|
HC CAP SCOPE DISTAL GIF-H180
|
Facility
IP
|
$178.23
|
|
| Hospital Charge Code |
41603092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.67 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Commercial |
$153.99
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cigna All Commercial |
$153.81
|
| Rate for Payer: CORVEL All Commercial |
$165.75
|
| Rate for Payer: Coventry All Commercial |
$156.84
|
| Rate for Payer: Encore All Commercial |
$164.06
|
| Rate for Payer: Frontpath All Commercial |
$163.97
|
| Rate for Payer: Humana ChoiceCare |
$153.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.41
|
| Rate for Payer: PHCS All Commercial |
$133.67
|
| Rate for Payer: PHP All Commercial |
$135.17
|
| Rate for Payer: Sagamore Health Network All Products |
$137.59
|
| Rate for Payer: Signature Care EPO |
$147.93
|
| Rate for Payer: Signature Care PPO |
$156.84
|
| Rate for Payer: United Healthcare Commercial |
$140.45
|
|
|
HC CAP SCOPE DISTAL GIF-H180
|
Facility
OP
|
$178.23
|
|
| Hospital Charge Code |
41603092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Commercial |
$150.43
|
| Rate for Payer: Aetna Medicare |
$58.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.70
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Centivo All Commercial |
$90.90
|
| Rate for Payer: Cigna All Commercial |
$153.81
|
| Rate for Payer: CORVEL All Commercial |
$165.75
|
| Rate for Payer: Coventry All Commercial |
$156.84
|
| Rate for Payer: Encore All Commercial |
$164.06
|
| Rate for Payer: Frontpath All Commercial |
$163.97
|
| Rate for Payer: Humana ChoiceCare |
$153.94
|
| Rate for Payer: Humana Medicare |
$90.90
|
| Rate for Payer: Lucent All Commercial |
$90.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.41
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$133.67
|
| Rate for Payer: PHP All Commercial |
$135.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.51
|
| Rate for Payer: Sagamore Health Network All Products |
$137.59
|
| Rate for Payer: Signature Care EPO |
$147.93
|
| Rate for Payer: Signature Care PPO |
$156.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$140.45
|
| Rate for Payer: United Healthcare Medicare |
$58.82
|
|
|
HC CAPSULAR TENSION RING ACTR10
|
Facility
OP
|
$994.00
|
|
| Hospital Charge Code |
41603431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$838.94
|
| Rate for Payer: Aetna Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Centivo All Commercial |
$506.94
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Humana Medicare |
$506.94
|
| Rate for Payer: Lucent All Commercial |
$506.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.66
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.90
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
| Rate for Payer: United Healthcare Medicare |
$328.02
|
|
|
HC CAPSULAR TENSION RING ACTR10
|
Facility
IP
|
$994.00
|
|
| Hospital Charge Code |
41603431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$858.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
|
|
HC CAPSULAR TENSION RING ACTR11
|
Facility
OP
|
$995.00
|
|
| Hospital Charge Code |
41602210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$925.35 |
| Rate for Payer: Aetna Commercial |
$839.78
|
| Rate for Payer: Aetna Medicare |
$328.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$571.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$361.18
|
| Rate for Payer: Cash Price |
$616.90
|
| Rate for Payer: Cash Price |
$616.90
|
| Rate for Payer: Centivo All Commercial |
$507.45
|
| Rate for Payer: Cigna All Commercial |
$858.68
|
| Rate for Payer: CORVEL All Commercial |
$925.35
|
| Rate for Payer: Coventry All Commercial |
$875.60
|
| Rate for Payer: Encore All Commercial |
$915.90
|
| Rate for Payer: Frontpath All Commercial |
$915.40
|
| Rate for Payer: Humana ChoiceCare |
$859.38
|
| Rate for Payer: Humana Medicare |
$507.45
|
| Rate for Payer: Lucent All Commercial |
$507.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$895.50
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$746.25
|
| Rate for Payer: PHP All Commercial |
