|
HC E STIM:MANUAL/15 MIN-OT
|
Facility
|
IP
|
$139.74
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
1738017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$104.81 |
| Max. Negotiated Rate |
$129.96 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Cash Price |
$83.84
|
| 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 |
$104.81
|
| 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-OT
|
Facility
|
OP
|
$139.74
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
1738017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$129.96 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Medicare |
$44.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$80.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.19
|
| Rate for Payer: Cash Price |
$83.84
|
| Rate for Payer: Cash Price |
$83.84
|
| Rate for Payer: Centivo All Commercial |
$76.02
|
| 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 |
$44.72
|
| Rate for Payer: Lucent All Commercial |
$76.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.77
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$104.81
|
| 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 |
$44.72
|
|
|
HC E STIM:MANUAL/15 MIN-PT
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
1728022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.15 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| 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 |
$121.03
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC E STIM:MANUAL/15 MIN-PT
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
1728022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.08
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.41
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Centivo All Commercial |
$74.82
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$44.01
|
| Rate for Payer: Lucent All Commercial |
$74.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| 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 |
$121.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$44.01
|
|
|
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 |
$91.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$130.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$130.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$104.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.32
|
| Rate for Payer: Cash Price |
$170.99
|
| Rate for Payer: Cash Price |
$170.99
|
| Rate for Payer: Centivo All Commercial |
$155.03
|
| Rate for Payer: Cigna All Commercial |
$245.95
|
| 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 |
$246.15
|
| Rate for Payer: Humana Medicare |
$91.20
|
| Rate for Payer: Lucent All Commercial |
$155.03
|
| 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 |
$216.14
|
| 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 |
$91.20
|
|
|
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 |
$170.99
|
| Rate for Payer: Cigna All Commercial |
$245.95
|
| 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 |
$246.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$256.49
|
| Rate for Payer: PHCS All Commercial |
$213.74
|
| Rate for Payer: PHP All Commercial |
$216.14
|
| 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 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 |
$194.85
|
| Rate for Payer: Aetna Medicare |
$73.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$32.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$106.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$32.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.26
|
| Rate for Payer: Cash Price |
$138.52
|
| Rate for Payer: Cash Price |
$138.52
|
| Rate for Payer: Centivo All Commercial |
$125.59
|
| Rate for Payer: Cigna All Commercial |
$199.23
|
| Rate for Payer: CORVEL All Commercial |
$214.70
|
| Rate for Payer: Coventry All Commercial |
$203.16
|
| Rate for Payer: Encore All Commercial |
$212.51
|
| Rate for Payer: Frontpath All Commercial |
$212.39
|
| Rate for Payer: Humana ChoiceCare |
$199.39
|
| Rate for Payer: Humana Medicare |
$73.88
|
| Rate for Payer: Lucent All Commercial |
$125.59
|
| 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 |
$173.15
|
| Rate for Payer: PHP All Commercial |
$175.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.04
|
