|
HC PAP THINPREP W/HPV 24251
|
Facility
OP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044014
|
|
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 W/HPV 24251
|
Facility
IP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044014
|
|
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 THINPREP W/HPV 24253
|
Facility
OP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044015
|
|
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 W/HPV 24253
|
Facility
IP
|
$166.90
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
63044015
|
|
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 PARACENTESIS
|
Facility
OP
|
$937.48
|
|
| Hospital Charge Code |
01682014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.37 |
| Max. Negotiated Rate |
$871.86 |
| Rate for Payer: Aetna Commercial |
$791.23
|
| Rate for Payer: Aetna Medicare |
$309.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$309.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$538.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$586.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$355.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$340.31
|
| Rate for Payer: Cash Price |
$581.24
|
| Rate for Payer: Centivo All Commercial |
$478.12
|
| Rate for Payer: Cigna All Commercial |
$809.05
|
| Rate for Payer: CORVEL All Commercial |
$871.86
|
| Rate for Payer: Coventry All Commercial |
$824.98
|
| Rate for Payer: Encore All Commercial |
$862.95
|
| Rate for Payer: Frontpath All Commercial |
$862.48
|
| Rate for Payer: Humana ChoiceCare |
$809.70
|
| Rate for Payer: Humana Medicare |
$478.12
|
| Rate for Payer: Lucent All Commercial |
$478.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$843.73
|
| Rate for Payer: PHCS All Commercial |
$703.11
|
| Rate for Payer: PHP All Commercial |
$710.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$365.62
|
| Rate for Payer: Sagamore Health Network All Products |
$723.74
|
| Rate for Payer: Signature Care EPO |
$778.11
|
| Rate for Payer: Signature Care PPO |
$824.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$796.86
|
| Rate for Payer: United Healthcare Commercial |
$738.74
|
| Rate for Payer: United Healthcare Medicare |
$309.37
|
|
|
HC PARACENTESIS
|
Facility
IP
|
$937.48
|
|
| Hospital Charge Code |
01682014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$703.11 |
| Max. Negotiated Rate |
$871.86 |
| Rate for Payer: Aetna Commercial |
$809.98
|
| Rate for Payer: Cash Price |
$581.24
|
| Rate for Payer: Cigna All Commercial |
$809.05
|
| Rate for Payer: CORVEL All Commercial |
$871.86
|
| Rate for Payer: Coventry All Commercial |
$824.98
|
| Rate for Payer: Encore All Commercial |
$862.95
|
| Rate for Payer: Frontpath All Commercial |
$862.48
|
| Rate for Payer: Humana ChoiceCare |
$809.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$843.73
|
| Rate for Payer: PHCS All Commercial |
$703.11
|
| Rate for Payer: PHP All Commercial |
$710.99
|
| Rate for Payer: Sagamore Health Network All Products |
$723.74
|
| Rate for Payer: Signature Care EPO |
$778.11
|
| Rate for Payer: Signature Care PPO |
$824.98
|
| Rate for Payer: United Healthcare Commercial |
$738.74
|
|
|
HC PARAFFIN BATH-OT
|
Facility
IP
|
$115.33
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
01738060
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$86.50 |
| Max. Negotiated Rate |
$107.26 |
| Rate for Payer: Aetna Commercial |
$99.65
|
| Rate for Payer: Cash Price |
$71.51
|
| Rate for Payer: Cigna All Commercial |
$99.53
|
| Rate for Payer: CORVEL All Commercial |
$107.26
|
| Rate for Payer: Coventry All Commercial |
$101.49
|
| Rate for Payer: Encore All Commercial |
$106.16
|
| Rate for Payer: Frontpath All Commercial |
$106.10
|
| Rate for Payer: Humana ChoiceCare |
$99.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.80
|
| Rate for Payer: PHCS All Commercial |
