|
HC BLADE SAW SAG 13X.27X90
|
Facility
OP
|
$359.52
|
|
| Hospital Charge Code |
41601239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.64 |
| Max. Negotiated Rate |
$334.35 |
| Rate for Payer: Aetna Commercial |
$303.43
|
| Rate for Payer: Aetna Medicare |
$118.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$118.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$206.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$224.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$136.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$130.51
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Centivo All Commercial |
$183.36
|
| Rate for Payer: Cigna All Commercial |
$310.27
|
| Rate for Payer: CORVEL All Commercial |
$334.35
|
| Rate for Payer: Coventry All Commercial |
$316.38
|
| Rate for Payer: Encore All Commercial |
$330.94
|
| Rate for Payer: Frontpath All Commercial |
$330.76
|
| Rate for Payer: Humana ChoiceCare |
$310.52
|
| Rate for Payer: Humana Medicare |
$183.36
|
| Rate for Payer: Lucent All Commercial |
$183.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$323.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$269.64
|
| Rate for Payer: PHP All Commercial |
$272.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.21
|
| Rate for Payer: Sagamore Health Network All Products |
$277.55
|
| Rate for Payer: Signature Care EPO |
$298.40
|
| Rate for Payer: Signature Care PPO |
$316.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$305.59
|
| Rate for Payer: United Healthcare Commercial |
$283.30
|
| Rate for Payer: United Healthcare Medicare |
$118.64
|
|
|
HC BLADE SAW SAG 13X.27X90
|
Facility
IP
|
$359.52
|
|
| Hospital Charge Code |
41601239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.64 |
| Max. Negotiated Rate |
$334.35 |
| Rate for Payer: Aetna Commercial |
$310.63
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna All Commercial |
$310.27
|
| Rate for Payer: CORVEL All Commercial |
$334.35
|
| Rate for Payer: Coventry All Commercial |
$316.38
|
| Rate for Payer: Encore All Commercial |
$330.94
|
| Rate for Payer: Frontpath All Commercial |
$330.76
|
| Rate for Payer: Humana ChoiceCare |
$310.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$323.57
|
| Rate for Payer: PHCS All Commercial |
$269.64
|
| Rate for Payer: PHP All Commercial |
$272.66
|
| Rate for Payer: Sagamore Health Network All Products |
$277.55
|
| Rate for Payer: Signature Care EPO |
$298.40
|
| Rate for Payer: Signature Care PPO |
$316.38
|
| Rate for Payer: United Healthcare Commercial |
$283.30
|
|
|
HC BLADE SAW SAG 19.5X1.27
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41602411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.51
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Centivo All Commercial |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$392.70
|
| Rate for Payer: Lucent All Commercial |
$392.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
|
|
HC BLADE SAW SAG 19.5X1.27
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41602411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC BLADE SAW SAG 25X1.27X90
|
Facility
IP
|
$388.71
|
|
| Hospital Charge Code |
41601240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.53 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Aetna Commercial |
$335.85
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna All Commercial |
$335.46
|
| Rate for Payer: CORVEL All Commercial |
$361.50
|
| Rate for Payer: Coventry All Commercial |
$342.06
|
| Rate for Payer: Encore All Commercial |
$357.81
|
| Rate for Payer: Frontpath All Commercial |
$357.61
|
| Rate for Payer: Humana ChoiceCare |
$335.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$349.84
|
| Rate for Payer: PHCS All Commercial |
$291.53
|
| Rate for Payer: PHP All Commercial |
$294.80
|
| Rate for Payer: Sagamore Health Network All Products |
$300.08
|
| Rate for Payer: Signature Care EPO |
$322.63
|
| Rate for Payer: Signature Care PPO |
$342.06
|
| Rate for Payer: United Healthcare Commercial |
