|
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 |
$104.35
|
| 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 |
$264.52
|
| Rate for Payer: Cash Price |
$183.70
|
| 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 |
$275.54
|
| 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 |
$254.11
|
| Rate for Payer: Signature Care PPO |
$269.42
|
| Rate for Payer: United Healthcare Commercial |
$241.25
|
|
|
HC FUNGAL CULT-BLOOD
|
Facility
|
OP
|
$306.16
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
63001068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$284.73 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Medicare |
$97.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$140.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.77
|
| Rate for Payer: Cash Price |
$183.70
|
| Rate for Payer: Cash Price |
$183.70
|
| Rate for Payer: Centivo All Commercial |
$166.55
|
| 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 |
$97.97
|
| Rate for Payer: Lucent All Commercial |
$166.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.54
|
| Rate for Payer: Managed Health Services Medicaid |
$20.46
|
| Rate for Payer: MDWise Medicaid |
$20.46
|
| 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 |
$254.11
|
| Rate for Payer: Signature Care PPO |
$269.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.24
|
| Rate for Payer: United Healthcare Commercial |
$241.25
|
| Rate for Payer: United Healthcare Medicare |
$97.97
|
|
|
HC FUNGAL CULT-OTHER
|
Facility
|
IP
|
$214.30
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
63001070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$199.30 |
| Rate for Payer: Aetna Commercial |
$185.16
|
| Rate for Payer: Cash Price |
$128.58
|
| Rate for Payer: Cigna All Commercial |
$184.94
|
| Rate for Payer: CORVEL All Commercial |
$199.30
|
| Rate for Payer: Coventry All Commercial |
$188.58
|
| 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 |
$160.72
|
| 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 |
$188.58
|
| 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 |
$68.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$98.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.43
|
| Rate for Payer: Cash Price |
$128.58
|
| Rate for Payer: Cash Price |
$128.58
|
| Rate for Payer: Centivo All Commercial |
$116.58
|
| Rate for Payer: Cigna All Commercial |
$184.94
|
| Rate for Payer: CORVEL All Commercial |
$199.30
|
| Rate for Payer: Coventry All Commercial |
$188.58
|
| 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 |
$68.58
|
| Rate for Payer: Lucent All Commercial |
$116.58
|
| 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 |
$160.72
|
| 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 |
$188.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.16
|
| Rate for Payer: United Healthcare Commercial |
$168.87
|
| Rate for Payer: United Healthcare Medicare |
$68.58
|
|
|
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 |
$99.81
|
| Rate for Payer: Cash Price |
$69.31
|
| Rate for Payer: Cigna All Commercial |
$99.69
|
| Rate for Payer: CORVEL All Commercial |
$107.43
|
| Rate for Payer: Coventry All Commercial |
$101.66
|
| Rate for Payer: Encore All Commercial |
$106.34
|
| Rate for Payer: Frontpath All Commercial |
$106.28
|
| Rate for Payer: Humana ChoiceCare |
$99.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.97
|
| 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 |
$101.66
|
| 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 |
$97.50
|
| Rate for Payer: Aetna Medicare |
$36.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$7.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$53.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.66
|
| Rate for Payer: Cash Price |
$69.31
|
| Rate for Payer: Cash Price |
$69.31
|
| Rate for Payer: Centivo All Commercial |
$62.84
|
| Rate for Payer: Cigna All Commercial |
$99.69
|
| Rate for Payer: CORVEL All Commercial |
$107.43
|
| Rate for Payer: Coventry All Commercial |
$101.66
|
| Rate for Payer: Encore All Commercial |
$106.34
|
| Rate for Payer: Frontpath All Commercial |
$106.28
|
| Rate for Payer: Humana ChoiceCare |
$99.77
|
| Rate for Payer: Humana Medicare |
$36.97
|
| Rate for Payer: Lucent All Commercial |
$62.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.97
|
| 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 |
$101.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.19
|
| Rate for Payer: United Healthcare Commercial |
$91.03
|
| Rate for Payer: United Healthcare Medicare |
$36.97
|
|
|
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 |
$37.53 |
| Rate for Payer: Aetna Commercial |
$34.87
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Cigna All Commercial |
$34.83
|
| Rate for Payer: CORVEL All Commercial |
$37.53
|
| 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 |
$36.32
|
| 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 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 |
$37.53 |
| Rate for Payer: Aetna Commercial |
$34.06
|
| Rate for Payer: Aetna Medicare |
$12.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.21
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Centivo All Commercial |
$21.96
|
| Rate for Payer: Cigna All Commercial |
$34.83
|
| Rate for Payer: CORVEL All Commercial |
$37.53
|
| 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 |
$12.92
|
| Rate for Payer: Lucent All Commercial |
$21.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.32
|
| 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 |
$12.92
|
|
|
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 |
$67.97
|
| 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
|
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 |