$86.50
|
| Rate for Payer: PHP All Commercial |
$87.47
|
| Rate for Payer: Sagamore Health Network All Products |
$89.04
|
| Rate for Payer: Signature Care EPO |
$95.73
|
| Rate for Payer: Signature Care PPO |
$101.49
|
| Rate for Payer: United Healthcare Commercial |
$90.88
|
|
|
HC PARAFFIN BATH-OT
|
Facility
OP
|
$115.33
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
01738060
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.06 |
| Max. Negotiated Rate |
$107.26 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Medicare |
$38.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.87
|
| Rate for Payer: Cash Price |
$71.51
|
| Rate for Payer: Centivo All Commercial |
$58.82
|
| Rate for Payer: Cigna All Commercial |
$99.53
|
| Rate for Payer: CORVEL All Commercial |
$107.26
|
| Rate for Payer: Coventry All Commercial |
$101.49
|
| Rate for Payer: Encore All Commercial |
$106.16
|
| Rate for Payer: Frontpath All Commercial |
$106.10
|
| Rate for Payer: Humana ChoiceCare |
$99.61
|
| Rate for Payer: Humana Medicare |
$58.82
|
| Rate for Payer: Lucent All Commercial |
$58.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.80
|
| Rate for Payer: PHCS All Commercial |
$86.50
|
| Rate for Payer: PHP All Commercial |
$87.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.98
|
| Rate for Payer: Sagamore Health Network All Products |
$89.04
|
| Rate for Payer: Signature Care EPO |
$95.73
|
| Rate for Payer: Signature Care PPO |
$101.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.03
|
| Rate for Payer: United Healthcare Commercial |
$90.88
|
| Rate for Payer: United Healthcare Medicare |
$38.06
|
|
|
HC PARAFFIN BATH-PT
|
Facility
OP
|
$110.89
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
01728062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$103.13 |
| Rate for Payer: Aetna Commercial |
$93.59
|
| Rate for Payer: Aetna Medicare |
$36.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.25
|
| Rate for Payer: Cash Price |
$68.76
|
| Rate for Payer: Centivo All Commercial |
$56.56
|
| Rate for Payer: Cigna All Commercial |
$95.70
|
| Rate for Payer: CORVEL All Commercial |
$103.13
|
| Rate for Payer: Coventry All Commercial |
$97.59
|
| Rate for Payer: Encore All Commercial |
$102.08
|
| Rate for Payer: Frontpath All Commercial |
$102.02
|
| Rate for Payer: Humana ChoiceCare |
$95.78
|
| Rate for Payer: Humana Medicare |
$56.56
|
| Rate for Payer: Lucent All Commercial |
$56.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.80
|
| Rate for Payer: PHCS All Commercial |
$83.17
|
| Rate for Payer: PHP All Commercial |
$84.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.25
|
| Rate for Payer: Sagamore Health Network All Products |
$85.61
|
| Rate for Payer: Signature Care EPO |
$92.04
|
| Rate for Payer: Signature Care PPO |
$97.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.26
|
| Rate for Payer: United Healthcare Commercial |
$87.38
|
| Rate for Payer: United Healthcare Medicare |
$36.60
|
|
|
HC PARAFFIN BATH-PT
|
Facility
IP
|
$110.89
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
01728062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.17 |
| Max. Negotiated Rate |
$103.13 |
| Rate for Payer: Aetna Commercial |
$95.81
|
| Rate for Payer: Cash Price |
$68.76
|
| Rate for Payer: Cigna All Commercial |
$95.70
|
| Rate for Payer: CORVEL All Commercial |
$103.13
|
| Rate for Payer: Coventry All Commercial |
$97.59
|
| Rate for Payer: Encore All Commercial |
$102.08
|
| Rate for Payer: Frontpath All Commercial |
$102.02
|
| Rate for Payer: Humana ChoiceCare |
$95.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.80
|
| Rate for Payer: PHCS All Commercial |
$83.17
|
| Rate for Payer: PHP All Commercial |
$84.10
|
| Rate for Payer: Sagamore Health Network All Products |
$85.61
|
| Rate for Payer: Signature Care EPO |
