|
HC ER BASIC METABOLIC W/IONIZED CALCIUM
|
Facility
IP
|
$355.89
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
63001361
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$266.92 |
| Max. Negotiated Rate |
$330.98 |
| Rate for Payer: Aetna Commercial |
$307.49
|
| Rate for Payer: Cash Price |
$220.65
|
| Rate for Payer: Cigna All Commercial |
$307.13
|
| Rate for Payer: CORVEL All Commercial |
$330.98
|
| Rate for Payer: Coventry All Commercial |
$313.18
|
| Rate for Payer: Encore All Commercial |
$327.60
|
| Rate for Payer: Frontpath All Commercial |
$327.42
|
| Rate for Payer: Humana ChoiceCare |
$307.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.30
|
| Rate for Payer: PHCS All Commercial |
$266.92
|
| Rate for Payer: PHP All Commercial |
$269.91
|
| Rate for Payer: Sagamore Health Network All Products |
$274.75
|
| Rate for Payer: Signature Care EPO |
$295.39
|
| Rate for Payer: Signature Care PPO |
$313.18
|
| Rate for Payer: United Healthcare Commercial |
$280.44
|
|
|
HC ERYTHROPOIETIN
|
Facility
OP
|
$243.47
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
63001532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.79 |
| Max. Negotiated Rate |
$226.43 |
| Rate for Payer: Aetna Commercial |
$205.49
|
| Rate for Payer: Aetna Medicare |
$80.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$139.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$152.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.38
|
| Rate for Payer: Cash Price |
$150.95
|
| Rate for Payer: Cash Price |
$150.95
|
| Rate for Payer: Centivo All Commercial |
$124.17
|
| Rate for Payer: Cigna All Commercial |
$210.12
|
| Rate for Payer: CORVEL All Commercial |
$226.43
|
| Rate for Payer: Coventry All Commercial |
$214.26
|
| Rate for Payer: Encore All Commercial |
$224.12
|
| Rate for Payer: Frontpath All Commercial |
$224.00
|
| Rate for Payer: Humana ChoiceCare |
$210.29
|
| Rate for Payer: Humana Medicare |
$124.17
|
| Rate for Payer: Lucent All Commercial |
$124.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.13
|
| Rate for Payer: Managed Health Services Medicaid |
$18.79
|
| Rate for Payer: MDWise Medicaid |
$18.79
|
| Rate for Payer: PHCS All Commercial |
$182.61
|
| Rate for Payer: PHP All Commercial |
$184.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.95
|
| Rate for Payer: Sagamore Health Network All Products |
$187.96
|
| Rate for Payer: Signature Care EPO |
$202.08
|
| Rate for Payer: Signature Care PPO |
$214.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$206.95
|
| Rate for Payer: United Healthcare Commercial |
$191.86
|
| Rate for Payer: United Healthcare Medicare |
$80.35
|
|
|
HC ERYTHROPOIETIN
|
Facility
IP
|
$243.47
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
63001532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$226.43 |
| Rate for Payer: Aetna Commercial |
$210.36
|
| Rate for Payer: Cash Price |
$150.95
|
| Rate for Payer: Cigna All Commercial |
$210.12
|
| Rate for Payer: CORVEL All Commercial |
$226.43
|
| Rate for Payer: Coventry All Commercial |
$214.26
|
| Rate for Payer: Encore All Commercial |
$224.12
|
| Rate for Payer: Frontpath All Commercial |
$224.00
|
| Rate for Payer: Humana ChoiceCare |
$210.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.13
|
| Rate for Payer: PHCS All Commercial |
$182.61
|
| Rate for Payer: PHP All Commercial |
$184.65
|
| Rate for Payer: Sagamore Health Network All Products |
$187.96
|
| Rate for Payer: Signature Care EPO |
$202.08
|
| Rate for Payer: Signature Care PPO |
$214.26
|
| Rate for Payer: United Healthcare Commercial |
$191.86
|
|
|
HC ESSURE
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT A4264
|
| Hospital Charge Code |
41603590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.50 |
| Max. Negotiated Rate |
$3,096.90 |
| Rate for Payer: Aetna Commercial |
$2,877.12
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cigna All Commercial |
$2,873.79
