|
HC BRA VELCRO 38-40 LRG
|
Facility
OP
|
$274.33
|
|
| Hospital Charge Code |
41601397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$255.13 |
| Rate for Payer: Aetna Commercial |
$231.53
|
| Rate for Payer: Aetna Medicare |
$90.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$157.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$104.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.58
|
| Rate for Payer: Cash Price |
$170.09
|
| Rate for Payer: Cash Price |
$170.09
|
| Rate for Payer: Centivo All Commercial |
$139.91
|
| Rate for Payer: Cigna All Commercial |
$236.75
|
| Rate for Payer: CORVEL All Commercial |
$255.13
|
| Rate for Payer: Coventry All Commercial |
$241.41
|
| Rate for Payer: Encore All Commercial |
$252.52
|
| Rate for Payer: Frontpath All Commercial |
$252.38
|
| Rate for Payer: Humana ChoiceCare |
$236.94
|
| Rate for Payer: Humana Medicare |
$139.91
|
| Rate for Payer: Lucent All Commercial |
$139.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.90
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$205.75
|
| Rate for Payer: PHP All Commercial |
$208.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.99
|
| Rate for Payer: Sagamore Health Network All Products |
$211.78
|
| Rate for Payer: Signature Care EPO |
$227.69
|
| Rate for Payer: Signature Care PPO |
$241.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$233.18
|
| Rate for Payer: United Healthcare Commercial |
$216.17
|
| Rate for Payer: United Healthcare Medicare |
$90.53
|
|
|
HC BRA VELCRO 42-44 XLRG
|
Facility
OP
|
$307.37
|
|
| Hospital Charge Code |
41601398
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$285.85 |
| Rate for Payer: Aetna Commercial |
$259.42
|
| Rate for Payer: Aetna Medicare |
$101.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$176.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$192.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.58
|
| Rate for Payer: Cash Price |
$190.57
|
| Rate for Payer: Cash Price |
$190.57
|
| Rate for Payer: Centivo All Commercial |
$156.76
|
| Rate for Payer: Cigna All Commercial |
$265.26
|
| Rate for Payer: CORVEL All Commercial |
$285.85
|
| Rate for Payer: Coventry All Commercial |
$270.49
|
| Rate for Payer: Encore All Commercial |
$282.93
|
| Rate for Payer: Frontpath All Commercial |
$282.78
|
| Rate for Payer: Humana ChoiceCare |
$265.48
|
| Rate for Payer: Humana Medicare |
$156.76
|
| Rate for Payer: Lucent All Commercial |
$156.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.63
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$230.53
|
| Rate for Payer: PHP All Commercial |
$233.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.87
|
| Rate for Payer: Sagamore Health Network All Products |
$237.29
|
| Rate for Payer: Signature Care EPO |
$255.12
|
| Rate for Payer: Signature Care PPO |
$270.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$261.26
|
| Rate for Payer: United Healthcare Commercial |
$242.21
|
| Rate for Payer: United Healthcare Medicare |
$101.43
|
|
|
HC BRA VELCRO 42-44 XLRG
|
Facility
IP
|
$307.37
|
|
| Hospital Charge Code |
41601398
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$285.85 |
| Rate for Payer: Aetna Commercial |
$265.57
|
| Rate for Payer: Cash Price |
$190.57
|
| Rate for Payer: Cigna All Commercial |
$265.26
|
| Rate for Payer: CORVEL All Commercial |
$285.85
|
| Rate for Payer: Coventry All Commercial |
$270.49
|
| Rate for Payer: Encore All Commercial |
$282.93
|
| Rate for Payer: Frontpath All Commercial |
$282.78
|
| Rate for Payer: Humana ChoiceCare |
$265.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.63
|
| Rate for Payer: PHCS All Commercial |
$230.53
|
| Rate for Payer: PHP All Commercial |
$233.11
|
| Rate for Payer: Sagamore Health Network All Products |
$237.29
|
| Rate for Payer: Signature Care EPO |
$255.12
|
| Rate for Payer: Signature Care PPO |
$270.49
|
| Rate for Payer: United Healthcare Commercial |
