for Payer: Sagamore Health Network All Products |
$31.16
|
| Rate for Payer: Signature Care EPO |
$33.50
|
| Rate for Payer: Signature Care PPO |
$35.52
|
| Rate for Payer: United Healthcare Commercial |
$31.80
|
|
|
HC FUNGAL SMEAR
|
Facility
OP
|
$113.29
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
63001082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$105.36 |
| Rate for Payer: Aetna Commercial |
$95.62
|
| Rate for Payer: Aetna Medicare |
$37.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.12
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Centivo All Commercial |
$57.78
|
| Rate for Payer: Cigna All Commercial |
$97.77
|
| Rate for Payer: CORVEL All Commercial |
$105.36
|
| Rate for Payer: Coventry All Commercial |
$99.70
|
| Rate for Payer: Encore All Commercial |
$104.28
|
| Rate for Payer: Frontpath All Commercial |
$104.23
|
| Rate for Payer: Humana ChoiceCare |
$97.85
|
| Rate for Payer: Humana Medicare |
$57.78
|
| Rate for Payer: Lucent All Commercial |
$57.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.96
|
| Rate for Payer: Managed Health Services Medicaid |
$5.39
|
| Rate for Payer: MDWise Medicaid |
$5.39
|
| Rate for Payer: PHCS All Commercial |
$84.97
|
| Rate for Payer: PHP All Commercial |
$85.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.18
|
| Rate for Payer: Sagamore Health Network All Products |
$87.46
|
| Rate for Payer: Signature Care EPO |
$94.03
|
| Rate for Payer: Signature Care PPO |
$99.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.30
|
| Rate for Payer: United Healthcare Commercial |
$89.27
|
| Rate for Payer: United Healthcare Medicare |
$37.39
|
|
|
HC FUNGAL SMEAR
|
Facility
IP
|
$113.29
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
63001082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.97 |
| Max. Negotiated Rate |
$105.36 |
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Cigna All Commercial |
$97.77
|
| Rate for Payer: CORVEL All Commercial |
$105.36
|
| Rate for Payer: Coventry All Commercial |
$99.70
|
| Rate for Payer: Encore All Commercial |
$104.28
|
| Rate for Payer: Frontpath All Commercial |
$104.23
|
| Rate for Payer: Humana ChoiceCare |
$97.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.96
|
| Rate for Payer: PHCS All Commercial |
$84.97
|
| Rate for Payer: PHP All Commercial |
$85.92
|
| Rate for Payer: Sagamore Health Network All Products |
$87.46
|
| Rate for Payer: Signature Care EPO |
$94.03
|
| Rate for Payer: Signature Care PPO |
$99.70
|
| Rate for Payer: United Healthcare Commercial |
$89.27
|
|
|
HC FUNGAL SMEAR - CHARGE ONLY
|
Facility
OP
|
$68.98
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
63002014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$64.15 |
| Rate for Payer: Aetna Commercial |
$58.22
|
| Rate for Payer: Aetna Medicare |
$22.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.04
|
| Rate for Payer: Cash Price |
$42.77
|
| Rate for Payer: Cash Price |
$42.77
|
| Rate for Payer: Centivo All Commercial |
$35.18
|
| Rate for Payer: Cigna All Commercial |
$59.53
|
| Rate for Payer: CORVEL All Commercial |
$64.15
|
| Rate for Payer: Coventry All Commercial |
$60.70
|
| Rate for Payer: Encore All Commercial |
$63.50
|
| Rate for Payer: Frontpath All Commercial |
$63.46
|
| Rate for Payer: Humana ChoiceCare |
$59.58
|
| Rate for Payer: Humana Medicare |
$35.18
|
| Rate for Payer: Lucent All Commercial |
$35.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.08
|
| Rate for Payer: Managed Health Services Medicaid |
$5.39
|
| Rate for Payer: MDWise Medicaid |
$5.39
|
| Rate for Payer: PHCS All Commercial |
$51.74
|
| Rate for Payer: PHP All Commercial |
$52.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.90
|
| Rate for Payer: Sagamore Health Network All Products |
$53.25
|
| Rate for Payer: Signature Care EPO |
$57.26
|
| Rate for Payer: Signature Care PPO |
$60.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.64
|
| Rate for Payer: United Healthcare Commercial |
$54.36
|
| Rate for Payer: United Healthcare Medicare |
$22.76
|
|
|
HC FUNGAL SMEAR - CHARGE ONLY
|
Facility
IP
|
$68.98
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
63002014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$64.15 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$42.77
|
| Rate for Payer: Cigna All Commercial |
$59.53
|
