|
HC AVITENE FLOUR 0.5GM
|
Facility
OP
|
$525.00
|
|
| Hospital Charge Code |
41601893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.25 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$443.10
|
| Rate for Payer: Aetna Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$301.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$328.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.58
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Centivo All Commercial |
$267.75
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Humana Medicare |
$267.75
|
| Rate for Payer: Lucent All Commercial |
$267.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$204.75
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$446.25
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
| Rate for Payer: United Healthcare Medicare |
$173.25
|
|
|
HC AVITENE FLOUR 0.5GM
|
Facility
IP
|
$525.00
|
|
| Hospital Charge Code |
41601893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
|
|
HC AVITENE SHEETS 35X35
|
Facility
IP
|
$607.60
|
|
| Hospital Charge Code |
41601894
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$455.70 |
| Max. Negotiated Rate |
$565.07 |
| Rate for Payer: Aetna Commercial |
$524.97
|
| Rate for Payer: Cash Price |
$376.71
|
| Rate for Payer: Cigna All Commercial |
$524.36
|
| Rate for Payer: CORVEL All Commercial |
$565.07
|
| Rate for Payer: Coventry All Commercial |
$534.69
|
| Rate for Payer: Encore All Commercial |
$559.30
|
| Rate for Payer: Frontpath All Commercial |
$558.99
|
| Rate for Payer: Humana ChoiceCare |
$524.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$546.84
|
| Rate for Payer: PHCS All Commercial |
$455.70
|
| Rate for Payer: PHP All Commercial |
$460.80
|
| Rate for Payer: Sagamore Health Network All Products |
$469.07
|
| Rate for Payer: Signature Care EPO |
$504.31
|
| Rate for Payer: Signature Care PPO |
$534.69
|
| Rate for Payer: United Healthcare Commercial |
$478.79
|
|
|
HC AVITENE SHEETS 35X35
|
Facility
OP
|
$607.60
|
|
| Hospital Charge Code |
41601894
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$565.07 |
| Rate for Payer: Aetna Commercial |
$512.81
|
| Rate for Payer: Aetna Medicare |
$200.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$200.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$348.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$379.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.56
|
| Rate for Payer: Cash Price |
$376.71
|
| Rate for Payer: Cash Price |
$376.71
|
| Rate for Payer: Centivo All Commercial |
$309.88
|
| Rate for Payer: Cigna All Commercial |
$524.36
|
| Rate for Payer: CORVEL All Commercial |
$565.07
|
| Rate for Payer: Coventry All Commercial |
$534.69
|
| Rate for Payer: Encore All Commercial |
$559.30
|
| Rate for Payer: Frontpath All Commercial |
$558.99
|
| Rate for Payer: Humana ChoiceCare |
$524.78
|
| Rate for Payer: Humana Medicare |
$309.88
|
| Rate for Payer: Lucent All Commercial |
$309.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$546.84
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$455.70
|
| Rate for Payer: PHP All Commercial |
$460.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$236.96
|
| Rate for Payer: Sagamore Health Network All Products |
$469.07
|
| Rate for Payer: Signature Care EPO |
$504.31
|
| Rate for Payer: Signature Care PPO |
$534.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$516.46
|
| Rate for Payer: United Healthcare Commercial |
$478.79
|
| Rate for Payer: United Healthcare Medicare |
$200.51
|
|
|
HC BABY ABO TYPE
|
Facility
OP
|
$84.57
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
63001352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$71.38
|
| Rate for Payer: Aetna Medicare |
$27.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.70
|
| Rate for Payer: Cash Price |
$52.43
|
| Rate for Payer: Cash Price |
$52.43
|
| Rate for Payer: Centivo All Commercial |
$43.13
|
| Rate for Payer: Cigna All Commercial |
$72.98
|
| Rate for Payer: CORVEL All Commercial |
$78.65
|
| Rate for Payer: Coventry All Commercial |