|
| Rate for Payer: CORVEL All Commercial |
$3,096.90
|
| Rate for Payer: Coventry All Commercial |
$2,930.40
|
| Rate for Payer: Encore All Commercial |
$3,065.26
|
| Rate for Payer: Frontpath All Commercial |
$3,063.60
|
| Rate for Payer: Humana ChoiceCare |
$2,876.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,997.00
|
| Rate for Payer: PHCS All Commercial |
$2,497.50
|
| Rate for Payer: PHP All Commercial |
$2,525.47
|
| Rate for Payer: Sagamore Health Network All Products |
$2,570.76
|
| Rate for Payer: Signature Care EPO |
$2,763.90
|
| Rate for Payer: Signature Care PPO |
$2,930.40
|
| Rate for Payer: United Healthcare Commercial |
$2,624.04
|
|
|
HC ESSURE
|
Facility
OP
|
$3,330.00
|
|
|
Service Code
|
CPT A4264
|
| Hospital Charge Code |
41603590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,096.90 |
| Rate for Payer: Aetna Commercial |
$2,810.52
|
| Rate for Payer: Aetna Medicare |
$1,098.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,098.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,912.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,081.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,263.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,208.79
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Centivo All Commercial |
$1,698.30
|
| Rate for Payer: Cigna All Commercial |
$2,873.79
|
| Rate for Payer: CORVEL All Commercial |
$3,096.90
|
| Rate for Payer: Coventry All Commercial |
$2,930.40
|
| Rate for Payer: Encore All Commercial |
$3,065.26
|
| Rate for Payer: Frontpath All Commercial |
$3,063.60
|
| Rate for Payer: Humana ChoiceCare |
$2,876.12
|
| Rate for Payer: Humana Medicare |
$1,698.30
|
| Rate for Payer: Lucent All Commercial |
$1,698.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,997.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,497.50
|
| Rate for Payer: PHP All Commercial |
$2,525.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,298.70
|
| Rate for Payer: Sagamore Health Network All Products |
$2,570.76
|
| Rate for Payer: Signature Care EPO |
$2,763.90
|
| Rate for Payer: Signature Care PPO |
$2,930.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,830.50
|
| Rate for Payer: United Healthcare Commercial |
$2,624.04
|
| Rate for Payer: United Healthcare Medicare |
$1,098.90
|
|
|
HC E STIM:MANUAL/15 MIN-OT
|
Facility
OP
|
$139.74
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
01738017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.11 |
| Max. Negotiated Rate |
$129.96 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Medicare |
$46.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.73
|
| Rate for Payer: Cash Price |
$86.64
|
| Rate for Payer: Centivo All Commercial |
$71.27
|
| Rate for Payer: Cigna All Commercial |
$120.60
|
| Rate for Payer: CORVEL All Commercial |
$129.96
|
| Rate for Payer: Coventry All Commercial |
$122.97
|
| Rate for Payer: Encore All Commercial |
$128.63
|
| Rate for Payer: Frontpath All Commercial |
$128.56
|
| Rate for Payer: Humana ChoiceCare |
$120.69
|
| Rate for Payer: Humana Medicare |
$71.27
|
| Rate for Payer: Lucent All Commercial |
$71.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.77
|
| Rate for Payer: PHCS All Commercial |
$104.80
|
| Rate for Payer: PHP All Commercial |
$105.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.50
|
| Rate for Payer: Sagamore Health Network All Products |
$107.88
|
| Rate for Payer: Signature Care EPO |
$115.98
|
| Rate for Payer: Signature Care PPO |
$122.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.78
|
| Rate for Payer: United Healthcare Commercial |
$110.12
|
| Rate for Payer: United Healthcare Medicare |
$46.11
|
|
|
HC E STIM:MANUAL/15 MIN-OT
|
Facility
IP
|
$139.74
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
01738017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$129.96 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Cash Price |
$86.64
|