$242.21
|
|
|
HC BRA VELCRO 44-46 XX LARGE
|
Facility
OP
|
$323.47
|
|
| Hospital Charge Code |
41601399
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$300.83 |
| Rate for Payer: Aetna Commercial |
$273.01
|
| Rate for Payer: Aetna Medicare |
$106.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$185.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$202.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$122.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$117.42
|
| Rate for Payer: Cash Price |
$200.55
|
| Rate for Payer: Cash Price |
$200.55
|
| Rate for Payer: Centivo All Commercial |
$164.97
|
| Rate for Payer: Cigna All Commercial |
$279.15
|
| Rate for Payer: CORVEL All Commercial |
$300.83
|
| Rate for Payer: Coventry All Commercial |
$284.65
|
| Rate for Payer: Encore All Commercial |
$297.75
|
| Rate for Payer: Frontpath All Commercial |
$297.59
|
| Rate for Payer: Humana ChoiceCare |
$279.38
|
| Rate for Payer: Humana Medicare |
$164.97
|
| Rate for Payer: Lucent All Commercial |
$164.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$291.12
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$242.60
|
| Rate for Payer: PHP All Commercial |
$245.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.15
|
| Rate for Payer: Sagamore Health Network All Products |
$249.72
|
| Rate for Payer: Signature Care EPO |
$268.48
|
| Rate for Payer: Signature Care PPO |
$284.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$254.89
|
| Rate for Payer: United Healthcare Medicare |
$106.75
|
|
|
HC BRA VELCRO 44-46 XX LARGE
|
Facility
IP
|
$323.47
|
|
| Hospital Charge Code |
41601399
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$242.60 |
| Max. Negotiated Rate |
$300.83 |
| Rate for Payer: Aetna Commercial |
$279.48
|
| Rate for Payer: Cash Price |
$200.55
|
| Rate for Payer: Cigna All Commercial |
$279.15
|
| Rate for Payer: CORVEL All Commercial |
$300.83
|
| Rate for Payer: Coventry All Commercial |
$284.65
|
| Rate for Payer: Encore All Commercial |
$297.75
|
| Rate for Payer: Frontpath All Commercial |
$297.59
|
| Rate for Payer: Humana ChoiceCare |
$279.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$291.12
|
| Rate for Payer: PHCS All Commercial |
$242.60
|
| Rate for Payer: PHP All Commercial |
$245.32
|
| Rate for Payer: Sagamore Health Network All Products |
$249.72
|
| Rate for Payer: Signature Care EPO |
$268.48
|
| Rate for Payer: Signature Care PPO |
$284.65
|
| Rate for Payer: United Healthcare Commercial |
$254.89
|
|
|
HC BRA VELCRO 46-48 QUEEN
|
Facility
OP
|
$383.11
|
|
| Hospital Charge Code |
41601400
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$356.29 |
| Rate for Payer: Aetna Commercial |
$323.34
|
| Rate for Payer: Aetna Medicare |
$126.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$220.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$239.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.07
|
| Rate for Payer: Cash Price |
$237.53
|
| Rate for Payer: Cash Price |
$237.53
|
| Rate for Payer: Centivo All Commercial |
$195.39
|
| Rate for Payer: Cigna All Commercial |
$330.62
|
| Rate for Payer: CORVEL All Commercial |
$356.29
|
| Rate for Payer: Coventry All Commercial |
$337.14
|
| Rate for Payer: Encore All Commercial |
$352.65
|
| Rate for Payer: Frontpath All Commercial |
$352.46
|
| Rate for Payer: Humana ChoiceCare |
$330.89
|
| Rate for Payer: Humana Medicare |
$195.39
|
| Rate for Payer: Lucent All Commercial |
$195.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$344.80
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$287.33
|
| Rate for Payer: PHP All Commercial |
$290.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.41
|
| Rate for Payer: Sagamore Health Network All Products |
$295.76
|
| Rate for Payer: Signature Care EPO |
$317.98
|
| Rate for Payer: Signature Care PPO |
$337.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$325.64
|
