|
HC PAP DIAGNOSTIC SUREPATH 24200
|
Facility
IP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044005
|
|
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 SUREPATH W/HPV 24202
|
Facility
IP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044006
|
|
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 SUREPATH W/HPV 24202
|
Facility
OP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044006
|
|
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 SUREPATH W/HPV 24212
|
Facility
IP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044007
|
|
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 SUREPATH W/HPV 24212
|
Facility
OP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044007
|
|
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 THINPREP 24350
|
Facility
OP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044002
|
|
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 THINPREP 24350
|
Facility
IP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$125.18 |
| Max. Negotiated Rate |
$155.22 |
| Rate for Payer: Cigna All Commercial |
$144.04
|
| Rate for Payer: Aetna Commercial |
$144.20
|
| Rate for Payer: Cash Price |
$103.48
|
| 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 THINPREP W/HPV 24351
|
Facility
OP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044008
|
|
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 THINPREP W/HPV 24351
|
Facility
IP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044008
|
|
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 THINPREP W/HPV 24353
|
Facility
OP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044009
|
|
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 THINPREP W/HPV 24353
|
Facility
IP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044009
|
|
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 HPV THINPREP 24254
|
Facility
OP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044010
|
|
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 HPV THINPREP 24254
|
Facility
IP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044010
|
|
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 SCREENING SUREPATH 24100
|
Facility
OP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044011
|
|
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 SCREENING SUREPATH 24100
|
Facility
IP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044011
|
|
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 SCREENING SUREPATH W/HPV 24206
|
Facility
OP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044000
|
|
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 SCREENING SUREPATH W/HPV 24206
|
Facility
IP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044000
|
|
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 SCREENING SUREPATH W/HPV 24208
|
Facility
OP
|
$125.82
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$117.01 |
| Rate for Payer: Aetna Commercial |
$106.19
|
| Rate for Payer: Aetna Medicare |
$41.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.67
|
| Rate for Payer: Cash Price |
$78.01
|
| Rate for Payer: Cash Price |
$78.01
|
| Rate for Payer: Centivo All Commercial |
$64.17
|
| Rate for Payer: Cigna All Commercial |
$108.58
|
| Rate for Payer: CORVEL All Commercial |
$117.01
|
| Rate for Payer: Coventry All Commercial |
$110.72
|
| Rate for Payer: Encore All Commercial |
$115.81
|
| Rate for Payer: Frontpath All Commercial |
$115.75
|
| Rate for Payer: Humana ChoiceCare |
$108.67
|
| Rate for Payer: Humana Medicare |
$64.17
|
| Rate for Payer: Lucent All Commercial |
$64.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.24
|
| Rate for Payer: Managed Health Services Medicaid |
$14.60
|
| Rate for Payer: MDWise Medicaid |
$14.60
|
| Rate for Payer: PHCS All Commercial |
$94.36
|
| Rate for Payer: PHP All Commercial |
$95.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.07
|
| Rate for Payer: Sagamore Health Network All Products |
$97.13
|
| Rate for Payer: Signature Care EPO |
$104.43
|
| Rate for Payer: Signature Care PPO |
$110.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.94
|
| Rate for Payer: United Healthcare Commercial |
$99.14
|
| Rate for Payer: United Healthcare Medicare |
$41.52
|
|
|
HC PAP SCREENING SUREPATH W/HPV 24208
|
Facility
IP
|
$125.82
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$117.01 |
| Rate for Payer: Aetna Commercial |
$108.71
|
| Rate for Payer: Cash Price |
$78.01
|
| Rate for Payer: Cigna All Commercial |
$108.58
|
| Rate for Payer: CORVEL All Commercial |
$117.01
|
| Rate for Payer: Coventry All Commercial |
$110.72
|
| Rate for Payer: Encore All Commercial |
$115.81
|
| Rate for Payer: Frontpath All Commercial |
$115.75
|
| Rate for Payer: Humana ChoiceCare |
$108.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.24
|
| Rate for Payer: PHCS All Commercial |
$94.36
|
| Rate for Payer: PHP All Commercial |
$95.42
|
| Rate for Payer: Sagamore Health Network All Products |
$97.13
|
| Rate for Payer: Signature Care EPO |
$104.43
|
| Rate for Payer: Signature Care PPO |
$110.72
|
| Rate for Payer: United Healthcare Commercial |
$99.14
|
|
|
HC PAP SCREENING SUREPATH W/HPV 24216
|
Facility
IP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044012
|
|
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 SCREENING SUREPATH W/HPV 24216
|
Facility
OP
|
$196.89
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63044012
|
|
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 TEST
|
Facility
IP
|
$73.44
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63087802
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$68.30 |
| Rate for Payer: Aetna Commercial |
$63.45
|
| Rate for Payer: Cash Price |
$45.53
|
| Rate for Payer: Cigna All Commercial |
$63.38
|
| Rate for Payer: CORVEL All Commercial |
$68.30
|
| Rate for Payer: Coventry All Commercial |
$64.63
|
| Rate for Payer: Encore All Commercial |
$67.60
|
| Rate for Payer: Frontpath All Commercial |
$67.56
|
| Rate for Payer: Humana ChoiceCare |
$63.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.10
|
| Rate for Payer: PHCS All Commercial |
$55.08
|
| Rate for Payer: PHP All Commercial |
$55.70
|
| Rate for Payer: Sagamore Health Network All Products |
$56.70
|
| Rate for Payer: Signature Care EPO |
$60.96
|
| Rate for Payer: Signature Care PPO |
$64.63
|
| Rate for Payer: United Healthcare Commercial |
$57.87
|
|
|
HC PAP TEST
|
Facility
OP
|
$73.44
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
63087802
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$68.30 |
| Rate for Payer: Aetna Commercial |
$61.98
|
| Rate for Payer: Aetna Medicare |
$24.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.66
|
| Rate for Payer: Cash Price |
$45.53
|
| Rate for Payer: Cash Price |
$45.53
|
| Rate for Payer: Centivo All Commercial |
$37.45
|
| Rate for Payer: Cigna All Commercial |
$63.38
|
| Rate for Payer: CORVEL All Commercial |
$68.30
|
| Rate for Payer: Coventry All Commercial |
$64.63
|
| Rate for Payer: Encore All Commercial |
$67.60
|
| Rate for Payer: Frontpath All Commercial |
$67.56
|
| Rate for Payer: Humana ChoiceCare |
$63.43
|
| Rate for Payer: Humana Medicare |
$37.45
|
| Rate for Payer: Lucent All Commercial |
$37.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.10
|
| Rate for Payer: Managed Health Services Medicaid |
$14.60
|
| Rate for Payer: MDWise Medicaid |
$14.60
|
| Rate for Payer: PHCS All Commercial |
$55.08
|
| Rate for Payer: PHP All Commercial |
$55.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.64
|
| Rate for Payer: Sagamore Health Network All Products |
$56.70
|
| Rate for Payer: Signature Care EPO |
$60.96
|
| Rate for Payer: Signature Care PPO |
$64.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.42
|
| Rate for Payer: United Healthcare Commercial |
$57.87
|
| Rate for Payer: United Healthcare Medicare |
$24.24
|
|
|
HC PAP THINPREP 24250
|
Facility
OP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044013
|
|
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 THINPREP 24250
|
Facility
IP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044013
|
|
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
|
|