| Rate for Payer: CORVEL All Commercial |
$64.15
|
| Rate for Payer: Coventry All Commercial |
$60.70
|
| Rate for Payer: Encore All Commercial |
$63.50
|
| Rate for Payer: Frontpath All Commercial |
$63.46
|
| Rate for Payer: Humana ChoiceCare |
$59.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.08
|
| Rate for Payer: PHCS All Commercial |
$51.74
|
| Rate for Payer: PHP All Commercial |
$52.32
|
| Rate for Payer: Sagamore Health Network All Products |
$53.25
|
| Rate for Payer: Signature Care EPO |
$57.26
|
| Rate for Payer: Signature Care PPO |
$60.70
|
| Rate for Payer: United Healthcare Commercial |
$54.36
|
|
|
HC FUNGAL SMEAR - REFLEX
|
Facility
OP
|
$68.98
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
63002015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$64.15 |
| Rate for Payer: Aetna Commercial |
$58.22
|
| Rate for Payer: Aetna Medicare |
$22.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.04
|
| Rate for Payer: Cash Price |
$42.77
|
| Rate for Payer: Cash Price |
$42.77
|
| Rate for Payer: Centivo All Commercial |
$35.18
|
| Rate for Payer: Cigna All Commercial |
$59.53
|
| Rate for Payer: CORVEL All Commercial |
$64.15
|
| Rate for Payer: Coventry All Commercial |
$60.70
|
| Rate for Payer: Encore All Commercial |
$63.50
|
| Rate for Payer: Frontpath All Commercial |
$63.46
|
| Rate for Payer: Humana ChoiceCare |
$59.58
|
| Rate for Payer: Humana Medicare |
$35.18
|
| Rate for Payer: Lucent All Commercial |
$35.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.08
|
| Rate for Payer: Managed Health Services Medicaid |
$5.39
|
| Rate for Payer: MDWise Medicaid |
$5.39
|
| Rate for Payer: PHCS All Commercial |
$51.74
|
| Rate for Payer: PHP All Commercial |
$52.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.90
|
| Rate for Payer: Sagamore Health Network All Products |
$53.25
|
| Rate for Payer: Signature Care EPO |
$57.26
|
| Rate for Payer: Signature Care PPO |
$60.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.64
|
| Rate for Payer: United Healthcare Commercial |
$54.36
|
| Rate for Payer: United Healthcare Medicare |
$22.76
|
|
|
HC FUNGAL SMEAR - REFLEX
|
Facility
IP
|
$68.98
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
63002015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$64.15 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$42.77
|
| Rate for Payer: Cigna All Commercial |
$59.53
|
| Rate for Payer: CORVEL All Commercial |
$64.15
|
| Rate for Payer: Coventry All Commercial |
$60.70
|
| Rate for Payer: Encore All Commercial |
$63.50
|
| Rate for Payer: Frontpath All Commercial |
$63.46
|
| Rate for Payer: Humana ChoiceCare |
$59.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.08
|
| Rate for Payer: PHCS All Commercial |
$51.74
|
| Rate for Payer: PHP All Commercial |
$52.32
|
| Rate for Payer: Sagamore Health Network All Products |
$53.25
|
| Rate for Payer: Signature Care EPO |
$57.26
|
| Rate for Payer: Signature Care PPO |
$60.70
|
| Rate for Payer: United Healthcare Commercial |
$54.36
|
|
|
HC FUNGUS ID CHARGE
|
Facility
OP
|
$383.05
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
63002003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$356.24 |
| Rate for Payer: Aetna Commercial |
$323.29
|
| Rate for Payer: Aetna Medicare |
$126.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$176.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$176.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.05
|
| Rate for Payer: Cash Price |
$237.49
|
| Rate for Payer: Cash Price |
$237.49
|
| Rate for Payer: Centivo All Commercial |
$195.36
|
| Rate for Payer: Cigna All Commercial |
$330.57
|
| Rate for Payer: CORVEL All Commercial |
$356.24
|
| Rate for Payer: Coventry All Commercial |
$337.08
|
| Rate for Payer: Encore All Commercial |
$352.60
|
| Rate for Payer: Frontpath All Commercial |
$352.41
|
| Rate for Payer: Humana ChoiceCare |
$330.84
|
| Rate for Payer: Humana Medicare |
$195.36
|
| Rate for Payer: Lucent All Commercial |
$195.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$344.75
|
| Rate for Payer: Managed Health Services Medicaid |
$10.32
|
| Rate for Payer: MDWise Medicaid |
$10.32
|
| Rate for Payer: PHCS All Commercial |
$287.29
|
| Rate for Payer: PHP All Commercial |
$290.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.39
|
| Rate for Payer: Sagamore Health Network All Products |