| Rate for Payer: United Healthcare Commercial |
$301.89
|
| Rate for Payer: United Healthcare Medicare |
$126.43
|
|
|
HC BRA VELCRO 46-48 QUEEN
|
Facility
IP
|
$383.11
|
|
| Hospital Charge Code |
41601400
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$287.33 |
| Max. Negotiated Rate |
$356.29 |
| Rate for Payer: Aetna Commercial |
$331.01
|
| Rate for Payer: Cash Price |
$237.53
|
| Rate for Payer: Cigna All Commercial |
$330.62
|
| Rate for Payer: CORVEL All Commercial |
$356.29
|
| Rate for Payer: Coventry All Commercial |
$337.14
|
| Rate for Payer: Encore All Commercial |
$352.65
|
| Rate for Payer: Frontpath All Commercial |
$352.46
|
| Rate for Payer: Humana ChoiceCare |
$330.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$344.80
|
| Rate for Payer: PHCS All Commercial |
$287.33
|
| Rate for Payer: PHP All Commercial |
$290.55
|
| Rate for Payer: Sagamore Health Network All Products |
$295.76
|
| Rate for Payer: Signature Care EPO |
$317.98
|
| Rate for Payer: Signature Care PPO |
$337.14
|
| Rate for Payer: United Healthcare Commercial |
$301.89
|
|
|
HC BRA VELCRO 50-54 SUPER QUEEN
|
Facility
IP
|
$476.14
|
|
| Hospital Charge Code |
41601456
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$357.10 |
| Max. Negotiated Rate |
$442.81 |
| Rate for Payer: Aetna Commercial |
$411.38
|
| Rate for Payer: Cash Price |
$295.21
|
| Rate for Payer: Cigna All Commercial |
$410.91
|
| Rate for Payer: CORVEL All Commercial |
$442.81
|
| Rate for Payer: Coventry All Commercial |
$419.00
|
| Rate for Payer: Encore All Commercial |
$438.29
|
| Rate for Payer: Frontpath All Commercial |
$438.05
|
| Rate for Payer: Humana ChoiceCare |
$411.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.53
|
| Rate for Payer: PHCS All Commercial |
$357.10
|
| Rate for Payer: PHP All Commercial |
$361.10
|
| Rate for Payer: Sagamore Health Network All Products |
$367.58
|
| Rate for Payer: Signature Care EPO |
$395.20
|
| Rate for Payer: Signature Care PPO |
$419.00
|
| Rate for Payer: United Healthcare Commercial |
$375.20
|
|
|
HC BRA VELCRO 50-54 SUPER QUEEN
|
Facility
OP
|
$476.14
|
|
| Hospital Charge Code |
41601456
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$442.81 |
| Rate for Payer: Aetna Commercial |
$401.86
|
| Rate for Payer: Aetna Medicare |
$157.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$273.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$297.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.84
|
| Rate for Payer: Cash Price |
$295.21
|
| Rate for Payer: Cash Price |
$295.21
|
| Rate for Payer: Centivo All Commercial |
$242.83
|
| Rate for Payer: Cigna All Commercial |
$410.91
|
| Rate for Payer: CORVEL All Commercial |
$442.81
|
| Rate for Payer: Coventry All Commercial |
$419.00
|
| Rate for Payer: Encore All Commercial |
$438.29
|
| Rate for Payer: Frontpath All Commercial |
$438.05
|
| Rate for Payer: Humana ChoiceCare |
$411.24
|
| Rate for Payer: Humana Medicare |
$242.83
|
| Rate for Payer: Lucent All Commercial |
$242.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.53
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$357.10
|
| Rate for Payer: PHP All Commercial |
$361.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.69
|
| Rate for Payer: Sagamore Health Network All Products |
$367.58
|
| Rate for Payer: Signature Care EPO |
$395.20
|
| Rate for Payer: Signature Care PPO |
$419.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$404.72
|
| Rate for Payer: United Healthcare Commercial |
$375.20
|
| Rate for Payer: United Healthcare Medicare |
$157.13
|
|
|
HC BREAST PUMP TUBING KIT DISP
|
Facility
OP
|
$209.93
|
|
| Hospital Charge Code |
41601819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$195.23 |
| Rate for Payer: Aetna Commercial |
$177.18
|
| Rate for Payer: Aetna Medicare |
$69.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.20
|
| Rate for Payer: Cash Price |
$130.16
|
| Rate for Payer: Cash Price |
$130.16
|
