|
HC PACKED RBC LR IRRAD
|
Facility
IP
|
$1,567.74
|
|
|
Service Code
|
CPT P9040
|
| Hospital Charge Code |
01371009
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,175.80 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Aetna Commercial |
$1,354.53
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cigna All Commercial |
$1,352.96
|
| Rate for Payer: CORVEL All Commercial |
$1,458.00
|
| Rate for Payer: Coventry All Commercial |
$1,379.61
|
| Rate for Payer: Encore All Commercial |
$1,443.10
|
| Rate for Payer: Frontpath All Commercial |
$1,442.32
|
| Rate for Payer: Humana ChoiceCare |
$1,354.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,410.97
|
| Rate for Payer: PHCS All Commercial |
$1,175.80
|
| Rate for Payer: PHP All Commercial |
$1,188.97
|
| Rate for Payer: Sagamore Health Network All Products |
$1,210.30
|
| Rate for Payer: Signature Care EPO |
$1,301.22
|
| Rate for Payer: Signature Care PPO |
$1,379.61
|
| Rate for Payer: United Healthcare Commercial |
$1,235.38
|
|
|
HC PACKED RBC LR IRRAD
|
Facility
OP
|
$1,567.74
|
|
|
Service Code
|
CPT P9040
|
| Hospital Charge Code |
01371009
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Aetna Commercial |
$1,323.17
|
| Rate for Payer: Aetna Medicare |
$517.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$517.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$900.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$979.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$594.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$569.09
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Centivo All Commercial |
$799.55
|
| Rate for Payer: Cigna All Commercial |
$1,352.96
|
| Rate for Payer: CORVEL All Commercial |
$1,458.00
|
| Rate for Payer: Coventry All Commercial |
$1,379.61
|
| Rate for Payer: Encore All Commercial |
$1,443.10
|
| Rate for Payer: Frontpath All Commercial |
$1,442.32
|
| Rate for Payer: Humana ChoiceCare |
$1,354.06
|
| Rate for Payer: Humana Medicare |
$799.55
|
| Rate for Payer: Lucent All Commercial |
$799.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,410.97
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$1,175.80
|
| Rate for Payer: PHP All Commercial |
$1,188.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$611.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,210.30
|
| Rate for Payer: Signature Care EPO |
$1,301.22
|
| Rate for Payer: Signature Care PPO |
$1,379.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,332.58
|
| Rate for Payer: United Healthcare Commercial |
$1,235.38
|
| Rate for Payer: United Healthcare Medicare |
$517.35
|
|
|
HC PACKED RBC LR IRRAD CMV NEG
|
Facility
IP
|
$1,888.58
|
|
|
Service Code
|
CPT P9058
|
| Hospital Charge Code |
01371014
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,416.44 |
| Max. Negotiated Rate |
$1,756.38 |
| Rate for Payer: Aetna Commercial |
$1,631.73
|
| Rate for Payer: Cash Price |
$1,170.92
|
| Rate for Payer: Cigna All Commercial |
$1,629.85
|
| Rate for Payer: CORVEL All Commercial |
$1,756.38
|
| Rate for Payer: Coventry All Commercial |
$1,661.95
|
| Rate for Payer: Encore All Commercial |
$1,738.44
|
| Rate for Payer: Frontpath All Commercial |
$1,737.49
|
| Rate for Payer: Humana ChoiceCare |
$1,631.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,699.72
|
| Rate for Payer: PHCS All Commercial |
$1,416.44
|
| Rate for Payer: PHP All Commercial |
$1,432.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,457.98
|
| Rate for Payer: Signature Care EPO |
$1,567.52
|
| Rate for Payer: Signature Care PPO |
$1,661.95
|
| Rate for Payer: United Healthcare Commercial |
$1,488.20
|
|
|
HC PACKED RBC LR IRRAD CMV NEG
|
Facility
OP
|
$1,888.58
|
|
|
Service Code
|
CPT P9058
|
| Hospital Charge Code |
01371014
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$1,756.38 |
| Rate for Payer: Aetna Commercial |
$1,593.96
|
| Rate for Payer: Aetna Medicare |
$623.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,084.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,180.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$716.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$685.55
|
| Rate for Payer: Cash Price |
$1,170.92
|
| Rate for Payer: Cash Price |
$1,170.92
|
| Rate for Payer: Centivo All Commercial |
