|
HC THUNDERBEAT LAP 5MM, 35 CM
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
41602185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
|
HC THUNDERBEAT LAP 5MM, 45 CM
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
41602180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$872.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$834.90
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Centivo All Commercial |
$1,173.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$1,173.00
|
| Rate for Payer: Lucent All Commercial |
$1,173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$759.00
|
|
|
HC THUNDERBEAT LAP 5MM, 45 CM
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
41602180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
|
HC THUNDERBEAT SMALL JAW
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
41602179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$872.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$834.90
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Centivo All Commercial |
$1,173.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$1,173.00
|
| Rate for Payer: Lucent All Commercial |
$1,173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$759.00
|
|
|
HC THUNDERBEAT SMALL JAW
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
41602179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
|
HC THY BINDING GLOB
|
Facility
|
OP
|
$246.84
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
63001690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$229.56 |
| Rate for Payer: Aetna Commercial |
$208.33
|
| Rate for Payer: Aetna Medicare |
$81.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.60
|
| Rate for Payer: Cash Price |
$153.04
|
| Rate for Payer: Cash Price |
$153.04
|
| Rate for Payer: Centivo All Commercial |
$125.89
|
| Rate for Payer: Cigna All Commercial |
$213.02
|
| Rate for Payer: CORVEL All Commercial |
$229.56
|
| Rate for Payer: Coventry All Commercial |
$217.22
|
| Rate for Payer: Encore All Commercial |
$227.22
|
| Rate for Payer: Frontpath All Commercial |
$227.09
|
| Rate for Payer: Humana ChoiceCare |
$213.20
|
| Rate for Payer: Humana Medicare |
$125.89
|
| Rate for Payer: Lucent All Commercial |
$125.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$222.16
|
| Rate for Payer: Managed Health Services Medicaid |
$14.78
|
| Rate for Payer: MDWise Medicaid |
$14.78
|
| Rate for Payer: PHCS All Commercial |
$185.13
|
| Rate for Payer: PHP All Commercial |
$187.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.27
|
| Rate for Payer: Sagamore Health Network All Products |
$190.56
|
| Rate for Payer: Signature Care EPO |
$204.88
|
| Rate for Payer: Signature Care PPO |
$217.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.81
|
| Rate for Payer: United Healthcare Commercial |
$194.51
|
| Rate for Payer: United Healthcare Medicare |
$81.46
|
|
|
HC THY BINDING GLOB
|
Facility
|
IP
|
$246.84
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
63001690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.13 |
| Max. Negotiated Rate |
$229.56 |
| Rate for Payer: Aetna Commercial |
$213.27
|
| Rate for Payer: Cash Price |
$153.04
|
| Rate for Payer: Cigna All Commercial |
$213.02
|
| Rate for Payer: CORVEL All Commercial |
$229.56
|
| Rate for Payer: Coventry All Commercial |
$217.22
|
| Rate for Payer: Encore All Commercial |
$227.22
|
| Rate for Payer: Frontpath All Commercial |
$227.09
|
| Rate for Payer: Humana ChoiceCare |
$213.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$222.16
|
| Rate for Payer: PHCS All Commercial |
$185.13
|
| Rate for Payer: PHP All Commercial |
$187.20
|
| Rate for Payer: Sagamore Health Network All Products |
$190.56
|
| Rate for Payer: Signature Care EPO |
$204.88
|
| Rate for Payer: Signature Care PPO |
$217.22
|
| Rate for Payer: United Healthcare Commercial |
$194.51
|
|
|
HC THY PEROX-MICROSOMAL
|
Facility
|
IP
|
$164.97
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$153.43 |
| Rate for Payer: Aetna Commercial |
$142.54
|
| Rate for Payer: Cash Price |
$102.28
|
| Rate for Payer: Cigna All Commercial |
$142.37
|
| Rate for Payer: CORVEL All Commercial |
$153.43
|
| Rate for Payer: Coventry All Commercial |
$145.18
|
| Rate for Payer: Encore All Commercial |
$151.86
|