| Rate for Payer: Centivo All Commercial |
$107.06
|
| Rate for Payer: Cigna All Commercial |
$181.17
|
| Rate for Payer: CORVEL All Commercial |
$195.23
|
| Rate for Payer: Coventry All Commercial |
$184.74
|
| Rate for Payer: Encore All Commercial |
$193.24
|
| Rate for Payer: Frontpath All Commercial |
$193.14
|
| Rate for Payer: Humana ChoiceCare |
$181.32
|
| Rate for Payer: Humana Medicare |
$107.06
|
| Rate for Payer: Lucent All Commercial |
$107.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.94
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$157.45
|
| Rate for Payer: PHP All Commercial |
$159.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.87
|
| Rate for Payer: Sagamore Health Network All Products |
$162.07
|
| Rate for Payer: Signature Care EPO |
$174.24
|
| Rate for Payer: Signature Care PPO |
$184.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.44
|
| Rate for Payer: United Healthcare Commercial |
$165.42
|
| Rate for Payer: United Healthcare Medicare |
$69.28
|
|
|
HC BREAST PUMP TUBING KIT DISP
|
Facility
IP
|
$209.93
|
|
| Hospital Charge Code |
41601819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.45 |
| Max. Negotiated Rate |
$195.23 |
| Rate for Payer: Aetna Commercial |
$181.38
|
| Rate for Payer: Cash Price |
$130.16
|
| Rate for Payer: Cigna All Commercial |
$181.17
|
| Rate for Payer: CORVEL All Commercial |
$195.23
|
| Rate for Payer: Coventry All Commercial |
$184.74
|
| Rate for Payer: Encore All Commercial |
$193.24
|
| Rate for Payer: Frontpath All Commercial |
$193.14
|
| Rate for Payer: Humana ChoiceCare |
$181.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.94
|
| Rate for Payer: PHCS All Commercial |
$157.45
|
| Rate for Payer: PHP All Commercial |
$159.21
|
| Rate for Payer: Sagamore Health Network All Products |
$162.07
|
| Rate for Payer: Signature Care EPO |
$174.24
|
| Rate for Payer: Signature Care PPO |
$184.74
|
| Rate for Payer: United Healthcare Commercial |
$165.42
|
|
|
HC BREAST SPECIMEN RADIOGRAPH
|
Facility
IP
|
$675.03
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
01616098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$506.27 |
| Max. Negotiated Rate |
$627.77 |
| Rate for Payer: Aetna Commercial |
$583.22
|
| Rate for Payer: Cash Price |
$418.52
|
| Rate for Payer: Cigna All Commercial |
$582.55
|
| Rate for Payer: CORVEL All Commercial |
$627.77
|
| Rate for Payer: Coventry All Commercial |
$594.02
|
| Rate for Payer: Encore All Commercial |
$621.36
|
| Rate for Payer: Frontpath All Commercial |
$621.02
|
| Rate for Payer: Humana ChoiceCare |
$583.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$607.52
|
| Rate for Payer: PHCS All Commercial |
$506.27
|
| Rate for Payer: PHP All Commercial |
$511.94
|
| Rate for Payer: Sagamore Health Network All Products |
$521.12
|
| Rate for Payer: Signature Care EPO |
$560.27
|
| Rate for Payer: Signature Care PPO |
$594.02
|
| Rate for Payer: United Healthcare Commercial |
$531.92
|
|
|
HC BREAST SPECIMEN RADIOGRAPH
|
Facility
OP
|
$675.03
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
01616098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$627.77 |
| Rate for Payer: Aetna Commercial |
$569.72
|
| Rate for Payer: Aetna Medicare |
$222.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$222.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$387.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$421.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$29.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$256.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$245.03
|
| Rate for Payer: Cash Price |
$418.52
|
| Rate for Payer: Cash Price |
$418.52
|
| Rate for Payer: Centivo All Commercial |
$344.26
|
| Rate for Payer: Cigna All Commercial |
$582.55
|
| Rate for Payer: CORVEL All Commercial |
$627.77
|
| Rate for Payer: Coventry All Commercial |
$594.02
|
| Rate for Payer: Encore All Commercial |
$621.36
|