$295.72
|
| Rate for Payer: Signature Care EPO |
$317.93
|
| Rate for Payer: Signature Care PPO |
$337.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$325.59
|
| Rate for Payer: United Healthcare Commercial |
$301.84
|
| Rate for Payer: United Healthcare Medicare |
$126.41
|
|
|
HC FUNGUS ID CHARGE
|
Facility
IP
|
$383.05
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
63002003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$287.29 |
| Max. Negotiated Rate |
$356.24 |
| Rate for Payer: Aetna Commercial |
$330.96
|
| Rate for Payer: Cash Price |
$237.49
|
| Rate for Payer: Cigna All Commercial |
$330.57
|
| Rate for Payer: CORVEL All Commercial |
$356.24
|
| Rate for Payer: Coventry All Commercial |
$337.08
|
| Rate for Payer: Encore All Commercial |
$352.60
|
| Rate for Payer: Frontpath All Commercial |
$352.41
|
| Rate for Payer: Humana ChoiceCare |
$330.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$344.75
|
| Rate for Payer: PHCS All Commercial |
$287.29
|
| Rate for Payer: PHP All Commercial |
$290.51
|
| Rate for Payer: Sagamore Health Network All Products |
$295.72
|
| Rate for Payer: Signature Care EPO |
$317.93
|
| Rate for Payer: Signature Care PPO |
$337.08
|
| Rate for Payer: United Healthcare Commercial |
$301.84
|
|
|
HC FUNGUS ID REFERRED
|
Facility
OP
|
$383.05
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
63002004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$356.24 |
| Rate for Payer: Aetna Commercial |
$323.29
|
| Rate for Payer: Aetna Medicare |
$126.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$176.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$176.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.05
|
| Rate for Payer: Cash Price |
$237.49
|
| Rate for Payer: Cash Price |
$237.49
|
| Rate for Payer: Centivo All Commercial |
$195.36
|
| Rate for Payer: Cigna All Commercial |
$330.57
|
| Rate for Payer: CORVEL All Commercial |
$356.24
|
| Rate for Payer: Coventry All Commercial |
$337.08
|
| Rate for Payer: Encore All Commercial |
$352.60
|
| Rate for Payer: Frontpath All Commercial |
$352.41
|
| Rate for Payer: Humana ChoiceCare |
$330.84
|
| Rate for Payer: Humana Medicare |
$195.36
|
| Rate for Payer: Lucent All Commercial |
$195.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$344.75
|
| Rate for Payer: Managed Health Services Medicaid |
$10.32
|
| Rate for Payer: MDWise Medicaid |
$10.32
|
| Rate for Payer: PHCS All Commercial |
$287.29
|
| Rate for Payer: PHP All Commercial |
$290.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.39
|
| Rate for Payer: Sagamore Health Network All Products |
$295.72
|
| Rate for Payer: Signature Care EPO |
$317.93
|
| Rate for Payer: Signature Care PPO |
$337.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$325.59
|
| Rate for Payer: United Healthcare Commercial |
$301.84
|
| Rate for Payer: United Healthcare Medicare |
$126.41
|
|
|
HC FUNGUS ID REFERRED
|
Facility
IP
|
$383.05
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
63002004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$287.29 |
| Max. Negotiated Rate |
$356.24 |
| Rate for Payer: Aetna Commercial |
$330.96
|
| Rate for Payer: Cash Price |
$237.49
|
| Rate for Payer: Cigna All Commercial |
$330.57
|
| Rate for Payer: CORVEL All Commercial |
$356.24
|
| Rate for Payer: Coventry All Commercial |
$337.08
|
| Rate for Payer: Encore All Commercial |
$352.60
|
| Rate for Payer: Frontpath All Commercial |
$352.41
|
| Rate for Payer: Humana ChoiceCare |
$330.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$344.75
|
| Rate for Payer: PHCS All Commercial |
$287.29
|
| Rate for Payer: PHP All Commercial |
$290.51
|
| Rate for Payer: Sagamore Health Network All Products |
$295.72
|
| Rate for Payer: Signature Care EPO |
$317.93
|
| Rate for Payer: Signature Care PPO |
$337.08
|
| Rate for Payer: United Healthcare Commercial |
$301.84
|
|
|
HC G6PD
|
Facility
OP
|
$144.74
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
63001564
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$134.61 |
| Rate for Payer: Aetna Commercial |
$122.16
|
| Rate for Payer: Aetna Medicare |
$47.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.54
|
| Rate for Payer: Cash Price |
$89.74
|
| Rate for Payer: Cash Price |
$89.74
|
| Rate for Payer: Centivo All Commercial |
$73.82
|