| Rate for Payer: Sagamore Health Network All Products |
$178.22
|
| Rate for Payer: Signature Care EPO |
$191.61
|
| Rate for Payer: Signature Care PPO |
$203.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$196.23
|
| Rate for Payer: United Healthcare Commercial |
$181.92
|
| Rate for Payer: United Healthcare Medicare |
$73.88
|
|
|
HC ESTROGEN FRACT-SERUM
|
Facility
|
IP
|
$230.86
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
63001533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.15 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Aetna Commercial |
$199.46
|
| Rate for Payer: Cash Price |
$138.52
|
| Rate for Payer: Cigna All Commercial |
$199.23
|
| Rate for Payer: CORVEL All Commercial |
$214.70
|
| Rate for Payer: Coventry All Commercial |
$203.16
|
| Rate for Payer: Encore All Commercial |
$212.51
|
| 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 |
$173.15
|
| 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 |
$203.16
|
| Rate for Payer: United Healthcare Commercial |
$181.92
|
|
|
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 |
$285.67
|
| Rate for Payer: Cigna All Commercial |
$410.88
|
| Rate for Payer: CORVEL All Commercial |
$442.78
|
| Rate for Payer: Coventry All Commercial |
$418.98
|
| Rate for Payer: Encore All Commercial |
$438.26
|
| Rate for Payer: Frontpath All Commercial |
$438.02
|
| Rate for Payer: Humana ChoiceCare |
$411.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.50
|
| Rate for Payer: PHCS All Commercial |
$357.08
|
| Rate for Payer: PHP All Commercial |
$361.08
|
| Rate for Payer: Sagamore Health Network All Products |
$367.56
|
| Rate for Payer: Signature Care EPO |
$395.17
|
| Rate for Payer: Signature Care PPO |
$418.98
|
| Rate for Payer: United Healthcare Commercial |
$375.17
|
|
|
HC ESTROGEN/PROG RECEPTOR
|
Facility
|
OP
|
$476.11
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
63002128
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$147.59 |
| Max. Negotiated Rate |
$442.78 |
| Rate for Payer: Aetna Commercial |
$401.84
|
| Rate for Payer: Aetna Medicare |
$152.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$183.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$218.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$183.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.59
|
| Rate for Payer: Cash Price |
$285.67
|
| Rate for Payer: Cash Price |
$285.67
|
| Rate for Payer: Centivo All Commercial |
$259.00
|
| Rate for Payer: Cigna All Commercial |
$410.88
|
| Rate for Payer: CORVEL All Commercial |
$442.78
|
| Rate for Payer: Coventry All Commercial |
$418.98
|
| Rate for Payer: Encore All Commercial |
$438.26
|
| Rate for Payer: Frontpath All Commercial |
$438.02
|
| Rate for Payer: Humana ChoiceCare |
$411.22
|
| Rate for Payer: Humana Medicare |
$152.36
|
| Rate for Payer: Lucent All Commercial |
$259.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.50
|
| Rate for Payer: Managed Health Services Medicaid |
$183.69
|
| Rate for Payer: MDWise Medicaid |
$183.69
|
| 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 |
$367.56
|
| Rate for Payer: Signature Care EPO |
$395.17
|
| Rate for Payer: Signature Care PPO |
$418.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$404.69
|
| Rate for Payer: United Healthcare Commercial |
$375.17
|
| Rate for Payer: United Healthcare Medicare |
$152.36
|
|
|
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 |
$63.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$91.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.36
|
| Rate for Payer: Cash Price |
$119.93
|
| Rate for Payer: Cash Price |
$119.93
|
| Rate for Payer: Centivo All Commercial |
$108.74
|
| Rate for Payer: Cigna All Commercial |
$172.51
|
| 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 |
$63.96
|
| Rate for Payer: Lucent All Commercial |
$108.74
|
| 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 |
$154.32
|
| 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 |
$63.96
|
|
|
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 |
$119.93
|
| Rate for Payer: Cigna All Commercial |
$172.51
|
| 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 |
$154.32
|
| 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
|
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 |
$134.64
|