$74.42
|
| Rate for Payer: Encore All Commercial |
$77.85
|
| Rate for Payer: Frontpath All Commercial |
$77.80
|
| Rate for Payer: Humana ChoiceCare |
$73.04
|
| Rate for Payer: Humana Medicare |
$43.13
|
| Rate for Payer: Lucent All Commercial |
$43.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.11
|
| Rate for Payer: Managed Health Services Medicaid |
$2.99
|
| Rate for Payer: MDWise Medicaid |
$2.99
|
| Rate for Payer: PHCS All Commercial |
$63.43
|
| Rate for Payer: PHP All Commercial |
$64.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.98
|
| Rate for Payer: Sagamore Health Network All Products |
$65.29
|
| Rate for Payer: Signature Care EPO |
$70.19
|
| Rate for Payer: Signature Care PPO |
$74.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.88
|
| Rate for Payer: United Healthcare Commercial |
$66.64
|
| Rate for Payer: United Healthcare Medicare |
$27.91
|
|
|
HC BABY ABO TYPE
|
Facility
IP
|
$84.57
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
63001352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.43 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Cash Price |
$52.43
|
| Rate for Payer: Cigna All Commercial |
$72.98
|
| Rate for Payer: CORVEL All Commercial |
$78.65
|
| Rate for Payer: Coventry All Commercial |
$74.42
|
| Rate for Payer: Encore All Commercial |
$77.85
|
| Rate for Payer: Frontpath All Commercial |
$77.80
|
| Rate for Payer: Humana ChoiceCare |
$73.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.11
|
| Rate for Payer: PHCS All Commercial |
$63.43
|
| Rate for Payer: PHP All Commercial |
$64.14
|
| Rate for Payer: Sagamore Health Network All Products |
$65.29
|
| Rate for Payer: Signature Care EPO |
$70.19
|
| Rate for Payer: Signature Care PPO |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$66.64
|
|
|
HC BABY RH
|
Facility
OP
|
$69.56
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
63001354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Aetna Commercial |
$58.71
|
| Rate for Payer: Aetna Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.25
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Centivo All Commercial |
$35.48
|
| Rate for Payer: Cigna All Commercial |
$60.03
|
| Rate for Payer: CORVEL All Commercial |
$64.69
|
| Rate for Payer: Coventry All Commercial |
$61.22
|
| Rate for Payer: Encore All Commercial |
$64.03
|
| Rate for Payer: Frontpath All Commercial |
$64.00
|
| Rate for Payer: Humana ChoiceCare |
$60.08
|
| Rate for Payer: Humana Medicare |
$35.48
|
| Rate for Payer: Lucent All Commercial |
$35.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.61
|
| Rate for Payer: Managed Health Services Medicaid |
$2.99
|
| Rate for Payer: MDWise Medicaid |
$2.99
|
| Rate for Payer: PHCS All Commercial |
$52.17
|
| Rate for Payer: PHP All Commercial |
$52.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.13
|
| Rate for Payer: Sagamore Health Network All Products |
$53.70
|
| Rate for Payer: Signature Care EPO |
$57.74
|
| Rate for Payer: Signature Care PPO |
$61.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.13
|
| Rate for Payer: United Healthcare Commercial |
$54.82
|
| Rate for Payer: United Healthcare Medicare |
$22.96
|
|
|
HC BABY RH
|
Facility
IP
|
$69.56
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
63001354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cigna All Commercial |
$60.03
|
| Rate for Payer: CORVEL All Commercial |
$64.69
|
| Rate for Payer: Coventry All Commercial |
$61.22
|
| Rate for Payer: Encore All Commercial |
$64.03
|
| Rate for Payer: Frontpath All Commercial |
$64.00
|
| Rate for Payer: Humana ChoiceCare |
$60.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.61
|
| Rate for Payer: PHCS All Commercial |
$52.17
|
| Rate for Payer: PHP All Commercial |
$52.76
|
| Rate for Payer: Sagamore Health Network All Products |
$53.70
|
| Rate for Payer: Signature Care EPO |
$57.74
|
| Rate for Payer: Signature Care PPO |
$61.22
|
| Rate for Payer: United Healthcare Commercial |
$54.82
|
|
|
HC BACTERIA ANAEROBE ID
|
Facility
OP
|
$135.46