$92.04
|
| Rate for Payer: Signature Care PPO |
$97.59
|
| Rate for Payer: United Healthcare Commercial |
$87.38
|
|
|
HC PARASITE EXAM BLOOD
|
Facility
IP
|
$34.57
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
63002016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.93 |
| Max. Negotiated Rate |
$32.15 |
| Rate for Payer: Aetna Commercial |
$29.87
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Cigna All Commercial |
$29.83
|
| Rate for Payer: CORVEL All Commercial |
$32.15
|
| Rate for Payer: Coventry All Commercial |
$30.42
|
| Rate for Payer: Encore All Commercial |
$31.82
|
| Rate for Payer: Frontpath All Commercial |
$31.80
|
| Rate for Payer: Humana ChoiceCare |
$29.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.11
|
| Rate for Payer: PHCS All Commercial |
$25.93
|
| Rate for Payer: PHP All Commercial |
$26.22
|
| Rate for Payer: Sagamore Health Network All Products |
$26.69
|
| Rate for Payer: Signature Care EPO |
$28.69
|
| Rate for Payer: Signature Care PPO |
$30.42
|
| Rate for Payer: United Healthcare Commercial |
$27.24
|
|
|
HC PARASITE EXAM BLOOD
|
Facility
OP
|
$34.57
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
63002016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$32.15 |
| Rate for Payer: Aetna Commercial |
$29.18
|
| Rate for Payer: Aetna Medicare |
$11.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.55
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Centivo All Commercial |
$17.63
|
| Rate for Payer: Cigna All Commercial |
$29.83
|
| Rate for Payer: CORVEL All Commercial |
$32.15
|
| Rate for Payer: Coventry All Commercial |
$30.42
|
| Rate for Payer: Encore All Commercial |
$31.82
|
| Rate for Payer: Frontpath All Commercial |
$31.80
|
| Rate for Payer: Humana ChoiceCare |
$29.86
|
| Rate for Payer: Humana Medicare |
$17.63
|
| Rate for Payer: Lucent All Commercial |
$17.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.11
|
| Rate for Payer: Managed Health Services Medicaid |
$5.99
|
| Rate for Payer: MDWise Medicaid |
$5.99
|
| Rate for Payer: PHCS All Commercial |
$25.93
|
| Rate for Payer: PHP All Commercial |
$26.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.48
|
| Rate for Payer: Sagamore Health Network All Products |
$26.69
|
| Rate for Payer: Signature Care EPO |
$28.69
|
| Rate for Payer: Signature Care PPO |
$30.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.38
|
| Rate for Payer: United Healthcare Commercial |
$27.24
|
| Rate for Payer: United Healthcare Medicare |
$11.41
|
|
|
HC PARASITE ID
|
Facility
OP
|
$138.69
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
63001080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$128.98 |
| Rate for Payer: Aetna Commercial |
$117.05
|
| Rate for Payer: Aetna Medicare |
$45.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.34
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Centivo All Commercial |
$70.73
|
| Rate for Payer: Cigna All Commercial |
$119.69
|
| Rate for Payer: CORVEL All Commercial |
$128.98
|
| Rate for Payer: Coventry All Commercial |
$122.05
|
| Rate for Payer: Encore All Commercial |
$127.66
|
| Rate for Payer: Frontpath All Commercial |
$127.59
|
| Rate for Payer: Humana ChoiceCare |
$119.79
|
| Rate for Payer: Humana Medicare |
$70.73
|
| Rate for Payer: Lucent All Commercial |
$70.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.82
|
| Rate for Payer: Managed Health Services Medicaid |
$4.31
|
| Rate for Payer: MDWise Medicaid |
$4.31
|
| Rate for Payer: PHCS All Commercial |
$104.02
|
| Rate for Payer: PHP All Commercial |
$105.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.09
|
| Rate for Payer: Sagamore Health Network All Products |
$107.07
|
| Rate for Payer: Signature Care EPO |
$115.11
|
| Rate for Payer: Signature Care PPO |
$122.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.89