| 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
|
|
|
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 |
$71.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$103.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.99
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Centivo All Commercial |
$122.07
|
| 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 |
$71.81
|
| Rate for Payer: Lucent All Commercial |
$122.07
|
| 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 |
$71.81
|
|
|
HC ETHOSUXIMIDE-ZARONTIN
|
Facility
|
IP
|
$80.43
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
63001373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.32 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Aetna Commercial |
$69.49
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cigna All Commercial |
$69.41
|
| Rate for Payer: CORVEL All Commercial |
$74.80
|
| Rate for Payer: Coventry All Commercial |
$70.78
|
| Rate for Payer: Encore All Commercial |
$74.04
|
| Rate for Payer: Frontpath All Commercial |
$74.00
|
| Rate for Payer: Humana ChoiceCare |
$69.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.39
|
| Rate for Payer: PHCS All Commercial |
$60.32
|
| Rate for Payer: PHP All Commercial |
$61.00
|
| Rate for Payer: Sagamore Health Network All Products |
$62.09
|
| Rate for Payer: Signature Care EPO |
$66.76
|
| Rate for Payer: Signature Care PPO |
$70.78
|
| Rate for Payer: United Healthcare Commercial |
$63.38
|
|
|
HC ETHOSUXIMIDE-ZARONTIN
|
Facility
|
OP
|
$80.43
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
63001373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Aetna Commercial |
$67.88
|
| Rate for Payer: Aetna Medicare |
$25.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.31
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Centivo All Commercial |
$43.75
|
| Rate for Payer: Cigna All Commercial |
$69.41
|
| Rate for Payer: CORVEL All Commercial |
$74.80
|
| Rate for Payer: Coventry All Commercial |
$70.78
|
| Rate for Payer: Encore All Commercial |
$74.04
|
| Rate for Payer: Frontpath All Commercial |
$74.00
|
| Rate for Payer: Humana ChoiceCare |
$69.47
|
| Rate for Payer: Humana Medicare |
$25.74
|
| Rate for Payer: Lucent All Commercial |
$43.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.39
|
| Rate for Payer: Managed Health Services Medicaid |
$16.34
|
| Rate for Payer: MDWise Medicaid |
$16.34
|
| Rate for Payer: PHCS All Commercial |
$60.32
|
| Rate for Payer: PHP All Commercial |
$61.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.37
|
| Rate for Payer: Sagamore Health Network All Products |
$62.09
|
| Rate for Payer: Signature Care EPO |
$66.76
|
| Rate for Payer: Signature Care PPO |
$70.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.37
|
| Rate for Payer: United Healthcare Commercial |
$63.38
|
| Rate for Payer: United Healthcare Medicare |
$25.74
|
|
|
HC EVACUATOR SILICONE 100CC
|
Facility
|
OP
|
$28.91
|
|
| Hospital Charge Code |
41602079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.18
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Centivo All Commercial |
$15.73
|
| Rate for Payer: Cigna All Commercial |
$24.95
|
| Rate for Payer: CORVEL All Commercial |
$26.89
|
| Rate for Payer: Coventry All Commercial |
$25.44
|
| Rate for Payer: Encore All Commercial |
$26.61
|
| Rate for Payer: Frontpath All Commercial |
$26.60
|
| Rate for Payer: Humana ChoiceCare |
$24.97
|
| Rate for Payer: Humana Medicare |
$9.25
|
| Rate for Payer: Lucent All Commercial |
$15.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.02
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$21.68
|
| Rate for Payer: PHP All Commercial |
$21.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.27
|
| Rate for Payer: Sagamore Health Network All Products |
$22.32
|
| Rate for Payer: Signature Care EPO |
$24.00
|
| Rate for Payer: Signature Care PPO |
$25.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.57
|
| Rate for Payer: United Healthcare Commercial |
$22.78
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
|
|
HC EVACUATOR SILICONE 100CC
|
Facility
|
IP
|
$28.91
|
|
| Hospital Charge Code |
41602079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$26.89 |
| Rate for Payer: Aetna Commercial |
$24.98
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cigna All Commercial |