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
63001079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$125.97 |
| Rate for Payer: Aetna Commercial |
$114.32
|
| Rate for Payer: Aetna Medicare |
$44.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$84.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.17
|
| Rate for Payer: Cash Price |
$83.98
|
| Rate for Payer: Cash Price |
$83.98
|
| Rate for Payer: Centivo All Commercial |
$69.08
|
| Rate for Payer: Cigna All Commercial |
$116.90
|
| Rate for Payer: CORVEL All Commercial |
$125.97
|
| Rate for Payer: Coventry All Commercial |
$119.20
|
| Rate for Payer: Encore All Commercial |
$124.69
|
| Rate for Payer: Frontpath All Commercial |
$124.62
|
| Rate for Payer: Humana ChoiceCare |
$116.99
|
| Rate for Payer: Humana Medicare |
$69.08
|
| Rate for Payer: Lucent All Commercial |
$69.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.91
|
| Rate for Payer: Managed Health Services Medicaid |
$8.08
|
| Rate for Payer: MDWise Medicaid |
$8.08
|
| Rate for Payer: PHCS All Commercial |
$101.59
|
| Rate for Payer: PHP All Commercial |
$102.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.83
|
| Rate for Payer: Sagamore Health Network All Products |
$104.57
|
| Rate for Payer: Signature Care EPO |
$112.43
|
| Rate for Payer: Signature Care PPO |
$119.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115.14
|
| Rate for Payer: United Healthcare Commercial |
$106.74
|
| Rate for Payer: United Healthcare Medicare |
$44.70
|
|
|
HC BACTERIA ANAEROBE ID
|
Facility
IP
|
$135.46
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
63001079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$125.97 |
| Rate for Payer: Aetna Commercial |
$117.03
|
| Rate for Payer: Cash Price |
$83.98
|
| Rate for Payer: Cigna All Commercial |
$116.90
|
| Rate for Payer: CORVEL All Commercial |
$125.97
|
| Rate for Payer: Coventry All Commercial |
$119.20
|
| Rate for Payer: Encore All Commercial |
$124.69
|
| Rate for Payer: Frontpath All Commercial |
$124.62
|
| Rate for Payer: Humana ChoiceCare |
$116.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.91
|
| Rate for Payer: PHCS All Commercial |
$101.59
|
| Rate for Payer: PHP All Commercial |
$102.73
|
| Rate for Payer: Sagamore Health Network All Products |
$104.57
|
| Rate for Payer: Signature Care EPO |
$112.43
|
| Rate for Payer: Signature Care PPO |
$119.20
|
| Rate for Payer: United Healthcare Commercial |
$106.74
|
|
|
HC BAG BILE
|
Facility
IP
|
$47.18
|
|
| Hospital Charge Code |
41601453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$40.76
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna All Commercial |
$40.72
|
| Rate for Payer: CORVEL All Commercial |
$43.88
|
| Rate for Payer: Coventry All Commercial |
$41.52
|
| Rate for Payer: Encore All Commercial |
$43.43
|
| Rate for Payer: Frontpath All Commercial |
$43.41
|
| Rate for Payer: Humana ChoiceCare |
$40.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.46
|
| Rate for Payer: PHCS All Commercial |
$35.38
|
| Rate for Payer: PHP All Commercial |
$35.78
|
| Rate for Payer: Sagamore Health Network All Products |
$36.42
|
| Rate for Payer: Signature Care EPO |
$39.16
|
| Rate for Payer: Signature Care PPO |
$41.52
|
| Rate for Payer: United Healthcare Commercial |
$37.18
|
|
|
HC BAG BILE
|
Facility
OP
|
$47.18
|
|
| Hospital Charge Code |
41601453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$39.82
|
| Rate for Payer: Aetna Medicare |
$15.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.13
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Centivo All Commercial |
$24.06
|
| Rate for Payer: Cigna All Commercial |
$40.72
|
| Rate for Payer: CORVEL All Commercial |
$43.88
|
| Rate for Payer: Coventry All Commercial |
$41.52
|
| Rate for Payer: Encore All Commercial |
$43.43
|
| Rate for Payer: Frontpath All Commercial |
$43.41
|
| Rate for Payer: Humana ChoiceCare |
$40.75
|
| Rate for Payer: Humana Medicare |
$24.06
|
| Rate for Payer: Lucent All Commercial |
$24.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$35.38
|