| Rate for Payer: Cigna All Commercial |
$124.91
|
| Rate for Payer: CORVEL All Commercial |
$134.61
|
| Rate for Payer: Coventry All Commercial |
$127.37
|
| Rate for Payer: Encore All Commercial |
$133.23
|
| Rate for Payer: Frontpath All Commercial |
$133.16
|
| Rate for Payer: Humana ChoiceCare |
$125.01
|
| Rate for Payer: Humana Medicare |
$73.82
|
| Rate for Payer: Lucent All Commercial |
$73.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.26
|
| Rate for Payer: Managed Health Services Medicaid |
$9.70
|
| Rate for Payer: MDWise Medicaid |
$9.70
|
| Rate for Payer: PHCS All Commercial |
$108.55
|
| Rate for Payer: PHP All Commercial |
$109.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.45
|
| Rate for Payer: Sagamore Health Network All Products |
$111.74
|
| Rate for Payer: Signature Care EPO |
$120.13
|
| Rate for Payer: Signature Care PPO |
$127.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.03
|
| Rate for Payer: United Healthcare Commercial |
$114.05
|
| Rate for Payer: United Healthcare Medicare |
$47.76
|
|
|
HC G6PD
|
Facility
IP
|
$144.74
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
63001564
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$134.61 |
| Rate for Payer: Aetna Commercial |
$125.05
|
| Rate for Payer: Cash Price |
$89.74
|
| Rate for Payer: Cigna All Commercial |
$124.91
|
| Rate for Payer: CORVEL All Commercial |
$134.61
|
| Rate for Payer: Coventry All Commercial |
$127.37
|
| Rate for Payer: Encore All Commercial |
$133.23
|
| Rate for Payer: Frontpath All Commercial |
$133.16
|
| Rate for Payer: Humana ChoiceCare |
$125.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.26
|
| Rate for Payer: PHCS All Commercial |
$108.55
|
| Rate for Payer: PHP All Commercial |
$109.77
|
| Rate for Payer: Sagamore Health Network All Products |
$111.74
|
| Rate for Payer: Signature Care EPO |
$120.13
|
| Rate for Payer: Signature Care PPO |
$127.37
|
| Rate for Payer: United Healthcare Commercial |
$114.05
|
|
|
HC GABAPENTIN/NEUR
|
Facility
IP
|
$180.64
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
63001374
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.48 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$156.07
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna All Commercial |
$155.89
|
| Rate for Payer: CORVEL All Commercial |
$168.00
|
| Rate for Payer: Coventry All Commercial |
$158.96
|
| Rate for Payer: Encore All Commercial |
$166.28
|
| Rate for Payer: Frontpath All Commercial |
$166.19
|
| Rate for Payer: Humana ChoiceCare |
$156.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.58
|
| Rate for Payer: PHCS All Commercial |
$135.48
|
| Rate for Payer: PHP All Commercial |
$137.00
|
| Rate for Payer: Sagamore Health Network All Products |
$139.46
|
| Rate for Payer: Signature Care EPO |
$149.93
|
| Rate for Payer: Signature Care PPO |
$158.96
|
| Rate for Payer: United Healthcare Commercial |
$142.35
|
|
|
HC GABAPENTIN/NEUR
|
Facility
OP
|
$180.64
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
63001374
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Aetna Medicare |
$59.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$103.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.57
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Centivo All Commercial |
$92.13
|
| Rate for Payer: Cigna All Commercial |
$155.89
|
| Rate for Payer: CORVEL All Commercial |
$168.00
|
| Rate for Payer: Coventry All Commercial |
$158.96
|
| Rate for Payer: Encore All Commercial |
$166.28
|
| Rate for Payer: Frontpath All Commercial |
$166.19
|
| Rate for Payer: Humana ChoiceCare |
$156.02
|
| Rate for Payer: Humana Medicare |
$92.13
|
| Rate for Payer: Lucent All Commercial |
$92.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.58
|
| Rate for Payer: Managed Health Services Medicaid |
$18.04
|
| Rate for Payer: MDWise Medicaid |
$18.04
|
| Rate for Payer: PHCS All Commercial |
$135.48
|
| Rate for Payer: PHP All Commercial |
$137.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.45
|
| Rate for Payer: Sagamore Health Network All Products |
$139.46
|
| Rate for Payer: Signature Care EPO |
$149.93
|
| Rate for Payer: Signature Care PPO |
$158.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$153.55
|
| Rate for Payer: United Healthcare Commercial |
$142.35
|
| Rate for Payer: United Healthcare Medicare |
$59.61
|
|