$24.95
|
| Rate for Payer: CORVEL All Commercial |
$26.89
|
| Rate for Payer: Coventry All Commercial |
$25.44
|
| Rate for Payer: Encore All Commercial |
$26.61
|
| Rate for Payer: Frontpath All Commercial |
$26.60
|
| Rate for Payer: Humana ChoiceCare |
$24.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.02
|
| Rate for Payer: PHCS All Commercial |
$21.68
|
| Rate for Payer: PHP All Commercial |
$21.93
|
| Rate for Payer: Sagamore Health Network All Products |
$22.32
|
| Rate for Payer: Signature Care EPO |
$24.00
|
| Rate for Payer: Signature Care PPO |
$25.44
|
| Rate for Payer: United Healthcare Commercial |
$22.78
|
|
|
HC EVAL ALT COMM DEVICE - SP
|
Facility
|
IP
|
$416.30
|
|
|
Service Code
|
CPT 92605 GN
|
| Hospital Charge Code |
1749050
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$312.23 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$359.68
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.34
|
| Rate for Payer: Encore All Commercial |
$383.20
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Sagamore Health Network All Products |
$321.38
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.34
|
| Rate for Payer: United Healthcare Commercial |
$328.04
|
|
|
HC EVAL ALT COMM DEVICE - SP
|
Facility
|
OP
|
$416.30
|
|
|
Service Code
|
CPT 92605 GN
|
| Hospital Charge Code |
1749050
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$387.16 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$133.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.54
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Cash Price |
$249.78
|
| Rate for Payer: Centivo All Commercial |
$226.47
|
| Rate for Payer: Cigna All Commercial |
$359.27
|
| Rate for Payer: CORVEL All Commercial |
$387.16
|
| Rate for Payer: Coventry All Commercial |
$366.34
|
| Rate for Payer: Encore All Commercial |
$383.20
|
| Rate for Payer: Frontpath All Commercial |
$383.00
|
| Rate for Payer: Humana ChoiceCare |
$359.56
|
| Rate for Payer: Humana Medicare |
$133.22
|
| Rate for Payer: Lucent All Commercial |
$226.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.67
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$312.23
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.38
|
| Rate for Payer: Signature Care EPO |
$345.53
|
| Rate for Payer: Signature Care PPO |
$366.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.86
|
| Rate for Payer: United Healthcare Commercial |
$328.04
|
| Rate for Payer: United Healthcare Medicare |
$133.22
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE - SP
|
Facility
|
OP
|
$444.45
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
1749070
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$375.12
|
| Rate for Payer: Aetna Medicare |
$142.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$255.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$277.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.45
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Centivo All Commercial |
$241.78
|
| Rate for Payer: Cigna All Commercial |
$383.56
|
| Rate for Payer: CORVEL All Commercial |
$413.34
|
| Rate for Payer: Coventry All Commercial |
$391.12
|
| Rate for Payer: Encore All Commercial |
$409.12
|
| Rate for Payer: Frontpath All Commercial |
$408.89
|
| Rate for Payer: Humana ChoiceCare |
$383.87
|
| Rate for Payer: Humana Medicare |
$142.22
|
| Rate for Payer: Lucent All Commercial |
$241.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.00
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$333.34
|
| Rate for Payer: PHP All Commercial |
$337.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.34
|
| Rate for Payer: Sagamore Health Network All Products |
$343.12
|
| Rate for Payer: Signature Care EPO |
$368.89
|
| Rate for Payer: Signature Care PPO |
$391.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$377.78
|
| Rate for Payer: United Healthcare Commercial |
$350.23
|
| Rate for Payer: United Healthcare Medicare |
$142.22
|
|
|
HC EVAL BEHAVRAL QUALIT ANALYS VOICE - SP
|
Facility
|
IP
|
$444.45
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
1749070
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$333.34 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$384.00
|
| Rate for Payer: Cash Price |
$266.67
|
| Rate for Payer: Cigna All Commercial |