| Rate for Payer: Frontpath All Commercial |
$151.78
|
| Rate for Payer: Humana ChoiceCare |
$142.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.48
|
| Rate for Payer: PHCS All Commercial |
$123.73
|
| Rate for Payer: PHP All Commercial |
$125.12
|
| Rate for Payer: Sagamore Health Network All Products |
$127.36
|
| Rate for Payer: Signature Care EPO |
$136.93
|
| Rate for Payer: Signature Care PPO |
$145.18
|
| Rate for Payer: United Healthcare Commercial |
$130.00
|
|
|
HC THY PEROX-MICROSOMAL
|
Facility
|
OP
|
$164.97
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$153.43 |
| Rate for Payer: Aetna Commercial |
$139.24
|
| Rate for Payer: Aetna Medicare |
$54.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.89
|
| Rate for Payer: Cash Price |
$102.28
|
| Rate for Payer: Cash Price |
$102.28
|
| Rate for Payer: Centivo All Commercial |
$84.14
|
| Rate for Payer: Cigna All Commercial |
$142.37
|
| Rate for Payer: CORVEL All Commercial |
$153.43
|
| Rate for Payer: Coventry All Commercial |
$145.18
|
| Rate for Payer: Encore All Commercial |
$151.86
|
| Rate for Payer: Frontpath All Commercial |
$151.78
|
| Rate for Payer: Humana ChoiceCare |
$142.49
|
| Rate for Payer: Humana Medicare |
$84.14
|
| Rate for Payer: Lucent All Commercial |
$84.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.48
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: MDWise Medicaid |
$14.55
|
| Rate for Payer: PHCS All Commercial |
$123.73
|
| Rate for Payer: PHP All Commercial |
$125.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.34
|
| Rate for Payer: Sagamore Health Network All Products |
$127.36
|
| Rate for Payer: Signature Care EPO |
$136.93
|
| Rate for Payer: Signature Care PPO |
$145.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.23
|
| Rate for Payer: United Healthcare Commercial |
$130.00
|
| Rate for Payer: United Healthcare Medicare |
$54.44
|
|
|
HC THYROGLOBULIN
|
Facility
|
IP
|
$188.50
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
63001021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.37 |
| Max. Negotiated Rate |
$175.30 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Cash Price |
$116.87
|
| Rate for Payer: Cigna All Commercial |
$162.67
|
| Rate for Payer: CORVEL All Commercial |
$175.30
|
| Rate for Payer: Coventry All Commercial |
$165.88
|
| Rate for Payer: Encore All Commercial |
$173.51
|
| Rate for Payer: Frontpath All Commercial |
$173.42
|
| Rate for Payer: Humana ChoiceCare |
$162.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.65
|
| Rate for Payer: PHCS All Commercial |
$141.37
|
| Rate for Payer: PHP All Commercial |
$142.96
|
| Rate for Payer: Sagamore Health Network All Products |
$145.52
|
| Rate for Payer: Signature Care EPO |
$156.45
|
| Rate for Payer: Signature Care PPO |
$165.88
|
| Rate for Payer: United Healthcare Commercial |
$148.53
|
|
|
HC THYROGLOBULIN
|
Facility
|
OP
|
$188.50
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
63001021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$175.30 |
| Rate for Payer: Aetna Commercial |
$159.09
|
| Rate for Payer: Aetna Medicare |
$62.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.42
|
| Rate for Payer: Cash Price |
$116.87
|
| Rate for Payer: Cash Price |
$116.87
|
| Rate for Payer: Centivo All Commercial |
$96.13
|
| Rate for Payer: Cigna All Commercial |
$162.67
|
| Rate for Payer: CORVEL All Commercial |
$175.30
|
| Rate for Payer: Coventry All Commercial |
$165.88
|
| Rate for Payer: Encore All Commercial |
$173.51
|
| Rate for Payer: Frontpath All Commercial |
$173.42
|
| Rate for Payer: Humana ChoiceCare |
$162.80
|
| Rate for Payer: Humana Medicare |
$96.13
|
| Rate for Payer: Lucent All Commercial |
$96.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.65
|
| Rate for Payer: Managed Health Services Medicaid |
$16.06
|
| Rate for Payer: MDWise Medicaid |
$16.06
|
| Rate for Payer: PHCS All Commercial |
$141.37
|
| Rate for Payer: PHP All Commercial |
$142.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.51
|
| Rate for Payer: Sagamore Health Network All Products |
$145.52
|
| Rate for Payer: Signature Care EPO |
$156.45
|
| Rate for Payer: Signature Care PPO |
$165.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.22
|
| Rate for Payer: United Healthcare Commercial |
$148.53
|