$963.18
|
| Rate for Payer: Cigna All Commercial |
$1,629.85
|
| Rate for Payer: CORVEL All Commercial |
$1,756.38
|
| Rate for Payer: Coventry All Commercial |
$1,661.95
|
| Rate for Payer: Encore All Commercial |
$1,738.44
|
| Rate for Payer: Frontpath All Commercial |
$1,737.49
|
| Rate for Payer: Humana ChoiceCare |
$1,631.17
|
| Rate for Payer: Humana Medicare |
$963.18
|
| Rate for Payer: Lucent All Commercial |
$963.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,699.72
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$1,416.44
|
| Rate for Payer: PHP All Commercial |
$1,432.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$736.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,457.98
|
| Rate for Payer: Signature Care EPO |
$1,567.52
|
| Rate for Payer: Signature Care PPO |
$1,661.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,605.29
|
| Rate for Payer: United Healthcare Commercial |
$1,488.20
|
| Rate for Payer: United Healthcare Medicare |
$623.23
|
|
|
HC PAD CPM FLEECE
|
Facility
OP
|
$160.65
|
|
| Hospital Charge Code |
41601235
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.01 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna Commercial |
$135.59
|
| Rate for Payer: Aetna Medicare |
$53.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.32
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Centivo All Commercial |
$81.93
|
| Rate for Payer: Cigna All Commercial |
$138.64
|
| Rate for Payer: CORVEL All Commercial |
$149.40
|
| Rate for Payer: Coventry All Commercial |
$141.37
|
| Rate for Payer: Encore All Commercial |
$147.88
|
| Rate for Payer: Frontpath All Commercial |
$147.80
|
| Rate for Payer: Humana ChoiceCare |
$138.75
|
| Rate for Payer: Humana Medicare |
$81.93
|
| Rate for Payer: Lucent All Commercial |
$81.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.58
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$120.49
|
| Rate for Payer: PHP All Commercial |
$121.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.65
|
| Rate for Payer: Sagamore Health Network All Products |
$124.02
|
| Rate for Payer: Signature Care EPO |
$133.34
|
| Rate for Payer: Signature Care PPO |
$141.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.55
|
| Rate for Payer: United Healthcare Commercial |
$126.59
|
| Rate for Payer: United Healthcare Medicare |
$53.01
|
|
|
HC PAD CPM FLEECE
|
Facility
IP
|
$160.65
|
|
| Hospital Charge Code |
41601235
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$120.49 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna Commercial |
$138.80
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna All Commercial |
$138.64
|
| Rate for Payer: CORVEL All Commercial |
$149.40
|
| Rate for Payer: Coventry All Commercial |
$141.37
|
| Rate for Payer: Encore All Commercial |
$147.88
|
| Rate for Payer: Frontpath All Commercial |
$147.80
|
| Rate for Payer: Humana ChoiceCare |
$138.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.58
|
| Rate for Payer: PHCS All Commercial |
$120.49
|
| Rate for Payer: PHP All Commercial |
$121.84
|
| Rate for Payer: Sagamore Health Network All Products |
$124.02
|
| Rate for Payer: Signature Care EPO |
$133.34
|
| Rate for Payer: Signature Care PPO |
$141.37
|
| Rate for Payer: United Healthcare Commercial |
$126.59
|
|
|
HC PAD REHAB PER SESSION; 1-36
|
Facility
IP
|
$238.68
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
01603668
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$221.97 |
| Rate for Payer: Aetna Commercial |
$206.22
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: Cigna All Commercial |
$205.98
|
| Rate for Payer: CORVEL All Commercial |
$221.97
|
| Rate for Payer: Coventry All Commercial |
$210.04
|
| Rate for Payer: Encore All Commercial |
$219.70
|
| Rate for Payer: Frontpath All Commercial |
$219.59
|
| Rate for Payer: Humana ChoiceCare |
$206.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.81
|
| Rate for Payer: PHCS All Commercial |
$179.01
|
| Rate for Payer: PHP All Commercial |
$181.01
|
| Rate for Payer: Sagamore Health Network All Products |
$184.26
|
| Rate for Payer: Signature Care EPO |
$198.10
|
| Rate for Payer: Signature Care PPO |
$210.04
|
| Rate for Payer: United Healthcare Commercial |
$188.08
|
|
|
HC PAD REHAB PER SESSION; 1-36