$383.56
|
| Rate for Payer: CORVEL All Commercial |
$413.34
|
| Rate for Payer: Coventry All Commercial |
$391.12
|
| Rate for Payer: Encore All Commercial |
$409.12
|
| Rate for Payer: Frontpath All Commercial |
$408.89
|
| Rate for Payer: Humana ChoiceCare |
$383.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.00
|
| Rate for Payer: PHCS All Commercial |
$333.34
|
| Rate for Payer: PHP All Commercial |
$337.07
|
| Rate for Payer: Sagamore Health Network All Products |
$343.12
|
| Rate for Payer: Signature Care EPO |
$368.89
|
| Rate for Payer: Signature Care PPO |
$391.12
|
| Rate for Payer: United Healthcare Commercial |
$350.23
|
|
|
HC EVAL/FIT VOICE PROSTH - SP
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT 92597 GN
|
| Hospital Charge Code |
1742597
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$474.75 |
| Max. Negotiated Rate |
$588.69 |
| Rate for Payer: Aetna Commercial |
$546.91
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna All Commercial |
$546.28
|
| Rate for Payer: CORVEL All Commercial |
$588.69
|
| Rate for Payer: Coventry All Commercial |
$557.04
|
| Rate for Payer: Encore All Commercial |
$582.68
|
| Rate for Payer: Frontpath All Commercial |
$582.36
|
| Rate for Payer: Humana ChoiceCare |
$546.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$569.70
|
| Rate for Payer: PHCS All Commercial |
$474.75
|
| Rate for Payer: PHP All Commercial |
$480.07
|
| Rate for Payer: Sagamore Health Network All Products |
$488.68
|
| Rate for Payer: Signature Care EPO |
$525.39
|
| Rate for Payer: Signature Care PPO |
$557.04
|
| Rate for Payer: United Healthcare Commercial |
$498.80
|
|
|
HC EVAL/FIT VOICE PROSTH - SP
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT 92597 GN
|
| Hospital Charge Code |
1742597
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$588.69 |
| Rate for Payer: Aetna Commercial |
$534.25
|
| Rate for Payer: Aetna Medicare |
$202.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$196.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$363.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$395.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$232.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$222.82
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Centivo All Commercial |
$344.35
|
| Rate for Payer: Cigna All Commercial |
$546.28
|
| Rate for Payer: CORVEL All Commercial |
$588.69
|
| Rate for Payer: Coventry All Commercial |
$557.04
|
| Rate for Payer: Encore All Commercial |
$582.68
|
| Rate for Payer: Frontpath All Commercial |
$582.36
|
| Rate for Payer: Humana ChoiceCare |
$546.72
|
| Rate for Payer: Humana Medicare |
$202.56
|
| Rate for Payer: Lucent All Commercial |
$344.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$569.70
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$474.75
|
| Rate for Payer: PHP All Commercial |
$480.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$246.87
|
| Rate for Payer: Sagamore Health Network All Products |
$488.68
|
| Rate for Payer: Signature Care EPO |
$525.39
|
| Rate for Payer: Signature Care PPO |
$557.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$538.05
|
| Rate for Payer: United Healthcare Commercial |
$498.80
|
| Rate for Payer: United Healthcare Medicare |
$202.56
|
|
|
HC EVAL SPEECH SOUND LANG COMPREHEN - SP
|
Facility
|
IP
|
$456.71
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
1749075
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$342.53 |
| Max. Negotiated Rate |
$424.74 |
| Rate for Payer: Aetna Commercial |
$394.60
|
| Rate for Payer: Cash Price |
$274.03
|
| Rate for Payer: Cigna All Commercial |
$394.14
|
| Rate for Payer: CORVEL All Commercial |
$424.74
|
| Rate for Payer: Coventry All Commercial |
$401.90
|
| Rate for Payer: Encore All Commercial |
$420.40
|
| Rate for Payer: Frontpath All Commercial |
$420.17
|
| Rate for Payer: Humana ChoiceCare |
$394.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$411.04
|
| Rate for Payer: PHCS All Commercial |
$342.53
|
| Rate for Payer: PHP All Commercial |
$346.37
|
| Rate for Payer: Sagamore Health Network All Products |
$352.58
|
| Rate for Payer: Signature Care EPO |
$379.07
|
| Rate for Payer: Signature Care PPO |
$401.90
|
| Rate for Payer: United Healthcare Commercial |
$359.89
|
|