| Rate for Payer: United Healthcare Medicare |
$62.20
|
|
|
HC THYROGLOBULIN AB
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
63001011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.09
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Centivo All Commercial |
$85.83
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$85.83
|
| Rate for Payer: Lucent All Commercial |
$85.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$15.91
|
| Rate for Payer: MDWise Medicaid |
$15.91
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$55.54
|
|
|
HC THYROGLOBULIN AB
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
63001011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC THYROID IMAGING W/BLOOD FLOW
|
Facility
|
OP
|
$551.53
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
01638010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$182.01 |
| Max. Negotiated Rate |
$512.93 |
| Rate for Payer: Aetna Commercial |
$465.50
|
| Rate for Payer: Aetna Medicare |
$182.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$182.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$316.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$344.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$483.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$209.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$200.21
|
| Rate for Payer: Cash Price |
$341.95
|
| Rate for Payer: Cash Price |
$341.95
|
| Rate for Payer: Centivo All Commercial |
$281.28
|
| Rate for Payer: Cigna All Commercial |
$475.97
|
| Rate for Payer: CORVEL All Commercial |
$512.93
|
| Rate for Payer: Coventry All Commercial |
$485.35
|
| Rate for Payer: Encore All Commercial |
$507.69
|
| Rate for Payer: Frontpath All Commercial |
$507.41
|
| Rate for Payer: Humana ChoiceCare |
$476.36
|
| Rate for Payer: Humana Medicare |
$281.28
|
| Rate for Payer: Lucent All Commercial |
$281.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$496.38
|
| Rate for Payer: Managed Health Services Medicaid |
$483.05
|
| Rate for Payer: MDWise Medicaid |
$483.05
|
| Rate for Payer: PHCS All Commercial |
$413.65
|
| Rate for Payer: PHP All Commercial |
$418.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$215.10
|
| Rate for Payer: Sagamore Health Network All Products |
$425.78
|
| Rate for Payer: Signature Care EPO |
$457.77
|
| Rate for Payer: Signature Care PPO |
$485.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$468.80
|
| Rate for Payer: United Healthcare Commercial |
$434.61
|
| Rate for Payer: United Healthcare Medicare |
$182.01
|
|
|
HC THYROID IMAGING W/BLOOD FLOW
|
Facility
|
IP
|
$551.53
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
01638010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$413.65 |
| Max. Negotiated Rate |
$512.93 |
| Rate for Payer: Aetna Commercial |
$476.53
|
| Rate for Payer: Cash Price |
$341.95
|
| Rate for Payer: Cigna All Commercial |
$475.97
|
| Rate for Payer: CORVEL All Commercial |
$512.93
|
| Rate for Payer: Coventry All Commercial |
$485.35
|
| Rate for Payer: Encore All Commercial |
$507.69
|
| Rate for Payer: Frontpath All Commercial |
$507.41
|
| Rate for Payer: Humana ChoiceCare |
$476.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$496.38
|
| Rate for Payer: PHCS All Commercial |
$413.65
|
| Rate for Payer: PHP All Commercial |
$418.28
|
| Rate for Payer: Sagamore Health Network All Products |
$425.78
|
| Rate for Payer: Signature Care EPO |
$457.77
|
| Rate for Payer: Signature Care PPO |
$485.35
|
| Rate for Payer: United Healthcare Commercial |
$434.61
|
|
|
HC THYROID STIM IMMUNO
|
Facility
|
IP
|
$427.48
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
63001694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$320.61 |
| Max. Negotiated Rate |
$397.56 |
| Rate for Payer: Aetna Commercial |
$369.34
|
| Rate for Payer: Cash Price |
$265.04
|
| Rate for Payer: Cigna All Commercial |
$368.92
|
| Rate for Payer: CORVEL All Commercial |
$397.56
|
| Rate for Payer: Coventry All Commercial |
$376.18
|
| Rate for Payer: Encore All Commercial |
$393.50
|
| Rate for Payer: Frontpath All Commercial |
$393.28
|
| Rate for Payer: Humana ChoiceCare |
$369.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$384.73
|
| Rate for Payer: PHCS All Commercial |
$320.61
|
| Rate for Payer: PHP All Commercial |