| Rate for Payer: Cigna All Commercial |
$120.60
|
| Rate for Payer: CORVEL All Commercial |
$129.96
|
| Rate for Payer: Coventry All Commercial |
$122.97
|
| Rate for Payer: Encore All Commercial |
$128.63
|
| Rate for Payer: Frontpath All Commercial |
$128.56
|
| Rate for Payer: Humana ChoiceCare |
$120.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.77
|
| Rate for Payer: PHCS All Commercial |
$104.80
|
| Rate for Payer: PHP All Commercial |
$105.98
|
| Rate for Payer: Sagamore Health Network All Products |
$107.88
|
| Rate for Payer: Signature Care EPO |
$115.98
|
| Rate for Payer: Signature Care PPO |
$122.97
|
| Rate for Payer: United Healthcare Commercial |
$110.12
|
|
|
HC E STIM:MANUAL/15 MIN-PT
|
Facility
OP
|
$137.53
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
01728022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC E STIM:MANUAL/15 MIN-PT
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
01728022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC ESTRADIOL
|
Facility
IP
|
$284.99
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
63001179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$213.74 |
| Max. Negotiated Rate |
$265.04 |
| Rate for Payer: Aetna Commercial |
$246.23
|
| Rate for Payer: Cash Price |
$176.69
|
| Rate for Payer: Cigna All Commercial |
$245.94
|
| Rate for Payer: CORVEL All Commercial |
$265.04
|
| Rate for Payer: Coventry All Commercial |
$250.79
|
| Rate for Payer: Encore All Commercial |
$262.33
|
| Rate for Payer: Frontpath All Commercial |
$262.19
|
| Rate for Payer: Humana ChoiceCare |
$246.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$256.49
|
| Rate for Payer: PHCS All Commercial |
$213.74
|
| Rate for Payer: PHP All Commercial |
$216.13
|
| Rate for Payer: Sagamore Health Network All Products |
$220.01
|
| Rate for Payer: Signature Care EPO |
$236.54
|
| Rate for Payer: Signature Care PPO |
$250.79
|
| Rate for Payer: United Healthcare Commercial |
$224.57
|
|
|
HC ESTRADIOL
|
Facility
OP
|
$284.99
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
63001179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$265.04 |
| Rate for Payer: Aetna Commercial |
$240.53
|
| Rate for Payer: Aetna Medicare |
$94.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$130.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$130.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.45
|
| Rate for Payer: Cash Price |
$176.69
|
| Rate for Payer: Cash Price |
$176.69
|
| Rate for Payer: Centivo All Commercial |
$145.34
|
| Rate for Payer: Cigna All Commercial |
$245.94
|
| Rate for Payer: CORVEL All Commercial |
$265.04
|
| Rate for Payer: Coventry All Commercial |
$250.79
|
| Rate for Payer: Encore All Commercial |
$262.33
|
| Rate for Payer: Frontpath All Commercial |
$262.19
|
| Rate for Payer: Humana ChoiceCare |
$246.14
|
| Rate for Payer: Humana Medicare |
$145.34
|
| Rate for Payer: Lucent All Commercial |
$145.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$256.49
|
| Rate for Payer: Managed Health Services Medicaid |
$27.94
|
| Rate for Payer: MDWise Medicaid |
$27.94
|
| Rate for Payer: PHCS All Commercial |
$213.74
|
| Rate for Payer: PHP All Commercial |
$216.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.15
|
| Rate for Payer: Sagamore Health Network All Products |
$220.01
|
| Rate for Payer: Signature Care EPO |
$236.54
|
| Rate for Payer: Signature Care PPO |
$250.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$242.24
|
| Rate for Payer: United Healthcare Commercial |
$224.57
|
| Rate for Payer: United Healthcare Medicare |
$94.05
|
|
|
HC ESTRIOL SERUM
|
Facility
OP
|
$118.48
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
63001535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$110.19 |
| Rate for Payer: Aetna Commercial |
$100.00
|
| Rate for Payer: Aetna Medicare |
$39.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.01
|
| Rate for Payer: Cash Price |
$73.46