$306.30
|
|
|
HC BLADE SAW SAG 25X1.27X90
|
Facility
OP
|
$388.71
|
|
| Hospital Charge Code |
41601240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Aetna Commercial |
$328.07
|
| Rate for Payer: Aetna Medicare |
$128.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$223.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$242.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.10
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Centivo All Commercial |
$198.24
|
| Rate for Payer: Cigna All Commercial |
$335.46
|
| Rate for Payer: CORVEL All Commercial |
$361.50
|
| Rate for Payer: Coventry All Commercial |
$342.06
|
| Rate for Payer: Encore All Commercial |
$357.81
|
| Rate for Payer: Frontpath All Commercial |
$357.61
|
| Rate for Payer: Humana ChoiceCare |
$335.73
|
| Rate for Payer: Humana Medicare |
$198.24
|
| Rate for Payer: Lucent All Commercial |
$198.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$349.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$291.53
|
| Rate for Payer: PHP All Commercial |
$294.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.60
|
| Rate for Payer: Sagamore Health Network All Products |
$300.08
|
| Rate for Payer: Signature Care EPO |
$322.63
|
| Rate for Payer: Signature Care PPO |
$342.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$330.40
|
| Rate for Payer: United Healthcare Commercial |
$306.30
|
| Rate for Payer: United Healthcare Medicare |
$128.27
|
|
|
HC BLADE SPEAR TIPPED
|
Facility
OP
|
$107.52
|
|
| Hospital Charge Code |
41602419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$90.75
|
| Rate for Payer: Aetna Medicare |
$35.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.03
|
| Rate for Payer: Cash Price |
$66.66
|
| Rate for Payer: Cash Price |
$66.66
|
| Rate for Payer: Centivo All Commercial |
$54.84
|
| Rate for Payer: Cigna All Commercial |
$92.79
|
| Rate for Payer: CORVEL All Commercial |
$99.99
|
| Rate for Payer: Coventry All Commercial |
$94.62
|
| Rate for Payer: Encore All Commercial |
$98.97
|
| Rate for Payer: Frontpath All Commercial |
$98.92
|
| Rate for Payer: Humana ChoiceCare |
$92.87
|
| Rate for Payer: Humana Medicare |
$54.84
|
| Rate for Payer: Lucent All Commercial |
$54.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.77
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$80.64
|
| Rate for Payer: PHP All Commercial |
$81.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.93
|
| Rate for Payer: Sagamore Health Network All Products |
$83.01
|
| Rate for Payer: Signature Care EPO |
$89.24
|
| Rate for Payer: Signature Care PPO |
$94.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.39
|
| Rate for Payer: United Healthcare Commercial |
$84.73
|
| Rate for Payer: United Healthcare Medicare |
$35.48
|
|
|
HC BLADE SPEAR TIPPED
|
Facility
IP
|
$107.52
|
|
| Hospital Charge Code |
41602419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.64 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: Aetna Commercial |
$92.90
|
| Rate for Payer: Cash Price |
$66.66
|
| Rate for Payer: Cigna All Commercial |
$92.79
|
| Rate for Payer: CORVEL All Commercial |
$99.99
|
| Rate for Payer: Coventry All Commercial |
$94.62
|
| Rate for Payer: Encore All Commercial |
$98.97
|
| Rate for Payer: Frontpath All Commercial |
$98.92
|
| Rate for Payer: Humana ChoiceCare |
$92.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.77
|
| Rate for Payer: PHCS All Commercial |
$80.64
|
| Rate for Payer: PHP All Commercial |
$81.54
|
| Rate for Payer: Sagamore Health Network All Products |
$83.01
|
| Rate for Payer: Signature Care EPO |
$89.24
|
| Rate for Payer: Signature Care PPO |
$94.62
|
| Rate for Payer: United Healthcare Commercial |
$84.73
|
|
|
HC BLADE TRICUT
|
Facility
OP
|
$1,069.20
|
|
| Hospital Charge Code |
41602432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$994.36 |
| Rate for Payer: Aetna Commercial |
$902.40
|
| Rate for Payer: Aetna Medicare |