|
| Rate for Payer: United Healthcare Commercial |
$109.29
|
| Rate for Payer: United Healthcare Medicare |
$45.77
|
|
|
HC PARASITE ID
|
Facility
IP
|
$138.69
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
63001080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$128.98 |
| Rate for Payer: Aetna Commercial |
$119.83
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cigna All Commercial |
$119.69
|
| Rate for Payer: CORVEL All Commercial |
$128.98
|
| Rate for Payer: Coventry All Commercial |
$122.05
|
| Rate for Payer: Encore All Commercial |
$127.66
|
| Rate for Payer: Frontpath All Commercial |
$127.59
|
| Rate for Payer: Humana ChoiceCare |
$119.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.82
|
| Rate for Payer: PHCS All Commercial |
$104.02
|
| Rate for Payer: PHP All Commercial |
$105.18
|
| Rate for Payer: Sagamore Health Network All Products |
$107.07
|
| Rate for Payer: Signature Care EPO |
$115.11
|
| Rate for Payer: Signature Care PPO |
$122.05
|
| Rate for Payer: United Healthcare Commercial |
$109.29
|
|
|
HC PARASITE ID-INSECT/SKIN
|
Facility
OP
|
$138.69
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
63002012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$128.98 |
| Rate for Payer: Aetna Commercial |
$117.05
|
| Rate for Payer: Aetna Medicare |
$45.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.34
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Centivo All Commercial |
$70.73
|
| Rate for Payer: Cigna All Commercial |
$119.69
|
| Rate for Payer: CORVEL All Commercial |
$128.98
|
| Rate for Payer: Coventry All Commercial |
$122.05
|
| Rate for Payer: Encore All Commercial |
$127.66
|
| Rate for Payer: Frontpath All Commercial |
$127.59
|
| Rate for Payer: Humana ChoiceCare |
$119.79
|
| Rate for Payer: Humana Medicare |
$70.73
|
| Rate for Payer: Lucent All Commercial |
$70.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.82
|
| Rate for Payer: Managed Health Services Medicaid |
$4.31
|
| Rate for Payer: MDWise Medicaid |
$4.31
|
| Rate for Payer: PHCS All Commercial |
$104.02
|
| Rate for Payer: PHP All Commercial |
$105.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.09
|
| Rate for Payer: Sagamore Health Network All Products |
$107.07
|
| Rate for Payer: Signature Care EPO |
$115.11
|
| Rate for Payer: Signature Care PPO |
$122.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.89
|
| Rate for Payer: United Healthcare Commercial |
$109.29
|
| Rate for Payer: United Healthcare Medicare |
$45.77
|
|
|
HC PARASITE ID-INSECT/SKIN
|
Facility
IP
|
$138.69
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
63002012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$128.98 |
| Rate for Payer: Aetna Commercial |
$119.83
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cigna All Commercial |
$119.69
|
| Rate for Payer: CORVEL All Commercial |
$128.98
|
| Rate for Payer: Coventry All Commercial |
$122.05
|
| Rate for Payer: Encore All Commercial |
$127.66
|
| Rate for Payer: Frontpath All Commercial |
$127.59
|
| Rate for Payer: Humana ChoiceCare |
$119.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.82
|
| Rate for Payer: PHCS All Commercial |
$104.02
|
| Rate for Payer: PHP All Commercial |
$105.18
|
| Rate for Payer: Sagamore Health Network All Products |
$107.07
|
| Rate for Payer: Signature Care EPO |
$115.11
|
| Rate for Payer: Signature Care PPO |
$122.05
|
| Rate for Payer: United Healthcare Commercial |
$109.29
|
|
|
HC PARATHYRD PLANAR W/WO SUBTRJ W SPECT
|
Facility
IP
|
$1,536.19
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
01638071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,152.14 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$1,327.27
|
| Rate for Payer: Cash Price |
$952.44
|
| Rate for Payer: Cigna All Commercial |
$1,325.73
|
| Rate for Payer: CORVEL All Commercial |