|
| Rate for Payer: Cash Price |
$73.46
|
| Rate for Payer: Centivo All Commercial |
$60.43
|
| Rate for Payer: Cigna All Commercial |
$102.25
|
| Rate for Payer: CORVEL All Commercial |
$110.19
|
| Rate for Payer: Coventry All Commercial |
$104.27
|
| Rate for Payer: Encore All Commercial |
$109.06
|
| Rate for Payer: Frontpath All Commercial |
$109.00
|
| Rate for Payer: Humana ChoiceCare |
$102.33
|
| Rate for Payer: Humana Medicare |
$60.43
|
| Rate for Payer: Lucent All Commercial |
$60.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.63
|
| Rate for Payer: Managed Health Services Medicaid |
$24.18
|
| Rate for Payer: MDWise Medicaid |
$24.18
|
| Rate for Payer: PHCS All Commercial |
$88.86
|
| Rate for Payer: PHP All Commercial |
$89.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.21
|
| Rate for Payer: Sagamore Health Network All Products |
$91.47
|
| Rate for Payer: Signature Care EPO |
$98.34
|
| Rate for Payer: Signature Care PPO |
$104.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$100.71
|
| Rate for Payer: United Healthcare Commercial |
$93.36
|
| Rate for Payer: United Healthcare Medicare |
$39.10
|
|
|
HC ESTRIOL SERUM
|
Facility
IP
|
$118.48
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
63001535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.86 |
| Max. Negotiated Rate |
$110.19 |
| Rate for Payer: Cigna All Commercial |
$102.25
|
| Rate for Payer: Aetna Commercial |
$102.37
|
| Rate for Payer: Cash Price |
$73.46
|
| Rate for Payer: CORVEL All Commercial |
$110.19
|
| Rate for Payer: Coventry All Commercial |
$104.27
|
| Rate for Payer: Encore All Commercial |
$109.06
|
| Rate for Payer: Frontpath All Commercial |
$109.00
|
| Rate for Payer: Humana ChoiceCare |
$102.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.63
|
| Rate for Payer: PHCS All Commercial |
$88.86
|
| Rate for Payer: PHP All Commercial |
$89.86
|
| Rate for Payer: Sagamore Health Network All Products |
$91.47
|
| Rate for Payer: Signature Care EPO |
$98.34
|
| Rate for Payer: Signature Care PPO |
$104.27
|
| Rate for Payer: United Healthcare Commercial |
$93.36
|
|
|
HC ESTROGEN FRACT-SERUM
|
Facility
OP
|
$230.86
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
63001533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: Aetna Medicare |
$76.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$32.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.80
|
| Rate for Payer: Cash Price |
$143.13
|
| Rate for Payer: Cash Price |
$143.13
|
| Rate for Payer: Centivo All Commercial |
$117.74
|
| Rate for Payer: Cigna All Commercial |
$199.23
|
| Rate for Payer: CORVEL All Commercial |
$214.70
|
| Rate for Payer: Coventry All Commercial |
$203.15
|
| Rate for Payer: Encore All Commercial |
$212.50
|
| Rate for Payer: Frontpath All Commercial |
$212.39
|
| Rate for Payer: Humana ChoiceCare |
$199.39
|
| Rate for Payer: Humana Medicare |
$117.74
|
| Rate for Payer: Lucent All Commercial |
$117.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.77
|
| Rate for Payer: Managed Health Services Medicaid |
$32.30
|
| Rate for Payer: MDWise Medicaid |
$32.30
|
| Rate for Payer: PHCS All Commercial |
$173.14
|
| Rate for Payer: PHP All Commercial |
$175.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.03
|
| Rate for Payer: Sagamore Health Network All Products |
$178.22
|
| Rate for Payer: Signature Care EPO |
$191.61
|
| Rate for Payer: Signature Care PPO |
$203.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$196.23
|
| Rate for Payer: United Healthcare Commercial |
$181.92
|
| Rate for Payer: United Healthcare Medicare |
$76.18
|
|
|
HC ESTROGEN FRACT-SERUM
|
Facility
IP
|
$230.86
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
63001533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.14 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Aetna Commercial |
$199.46
|
| Rate for Payer: Cash Price |
$143.13
|
| Rate for Payer: Cigna All Commercial |