|
Facility
OP
|
$238.68
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
01603668
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$648.65 |
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Medicare |
$78.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$137.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$648.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.64
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: Centivo All Commercial |
$121.73
|
| Rate for Payer: Cigna All Commercial |
$205.98
|
| Rate for Payer: CORVEL All Commercial |
$221.97
|
| Rate for Payer: Coventry All Commercial |
$210.04
|
| Rate for Payer: Encore All Commercial |
$219.70
|
| Rate for Payer: Frontpath All Commercial |
$219.59
|
| Rate for Payer: Humana ChoiceCare |
$206.15
|
| Rate for Payer: Humana Medicare |
$121.73
|
| Rate for Payer: Lucent All Commercial |
$121.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.81
|
| Rate for Payer: Managed Health Services Medicaid |
$648.65
|
| Rate for Payer: MDWise Medicaid |
$648.65
|
| Rate for Payer: PHCS All Commercial |
$179.01
|
| Rate for Payer: PHP All Commercial |
$181.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.09
|
| Rate for Payer: Sagamore Health Network All Products |
$184.26
|
| Rate for Payer: Signature Care EPO |
$198.10
|
| Rate for Payer: Signature Care PPO |
$210.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$202.88
|
| Rate for Payer: United Healthcare Commercial |
$188.08
|
| Rate for Payer: United Healthcare Medicare |
$78.76
|
|
|
HC PAIN MANAGEMENT CHARGE CLASS B
|
Facility
OP
|
$186.89
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001398
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Aetna Commercial |
$157.74
|
| Rate for Payer: Aetna Medicare |
$61.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.84
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Centivo All Commercial |
$95.32
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.47
|
| Rate for Payer: Encore All Commercial |
$172.04
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Humana Medicare |
$95.32
|
| Rate for Payer: Lucent All Commercial |
$95.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.21
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$140.17
|
| Rate for Payer: PHP All Commercial |
$141.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.89
|
| Rate for Payer: Sagamore Health Network All Products |
$144.28
|
| Rate for Payer: Signature Care EPO |
$155.12
|
| Rate for Payer: Signature Care PPO |
$164.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158.86
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
| Rate for Payer: United Healthcare Medicare |
$61.68
|
|
|
HC PAIN MANAGEMENT CHARGE CLASS B
|
Facility
IP
|
$186.89
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001398
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Aetna Commercial |
$161.48
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.47
|
| Rate for Payer: Encore All Commercial |
$172.04
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.21
|
| Rate for Payer: PHCS All Commercial |
$140.17
|
| Rate for Payer: PHP All Commercial |
$141.74
|
| Rate for Payer: Sagamore Health Network All Products |
$144.28
|
| Rate for Payer: Signature Care EPO |
$155.12
|
| Rate for Payer: Signature Care PPO |
$164.47
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
|
|
HC PAIN MANAGEMENT CHARGE CLASS EA
|
Facility
OP
|
$186.89
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Aetna Commercial |
$157.74
|
| Rate for Payer: Aetna Medicare |
$61.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.84
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Centivo All Commercial |
$95.32
|
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.47
|
| Rate for Payer: Encore All Commercial |
$172.04
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Humana Medicare |
$95.32
|
| Rate for Payer: Lucent All Commercial |
$95.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.21
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$140.17
|
| Rate for Payer: PHP All Commercial |
$141.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.89
|
| Rate for Payer: Sagamore Health Network All Products |
$144.28
|
| Rate for Payer: Signature Care EPO |