$754.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$388.05
|
| Rate for Payer: Sagamore Health Network All Products |
$768.14
|
| Rate for Payer: Signature Care EPO |
$825.85
|
| Rate for Payer: Signature Care PPO |
$875.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$845.75
|
| Rate for Payer: United Healthcare Commercial |
$784.06
|
| Rate for Payer: United Healthcare Medicare |
$328.35
|
|
|
HC CAPSULAR TENSION RING ACTR11
|
Facility
IP
|
$995.00
|
|
| Hospital Charge Code |
41602210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$746.25 |
| Max. Negotiated Rate |
$925.35 |
| Rate for Payer: Aetna Commercial |
$859.68
|
| Rate for Payer: Cash Price |
$616.90
|
| Rate for Payer: Cigna All Commercial |
$858.68
|
| Rate for Payer: CORVEL All Commercial |
$925.35
|
| Rate for Payer: Coventry All Commercial |
$875.60
|
| Rate for Payer: Encore All Commercial |
$915.90
|
| Rate for Payer: Frontpath All Commercial |
$915.40
|
| Rate for Payer: Humana ChoiceCare |
$859.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$895.50
|
| Rate for Payer: PHCS All Commercial |
$746.25
|
| Rate for Payer: PHP All Commercial |
$754.61
|
| Rate for Payer: Sagamore Health Network All Products |
$768.14
|
| Rate for Payer: Signature Care EPO |
$825.85
|
| Rate for Payer: Signature Care PPO |
$875.60
|
| Rate for Payer: United Healthcare Commercial |
$784.06
|
|
|
HC CAPTIVATOR 10MM
|
Facility
OP
|
$91.00
|
|
| Hospital Charge Code |
41608236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$76.80
|
| Rate for Payer: Aetna Medicare |
$30.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.03
|
| Rate for Payer: Cash Price |
$56.42
|
| Rate for Payer: Cash Price |
$56.42
|
| Rate for Payer: Centivo All Commercial |
$46.41
|
| Rate for Payer: Cigna All Commercial |
$78.53
|
| Rate for Payer: CORVEL All Commercial |
$84.63
|
| Rate for Payer: Coventry All Commercial |
$80.08
|
| Rate for Payer: Encore All Commercial |
$83.77
|
| Rate for Payer: Frontpath All Commercial |
$83.72
|
| Rate for Payer: Humana ChoiceCare |
$78.60
|
| Rate for Payer: Humana Medicare |
$46.41
|
| Rate for Payer: Lucent All Commercial |
$46.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$68.25
|
| Rate for Payer: PHP All Commercial |
$69.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.49
|
| Rate for Payer: Sagamore Health Network All Products |
$70.25
|
| Rate for Payer: Signature Care EPO |
$75.53
|
| Rate for Payer: Signature Care PPO |
$80.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.35
|
| Rate for Payer: United Healthcare Commercial |
$71.71
|
| Rate for Payer: United Healthcare Medicare |
$30.03
|
|
|
HC CAPTIVATOR 10MM
|
Facility
IP
|
$91.00
|
|
| Hospital Charge Code |
41608236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Cash Price |
$56.42
|
| Rate for Payer: Cigna All Commercial |
$78.53
|
| Rate for Payer: CORVEL All Commercial |
$84.63
|
| Rate for Payer: Coventry All Commercial |
$80.08
|
| Rate for Payer: Encore All Commercial |
$83.77
|
| Rate for Payer: Frontpath All Commercial |
$83.72
|
| Rate for Payer: Humana ChoiceCare |
$78.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.90
|
| Rate for Payer: PHCS All Commercial |
$68.25
|
| Rate for Payer: PHP All Commercial |
$69.01
|
| Rate for Payer: Sagamore Health Network All Products |
$70.25
|
| Rate for Payer: Signature Care EPO |
$75.53
|
| Rate for Payer: Signature Care PPO |
$80.08
|
| Rate for Payer: United Healthcare Commercial |
$71.71
|
|
|
HC CAPTIVATOR 20MM
|
Facility
IP
|
$63.60
|
|
| Hospital Charge Code |
41608210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$59.15 |
| Rate for Payer: Aetna Commercial |
$54.95
|
| Rate for Payer: Cash Price |
$39.43
|
| Rate for Payer: Cigna All Commercial |
$54.89
|
| Rate for Payer: CORVEL All Commercial |
$59.15
|
| Rate for Payer: Coventry All Commercial |
$55.97
|
| Rate for Payer: Encore All Commercial |
$58.54
|
| Rate for Payer: Frontpath All Commercial |
$58.51
|
| Rate for Payer: Humana ChoiceCare |
$54.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.24
|
| Rate for Payer: PHCS All Commercial |