$1,428.66
|
| Rate for Payer: Coventry All Commercial |
$1,351.85
|
| Rate for Payer: Encore All Commercial |
$1,414.06
|
| Rate for Payer: Frontpath All Commercial |
$1,413.30
|
| Rate for Payer: Humana ChoiceCare |
$1,326.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,382.57
|
| Rate for Payer: PHCS All Commercial |
$1,152.14
|
| Rate for Payer: PHP All Commercial |
$1,165.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,185.94
|
| Rate for Payer: Signature Care EPO |
$1,275.04
|
| Rate for Payer: Signature Care PPO |
$1,351.85
|
| Rate for Payer: United Healthcare Commercial |
$1,210.52
|
|
|
HC PARATHYRD PLANAR W/WO SUBTRJ W SPECT
|
Facility
OP
|
$1,536.19
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
01638071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$506.94 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$1,296.55
|
| Rate for Payer: Aetna Medicare |
$506.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$506.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$882.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$960.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$801.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$582.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$557.64
|
| Rate for Payer: Cash Price |
$952.44
|
| Rate for Payer: Cash Price |
$952.44
|
| Rate for Payer: Centivo All Commercial |
$783.46
|
| Rate for Payer: Cigna All Commercial |
$1,325.73
|
| Rate for Payer: CORVEL All Commercial |
$1,428.66
|
| Rate for Payer: Coventry All Commercial |
$1,351.85
|
| Rate for Payer: Encore All Commercial |
$1,414.06
|
| Rate for Payer: Frontpath All Commercial |
$1,413.30
|
| Rate for Payer: Humana ChoiceCare |
$1,326.81
|
| Rate for Payer: Humana Medicare |
$783.46
|
| Rate for Payer: Lucent All Commercial |
$783.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,382.57
|
| Rate for Payer: Managed Health Services Medicaid |
$801.84
|
| Rate for Payer: MDWise Medicaid |
$801.84
|
| Rate for Payer: PHCS All Commercial |
$1,152.14
|
| Rate for Payer: PHP All Commercial |
$1,165.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$599.11
|
| Rate for Payer: Sagamore Health Network All Products |
$1,185.94
|
| Rate for Payer: Signature Care EPO |
$1,275.04
|
| Rate for Payer: Signature Care PPO |
$1,351.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,305.76
|
| Rate for Payer: United Healthcare Commercial |
$1,210.52
|
| Rate for Payer: United Healthcare Medicare |
$506.94
|
|
|
HC PARATHYROID PLANAR IMAGING
|
Facility
IP
|
$1,536.19
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
01638070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,152.14 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$1,327.27
|
| Rate for Payer: Cash Price |
$952.44
|
| Rate for Payer: Cigna All Commercial |
$1,325.73
|
| Rate for Payer: CORVEL All Commercial |
$1,428.66
|
| Rate for Payer: Coventry All Commercial |
$1,351.85
|
| Rate for Payer: Encore All Commercial |
$1,414.06
|
| Rate for Payer: Frontpath All Commercial |
$1,413.30
|
| Rate for Payer: Humana ChoiceCare |
$1,326.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,382.57
|
| Rate for Payer: PHCS All Commercial |
$1,152.14
|
| Rate for Payer: PHP All Commercial |
$1,165.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,185.94
|
| Rate for Payer: Signature Care EPO |
$1,275.04
|
| Rate for Payer: Signature Care PPO |
$1,351.85
|
| Rate for Payer: United Healthcare Commercial |
$1,210.52
|
|
|
HC PARATHYROID PLANAR IMAGING
|
Facility
OP
|
$1,536.19
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
01638070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$506.94 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$1,296.55
|
| Rate for Payer: Aetna Medicare |