| Rate for Payer: PHP All Commercial |
$35.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.40
|
| Rate for Payer: Sagamore Health Network All Products |
$36.42
|
| Rate for Payer: Signature Care EPO |
$39.16
|
| Rate for Payer: Signature Care PPO |
$41.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.10
|
| Rate for Payer: United Healthcare Commercial |
$37.18
|
| Rate for Payer: United Healthcare Medicare |
$15.57
|
|
|
HC BAG RESUS AD W/VALVE CO2 DETEC
|
Facility
IP
|
$145.54
|
|
| Hospital Charge Code |
41607944
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.16 |
| Max. Negotiated Rate |
$135.35 |
| Rate for Payer: Aetna Commercial |
$125.75
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cigna All Commercial |
$125.60
|
| Rate for Payer: CORVEL All Commercial |
$135.35
|
| Rate for Payer: Coventry All Commercial |
$128.08
|
| Rate for Payer: Encore All Commercial |
$133.97
|
| Rate for Payer: Frontpath All Commercial |
$133.90
|
| Rate for Payer: Humana ChoiceCare |
$125.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.99
|
| Rate for Payer: PHCS All Commercial |
$109.16
|
| Rate for Payer: PHP All Commercial |
$110.38
|
| Rate for Payer: Sagamore Health Network All Products |
$112.36
|
| Rate for Payer: Signature Care EPO |
$120.80
|
| Rate for Payer: Signature Care PPO |
$128.08
|
| Rate for Payer: United Healthcare Commercial |
$114.69
|
|
|
HC BAG RESUS AD W/VALVE CO2 DETEC
|
Facility
OP
|
$145.54
|
|
| Hospital Charge Code |
41607944
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$135.35 |
| Rate for Payer: Aetna Commercial |
$122.84
|
| Rate for Payer: Aetna Medicare |
$48.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.83
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Centivo All Commercial |
$74.23
|
| Rate for Payer: Cigna All Commercial |
$125.60
|
| Rate for Payer: CORVEL All Commercial |
$135.35
|
| Rate for Payer: Coventry All Commercial |
$128.08
|
| Rate for Payer: Encore All Commercial |
$133.97
|
| Rate for Payer: Frontpath All Commercial |
$133.90
|
| Rate for Payer: Humana ChoiceCare |
$125.70
|
| Rate for Payer: Humana Medicare |
$74.23
|
| Rate for Payer: Lucent All Commercial |
$74.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.99
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$109.16
|
| Rate for Payer: PHP All Commercial |
$110.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.76
|
| Rate for Payer: Sagamore Health Network All Products |
$112.36
|
| Rate for Payer: Signature Care EPO |
$120.80
|
| Rate for Payer: Signature Care PPO |
$128.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.71
|
| Rate for Payer: United Healthcare Commercial |
$114.69
|
| Rate for Payer: United Healthcare Medicare |
$48.03
|
|
|
HC BAG URINARY DRAINAGE
|
Facility
OP
|
$19.08
|
|
| Hospital Charge Code |
41607785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Medicare |
$6.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.93
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Centivo All Commercial |
$9.73
|
| Rate for Payer: Cigna All Commercial |
$16.47
|
| Rate for Payer: CORVEL All Commercial |
$17.74
|
| Rate for Payer: Coventry All Commercial |
$16.79
|
| Rate for Payer: Encore All Commercial |
$17.56
|
| Rate for Payer: Frontpath All Commercial |
$17.55
|
| Rate for Payer: Humana ChoiceCare |
$16.48
|
| Rate for Payer: Humana Medicare |
$9.73
|
| Rate for Payer: Lucent All Commercial |
$9.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.17
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.31
|
| Rate for Payer: PHP All Commercial |
$14.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.44
|
| Rate for Payer: Sagamore Health Network All Products |
$14.73
|
| Rate for Payer: Signature Care EPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$16.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$15.04
|
| Rate for Payer: United Healthcare Medicare |
$6.30
|
|
|
HC BAG URINARY DRAINAGE
|
Facility
OP
|
$18.43
|
|
| Hospital Charge Code |
41601007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.69