$36.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.88
|
| Rate for Payer: Cash Price |
$67.97
|
| Rate for Payer: Cash Price |
$67.97
|
| Rate for Payer: Centivo All Commercial |
$61.63
|
| 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 |
$36.25
|
| Rate for Payer: Lucent All Commercial |
$61.63
|
| 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 |
$36.25
|
|
|
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 |
$229.83
|
| 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 |
$295.71
|
| 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 |
$122.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$118.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$176.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$176.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.83
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Centivo All Commercial |
$208.38
|
| 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 |
$122.58
|
| Rate for Payer: Lucent All Commercial |
$208.38
|
| 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 |
$295.71
|
| 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 |
$122.58
|
|
|
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 |
$46.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.95
|
| Rate for Payer: Cash Price |
$86.84
|
| Rate for Payer: Cash Price |
$86.84
|
| Rate for Payer: Centivo All Commercial |
$78.74
|
| 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: Humana Medicare |
$46.32
|
| Rate for Payer: Lucent All Commercial |
$78.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.27
|
| Rate for Payer: Managed Health Services Medicaid |
$9.70
|
| Rate for Payer: MDWise Medicaid |
$9.70
|
| Rate for Payer: PHCS All Commercial |
$108.56
|
| 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 |
$114.06
|
| Rate for Payer: United Healthcare Medicare |
$46.32
|
|
|
HC G6PD
|
Facility
|
IP
|
$144.74
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
63001564
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$134.61 |
| Rate for Payer: Aetna Commercial |
$125.06
|
| Rate for Payer: Cash Price |
$86.84
|
| 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 |
$130.27
|
| Rate for Payer: PHCS All Commercial |
$108.56
|
| 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 |
$114.06
|
|
|
HC GAIT TRAINING/15 MIN-PT
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
1728036
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.15 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC GAIT TRAINING/15 MIN-PT
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
1728036
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.08
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.41
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Centivo All Commercial |
$74.82
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$44.01
|
| Rate for Payer: Lucent All Commercial |
$74.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$44.01
|
|
|
HC GAIT TRAINING THERAPY OT
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97116 GO
|
| Hospital Charge Code |
1739711
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.15 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC GAIT TRAINING THERAPY OT
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97116 GO
|
| Hospital Charge Code |
1739711
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.08
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.41
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Centivo All Commercial |
$74.82
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$44.01
|
| Rate for Payer: Lucent All Commercial |
$74.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$44.01
|
|
|
HC GASTRIC EMPTYING
|
Facility
|
IP
|
$2,092.86
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
1638453
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,569.64 |
| Max. Negotiated Rate |
$1,946.36 |
| Rate for Payer: Aetna Commercial |
$1,808.23
|
| Rate for Payer: Cash Price |
$1,255.72
|
| Rate for Payer: Cigna All Commercial |
$1,806.14
|
| Rate for Payer: CORVEL All Commercial |
$1,946.36
|
| Rate for Payer: Coventry All Commercial |
$1,841.72
|
| Rate for Payer: Encore All Commercial |
$1,926.48
|
| Rate for Payer: Frontpath All Commercial |
$1,925.43
|
| Rate for Payer: Humana ChoiceCare |
$1,807.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,883.57
|
| Rate for Payer: PHCS All Commercial |
$1,569.64
|
| Rate for Payer: PHP All Commercial |
$1,587.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,615.69
|
| Rate for Payer: Signature Care EPO |
$1,737.07
|
| Rate for Payer: Signature Care PPO |
$1,841.72
|
| Rate for Payer: United Healthcare Commercial |
$1,649.17
|
|
|
HC GASTRIC EMPTYING
|
Facility
|
OP
|
$2,092.86
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
1638453
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$215.43 |
| Max. Negotiated Rate |
$1,946.36 |
| Rate for Payer: Aetna Commercial |
$1,766.37
|
| Rate for Payer: Aetna Medicare |
$669.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$215.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$648.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,201.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,308.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$215.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$770.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$736.69
|
| Rate for Payer: Cash Price |
$1,255.72
|
| Rate for Payer: Cash Price |
$1,255.72
|
| Rate for Payer: Centivo All Commercial |
$1,138.52
|
| Rate for Payer: Cigna All Commercial |
$1,806.14
|
| Rate for Payer: CORVEL All Commercial |
$1,946.36
|
| Rate for Payer: Coventry All Commercial |
$1,841.72
|
| Rate for Payer: Encore All Commercial |
$1,926.48