$155.12
|
| Rate for Payer: Signature Care PPO |
$164.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158.86
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
| Rate for Payer: United Healthcare Medicare |
$61.68
|
|
|
HC PAIN MANAGEMENT CHARGE CLASS EA
|
Facility
IP
|
$186.89
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Cigna All Commercial |
$161.29
|
| Rate for Payer: Aetna Commercial |
$161.48
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: CORVEL All Commercial |
$173.81
|
| Rate for Payer: Coventry All Commercial |
$164.47
|
| Rate for Payer: Encore All Commercial |
$172.04
|
| Rate for Payer: Frontpath All Commercial |
$171.94
|
| Rate for Payer: Humana ChoiceCare |
$161.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.21
|
| Rate for Payer: PHCS All Commercial |
$140.17
|
| Rate for Payer: PHP All Commercial |
$141.74
|
| Rate for Payer: Sagamore Health Network All Products |
$144.28
|
| Rate for Payer: Signature Care EPO |
$155.12
|
| Rate for Payer: Signature Care PPO |
$164.47
|
| Rate for Payer: United Healthcare Commercial |
$147.27
|
|
|
HC PAIN MANAGEMENT CHARGE CREAT
|
Facility
OP
|
$84.50
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63001524
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$78.58 |
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Medicare |
$27.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.67
|
| Rate for Payer: Cash Price |
$52.39
|
| Rate for Payer: Cash Price |
$52.39
|
| Rate for Payer: Centivo All Commercial |
$43.09
|
| Rate for Payer: Cigna All Commercial |
$72.92
|
| Rate for Payer: CORVEL All Commercial |
$78.58
|
| Rate for Payer: Coventry All Commercial |
$74.36
|
| Rate for Payer: Encore All Commercial |
$77.78
|
| Rate for Payer: Frontpath All Commercial |
$77.74
|
| Rate for Payer: Humana ChoiceCare |
$72.98
|
| Rate for Payer: Humana Medicare |
$43.09
|
| Rate for Payer: Lucent All Commercial |
$43.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.05
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$63.37
|
| Rate for Payer: PHP All Commercial |
$64.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.95
|
| Rate for Payer: Sagamore Health Network All Products |
$65.23
|
| Rate for Payer: Signature Care EPO |
$70.13
|
| Rate for Payer: Signature Care PPO |
$74.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.82
|
| Rate for Payer: United Healthcare Commercial |
$66.58
|
| Rate for Payer: United Healthcare Medicare |
$27.88
|
|
|
HC PAIN MANAGEMENT CHARGE CREAT
|
Facility
IP
|
$84.50
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63001524
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$78.58 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Cash Price |
$52.39
|
| Rate for Payer: Cigna All Commercial |
$72.92
|
| Rate for Payer: CORVEL All Commercial |
$78.58
|
| Rate for Payer: Coventry All Commercial |
$74.36
|
| Rate for Payer: Encore All Commercial |
$77.78
|
| Rate for Payer: Frontpath All Commercial |
$77.74
|
| Rate for Payer: Humana ChoiceCare |
$72.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.05
|
| Rate for Payer: PHCS All Commercial |
$63.37
|
| Rate for Payer: PHP All Commercial |
$64.08
|
| Rate for Payer: Sagamore Health Network All Products |
$65.23
|
| Rate for Payer: Signature Care EPO |
$70.13
|
| Rate for Payer: Signature Care PPO |
$74.36
|
| Rate for Payer: United Healthcare Commercial |
$66.58
|
|
|
HC PAIN MANAGEMENT PH CHARGE
|
Facility
IP
|
$50.97
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
63001650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.23 |
| Max. Negotiated Rate |
$47.40 |
| Rate for Payer: Aetna Commercial |
$44.04
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cigna All Commercial |
$43.99
|
| Rate for Payer: CORVEL All Commercial |
$47.40
|
| Rate for Payer: Coventry All Commercial |
$44.85
|
| Rate for Payer: Encore All Commercial |
$46.92
|
| Rate for Payer: Frontpath All Commercial |
$46.89
|
| Rate for Payer: Humana ChoiceCare |
$44.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.87
|
| Rate for Payer: PHCS All Commercial |
$38.23
|
| Rate for Payer: PHP All Commercial |
$38.66
|
| Rate for Payer: Sagamore Health Network All Products |
$39.35
|
| Rate for Payer: Signature Care EPO |
$42.30
|
| Rate for Payer: Signature Care PPO |