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Centivo All Commercial |
$9.40
|
| Rate for Payer: Cigna All Commercial |
$15.91
|
| Rate for Payer: CORVEL All Commercial |
$17.14
|
| Rate for Payer: Coventry All Commercial |
$16.22
|
| Rate for Payer: Encore All Commercial |
$16.96
|
| Rate for Payer: Frontpath All Commercial |
$16.96
|
| Rate for Payer: Humana ChoiceCare |
$15.92
|
| Rate for Payer: Humana Medicare |
$9.40
|
| Rate for Payer: Lucent All Commercial |
$9.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.59
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$13.82
|
| Rate for Payer: PHP All Commercial |
$13.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.19
|
| Rate for Payer: Sagamore Health Network All Products |
$14.23
|
| Rate for Payer: Signature Care EPO |
$15.30
|
| Rate for Payer: Signature Care PPO |
$16.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.67
|
| Rate for Payer: United Healthcare Commercial |
$14.52
|
| Rate for Payer: United Healthcare Medicare |
$6.08
|
|
|
HC BAG URINARY DRAINAGE
|
Facility
IP
|
$18.43
|
|
| Hospital Charge Code |
41601007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cigna All Commercial |
$15.91
|
| Rate for Payer: CORVEL All Commercial |
$17.14
|
| Rate for Payer: Coventry All Commercial |
$16.22
|
| Rate for Payer: Encore All Commercial |
$16.96
|
| Rate for Payer: Frontpath All Commercial |
$16.96
|
| Rate for Payer: Humana ChoiceCare |
$15.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.59
|
| Rate for Payer: PHCS All Commercial |
$13.82
|
| Rate for Payer: PHP All Commercial |
$13.98
|
| Rate for Payer: Sagamore Health Network All Products |
$14.23
|
| Rate for Payer: Signature Care EPO |
$15.30
|
| Rate for Payer: Signature Care PPO |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$14.52
|
|
|
HC BAG URINARY DRAINAGE
|
Facility
IP
|
$19.08
|
|
| Hospital Charge Code |
41607785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: Aetna Commercial |
$16.49
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cigna All Commercial |
$16.47
|
| Rate for Payer: CORVEL All Commercial |
$17.74
|
| Rate for Payer: Coventry All Commercial |
$16.79
|
| Rate for Payer: Encore All Commercial |
$17.56
|
| Rate for Payer: Frontpath All Commercial |
$17.55
|
| Rate for Payer: Humana ChoiceCare |
$16.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.17
|
| Rate for Payer: PHCS All Commercial |
$14.31
|
| Rate for Payer: PHP All Commercial |
$14.47
|
| Rate for Payer: Sagamore Health Network All Products |
$14.73
|
| Rate for Payer: Signature Care EPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$16.79
|
| Rate for Payer: United Healthcare Commercial |
$15.04
|
|
|
HC BAG URINE DRAINAGE LEG
|
Facility
IP
|
$15.47
|
|
| Hospital Charge Code |
41601794
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$14.39 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Cash Price |
$9.59
|
| Rate for Payer: Cigna All Commercial |
$13.35
|
| Rate for Payer: CORVEL All Commercial |
$14.39
|
| Rate for Payer: Coventry All Commercial |
$13.61
|
| Rate for Payer: Encore All Commercial |
$14.24
|
| Rate for Payer: Frontpath All Commercial |
$14.23
|
| Rate for Payer: Humana ChoiceCare |
$13.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.92
|
| Rate for Payer: PHCS All Commercial |
$11.60
|
| Rate for Payer: PHP All Commercial |
$11.73
|
| Rate for Payer: Sagamore Health Network All Products |
$11.94
|
| Rate for Payer: Signature Care EPO |
$12.84
|
| Rate for Payer: Signature Care PPO |
$13.61
|
| Rate for Payer: United Healthcare Commercial |
$12.19
|
|
|
HC BAG URINE DRAINAGE LEG
|
Facility
OP
|
$15.47
|
|
| Hospital Charge Code |
41601794
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Medicare |
$5.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.62
|
| Rate for Payer: Cash Price |
$9.59
|
| Rate for Payer: Cash Price |
$9.59
|
| Rate for Payer: Centivo All Commercial |
$7.89
|
| Rate for Payer: Cigna All Commercial |
$13.35
|
| Rate for Payer: CORVEL All Commercial |
$14.39
|
| Rate for Payer: Coventry All Commercial |