$199.23
|
| Rate for Payer: CORVEL All Commercial |
$214.70
|
| Rate for Payer: Coventry All Commercial |
$203.15
|
| Rate for Payer: Encore All Commercial |
$212.50
|
| Rate for Payer: Frontpath All Commercial |
$212.39
|
| Rate for Payer: Humana ChoiceCare |
$199.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.77
|
| Rate for Payer: PHCS All Commercial |
$173.14
|
| Rate for Payer: PHP All Commercial |
$175.08
|
| Rate for Payer: Sagamore Health Network All Products |
$178.22
|
| Rate for Payer: Signature Care EPO |
$191.61
|
| Rate for Payer: Signature Care PPO |
$203.15
|
| Rate for Payer: United Healthcare Commercial |
$181.92
|
|
|
HC ESTROGEN/PROG RECEPTOR
|
Facility
OP
|
$476.11
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
63002128
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$157.11 |
| Max. Negotiated Rate |
$716.39 |
| Rate for Payer: Aetna Commercial |
$401.83
|
| Rate for Payer: Aetna Medicare |
$157.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$273.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$297.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$716.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.83
|
| Rate for Payer: Cash Price |
$295.19
|
| Rate for Payer: Cash Price |
$295.19
|
| Rate for Payer: Centivo All Commercial |
$242.81
|
| Rate for Payer: Cigna All Commercial |
$410.88
|
| Rate for Payer: CORVEL All Commercial |
$442.78
|
| Rate for Payer: Coventry All Commercial |
$418.97
|
| Rate for Payer: Encore All Commercial |
$438.26
|
| Rate for Payer: Frontpath All Commercial |
$438.02
|
| Rate for Payer: Humana ChoiceCare |
$411.21
|
| Rate for Payer: Humana Medicare |
$242.81
|
| Rate for Payer: Lucent All Commercial |
$242.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.49
|
| Rate for Payer: Managed Health Services Medicaid |
$716.39
|
| Rate for Payer: MDWise Medicaid |
$716.39
|
| Rate for Payer: PHCS All Commercial |
$357.08
|
| Rate for Payer: PHP All Commercial |
$361.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.68
|
| Rate for Payer: Sagamore Health Network All Products |
$367.55
|
| Rate for Payer: Signature Care EPO |
$395.17
|
| Rate for Payer: Signature Care PPO |
$418.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$404.69
|
| Rate for Payer: United Healthcare Commercial |
$375.17
|
| Rate for Payer: United Healthcare Medicare |
$157.11
|
|
|
HC ESTROGEN/PROG RECEPTOR
|
Facility
IP
|
$476.11
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
63002128
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$357.08 |
| Max. Negotiated Rate |
$442.78 |
| Rate for Payer: Aetna Commercial |
$411.36
|
| Rate for Payer: Cash Price |
$295.19
|
| Rate for Payer: Cigna All Commercial |
$410.88
|
| Rate for Payer: CORVEL All Commercial |
$442.78
|
| Rate for Payer: Coventry All Commercial |
$418.97
|
| Rate for Payer: Encore All Commercial |
$438.26
|
| Rate for Payer: Frontpath All Commercial |
$438.02
|
| Rate for Payer: Humana ChoiceCare |
$411.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.49
|
| Rate for Payer: PHCS All Commercial |
$357.08
|
| Rate for Payer: PHP All Commercial |
$361.08
|
| Rate for Payer: Sagamore Health Network All Products |
$367.55
|
| Rate for Payer: Signature Care EPO |
$395.17
|
| Rate for Payer: Signature Care PPO |
$418.97
|
| Rate for Payer: United Healthcare Commercial |
$375.17
|
|
|
HC ESTROGEN/PROG RECEPTOR PATH
|
Facility
OP
|
$476.11
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
63002130
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$157.11 |
| Max. Negotiated Rate |
$716.39 |
| Rate for Payer: Aetna Commercial |
$401.83
|
| Rate for Payer: Aetna Medicare |
$157.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$273.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$297.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$716.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.83
|
| Rate for Payer: Cash Price |