$352.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$352.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$614.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$668.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$405.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.12
|
| Rate for Payer: Cash Price |
$662.90
|
| Rate for Payer: Cash Price |
$662.90
|
| Rate for Payer: Centivo All Commercial |
$545.29
|
| Rate for Payer: Cigna All Commercial |
$922.72
|
| Rate for Payer: CORVEL All Commercial |
$994.36
|
| Rate for Payer: Coventry All Commercial |
$940.90
|
| Rate for Payer: Encore All Commercial |
$984.20
|
| Rate for Payer: Frontpath All Commercial |
$983.66
|
| Rate for Payer: Humana ChoiceCare |
$923.47
|
| Rate for Payer: Humana Medicare |
$545.29
|
| Rate for Payer: Lucent All Commercial |
$545.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$962.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$801.90
|
| Rate for Payer: PHP All Commercial |
$810.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$416.99
|
| Rate for Payer: Sagamore Health Network All Products |
$825.42
|
| Rate for Payer: Signature Care EPO |
$887.44
|
| Rate for Payer: Signature Care PPO |
$940.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$908.82
|
| Rate for Payer: United Healthcare Commercial |
$842.53
|
| Rate for Payer: United Healthcare Medicare |
$352.84
|
|
|
HC BLADE TRICUT
|
Facility
IP
|
$1,069.20
|
|
| Hospital Charge Code |
41602432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$801.90 |
| Max. Negotiated Rate |
$994.36 |
| Rate for Payer: Aetna Commercial |
$923.79
|
| Rate for Payer: Cash Price |
$662.90
|
| Rate for Payer: Cigna All Commercial |
$922.72
|
| Rate for Payer: CORVEL All Commercial |
$994.36
|
| Rate for Payer: Coventry All Commercial |
$940.90
|
| Rate for Payer: Encore All Commercial |
$984.20
|
| Rate for Payer: Frontpath All Commercial |
$983.66
|
| Rate for Payer: Humana ChoiceCare |
$923.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$962.28
|
| Rate for Payer: PHCS All Commercial |
$801.90
|
| Rate for Payer: PHP All Commercial |
$810.88
|
| Rate for Payer: Sagamore Health Network All Products |
$825.42
|
| Rate for Payer: Signature Care EPO |
$887.44
|
| Rate for Payer: Signature Care PPO |
$940.90
|
| Rate for Payer: United Healthcare Commercial |
$842.53
|
|
|
HC BLANKET BAIR HUGGER FULL UNDER
|
Facility
OP
|
$168.63
|
|
| Hospital Charge Code |
41601787
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$156.83 |
| Rate for Payer: Aetna Commercial |
$142.32
|
| Rate for Payer: Aetna Medicare |
$55.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.21
|
| Rate for Payer: Cash Price |
$104.55
|
| Rate for Payer: Cash Price |
$104.55
|
| Rate for Payer: Centivo All Commercial |
$86.00
|
| Rate for Payer: Cigna All Commercial |
$145.53
|
| Rate for Payer: CORVEL All Commercial |
$156.83
|
| Rate for Payer: Coventry All Commercial |
$148.39
|
| Rate for Payer: Encore All Commercial |
$155.22
|
| Rate for Payer: Frontpath All Commercial |
$155.14
|
| Rate for Payer: Humana ChoiceCare |
$145.65
|
| Rate for Payer: Humana Medicare |
$86.00
|
| Rate for Payer: Lucent All Commercial |
$86.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.77
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$126.47
|
| Rate for Payer: PHP All Commercial |
$127.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.77
|
| Rate for Payer: Sagamore Health Network All Products |
$130.18
|
| Rate for Payer: Signature Care EPO |
$139.96
|
| Rate for Payer: Signature Care PPO |
$148.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.34
|
| Rate for Payer: United Healthcare Commercial |
$132.88
|
| Rate for Payer: United Healthcare Medicare |
$55.65
|
|
|
HC BLANKET BAIR HUGGER FULL UNDER
|
Facility
IP
|
$168.63
|
|
| Hospital Charge Code |
41601787
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$126.47 |
| Max. Negotiated Rate |
$156.83 |
| Rate for Payer: Aetna Commercial |
$145.70
|
| Rate for Payer: Cash Price |
$104.55
|
| Rate for Payer: Cigna All Commercial |