| Rate for Payer: Frontpath All Commercial |
$621.02
|
| Rate for Payer: Humana ChoiceCare |
$583.02
|
| Rate for Payer: Humana Medicare |
$344.26
|
| Rate for Payer: Lucent All Commercial |
$344.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$607.52
|
| Rate for Payer: Managed Health Services Medicaid |
$29.64
|
| Rate for Payer: MDWise Medicaid |
$29.64
|
| Rate for Payer: PHCS All Commercial |
$506.27
|
| Rate for Payer: PHP All Commercial |
$511.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$263.26
|
| Rate for Payer: Sagamore Health Network All Products |
$521.12
|
| Rate for Payer: Signature Care EPO |
$560.27
|
| Rate for Payer: Signature Care PPO |
$594.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$573.77
|
| Rate for Payer: United Healthcare Commercial |
$531.92
|
| Rate for Payer: United Healthcare Medicare |
$222.76
|
|
|
HC BREATHALYZER COMPANY
|
Facility
IP
|
$40.79
|
|
|
Service Code
|
CPT 82075
|
| Hospital Charge Code |
63001201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$37.93 |
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Cigna All Commercial |
$35.20
|
| Rate for Payer: CORVEL All Commercial |
$37.93
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.55
|
| Rate for Payer: Frontpath All Commercial |
$37.53
|
| Rate for Payer: Humana ChoiceCare |
$35.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.71
|
| Rate for Payer: PHCS All Commercial |
$30.59
|
| Rate for Payer: PHP All Commercial |
$30.93
|
| Rate for Payer: Sagamore Health Network All Products |
$31.49
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: United Healthcare Commercial |
$32.14
|
|
|
HC BREATHALYZER COMPANY
|
Facility
OP
|
$40.79
|
|
|
Service Code
|
CPT 82075
|
| Hospital Charge Code |
63001201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$37.93 |
| Rate for Payer: Aetna Commercial |
$34.43
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.81
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Centivo All Commercial |
$20.80
|
| Rate for Payer: Cigna All Commercial |
$35.20
|
| Rate for Payer: CORVEL All Commercial |
$37.93
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.55
|
| Rate for Payer: Frontpath All Commercial |
$37.53
|
| Rate for Payer: Humana ChoiceCare |
$35.23
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Lucent All Commercial |
$20.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.71
|
| Rate for Payer: Managed Health Services Medicaid |
$16.40
|
| Rate for Payer: MDWise Medicaid |
$16.40
|
| Rate for Payer: PHCS All Commercial |
$30.59
|
| Rate for Payer: PHP All Commercial |
$30.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.91
|
| Rate for Payer: Sagamore Health Network All Products |
$31.49
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.67
|
| Rate for Payer: United Healthcare Commercial |
$32.14
|
| Rate for Payer: United Healthcare Medicare |
$13.46
|
|
|
HC BREATHALYZER CONFIRMATION
|
Facility
IP
|
$40.79
|
|
|
Service Code
|
CPT 82075
|
| Hospital Charge Code |
63001202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$37.93 |
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Cigna All Commercial |
$35.20
|
| Rate for Payer: CORVEL All Commercial |
$37.93
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.55
|
| Rate for Payer: Frontpath All Commercial |
$37.53
|
| Rate for Payer: Humana ChoiceCare |
$35.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.71
|
| Rate for Payer: PHCS All Commercial |
$30.59
|
| Rate for Payer: PHP All Commercial |
$30.93
|
| Rate for Payer: Sagamore Health Network All Products |
$31.49
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: United Healthcare Commercial |
$32.14
|
|
|
HC BREATHALYZER CONFIRMATION
|
Facility
OP
|
$40.79
|
|
|
Service Code
|
CPT 82075
|
| Hospital Charge Code |
63001202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$37.93 |
| Rate for Payer: Aetna Commercial |
$34.43