$295.19
|
| Rate for Payer: Cash Price |
$295.19
|
| Rate for Payer: Centivo All Commercial |
$242.81
|
| Rate for Payer: Cigna All Commercial |
$410.88
|
| Rate for Payer: CORVEL All Commercial |
$442.78
|
| Rate for Payer: Coventry All Commercial |
$418.97
|
| Rate for Payer: Encore All Commercial |
$438.26
|
| Rate for Payer: Frontpath All Commercial |
$438.02
|
| Rate for Payer: Humana ChoiceCare |
$411.21
|
| Rate for Payer: Humana Medicare |
$242.81
|
| Rate for Payer: Lucent All Commercial |
$242.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.49
|
| Rate for Payer: Managed Health Services Medicaid |
$716.39
|
| Rate for Payer: MDWise Medicaid |
$716.39
|
| Rate for Payer: PHCS All Commercial |
$357.08
|
| Rate for Payer: PHP All Commercial |
$361.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.68
|
| Rate for Payer: Sagamore Health Network All Products |
$367.55
|
| Rate for Payer: Signature Care EPO |
$395.17
|
| Rate for Payer: Signature Care PPO |
$418.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$404.69
|
| Rate for Payer: United Healthcare Commercial |
$375.17
|
| Rate for Payer: United Healthcare Medicare |
$157.11
|
|
|
HC ESTROGEN/PROG RECEPTOR PATH
|
Facility
IP
|
$476.11
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
63002130
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$357.08 |
| Max. Negotiated Rate |
$442.78 |
| Rate for Payer: Aetna Commercial |
$411.36
|
| Rate for Payer: Cash Price |
$295.19
|
| Rate for Payer: Cigna All Commercial |
$410.88
|
| Rate for Payer: CORVEL All Commercial |
$442.78
|
| Rate for Payer: Coventry All Commercial |
$418.97
|
| Rate for Payer: Encore All Commercial |
$438.26
|
| Rate for Payer: Frontpath All Commercial |
$438.02
|
| Rate for Payer: Humana ChoiceCare |
$411.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.49
|
| Rate for Payer: PHCS All Commercial |
$357.08
|
| Rate for Payer: PHP All Commercial |
$361.08
|
| Rate for Payer: Sagamore Health Network All Products |
$367.55
|
| Rate for Payer: Signature Care EPO |
$395.17
|
| Rate for Payer: Signature Care PPO |
$418.97
|
| Rate for Payer: United Healthcare Commercial |
$375.17
|
|
|
HC ESTROGENS, TOTAL
|
Facility
IP
|
$53.55
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
63044043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
|
HC ESTROGENS, TOTAL
|
Facility
OP
|
$53.55
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
63044043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.44
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Centivo All Commercial |
$27.31
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$27.31
|
| Rate for Payer: Lucent All Commercial |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$21.70
|
| Rate for Payer: MDWise Medicaid |
$21.70
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.67
|
|
|
HC ESTROGEN TOTAL
|
Facility
OP
|
$199.89
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
63001534
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Commercial |
$168.71
|
| Rate for Payer: Aetna Medicare |
$65.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.56
|
| Rate for Payer: Cash Price |
$123.93
|
| Rate for Payer: Cash Price |
$123.93
|
| Rate for Payer: Centivo All Commercial |
$101.94
|
| Rate for Payer: Cigna All Commercial |
$172.50
|
| Rate for Payer: CORVEL All Commercial |
$185.90
|
| Rate for Payer: Coventry All Commercial |
$175.90
|
| Rate for Payer: Encore All Commercial |
$184.00
|
| Rate for Payer: Frontpath All Commercial |
$183.90
|
| Rate for Payer: Humana ChoiceCare |
$172.64
|
| Rate for Payer: Humana Medicare |
$101.94
|
| Rate for Payer: Lucent All Commercial |
$101.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.90
|
| Rate for Payer: Managed Health Services Medicaid |
$21.70
|
| Rate for Payer: MDWise Medicaid |
$21.70
|
| Rate for Payer: PHCS All Commercial |
$149.92
|
| Rate for Payer: PHP All Commercial |