$145.53
|
| Rate for Payer: CORVEL All Commercial |
$156.83
|
| Rate for Payer: Coventry All Commercial |
$148.39
|
| Rate for Payer: Encore All Commercial |
$155.22
|
| Rate for Payer: Frontpath All Commercial |
$155.14
|
| Rate for Payer: Humana ChoiceCare |
$145.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.77
|
| Rate for Payer: PHCS All Commercial |
$126.47
|
| Rate for Payer: PHP All Commercial |
$127.89
|
| Rate for Payer: Sagamore Health Network All Products |
$130.18
|
| Rate for Payer: Signature Care EPO |
$139.96
|
| Rate for Payer: Signature Care PPO |
$148.39
|
| Rate for Payer: United Healthcare Commercial |
$132.88
|
|
|
HC BLANKET BAIR HUGGER LOWER BODY
|
Facility
IP
|
$42.13
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
41604332
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$39.18 |
| Rate for Payer: Aetna Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$26.12
|
| Rate for Payer: Cigna All Commercial |
$36.36
|
| Rate for Payer: CORVEL All Commercial |
$39.18
|
| Rate for Payer: Coventry All Commercial |
$37.07
|
| Rate for Payer: Encore All Commercial |
$38.78
|
| Rate for Payer: Frontpath All Commercial |
$38.76
|
| Rate for Payer: Humana ChoiceCare |
$36.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.92
|
| Rate for Payer: PHCS All Commercial |
$31.60
|
| Rate for Payer: PHP All Commercial |
$31.95
|
| Rate for Payer: Sagamore Health Network All Products |
$32.52
|
| Rate for Payer: Signature Care EPO |
$34.97
|
| Rate for Payer: Signature Care PPO |
$37.07
|
| Rate for Payer: United Healthcare Commercial |
$33.20
|
|
|
HC BLANKET BAIR HUGGER LOWER BODY
|
Facility
OP
|
$42.13
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
41604332
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.56
|
| Rate for Payer: Aetna Medicare |
$13.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.29
|
| Rate for Payer: Cash Price |
$26.12
|
| Rate for Payer: Cash Price |
$26.12
|
| Rate for Payer: Centivo All Commercial |
$21.49
|
| Rate for Payer: Cigna All Commercial |
$36.36
|
| Rate for Payer: CORVEL All Commercial |
$39.18
|
| Rate for Payer: Coventry All Commercial |
$37.07
|
| Rate for Payer: Encore All Commercial |
$38.78
|
| Rate for Payer: Frontpath All Commercial |
$38.76
|
| Rate for Payer: Humana ChoiceCare |
$36.39
|
| Rate for Payer: Humana Medicare |
$21.49
|
| Rate for Payer: Lucent All Commercial |
$21.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.92
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.60
|
| Rate for Payer: PHP All Commercial |
$31.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.43
|
| Rate for Payer: Sagamore Health Network All Products |
$32.52
|
| Rate for Payer: Signature Care EPO |
$34.97
|
| Rate for Payer: Signature Care PPO |
$37.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.81
|
| Rate for Payer: United Healthcare Commercial |
$33.20
|
| Rate for Payer: United Healthcare Medicare |
$13.90
|
|
|
HC BLANKET BAIR HUGGER UPPER BODY
|
Facility
IP
|
$44.58
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
41604333
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.44 |
| Max. Negotiated Rate |
$41.46 |
| Rate for Payer: Aetna Commercial |
$38.52
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Cigna All Commercial |
$38.47
|
| Rate for Payer: CORVEL All Commercial |
$41.46
|
| Rate for Payer: Coventry All Commercial |
$39.23
|
| Rate for Payer: Encore All Commercial |
$41.04
|
| Rate for Payer: Frontpath All Commercial |
$41.01
|
| Rate for Payer: Humana ChoiceCare |
$38.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.12
|
| Rate for Payer: PHCS All Commercial |
$33.44
|
| Rate for Payer: PHP All Commercial |
$33.81
|
| Rate for Payer: Sagamore Health Network All Products |
$34.42
|
| Rate for Payer: Signature Care EPO |
$37.00
|
| Rate for Payer: Signature Care PPO |
$39.23
|
| Rate for Payer: United Healthcare Commercial |
$35.13
|
|
|
HC BLANKET BAIR HUGGER UPPER BODY
|
Facility
OP
|
$44.58
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