$506.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$506.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$882.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$960.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$712.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$582.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$557.64
|
| Rate for Payer: Cash Price |
$952.44
|
| Rate for Payer: Cash Price |
$952.44
|
| Rate for Payer: Centivo All Commercial |
$783.46
|
| Rate for Payer: Cigna All Commercial |
$1,325.73
|
| Rate for Payer: CORVEL All Commercial |
$1,428.66
|
| Rate for Payer: Coventry All Commercial |
$1,351.85
|
| Rate for Payer: Encore All Commercial |
$1,414.06
|
| Rate for Payer: Frontpath All Commercial |
$1,413.30
|
| Rate for Payer: Humana ChoiceCare |
$1,326.81
|
| Rate for Payer: Humana Medicare |
$783.46
|
| Rate for Payer: Lucent All Commercial |
$783.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,382.57
|
| Rate for Payer: Managed Health Services Medicaid |
$712.02
|
| Rate for Payer: MDWise Medicaid |
$712.02
|
| Rate for Payer: PHCS All Commercial |
$1,152.14
|
| Rate for Payer: PHP All Commercial |
$1,165.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$599.11
|
| Rate for Payer: Sagamore Health Network All Products |
$1,185.94
|
| Rate for Payer: Signature Care EPO |
$1,275.04
|
| Rate for Payer: Signature Care PPO |
$1,351.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,305.76
|
| Rate for Payer: United Healthcare Commercial |
$1,210.52
|
| Rate for Payer: United Healthcare Medicare |
$506.94
|
|
|
HC PARING/CUTG B9 HYPRKER LES 1
|
Facility
IP
|
$176.26
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
01681055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.19 |
| Max. Negotiated Rate |
$163.92 |
| Rate for Payer: Aetna Commercial |
$152.29
|
| Rate for Payer: Cash Price |
$109.28
|
| Rate for Payer: Cigna All Commercial |
$152.11
|
| Rate for Payer: CORVEL All Commercial |
$163.92
|
| Rate for Payer: Coventry All Commercial |
$155.11
|
| Rate for Payer: Encore All Commercial |
$162.24
|
| Rate for Payer: Frontpath All Commercial |
$162.16
|
| Rate for Payer: Humana ChoiceCare |
$152.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.63
|
| Rate for Payer: PHCS All Commercial |
$132.19
|
| Rate for Payer: PHP All Commercial |
$133.67
|
| Rate for Payer: Sagamore Health Network All Products |
$136.07
|
| Rate for Payer: Signature Care EPO |
$146.29
|
| Rate for Payer: Signature Care PPO |
$155.11
|
| Rate for Payer: United Healthcare Commercial |
$138.89
|
|
|
HC PARING/CUTG B9 HYPRKER LES 1
|
Facility
OP
|
$176.26
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
01681055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$1,242.31 |
| Rate for Payer: Aetna Commercial |
$148.76
|
| Rate for Payer: Aetna Medicare |
$58.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$101.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,242.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.98
|
| Rate for Payer: Cash Price |
$109.28
|
| Rate for Payer: Cash Price |
$109.28
|
| Rate for Payer: Centivo All Commercial |
$89.89
|
| Rate for Payer: Cigna All Commercial |
$152.11
|
| Rate for Payer: CORVEL All Commercial |
$163.92
|
| Rate for Payer: Coventry All Commercial |
$155.11
|
| Rate for Payer: Encore All Commercial |
$162.24
|
| Rate for Payer: Frontpath All Commercial |
$162.16
|
| Rate for Payer: Humana ChoiceCare |
$152.23
|
| Rate for Payer: Humana Medicare |
$89.89
|
| Rate for Payer: Lucent All Commercial |
$89.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.63
|
| Rate for Payer: Managed Health Services Medicaid |
$1,242.31
|
| Rate for Payer: MDWise Medicaid |
$1,242.31
|
| Rate for Payer: PHCS All Commercial |
$132.19
|
| Rate for Payer: PHP All Commercial |
$133.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.74
|
| Rate for Payer: Sagamore Health Network All Products |