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.81
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Centivo All Commercial |
$20.80
|
| Rate for Payer: Cigna All Commercial |
$35.20
|
| Rate for Payer: CORVEL All Commercial |
$37.93
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.55
|
| Rate for Payer: Frontpath All Commercial |
$37.53
|
| Rate for Payer: Humana ChoiceCare |
$35.23
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Lucent All Commercial |
$20.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.71
|
| Rate for Payer: Managed Health Services Medicaid |
$16.40
|
| Rate for Payer: MDWise Medicaid |
$16.40
|
| Rate for Payer: PHCS All Commercial |
$30.59
|
| Rate for Payer: PHP All Commercial |
$30.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.91
|
| Rate for Payer: Sagamore Health Network All Products |
$31.49
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.67
|
| Rate for Payer: United Healthcare Commercial |
$32.14
|
| Rate for Payer: United Healthcare Medicare |
$13.46
|
|
|
HC BRONCH GLIDE BFLEX 3.8
|
Facility
OP
|
$1,327.50
|
|
| Hospital Charge Code |
41607854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,234.58 |
| Rate for Payer: Aetna Commercial |
$1,120.41
|
| Rate for Payer: Aetna Medicare |
$438.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$438.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$762.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$829.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$503.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$481.88
|
| Rate for Payer: Cash Price |
$823.05
|
| Rate for Payer: Cash Price |
$823.05
|
| Rate for Payer: Centivo All Commercial |
$677.02
|
| Rate for Payer: Cigna All Commercial |
$1,145.63
|
| Rate for Payer: CORVEL All Commercial |
$1,234.58
|
| Rate for Payer: Coventry All Commercial |
$1,168.20
|
| Rate for Payer: Encore All Commercial |
$1,221.96
|
| Rate for Payer: Frontpath All Commercial |
$1,221.30
|
| Rate for Payer: Humana ChoiceCare |
$1,146.56
|
| Rate for Payer: Humana Medicare |
$677.02
|
| Rate for Payer: Lucent All Commercial |
$677.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,194.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$995.62
|
| Rate for Payer: PHP All Commercial |
$1,006.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$517.72
|
| Rate for Payer: Sagamore Health Network All Products |
$1,024.83
|
| Rate for Payer: Signature Care EPO |
$1,101.82
|
| Rate for Payer: Signature Care PPO |
$1,168.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,128.38
|
| Rate for Payer: United Healthcare Commercial |
$1,046.07
|
| Rate for Payer: United Healthcare Medicare |
$438.08
|
|
|
HC BRONCH GLIDE BFLEX 3.8
|
Facility
IP
|
$1,327.50
|
|
| Hospital Charge Code |
41607854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.62 |
| Max. Negotiated Rate |
$1,234.58 |
| Rate for Payer: Aetna Commercial |
$1,146.96
|
| Rate for Payer: Cash Price |
$823.05
|
| Rate for Payer: Cigna All Commercial |
$1,145.63
|
| Rate for Payer: CORVEL All Commercial |
$1,234.58
|
| Rate for Payer: Coventry All Commercial |
$1,168.20
|
| Rate for Payer: Encore All Commercial |
$1,221.96
|
| Rate for Payer: Frontpath All Commercial |
$1,221.30
|
| Rate for Payer: Humana ChoiceCare |
$1,146.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,194.75
|
| Rate for Payer: PHCS All Commercial |
$995.62
|
| Rate for Payer: PHP All Commercial |
$1,006.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,024.83
|
| Rate for Payer: Signature Care EPO |
$1,101.82
|
| Rate for Payer: Signature Care PPO |
$1,168.20
|
| Rate for Payer: United Healthcare Commercial |
$1,046.07
|
|
|
HC BRONCH GLIDE BFLEX 5.8
|
Facility
IP
|
$1,615.00
|
|
| Hospital Charge Code |
41607853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,211.25 |
| Max. Negotiated Rate |
$1,501.95 |
| Rate for Payer: Aetna Commercial |
$1,395.36
|
| Rate for Payer: Cash Price |
$1,001.30
|