41604333
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$37.63
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.18
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Centivo All Commercial |
$22.74
|
| Rate for Payer: Cigna All Commercial |
$38.47
|
| Rate for Payer: CORVEL All Commercial |
$41.46
|
| Rate for Payer: Coventry All Commercial |
$39.23
|
| Rate for Payer: Encore All Commercial |
$41.04
|
| Rate for Payer: Frontpath All Commercial |
$41.01
|
| Rate for Payer: Humana ChoiceCare |
$38.50
|
| Rate for Payer: Humana Medicare |
$22.74
|
| Rate for Payer: Lucent All Commercial |
$22.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.12
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$33.44
|
| Rate for Payer: PHP All Commercial |
$33.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.39
|
| Rate for Payer: Sagamore Health Network All Products |
$34.42
|
| Rate for Payer: Signature Care EPO |
$37.00
|
| Rate for Payer: Signature Care PPO |
$39.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.89
|
| Rate for Payer: United Healthcare Commercial |
$35.13
|
| Rate for Payer: United Healthcare Medicare |
$14.71
|
|
|
HC BLANKET HYPOTHERMIA
|
Facility
OP
|
$93.24
|
|
| Hospital Charge Code |
41601010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$86.71 |
| Rate for Payer: Aetna Commercial |
$78.69
|
| Rate for Payer: Aetna Medicare |
$30.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.85
|
| Rate for Payer: Cash Price |
$57.81
|
| Rate for Payer: Cash Price |
$57.81
|
| Rate for Payer: Centivo All Commercial |
$47.55
|
| Rate for Payer: Cigna All Commercial |
$80.47
|
| Rate for Payer: CORVEL All Commercial |
$86.71
|
| Rate for Payer: Coventry All Commercial |
$82.05
|
| Rate for Payer: Encore All Commercial |
$85.83
|
| Rate for Payer: Frontpath All Commercial |
$85.78
|
| Rate for Payer: Humana ChoiceCare |
$80.53
|
| Rate for Payer: Humana Medicare |
$47.55
|
| Rate for Payer: Lucent All Commercial |
$47.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.92
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$69.93
|
| Rate for Payer: PHP All Commercial |
$70.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.36
|
| Rate for Payer: Sagamore Health Network All Products |
$71.98
|
| Rate for Payer: Signature Care EPO |
$77.39
|
| Rate for Payer: Signature Care PPO |
$82.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.25
|
| Rate for Payer: United Healthcare Commercial |
$73.47
|
| Rate for Payer: United Healthcare Medicare |
$30.77
|
|
|
HC BLANKET HYPOTHERMIA
|
Facility
IP
|
$93.24
|
|
| Hospital Charge Code |
41601010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$86.71 |
| Rate for Payer: Aetna Commercial |
$80.56
|
| Rate for Payer: Cash Price |
$57.81
|
| Rate for Payer: Cigna All Commercial |
$80.47
|
| Rate for Payer: CORVEL All Commercial |
$86.71
|
| Rate for Payer: Coventry All Commercial |
$82.05
|
| Rate for Payer: Encore All Commercial |
$85.83
|
| Rate for Payer: Frontpath All Commercial |
$85.78
|
| Rate for Payer: Humana ChoiceCare |
$80.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.92
|
| Rate for Payer: PHCS All Commercial |
$69.93
|
| Rate for Payer: PHP All Commercial |
$70.71
|
| Rate for Payer: Sagamore Health Network All Products |
$71.98
|
| Rate for Payer: Signature Care EPO |
$77.39
|
| Rate for Payer: Signature Care PPO |
$82.05
|
| Rate for Payer: United Healthcare Commercial |
$73.47
|
|
|
HC BLANKET MULTI ACCESS
|
Facility
OP
|
$31.99
|
|
| Hospital Charge Code |
41601877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Medicare |
$10.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.61
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Centivo All Commercial |
$16.31
|
| Rate for Payer: Cigna All Commercial |
$27.61
|
| Rate for Payer: CORVEL All Commercial |
$29.75
|
| Rate for Payer: Coventry All Commercial |
$28.15
|
| Rate for Payer: Encore All Commercial |
$29.45
|
| Rate for Payer: Frontpath All Commercial |
$29.43
|