$324.20
|
| Rate for Payer: Sagamore Health Network All Products |
$330.02
|
| Rate for Payer: Signature Care EPO |
$354.81
|
| Rate for Payer: Signature Care PPO |
$376.18
|
| Rate for Payer: United Healthcare Commercial |
$336.86
|
|
|
HC THYROID STIM IMMUNO
|
Facility
|
OP
|
$427.48
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
63001694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$397.56 |
| Rate for Payer: Aetna Commercial |
$360.79
|
| Rate for Payer: Aetna Medicare |
$141.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$245.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$267.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$50.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.18
|
| Rate for Payer: Cash Price |
$265.04
|
| Rate for Payer: Cash Price |
$265.04
|
| Rate for Payer: Centivo All Commercial |
$218.02
|
| Rate for Payer: Cigna All Commercial |
$368.92
|
| Rate for Payer: CORVEL All Commercial |
$397.56
|
| Rate for Payer: Coventry All Commercial |
$376.18
|
| Rate for Payer: Encore All Commercial |
$393.50
|
| Rate for Payer: Frontpath All Commercial |
$393.28
|
| Rate for Payer: Humana ChoiceCare |
$369.22
|
| Rate for Payer: Humana Medicare |
$218.02
|
| Rate for Payer: Lucent All Commercial |
$218.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$384.73
|
| Rate for Payer: Managed Health Services Medicaid |
$50.86
|
| Rate for Payer: MDWise Medicaid |
$50.86
|
| Rate for Payer: PHCS All Commercial |
$320.61
|
| Rate for Payer: PHP All Commercial |
$324.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.72
|
| Rate for Payer: Sagamore Health Network All Products |
$330.02
|
| Rate for Payer: Signature Care EPO |
$354.81
|
| Rate for Payer: Signature Care PPO |
$376.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$363.36
|
| Rate for Payer: United Healthcare Commercial |
$336.86
|
| Rate for Payer: United Healthcare Medicare |
$141.07
|
|
|
HC THYROID UPTAKE MEASUREMENT
|
Facility
|
OP
|
$581.10
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
01638012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$540.43 |
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: Aetna Medicare |
$191.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$191.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$333.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$363.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.94
|
| Rate for Payer: Cash Price |
$360.29
|
| Rate for Payer: Cash Price |
$360.29
|
| Rate for Payer: Centivo All Commercial |
$296.36
|
| Rate for Payer: Cigna All Commercial |
$501.49
|
| Rate for Payer: CORVEL All Commercial |
$540.43
|
| Rate for Payer: Coventry All Commercial |
$511.37
|
| Rate for Payer: Encore All Commercial |
$534.91
|
| Rate for Payer: Frontpath All Commercial |
$534.62
|
| Rate for Payer: Humana ChoiceCare |
$501.90
|
| Rate for Payer: Humana Medicare |
$296.36
|
| Rate for Payer: Lucent All Commercial |
$296.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$522.99
|
| Rate for Payer: Managed Health Services Medicaid |
$186.15
|
| Rate for Payer: MDWise Medicaid |
$186.15
|
| Rate for Payer: PHCS All Commercial |
$435.83
|
| Rate for Payer: PHP All Commercial |
$440.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.63
|
| Rate for Payer: Sagamore Health Network All Products |
$448.61
|
| Rate for Payer: Signature Care EPO |
$482.32
|
| Rate for Payer: Signature Care PPO |
$511.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$493.94
|
| Rate for Payer: United Healthcare Commercial |
$457.91
|
| Rate for Payer: United Healthcare Medicare |
$191.76
|
|
|
HC THYROID UPTAKE MEASUREMENT
|
Facility
|
IP
|
$581.10
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
01638012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$435.83 |
| Max. Negotiated Rate |
$540.43 |
| Rate for Payer: Aetna Commercial |
$502.07
|
| Rate for Payer: Cash Price |
$360.29
|
| Rate for Payer: Cigna All Commercial |
$501.49
|
| Rate for Payer: CORVEL All Commercial |
$540.43
|
| Rate for Payer: Coventry All Commercial |
$511.37
|
| Rate for Payer: Encore All Commercial |
$534.91
|
| Rate for Payer: Frontpath All Commercial |
$534.62
|
| Rate for Payer: Humana ChoiceCare |
$501.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$522.99
|