| Rate for Payer: Cigna All Commercial |
$1,393.74
|
| Rate for Payer: CORVEL All Commercial |
$1,501.95
|
| Rate for Payer: Coventry All Commercial |
$1,421.20
|
| Rate for Payer: Encore All Commercial |
$1,486.61
|
| Rate for Payer: Frontpath All Commercial |
$1,485.80
|
| Rate for Payer: Humana ChoiceCare |
$1,394.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,453.50
|
| Rate for Payer: PHCS All Commercial |
$1,211.25
|
| Rate for Payer: PHP All Commercial |
$1,224.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1,246.78
|
| Rate for Payer: Signature Care EPO |
$1,340.45
|
| Rate for Payer: Signature Care PPO |
$1,421.20
|
| Rate for Payer: United Healthcare Commercial |
$1,272.62
|
|
|
HC BRONCH GLIDE BFLEX 5.8
|
Facility
OP
|
$1,615.00
|
|
| Hospital Charge Code |
41607853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,501.95 |
| Rate for Payer: Aetna Commercial |
$1,363.06
|
| Rate for Payer: Aetna Medicare |
$532.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$532.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$927.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,009.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$612.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$586.24
|
| Rate for Payer: Cash Price |
$1,001.30
|
| Rate for Payer: Cash Price |
$1,001.30
|
| Rate for Payer: Centivo All Commercial |
$823.65
|
| Rate for Payer: Cigna All Commercial |
$1,393.74
|
| Rate for Payer: CORVEL All Commercial |
$1,501.95
|
| Rate for Payer: Coventry All Commercial |
$1,421.20
|
| Rate for Payer: Encore All Commercial |
$1,486.61
|
| Rate for Payer: Frontpath All Commercial |
$1,485.80
|
| Rate for Payer: Humana ChoiceCare |
$1,394.88
|
| Rate for Payer: Humana Medicare |
$823.65
|
| Rate for Payer: Lucent All Commercial |
$823.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,453.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,211.25
|
| Rate for Payer: PHP All Commercial |
$1,224.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$629.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,246.78
|
| Rate for Payer: Signature Care EPO |
$1,340.45
|
| Rate for Payer: Signature Care PPO |
$1,421.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,372.75
|
| Rate for Payer: United Healthcare Commercial |
$1,272.62
|
| Rate for Payer: United Healthcare Medicare |
$532.95
|
|
|
HC BRONCHIAL PROVOCATION
|
Facility
IP
|
$1,354.73
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
01706680
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$1,016.05 |
| Max. Negotiated Rate |
$1,259.90 |
| Rate for Payer: Aetna Commercial |
$1,170.49
|
| Rate for Payer: Cash Price |
$839.94
|
| Rate for Payer: Cigna All Commercial |
$1,169.13
|
| Rate for Payer: CORVEL All Commercial |
$1,259.90
|
| Rate for Payer: Coventry All Commercial |
$1,192.17
|
| Rate for Payer: Encore All Commercial |
$1,247.03
|
| Rate for Payer: Frontpath All Commercial |
$1,246.35
|
| Rate for Payer: Humana ChoiceCare |
$1,170.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,219.26
|
| Rate for Payer: PHCS All Commercial |
$1,016.05
|
| Rate for Payer: PHP All Commercial |
$1,027.43
|
| Rate for Payer: Sagamore Health Network All Products |
$1,045.85
|
| Rate for Payer: Signature Care EPO |
$1,124.43
|
| Rate for Payer: Signature Care PPO |
$1,192.17
|
| Rate for Payer: United Healthcare Commercial |
$1,067.53
|
|
|
HC BRONCHIAL PROVOCATION
|
Facility
OP
|
$1,354.73
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
01706680
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$1,259.90 |
| Rate for Payer: Aetna Commercial |
$1,143.39
|
| Rate for Payer: Aetna Medicare |
$447.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$447.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$778.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$846.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$186.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$514.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$491.77