| Rate for Payer: Humana ChoiceCare |
$27.63
|
| Rate for Payer: Humana Medicare |
$16.31
|
| Rate for Payer: Lucent All Commercial |
$16.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.79
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$23.99
|
| Rate for Payer: PHP All Commercial |
$24.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.48
|
| Rate for Payer: Sagamore Health Network All Products |
$24.70
|
| Rate for Payer: Signature Care EPO |
$26.55
|
| Rate for Payer: Signature Care PPO |
$28.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.19
|
| Rate for Payer: United Healthcare Commercial |
$25.21
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
|
|
HC BLANKET MULTI ACCESS
|
Facility
IP
|
$31.99
|
|
| Hospital Charge Code |
41601877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Aetna Commercial |
$27.64
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cigna All Commercial |
$27.61
|
| Rate for Payer: CORVEL All Commercial |
$29.75
|
| Rate for Payer: Coventry All Commercial |
$28.15
|
| Rate for Payer: Encore All Commercial |
$29.45
|
| Rate for Payer: Frontpath All Commercial |
$29.43
|
| Rate for Payer: Humana ChoiceCare |
$27.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.79
|
| Rate for Payer: PHCS All Commercial |
$23.99
|
| Rate for Payer: PHP All Commercial |
$24.26
|
| Rate for Payer: Sagamore Health Network All Products |
$24.70
|
| Rate for Payer: Signature Care EPO |
$26.55
|
| Rate for Payer: Signature Care PPO |
$28.15
|
| Rate for Payer: United Healthcare Commercial |
$25.21
|
|
|
HC BLASTOMYCES AB - CF
|
Facility
OP
|
$125.66
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
63001922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$116.87 |
| Rate for Payer: Aetna Commercial |
$106.06
|
| Rate for Payer: Aetna Medicare |
$41.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$72.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.62
|
| Rate for Payer: Cash Price |
$77.91
|
| Rate for Payer: Cash Price |
$77.91
|
| Rate for Payer: Centivo All Commercial |
$64.09
|
| Rate for Payer: Cigna All Commercial |
$108.45
|
| Rate for Payer: CORVEL All Commercial |
$116.87
|
| Rate for Payer: Coventry All Commercial |
$110.58
|
| Rate for Payer: Encore All Commercial |
$115.67
|
| Rate for Payer: Frontpath All Commercial |
$115.61
|
| Rate for Payer: Humana ChoiceCare |
$108.54
|
| Rate for Payer: Humana Medicare |
$64.09
|
| Rate for Payer: Lucent All Commercial |
$64.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.10
|
| Rate for Payer: Managed Health Services Medicaid |
$12.90
|
| Rate for Payer: MDWise Medicaid |
$12.90
|
| Rate for Payer: PHCS All Commercial |
$94.25
|
| Rate for Payer: PHP All Commercial |
$95.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.01
|
| Rate for Payer: Sagamore Health Network All Products |
$97.01
|
| Rate for Payer: Signature Care EPO |
$104.30
|
| Rate for Payer: Signature Care PPO |
$110.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.81
|
| Rate for Payer: United Healthcare Commercial |
$99.02
|
| Rate for Payer: United Healthcare Medicare |
$41.47
|
|
|
HC BLASTOMYCES AB - CF
|
Facility
IP
|
$125.66
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
63001922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$116.87 |
| Rate for Payer: Aetna Commercial |
$108.57
|
| Rate for Payer: Cash Price |
$77.91
|
| Rate for Payer: Cigna All Commercial |
$108.45
|
| Rate for Payer: CORVEL All Commercial |
$116.87
|
| Rate for Payer: Coventry All Commercial |
$110.58
|
| Rate for Payer: Encore All Commercial |
$115.67
|
| Rate for Payer: Frontpath All Commercial |
$115.61
|
| Rate for Payer: Humana ChoiceCare |
$108.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.10
|
| Rate for Payer: PHCS All Commercial |
$94.25
|
| Rate for Payer: PHP All Commercial |
$95.30
|
| Rate for Payer: Sagamore Health Network All Products |
$97.01
|
| Rate for Payer: Signature Care EPO |
$104.30
|
| Rate for Payer: Signature Care PPO |
$110.58
|