$151.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.96
|
| Rate for Payer: Sagamore Health Network All Products |
$154.31
|
| Rate for Payer: Signature Care EPO |
$165.91
|
| Rate for Payer: Signature Care PPO |
$175.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$169.91
|
| Rate for Payer: United Healthcare Commercial |
$157.51
|
| Rate for Payer: United Healthcare Medicare |
$65.96
|
|
|
HC ESTROGEN TOTAL
|
Facility
IP
|
$199.89
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
63001534
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.92 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Commercial |
$172.70
|
| Rate for Payer: Cash Price |
$123.93
|
| Rate for Payer: Cigna All Commercial |
$172.50
|
| Rate for Payer: CORVEL All Commercial |
$185.90
|
| Rate for Payer: Coventry All Commercial |
$175.90
|
| Rate for Payer: Encore All Commercial |
$184.00
|
| Rate for Payer: Frontpath All Commercial |
$183.90
|
| Rate for Payer: Humana ChoiceCare |
$172.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.90
|
| Rate for Payer: PHCS All Commercial |
$149.92
|
| Rate for Payer: PHP All Commercial |
$151.60
|
| Rate for Payer: Sagamore Health Network All Products |
$154.31
|
| Rate for Payer: Signature Care EPO |
$165.91
|
| Rate for Payer: Signature Care PPO |
$175.90
|
| Rate for Payer: United Healthcare Commercial |
$157.51
|
|
|
HC ESTRONE-SERUM
|
Facility
OP
|
$224.40
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
63001536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.95 |
| Max. Negotiated Rate |
$208.69 |
| Rate for Payer: Aetna Commercial |
$189.39
|
| Rate for Payer: Aetna Medicare |
$74.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$128.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.46
|
| Rate for Payer: Cash Price |
$139.13
|
| Rate for Payer: Cash Price |
$139.13
|
| Rate for Payer: Centivo All Commercial |
$114.44
|
| Rate for Payer: Cigna All Commercial |
$193.66
|
| Rate for Payer: CORVEL All Commercial |
$208.69
|
| Rate for Payer: Coventry All Commercial |
$197.47
|
| Rate for Payer: Encore All Commercial |
$206.56
|
| Rate for Payer: Frontpath All Commercial |
$206.45
|
| Rate for Payer: Humana ChoiceCare |
$193.81
|
| Rate for Payer: Humana Medicare |
$114.44
|
| Rate for Payer: Lucent All Commercial |
$114.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$201.96
|
| Rate for Payer: Managed Health Services Medicaid |
$24.95
|
| Rate for Payer: MDWise Medicaid |
$24.95
|
| Rate for Payer: PHCS All Commercial |
$168.30
|
| Rate for Payer: PHP All Commercial |
$170.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.52
|
| Rate for Payer: Sagamore Health Network All Products |
$173.24
|
| Rate for Payer: Signature Care EPO |
$186.25
|
| Rate for Payer: Signature Care PPO |
$197.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$190.74
|
| Rate for Payer: United Healthcare Commercial |
$176.83
|
| Rate for Payer: United Healthcare Medicare |
$74.05
|
|
|
HC ESTRONE-SERUM
|
Facility
IP
|
$224.40
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
63001536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.30 |
| Max. Negotiated Rate |
$208.69 |
| Rate for Payer: Aetna Commercial |
$193.88
|
| Rate for Payer: Cash Price |
$139.13
|
| Rate for Payer: Cigna All Commercial |
$193.66
|
| Rate for Payer: CORVEL All Commercial |
$208.69
|
| Rate for Payer: Coventry All Commercial |
$197.47
|
| Rate for Payer: Encore All Commercial |
$206.56
|
| Rate for Payer: Frontpath All Commercial |
$206.45
|
| Rate for Payer: Humana ChoiceCare |
$193.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$201.96
|
| Rate for Payer: PHCS All Commercial |
$168.30
|
| Rate for Payer: PHP All Commercial |
$170.18
|
| Rate for Payer: Sagamore Health Network All Products |
$173.24
|
| Rate for Payer: Signature Care EPO |
$186.25
|
| Rate for Payer: Signature Care PPO |
$197.47
|
| Rate for Payer: United Healthcare Commercial |
$176.83
|
|