|
| Rate for Payer: Frontpath All Commercial |
$1,925.43
|
| Rate for Payer: Humana ChoiceCare |
$1,807.60
|
| Rate for Payer: Humana Medicare |
$669.72
|
| Rate for Payer: Lucent All Commercial |
$1,138.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,883.57
|
| Rate for Payer: Managed Health Services Medicaid |
$215.43
|
| Rate for Payer: MDWise Medicaid |
$215.43
|
| Rate for Payer: PHCS All Commercial |
$1,569.64
|
| Rate for Payer: PHP All Commercial |
$1,587.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$816.22
|
| Rate for Payer: Sagamore Health Network All Products |
$1,615.69
|
| Rate for Payer: Signature Care EPO |
$1,737.07
|
| Rate for Payer: Signature Care PPO |
$1,841.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,778.93
|
| Rate for Payer: United Healthcare Commercial |
$1,649.17
|
| Rate for Payer: United Healthcare Medicare |
$669.72
|
|
|
HC GASTRIN
|
Facility
|
OP
|
$220.09
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
63001549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$204.68 |
| Rate for Payer: Aetna Commercial |
$185.76
|
| Rate for Payer: Aetna Medicare |
$70.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$101.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.47
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Centivo All Commercial |
$119.73
|
| Rate for Payer: Cigna All Commercial |
$189.94
|
| Rate for Payer: CORVEL All Commercial |
$204.68
|
| Rate for Payer: Coventry All Commercial |
$193.68
|
| Rate for Payer: Encore All Commercial |
$202.59
|
| Rate for Payer: Frontpath All Commercial |
$202.48
|
| Rate for Payer: Humana ChoiceCare |
$190.09
|
| Rate for Payer: Humana Medicare |
$70.43
|
| Rate for Payer: Lucent All Commercial |
$119.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.08
|
| Rate for Payer: Managed Health Services Medicaid |
$17.63
|
| Rate for Payer: MDWise Medicaid |
$17.63
|
| Rate for Payer: PHCS All Commercial |
$165.07
|
| Rate for Payer: PHP All Commercial |
$166.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.84
|
| Rate for Payer: Sagamore Health Network All Products |
$169.91
|
| Rate for Payer: Signature Care EPO |
$182.67
|
| Rate for Payer: Signature Care PPO |
$193.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$187.08
|
| Rate for Payer: United Healthcare Commercial |
$173.43
|
| Rate for Payer: United Healthcare Medicare |
$70.43
|
|
|
HC GASTRIN
|
Facility
|
IP
|
$220.09
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
63001549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.07 |
| Max. Negotiated Rate |
$204.68 |
| Rate for Payer: Aetna Commercial |
$190.16
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cigna All Commercial |
$189.94
|
| Rate for Payer: CORVEL All Commercial |
$204.68
|
| Rate for Payer: Coventry All Commercial |
$193.68
|
| Rate for Payer: Encore All Commercial |
$202.59
|
| Rate for Payer: Frontpath All Commercial |
$202.48
|
| Rate for Payer: Humana ChoiceCare |
$190.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.08
|
| Rate for Payer: PHCS All Commercial |
$165.07
|
| Rate for Payer: PHP All Commercial |
$166.92
|
| Rate for Payer: Sagamore Health Network All Products |
$169.91
|
| Rate for Payer: Signature Care EPO |
$182.67
|
| Rate for Payer: Signature Care PPO |
$193.68
|
| Rate for Payer: United Healthcare Commercial |
$173.43
|
|
|
HC GASTROCCULT
|
Facility
|
OP
|
$71.53
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
63001223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$66.52 |
| Rate for Payer: Aetna Commercial |
$60.37
|
| Rate for Payer: Aetna Medicare |
$22.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$32.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.18
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Centivo All Commercial |
$38.91
|
| Rate for Payer: Cigna All Commercial |
$61.73
|
| Rate for Payer: CORVEL All Commercial |
$66.52
|
| Rate for Payer: Coventry All Commercial |
$62.95
|
| Rate for Payer: Encore All Commercial |
$65.84
|
| Rate for Payer: Frontpath All Commercial |
$65.81
|
| Rate for Payer: Humana ChoiceCare |
$61.78
|
| Rate for Payer: Humana Medicare |
$22.89
|
| Rate for Payer: Lucent All Commercial |
$38.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.38
|
| Rate for Payer: Managed Health Services Medicaid |
$5.32
|
| Rate for Payer: MDWise Medicaid |
$5.32
|
| Rate for Payer: PHCS All Commercial |
$53.65
|
| Rate for Payer: PHP All Commercial |
$54.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.90
|
| Rate for Payer: Sagamore Health Network All Products |
$55.22
|
| Rate for Payer: Signature Care EPO |
$59.37
|
| Rate for Payer: Signature Care PPO |
$62.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.80
|
| Rate for Payer: United Healthcare Commercial |
$56.37
|
| Rate for Payer: United Healthcare Medicare |
$22.89
|
|
|
HC GASTROCCULT
|
Facility
|
IP
|
$71.53
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
63001223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.65 |
| Max. Negotiated Rate |
$66.52 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cigna All Commercial |
$61.73
|
| Rate for Payer: CORVEL All Commercial |
$66.52
|
| Rate for Payer: Coventry All Commercial |
$62.95
|
| Rate for Payer: Encore All Commercial |
$65.84
|
| Rate for Payer: Frontpath All Commercial |
$65.81
|
| Rate for Payer: Humana ChoiceCare |
$61.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.38
|
| Rate for Payer: PHCS All Commercial |
$53.65
|
| Rate for Payer: PHP All Commercial |
$54.25
|
| Rate for Payer: Sagamore Health Network All Products |
$55.22
|
| Rate for Payer: Signature Care EPO |
$59.37
|
| Rate for Payer: Signature Care PPO |
$62.95
|
| Rate for Payer: United Healthcare Commercial |
$56.37
|
|