| Rate for Payer: PHCS All Commercial |
$435.83
|
| Rate for Payer: PHP All Commercial |
$440.71
|
| Rate for Payer: Sagamore Health Network All Products |
$448.61
|
| Rate for Payer: Signature Care EPO |
$482.32
|
| Rate for Payer: Signature Care PPO |
$511.37
|
| Rate for Payer: United Healthcare Commercial |
$457.91
|
|
|
HC THYROID UPTAKE & SCAN W/BLD FL
|
Facility
|
OP
|
$1,690.34
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
01638080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.81 |
| Max. Negotiated Rate |
$1,572.02 |
| Rate for Payer: Aetna Commercial |
$1,426.65
|
| Rate for Payer: Aetna Medicare |
$557.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$557.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$970.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,056.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$577.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$641.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$613.59
|
| Rate for Payer: Cash Price |
$1,048.01
|
| Rate for Payer: Cash Price |
$1,048.01
|
| Rate for Payer: Centivo All Commercial |
$862.08
|
| Rate for Payer: Cigna All Commercial |
$1,458.77
|
| Rate for Payer: CORVEL All Commercial |
$1,572.02
|
| Rate for Payer: Coventry All Commercial |
$1,487.50
|
| Rate for Payer: Encore All Commercial |
$1,555.96
|
| Rate for Payer: Frontpath All Commercial |
$1,555.12
|
| Rate for Payer: Humana ChoiceCare |
$1,459.95
|
| Rate for Payer: Humana Medicare |
$862.08
|
| Rate for Payer: Lucent All Commercial |
$862.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,521.31
|
| Rate for Payer: Managed Health Services Medicaid |
$577.71
|
| Rate for Payer: MDWise Medicaid |
$577.71
|
| Rate for Payer: PHCS All Commercial |
$1,267.76
|
| Rate for Payer: PHP All Commercial |
$1,281.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$659.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,304.95
|
| Rate for Payer: Signature Care EPO |
$1,402.99
|
| Rate for Payer: Signature Care PPO |
$1,487.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,436.79
|
| Rate for Payer: United Healthcare Commercial |
$1,331.99
|
| Rate for Payer: United Healthcare Medicare |
$557.81
|
|
|
HC THYROID UPTAKE & SCAN W/BLD FL
|
Facility
|
IP
|
$1,690.34
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
01638080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,267.76 |
| Max. Negotiated Rate |
$1,572.02 |
| Rate for Payer: Aetna Commercial |
$1,460.46
|
| Rate for Payer: Cash Price |
$1,048.01
|
| Rate for Payer: Cigna All Commercial |
$1,458.77
|
| Rate for Payer: CORVEL All Commercial |
$1,572.02
|
| Rate for Payer: Coventry All Commercial |
$1,487.50
|
| Rate for Payer: Encore All Commercial |
$1,555.96
|
| Rate for Payer: Frontpath All Commercial |
$1,555.12
|
| Rate for Payer: Humana ChoiceCare |
$1,459.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,521.31
|
| Rate for Payer: PHCS All Commercial |
$1,267.76
|
| Rate for Payer: PHP All Commercial |
$1,281.96
|
| Rate for Payer: Sagamore Health Network All Products |
$1,304.95
|
| Rate for Payer: Signature Care EPO |
$1,402.99
|
| Rate for Payer: Signature Care PPO |
$1,487.50
|
| Rate for Payer: United Healthcare Commercial |
$1,331.99
|
|
|
HC TILT TABLE STUDY
|
Facility
|
IP
|
$1,586.96
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
01593660
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,190.22 |
| Max. Negotiated Rate |
$1,475.87 |
| Rate for Payer: Aetna Commercial |
$1,371.13
|
| Rate for Payer: Cash Price |
$983.91
|
| Rate for Payer: Cigna All Commercial |
$1,369.54
|
| Rate for Payer: CORVEL All Commercial |
$1,475.87
|
| Rate for Payer: Coventry All Commercial |
$1,396.52
|
| Rate for Payer: Encore All Commercial |
$1,460.79
|
| Rate for Payer: Frontpath All Commercial |
$1,460.00
|
| Rate for Payer: Humana ChoiceCare |
$1,370.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,428.26
|
| Rate for Payer: PHCS All Commercial |
$1,190.22
|
| Rate for Payer: PHP All Commercial |
$1,203.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,225.13
|
| Rate for Payer: Signature Care EPO |
$1,317.17
|
| Rate for Payer: Signature Care PPO |
$1,396.52
|
| Rate for Payer: United Healthcare Commercial |
$1,250.52
|
|
|
HC TILT TABLE STUDY
|
Facility
|
OP
|
$1,586.96