$44.85
|
| Rate for Payer: United Healthcare Commercial |
$40.16
|
|
|
HC PAIN MANAGEMENT PH CHARGE
|
Facility
OP
|
$50.97
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
63001650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$47.40 |
| Rate for Payer: Aetna Commercial |
$43.02
|
| Rate for Payer: Aetna Medicare |
$16.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.50
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Centivo All Commercial |
$25.99
|
| Rate for Payer: Cigna All Commercial |
$43.99
|
| Rate for Payer: CORVEL All Commercial |
$47.40
|
| Rate for Payer: Coventry All Commercial |
$44.85
|
| Rate for Payer: Encore All Commercial |
$46.92
|
| Rate for Payer: Frontpath All Commercial |
$46.89
|
| Rate for Payer: Humana ChoiceCare |
$44.02
|
| Rate for Payer: Humana Medicare |
$25.99
|
| Rate for Payer: Lucent All Commercial |
$25.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.87
|
| Rate for Payer: Managed Health Services Medicaid |
$3.58
|
| Rate for Payer: MDWise Medicaid |
$3.58
|
| Rate for Payer: PHCS All Commercial |
$38.23
|
| Rate for Payer: PHP All Commercial |
$38.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.88
|
| Rate for Payer: Sagamore Health Network All Products |
$39.35
|
| Rate for Payer: Signature Care EPO |
$42.30
|
| Rate for Payer: Signature Care PPO |
$44.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.32
|
| Rate for Payer: United Healthcare Commercial |
$40.16
|
| Rate for Payer: United Healthcare Medicare |
$16.82
|
|
|
HC PAIN MANAGEMENT SPECTRO CHARGE
|
Facility
IP
|
$126.83
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
63001681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.12 |
| Max. Negotiated Rate |
$117.95 |
| Rate for Payer: Aetna Commercial |
$109.58
|
| Rate for Payer: Cash Price |
$78.63
|
| Rate for Payer: Cigna All Commercial |
$109.45
|
| Rate for Payer: CORVEL All Commercial |
$117.95
|
| Rate for Payer: Coventry All Commercial |
$111.61
|
| Rate for Payer: Encore All Commercial |
$116.74
|
| Rate for Payer: Frontpath All Commercial |
$116.68
|
| Rate for Payer: Humana ChoiceCare |
$109.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.14
|
| Rate for Payer: PHCS All Commercial |
$95.12
|
| Rate for Payer: PHP All Commercial |
$96.19
|
| Rate for Payer: Sagamore Health Network All Products |
$97.91
|
| Rate for Payer: Signature Care EPO |
$105.27
|
| Rate for Payer: Signature Care PPO |
$111.61
|
| Rate for Payer: United Healthcare Commercial |
$99.94
|
|
|
HC PAIN MANAGEMENT SPECTRO CHARGE
|
Facility
OP
|
$126.83
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
63001681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$117.95 |
| Rate for Payer: Aetna Commercial |
$107.04
|
| Rate for Payer: Aetna Medicare |
$41.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$72.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.04
|
| Rate for Payer: Cash Price |
$78.63
|
| Rate for Payer: Cash Price |
$78.63
|
| Rate for Payer: Centivo All Commercial |
$64.68
|
| Rate for Payer: Cigna All Commercial |
$109.45
|
| Rate for Payer: CORVEL All Commercial |
$117.95
|
| Rate for Payer: Coventry All Commercial |
$111.61
|
| Rate for Payer: Encore All Commercial |
$116.74
|
| Rate for Payer: Frontpath All Commercial |
$116.68
|
| Rate for Payer: Humana ChoiceCare |
$109.54
|
| Rate for Payer: Humana Medicare |
$64.68
|
| Rate for Payer: Lucent All Commercial |
$64.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.14
|
| Rate for Payer: Managed Health Services Medicaid |
$8.10
|
| Rate for Payer: MDWise Medicaid |
$8.10
|
| Rate for Payer: PHCS All Commercial |
$95.12
|
| Rate for Payer: PHP All Commercial |
$96.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.46
|
| Rate for Payer: Sagamore Health Network All Products |
$97.91
|
| Rate for Payer: Signature Care EPO |
$105.27
|
| Rate for Payer: Signature Care PPO |
$111.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$107.80
|
| Rate for Payer: United Healthcare Commercial |
$99.94
|
| Rate for Payer: United Healthcare Medicare |
$41.85
|
|
|
HC PANCREATIC ELASTASE-FECE
|
Facility
OP
|
$330.47
|
|
|
Service Code
|
CPT 82656
|
| Hospital Charge Code |
63001531
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$307.34 |