|
| Rate for Payer: Cash Price |
$839.94
|
| Rate for Payer: Cash Price |
$839.94
|
| Rate for Payer: Centivo All Commercial |
$690.91
|
| Rate for Payer: Cigna All Commercial |
$1,169.13
|
| Rate for Payer: CORVEL All Commercial |
$1,259.90
|
| Rate for Payer: Coventry All Commercial |
$1,192.17
|
| Rate for Payer: Encore All Commercial |
$1,247.03
|
| Rate for Payer: Frontpath All Commercial |
$1,246.35
|
| Rate for Payer: Humana ChoiceCare |
$1,170.08
|
| Rate for Payer: Humana Medicare |
$690.91
|
| Rate for Payer: Lucent All Commercial |
$690.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,219.26
|
| Rate for Payer: Managed Health Services Medicaid |
$186.46
|
| Rate for Payer: MDWise Medicaid |
$186.46
|
| Rate for Payer: PHCS All Commercial |
$1,016.05
|
| Rate for Payer: PHP All Commercial |
$1,027.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$528.35
|
| Rate for Payer: Sagamore Health Network All Products |
$1,045.85
|
| Rate for Payer: Signature Care EPO |
$1,124.43
|
| Rate for Payer: Signature Care PPO |
$1,192.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,151.52
|
| Rate for Payer: United Healthcare Commercial |
$1,067.53
|
| Rate for Payer: United Healthcare Medicare |
$447.06
|
|
|
HC BRONCHOSCOPY BEDSIDE
|
Facility
IP
|
$2,163.00
|
|
| Hospital Charge Code |
01701624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,622.25 |
| Max. Negotiated Rate |
$2,011.59 |
| Rate for Payer: Aetna Commercial |
$1,868.83
|
| Rate for Payer: Cash Price |
$1,341.06
|
| Rate for Payer: Cigna All Commercial |
$1,866.67
|
| Rate for Payer: CORVEL All Commercial |
$2,011.59
|
| Rate for Payer: Coventry All Commercial |
$1,903.44
|
| Rate for Payer: Encore All Commercial |
$1,991.04
|
| Rate for Payer: Frontpath All Commercial |
$1,989.96
|
| Rate for Payer: Humana ChoiceCare |
$1,868.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,946.70
|
| Rate for Payer: PHCS All Commercial |
$1,622.25
|
| Rate for Payer: PHP All Commercial |
$1,640.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,669.84
|
| Rate for Payer: Signature Care EPO |
$1,795.29
|
| Rate for Payer: Signature Care PPO |
$1,903.44
|
| Rate for Payer: United Healthcare Commercial |
$1,704.44
|
|
|
HC BRONCHOSCOPY BEDSIDE
|
Facility
OP
|
$2,163.00
|
|
| Hospital Charge Code |
01701624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$713.79 |
| Max. Negotiated Rate |
$2,011.59 |
| Rate for Payer: Aetna Commercial |
$1,825.57
|
| Rate for Payer: Aetna Medicare |
$713.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$713.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,242.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,352.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$820.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$785.17
|
| Rate for Payer: Cash Price |
$1,341.06
|
| Rate for Payer: Centivo All Commercial |
$1,103.13
|
| Rate for Payer: Cigna All Commercial |
$1,866.67
|
| Rate for Payer: CORVEL All Commercial |
$2,011.59
|
| Rate for Payer: Coventry All Commercial |
$1,903.44
|
| Rate for Payer: Encore All Commercial |
$1,991.04
|
| Rate for Payer: Frontpath All Commercial |
$1,989.96
|
| Rate for Payer: Humana ChoiceCare |
$1,868.18
|
| Rate for Payer: Humana Medicare |
$1,103.13
|
| Rate for Payer: Lucent All Commercial |
$1,103.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,946.70
|
| Rate for Payer: PHCS All Commercial |
$1,622.25
|
| Rate for Payer: PHP All Commercial |
$1,640.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$843.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,669.84
|
| Rate for Payer: Signature Care EPO |
$1,795.29
|
| Rate for Payer: Signature Care PPO |
$1,903.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,838.55
|
| Rate for Payer: United Healthcare Commercial |
$1,704.44
|
| Rate for Payer: United Healthcare Medicare |
$713.79
|
|