| Rate for Payer: United Healthcare Commercial |
$99.02
|
|
|
HC BLASTOMYCES QUANTITATIVE ANTIGEN BY EIA (MIRAVISTA)
|
Facility
IP
|
$187.81
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
63044066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.86 |
| Max. Negotiated Rate |
$174.67 |
| Rate for Payer: Aetna Commercial |
$162.27
|
| Rate for Payer: Cash Price |
$116.44
|
| Rate for Payer: Cigna All Commercial |
$162.08
|
| Rate for Payer: CORVEL All Commercial |
$174.67
|
| Rate for Payer: Coventry All Commercial |
$165.28
|
| Rate for Payer: Encore All Commercial |
$172.88
|
| Rate for Payer: Frontpath All Commercial |
$172.79
|
| Rate for Payer: Humana ChoiceCare |
$162.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.03
|
| Rate for Payer: PHCS All Commercial |
$140.86
|
| Rate for Payer: PHP All Commercial |
$142.44
|
| Rate for Payer: Sagamore Health Network All Products |
$144.99
|
| Rate for Payer: Signature Care EPO |
$155.88
|
| Rate for Payer: Signature Care PPO |
$165.28
|
| Rate for Payer: United Healthcare Commercial |
$148.00
|
|
|
HC BLASTOMYCES QUANTITATIVE ANTIGEN BY EIA (MIRAVISTA)
|
Facility
OP
|
$187.81
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
63044066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$174.67 |
| Rate for Payer: Aetna Commercial |
$158.51
|
| Rate for Payer: Aetna Medicare |
$61.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$116.44
|
| Rate for Payer: Cash Price |
$116.44
|
| Rate for Payer: Centivo All Commercial |
$95.78
|
| Rate for Payer: Cigna All Commercial |
$162.08
|
| Rate for Payer: CORVEL All Commercial |
$174.67
|
| Rate for Payer: Coventry All Commercial |
$165.28
|
| Rate for Payer: Encore All Commercial |
$172.88
|
| Rate for Payer: Frontpath All Commercial |
$172.79
|
| Rate for Payer: Humana ChoiceCare |
$162.21
|
| Rate for Payer: Humana Medicare |
$95.78
|
| Rate for Payer: Lucent All Commercial |
$95.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.03
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$140.86
|
| Rate for Payer: PHP All Commercial |
$142.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.25
|
| Rate for Payer: Sagamore Health Network All Products |
$144.99
|
| Rate for Payer: Signature Care EPO |
$155.88
|
| Rate for Payer: Signature Care PPO |
$165.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.64
|
| Rate for Payer: United Healthcare Commercial |
$148.00
|
| Rate for Payer: United Healthcare Medicare |
$61.98
|
|
|
HC BLOOD BANK REF LAB REPORT
|
Facility
OP
|
$648.72
|
|
| Hospital Charge Code |
63002253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.08 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Aetna Commercial |
$547.52
|
| Rate for Payer: Aetna Medicare |
$214.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$372.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$405.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$246.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.49
|
| Rate for Payer: Cash Price |
$402.21
|
| Rate for Payer: Centivo All Commercial |
$330.85
|
| Rate for Payer: Cigna All Commercial |
$559.85
|
| Rate for Payer: CORVEL All Commercial |
$603.31
|
| Rate for Payer: Coventry All Commercial |
$570.87
|
| Rate for Payer: Encore All Commercial |
$597.15
|
| Rate for Payer: Frontpath All Commercial |
$596.82
|
| Rate for Payer: Humana ChoiceCare |
$560.30
|
| Rate for Payer: Humana Medicare |
$330.85
|
| Rate for Payer: Lucent All Commercial |
$330.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$583.85
|
| Rate for Payer: PHCS All Commercial |
$486.54
|
| Rate for Payer: PHP All Commercial |
$491.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.00
|
| Rate for Payer: Sagamore Health Network All Products |
$500.81
|
| Rate for Payer: Signature Care EPO |
$538.44
|
| Rate for Payer: Signature Care PPO |
$570.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$551.41
|
| Rate for Payer: United Healthcare Commercial |
$511.19
|
| Rate for Payer: United Healthcare Medicare |
$214.08
|
|