$13.61
|
| Rate for Payer: Encore All Commercial |
$14.24
|
| Rate for Payer: Frontpath All Commercial |
$14.23
|
| Rate for Payer: Humana ChoiceCare |
$13.36
|
| Rate for Payer: Humana Medicare |
$7.89
|
| Rate for Payer: Lucent All Commercial |
$7.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.92
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$11.60
|
| Rate for Payer: PHP All Commercial |
$11.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.03
|
| Rate for Payer: Sagamore Health Network All Products |
$11.94
|
| Rate for Payer: Signature Care EPO |
$12.84
|
| Rate for Payer: Signature Care PPO |
$13.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.15
|
| Rate for Payer: United Healthcare Commercial |
$12.19
|
| Rate for Payer: United Healthcare Medicare |
$5.11
|
|
|
HC BAG URINE METER
|
Facility
OP
|
$48.58
|
|
| Hospital Charge Code |
41601008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Medicare |
$16.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.63
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Centivo All Commercial |
$24.78
|
| Rate for Payer: Cigna All Commercial |
$41.92
|
| Rate for Payer: CORVEL All Commercial |
$45.18
|
| Rate for Payer: Coventry All Commercial |
$42.75
|
| Rate for Payer: Encore All Commercial |
$44.72
|
| Rate for Payer: Frontpath All Commercial |
$44.69
|
| Rate for Payer: Humana ChoiceCare |
$41.96
|
| Rate for Payer: Humana Medicare |
$24.78
|
| Rate for Payer: Lucent All Commercial |
$24.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.72
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$36.44
|
| Rate for Payer: PHP All Commercial |
$36.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.95
|
| Rate for Payer: Sagamore Health Network All Products |
$37.50
|
| Rate for Payer: Signature Care EPO |
$40.32
|
| Rate for Payer: Signature Care PPO |
$42.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.29
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
| Rate for Payer: United Healthcare Medicare |
$16.03
|
|
|
HC BAG URINE METER
|
Facility
IP
|
$48.58
|
|
| Hospital Charge Code |
41601008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Aetna Commercial |
$41.97
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Cigna All Commercial |
$41.92
|
| Rate for Payer: CORVEL All Commercial |
$45.18
|
| Rate for Payer: Coventry All Commercial |
$42.75
|
| Rate for Payer: Encore All Commercial |
$44.72
|
| Rate for Payer: Frontpath All Commercial |
$44.69
|
| Rate for Payer: Humana ChoiceCare |
$41.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.72
|
| Rate for Payer: PHCS All Commercial |
$36.44
|
| Rate for Payer: PHP All Commercial |
$36.84
|
| Rate for Payer: Sagamore Health Network All Products |
$37.50
|
| Rate for Payer: Signature Care EPO |
$40.32
|
| Rate for Payer: Signature Care PPO |
$42.75
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
|
|
HC BALLOON DILATION 10-12
|
Facility
OP
|
$964.80
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$814.29
|
| Rate for Payer: Aetna Medicare |
$318.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$554.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.22
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Centivo All Commercial |
$492.05
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Humana Medicare |
$492.05
|
| Rate for Payer: Lucent All Commercial |
$492.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.27
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.08
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
| Rate for Payer: United Healthcare Medicare |
$318.38
|
|
|
HC BALLOON DILATION 10-12
|
Facility
IP
|
$964.80
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.60 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$833.59
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
|
|
HC BALLOON DILATION 12-15
|
Facility
IP
|
$964.80
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.60 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$833.59
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
|