| Rate for Payer: Aetna Commercial |
$278.92
|
| Rate for Payer: Aetna Medicare |
$109.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$109.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$189.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$206.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.96
|
| Rate for Payer: Cash Price |
$204.89
|
| Rate for Payer: Cash Price |
$204.89
|
| Rate for Payer: Centivo All Commercial |
$168.54
|
| Rate for Payer: Cigna All Commercial |
$285.20
|
| Rate for Payer: CORVEL All Commercial |
$307.34
|
| Rate for Payer: Coventry All Commercial |
$290.81
|
| Rate for Payer: Encore All Commercial |
$304.20
|
| Rate for Payer: Frontpath All Commercial |
$304.03
|
| Rate for Payer: Humana ChoiceCare |
$285.43
|
| Rate for Payer: Humana Medicare |
$168.54
|
| Rate for Payer: Lucent All Commercial |
$168.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.42
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$247.85
|
| Rate for Payer: PHP All Commercial |
$250.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.88
|
| Rate for Payer: Sagamore Health Network All Products |
$255.12
|
| Rate for Payer: Signature Care EPO |
$274.29
|
| Rate for Payer: Signature Care PPO |
$290.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$280.90
|
| Rate for Payer: United Healthcare Commercial |
$260.41
|
| Rate for Payer: United Healthcare Medicare |
$109.06
|
|
|
HC PANCREATIC ELASTASE-FECE
|
Facility
IP
|
$330.47
|
|
|
Service Code
|
CPT 82656
|
| Hospital Charge Code |
63001531
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$247.85 |
| Max. Negotiated Rate |
$307.34 |
| Rate for Payer: Aetna Commercial |
$285.53
|
| Rate for Payer: Cash Price |
$204.89
|
| Rate for Payer: Cigna All Commercial |
$285.20
|
| Rate for Payer: CORVEL All Commercial |
$307.34
|
| Rate for Payer: Coventry All Commercial |
$290.81
|
| Rate for Payer: Encore All Commercial |
$304.20
|
| Rate for Payer: Frontpath All Commercial |
$304.03
|
| Rate for Payer: Humana ChoiceCare |
$285.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.42
|
| Rate for Payer: PHCS All Commercial |
$247.85
|
| Rate for Payer: PHP All Commercial |
$250.63
|
| Rate for Payer: Sagamore Health Network All Products |
$255.12
|
| Rate for Payer: Signature Care EPO |
$274.29
|
| Rate for Payer: Signature Care PPO |
$290.81
|
| Rate for Payer: United Healthcare Commercial |
$260.41
|
|
|
HC PAP DIAGNOSTIC HPV SUREPATH 24204
|
Facility
IP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$147.67 |
| Max. Negotiated Rate |
$183.11 |
| Rate for Payer: Aetna Commercial |
$170.11
|
| Rate for Payer: Cash Price |
$122.07
|
| Rate for Payer: Cigna All Commercial |
$169.92
|
| Rate for Payer: CORVEL All Commercial |
$183.11
|
| Rate for Payer: Coventry All Commercial |
$173.26
|
| Rate for Payer: Encore All Commercial |
$181.24
|
| Rate for Payer: Frontpath All Commercial |
$181.14
|
| Rate for Payer: Humana ChoiceCare |
$170.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.20
|
| Rate for Payer: PHCS All Commercial |
$147.67
|
| Rate for Payer: PHP All Commercial |
$149.32
|
| Rate for Payer: Sagamore Health Network All Products |
$152.00
|
| Rate for Payer: Signature Care EPO |
$163.42
|
| Rate for Payer: Signature Care PPO |
$173.26
|
| Rate for Payer: United Healthcare Commercial |
$155.15
|
|
|
HC PAP DIAGNOSTIC HPV SUREPATH 24204
|
Facility
OP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$183.11 |
| Rate for Payer: Aetna Commercial |
$166.18
|
| Rate for Payer: Aetna Medicare |
$64.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.47
|
| Rate for Payer: Cash Price |
$122.07
|
| Rate for Payer: Cash Price |
$122.07
|
| Rate for Payer: Centivo All Commercial |
$100.41
|
| Rate for Payer: Cigna All Commercial |
$169.92
|
| Rate for Payer: CORVEL All Commercial |
$183.11
|
| Rate for Payer: Coventry All Commercial |
$173.26
|
| Rate for Payer: Encore All Commercial |
$181.24
|
| Rate for Payer: Frontpath All Commercial |
$181.14
|
| Rate for Payer: Humana ChoiceCare |
$170.05
|
| Rate for Payer: Humana Medicare |
$100.41
|
| Rate for Payer: Lucent All Commercial |
$100.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.20
|
| Rate for Payer: Managed Health Services Medicaid |
$14.60
|
| Rate for Payer: MDWise Medicaid |