$136.07
|
| Rate for Payer: Signature Care EPO |
$146.29
|
| Rate for Payer: Signature Care PPO |
$155.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$149.82
|
| Rate for Payer: United Healthcare Commercial |
$138.89
|
| Rate for Payer: United Healthcare Medicare |
$58.16
|
|
|
HC PARNG/CUTG B9 HYPRKR LES 2-4
|
Facility
IP
|
$258.06
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
01681056
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.54 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$222.96
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna All Commercial |
$222.71
|
| Rate for Payer: CORVEL All Commercial |
$240.00
|
| Rate for Payer: Coventry All Commercial |
$227.09
|
| Rate for Payer: Encore All Commercial |
$237.54
|
| Rate for Payer: Frontpath All Commercial |
$237.42
|
| Rate for Payer: Humana ChoiceCare |
$222.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.25
|
| Rate for Payer: PHCS All Commercial |
$193.54
|
| Rate for Payer: PHP All Commercial |
$195.71
|
| Rate for Payer: Sagamore Health Network All Products |
$199.22
|
| Rate for Payer: Signature Care EPO |
$214.19
|
| Rate for Payer: Signature Care PPO |
$227.09
|
| Rate for Payer: United Healthcare Commercial |
$203.35
|
|
|
HC PARNG/CUTG B9 HYPRKR LES 2-4
|
Facility
OP
|
$258.06
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
01681056
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.16 |
| Max. Negotiated Rate |
$1,242.31 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: Aetna Medicare |
$85.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$148.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,242.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.68
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Centivo All Commercial |
$131.61
|
| Rate for Payer: Cigna All Commercial |
$222.71
|
| Rate for Payer: CORVEL All Commercial |
$240.00
|
| Rate for Payer: Coventry All Commercial |
$227.09
|
| Rate for Payer: Encore All Commercial |
$237.54
|
| Rate for Payer: Frontpath All Commercial |
$237.42
|
| Rate for Payer: Humana ChoiceCare |
$222.89
|
| Rate for Payer: Humana Medicare |
$131.61
|
| Rate for Payer: Lucent All Commercial |
$131.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.25
|
| Rate for Payer: Managed Health Services Medicaid |
$1,242.31
|
| Rate for Payer: MDWise Medicaid |
$1,242.31
|
| Rate for Payer: PHCS All Commercial |
$193.54
|
| Rate for Payer: PHP All Commercial |
$195.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.64
|
| Rate for Payer: Sagamore Health Network All Products |
$199.22
|
| Rate for Payer: Signature Care EPO |
$214.19
|
| Rate for Payer: Signature Care PPO |
$227.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$219.35
|
| Rate for Payer: United Healthcare Commercial |
$203.35
|
| Rate for Payer: United Healthcare Medicare |
$85.16
|
|
|
HC PARVOVIRUS B19 AB, IGM
|
Facility
IP
|
$165.06
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
63001965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.79 |
| Max. Negotiated Rate |
$153.50 |
| Rate for Payer: Aetna Commercial |
$142.61
|
| Rate for Payer: Cash Price |
$102.34
|
| Rate for Payer: Cigna All Commercial |
$142.44
|
| Rate for Payer: CORVEL All Commercial |
$153.50
|
| Rate for Payer: Coventry All Commercial |
$145.25
|
| Rate for Payer: Encore All Commercial |
$151.93
|
| Rate for Payer: Frontpath All Commercial |
$151.85
|
| Rate for Payer: Humana ChoiceCare |
$142.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.55
|
| Rate for Payer: PHCS All Commercial |
$123.79
|
| Rate for Payer: PHP All Commercial |
$125.18
|
| Rate for Payer: Sagamore Health Network All Products |
$127.42
|
| Rate for Payer: Signature Care EPO |
$137.00
|
| Rate for Payer: Signature Care PPO |
$145.25
|
| Rate for Payer: United Healthcare Commercial |
$130.06
|
|