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
01593660
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$523.70 |
| Max. Negotiated Rate |
$1,475.87 |
| Rate for Payer: Aetna Commercial |
$1,339.39
|
| Rate for Payer: Aetna Medicare |
$523.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$523.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$911.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$992.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$648.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$602.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$576.07
|
| Rate for Payer: Cash Price |
$983.91
|
| Rate for Payer: Cash Price |
$983.91
|
| Rate for Payer: Centivo All Commercial |
$809.35
|
| Rate for Payer: Cigna All Commercial |
$1,369.54
|
| Rate for Payer: CORVEL All Commercial |
$1,475.87
|
| Rate for Payer: Coventry All Commercial |
$1,396.52
|
| Rate for Payer: Encore All Commercial |
$1,460.79
|
| Rate for Payer: Frontpath All Commercial |
$1,460.00
|
| Rate for Payer: Humana ChoiceCare |
$1,370.65
|
| Rate for Payer: Humana Medicare |
$809.35
|
| Rate for Payer: Lucent All Commercial |
$809.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,428.26
|
| Rate for Payer: Managed Health Services Medicaid |
$648.65
|
| Rate for Payer: MDWise Medicaid |
$648.65
|
| Rate for Payer: PHCS All Commercial |
$1,190.22
|
| Rate for Payer: PHP All Commercial |
$1,203.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$618.91
|
| Rate for Payer: Sagamore Health Network All Products |
$1,225.13
|
| Rate for Payer: Signature Care EPO |
$1,317.17
|
| Rate for Payer: Signature Care PPO |
$1,396.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,348.91
|
| Rate for Payer: United Healthcare Commercial |
$1,250.52
|
| Rate for Payer: United Healthcare Medicare |
$523.70
|
|
|
HC TISSUE CULT-ADDL EA
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 87253
|
| Hospital Charge Code |
63002023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$76.84 |
| Rate for Payer: Aetna Commercial |
$69.73
|
| Rate for Payer: Aetna Medicare |
$27.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.99
|
| Rate for Payer: Cash Price |
$51.22
|
| Rate for Payer: Cash Price |
$51.22
|
| Rate for Payer: Centivo All Commercial |
$42.14
|
| Rate for Payer: Cigna All Commercial |
$71.30
|
| Rate for Payer: CORVEL All Commercial |
$76.84
|
| Rate for Payer: Coventry All Commercial |
$72.71
|
| Rate for Payer: Encore All Commercial |
$76.05
|
| Rate for Payer: Frontpath All Commercial |
$76.01
|
| Rate for Payer: Humana ChoiceCare |
$71.36
|
| Rate for Payer: Humana Medicare |
$42.14
|
| Rate for Payer: Lucent All Commercial |
$42.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.36
|
| Rate for Payer: Managed Health Services Medicaid |
$20.20
|
| Rate for Payer: MDWise Medicaid |
$20.20
|
| Rate for Payer: PHCS All Commercial |
$61.96
|
| Rate for Payer: PHP All Commercial |
$62.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.22
|
| Rate for Payer: Sagamore Health Network All Products |
$63.78
|
| Rate for Payer: Signature Care EPO |
$68.57
|
| Rate for Payer: Signature Care PPO |
$72.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.23
|
| Rate for Payer: United Healthcare Commercial |
$65.10
|
| Rate for Payer: United Healthcare Medicare |
$27.26
|
|
|
HC TISSUE CULT-ADDL EA
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 87253
|
| Hospital Charge Code |
63002023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.96 |
| Max. Negotiated Rate |
$76.84 |
| Rate for Payer: Aetna Commercial |
$71.38
|
| Rate for Payer: Cash Price |
$51.22
|
| Rate for Payer: Cigna All Commercial |
$71.30
|
| Rate for Payer: CORVEL All Commercial |
$76.84
|
| Rate for Payer: Coventry All Commercial |
$72.71
|
| Rate for Payer: Encore All Commercial |
$76.05
|
| Rate for Payer: Frontpath All Commercial |
$76.01
|
| Rate for Payer: Humana ChoiceCare |
$71.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.36
|
| Rate for Payer: PHCS All Commercial |
$61.96
|
| Rate for Payer: PHP All Commercial |
$62.66
|
| Rate for Payer: Sagamore Health Network All Products |
$63.78
|
| Rate for Payer: Signature Care EPO |
$68.57
|
| Rate for Payer: Signature Care PPO |
$72.71
|
| Rate for Payer: United Healthcare Commercial |
$65.10
|
|