$14.60
|
| Rate for Payer: PHCS All Commercial |
$147.67
|
| Rate for Payer: PHP All Commercial |
$149.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.79
|
| Rate for Payer: Sagamore Health Network All Products |
$152.00
|
| Rate for Payer: Signature Care EPO |
$163.42
|
| Rate for Payer: Signature Care PPO |
$173.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$167.36
|
| Rate for Payer: United Healthcare Commercial |
$155.15
|
| Rate for Payer: United Healthcare Medicare |
$64.97
|
|
|
HC PAP DIAGNOSTIC HPV THINPREP 24354
|
Facility
OP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$155.22 |
| Rate for Payer: Aetna Commercial |
$140.87
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.59
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Centivo All Commercial |
$85.12
|
| Rate for Payer: Cigna All Commercial |
$144.04
|
| Rate for Payer: CORVEL All Commercial |
$155.22
|
| Rate for Payer: Coventry All Commercial |
$146.87
|
| Rate for Payer: Encore All Commercial |
$153.63
|
| Rate for Payer: Frontpath All Commercial |
$153.55
|
| Rate for Payer: Humana ChoiceCare |
$144.15
|
| Rate for Payer: Humana Medicare |
$85.12
|
| Rate for Payer: Lucent All Commercial |
$85.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.21
|
| Rate for Payer: Managed Health Services Medicaid |
$14.76
|
| Rate for Payer: MDWise Medicaid |
$14.76
|
| Rate for Payer: PHCS All Commercial |
$125.18
|
| Rate for Payer: PHP All Commercial |
$126.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.09
|
| Rate for Payer: Sagamore Health Network All Products |
$128.85
|
| Rate for Payer: Signature Care EPO |
$138.53
|
| Rate for Payer: Signature Care PPO |
$146.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.87
|
| Rate for Payer: United Healthcare Commercial |
$131.52
|
| Rate for Payer: United Healthcare Medicare |
$55.08
|
|
|
HC PAP DIAGNOSTIC HPV THINPREP 24354
|
Facility
IP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$125.18 |
| Max. Negotiated Rate |
$155.22 |
| Rate for Payer: Aetna Commercial |
$144.20
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cigna All Commercial |
$144.04
|
| Rate for Payer: CORVEL All Commercial |
$155.22
|
| Rate for Payer: Coventry All Commercial |
$146.87
|
| Rate for Payer: Encore All Commercial |
$153.63
|
| Rate for Payer: Frontpath All Commercial |
$153.55
|
| Rate for Payer: Humana ChoiceCare |
$144.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.21
|
| Rate for Payer: PHCS All Commercial |
$125.18
|
| Rate for Payer: PHP All Commercial |
$126.58
|
| Rate for Payer: Sagamore Health Network All Products |
$128.85
|
| Rate for Payer: Signature Care EPO |
$138.53
|
| Rate for Payer: Signature Care PPO |
$146.87
|
| Rate for Payer: United Healthcare Commercial |
$131.52
|
|
|
HC PAP DIAGNOSTIC SUREPATH 24200
|
Facility
OP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044005
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$183.11 |
| Rate for Payer: Aetna Commercial |
$166.18
|
| Rate for Payer: Aetna Medicare |
$64.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.47
|
| Rate for Payer: Cash Price |
$122.07
|
| Rate for Payer: Cash Price |
$122.07
|
| Rate for Payer: Centivo All Commercial |
$100.41
|
| Rate for Payer: Cigna All Commercial |
$169.92
|
| Rate for Payer: CORVEL All Commercial |
$183.11
|
| Rate for Payer: Coventry All Commercial |
$173.26
|
| Rate for Payer: Encore All Commercial |
$181.24
|
| Rate for Payer: Frontpath All Commercial |
$181.14
|
| Rate for Payer: Humana ChoiceCare |
$170.05
|
| Rate for Payer: Humana Medicare |
$100.41
|
| Rate for Payer: Lucent All Commercial |
$100.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.20
|
| Rate for Payer: Managed Health Services Medicaid |
$14.60
|
| Rate for Payer: MDWise Medicaid |
$14.60
|
| Rate for Payer: PHCS All Commercial |
$147.67
|
| Rate for Payer: PHP All Commercial |
$149.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.79
|
| Rate for Payer: Sagamore Health Network All Products |
$152.00
|
| Rate for Payer: Signature Care EPO |
$163.42
|
| Rate for Payer: Signature Care PPO |
$173.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$167.36
|
| Rate for Payer: United Healthcare Commercial |
$155.15
|
| Rate for Payer: United Healthcare Medicare |
$64.97
|
|