$47.70
|
| Rate for Payer: PHP All Commercial |
$48.23
|
| Rate for Payer: Sagamore Health Network All Products |
$49.10
|
| Rate for Payer: Signature Care EPO |
$52.79
|
| Rate for Payer: Signature Care PPO |
$55.97
|
| Rate for Payer: United Healthcare Commercial |
$50.12
|
|
|
HC CAPTIVATOR 20MM
|
Facility
OP
|
$63.60
|
|
| Hospital Charge Code |
41608210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$53.68
|
| Rate for Payer: Aetna Medicare |
$20.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.09
|
| Rate for Payer: Cash Price |
$39.43
|
| Rate for Payer: Cash Price |
$39.43
|
| Rate for Payer: Centivo All Commercial |
$32.44
|
| Rate for Payer: Cigna All Commercial |
$54.89
|
| Rate for Payer: CORVEL All Commercial |
$59.15
|
| Rate for Payer: Coventry All Commercial |
$55.97
|
| Rate for Payer: Encore All Commercial |
$58.54
|
| Rate for Payer: Frontpath All Commercial |
$58.51
|
| Rate for Payer: Humana ChoiceCare |
$54.93
|
| Rate for Payer: Humana Medicare |
$32.44
|
| Rate for Payer: Lucent All Commercial |
$32.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$47.70
|
| Rate for Payer: PHP All Commercial |
$48.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.80
|
| Rate for Payer: Sagamore Health Network All Products |
$49.10
|
| Rate for Payer: Signature Care EPO |
$52.79
|
| Rate for Payer: Signature Care PPO |
$55.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.06
|
| Rate for Payer: United Healthcare Commercial |
$50.12
|
| Rate for Payer: United Healthcare Medicare |
$20.99
|
|
|
HC CAPTIVATOR 20MM
|
Facility
IP
|
$93.73
|
|
| Hospital Charge Code |
41608209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$87.17 |
| Rate for Payer: Aetna Commercial |
$80.98
|
| Rate for Payer: Cash Price |
$58.11
|
| Rate for Payer: Cigna All Commercial |
$80.89
|
| Rate for Payer: CORVEL All Commercial |
$87.17
|
| Rate for Payer: Coventry All Commercial |
$82.48
|
| Rate for Payer: Encore All Commercial |
$86.28
|
| Rate for Payer: Frontpath All Commercial |
$86.23
|
| Rate for Payer: Humana ChoiceCare |
$80.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.36
|
| Rate for Payer: PHCS All Commercial |
$70.30
|
| Rate for Payer: PHP All Commercial |
$71.08
|
| Rate for Payer: Sagamore Health Network All Products |
$72.36
|
| Rate for Payer: Signature Care EPO |
$77.80
|
| Rate for Payer: Signature Care PPO |
$82.48
|
| Rate for Payer: United Healthcare Commercial |
$73.86
|
|
|
HC CAPTIVATOR 20MM
|
Facility
OP
|
$93.73
|
|
| Hospital Charge Code |
41608209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$79.11
|
| Rate for Payer: Aetna Medicare |
$30.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.02
|
| Rate for Payer: Cash Price |
$58.11
|
| Rate for Payer: Cash Price |
$58.11
|
| Rate for Payer: Centivo All Commercial |
$47.80
|
| Rate for Payer: Cigna All Commercial |
$80.89
|
| Rate for Payer: CORVEL All Commercial |
$87.17
|
| Rate for Payer: Coventry All Commercial |
$82.48
|
| Rate for Payer: Encore All Commercial |
$86.28
|
| Rate for Payer: Frontpath All Commercial |
$86.23
|
| Rate for Payer: Humana ChoiceCare |
$80.95
|
| Rate for Payer: Humana Medicare |
$47.80
|
| Rate for Payer: Lucent All Commercial |
$47.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.36
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$70.30
|
| Rate for Payer: PHP All Commercial |
$71.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.55
|
| Rate for Payer: Sagamore Health Network All Products |
$72.36
|
| Rate for Payer: Signature Care EPO |
$77.80
|
| Rate for Payer: Signature Care PPO |
$82.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.67
|
| Rate for Payer: United Healthcare Commercial |
$73.86
|
| Rate for Payer: United Healthcare Medicare |
$30.93
|
|
|
HC CAPTIVATOR 27MM
|
Facility
OP
|
$97.64
|
|
| Hospital Charge Code |
41608211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$82.41
|
| Rate for Payer: Aetna Medicare |
$32.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.44
|
| Rate for Payer: Cash Price |
$60.54
|
| Rate for Payer: Cash Price |
$60.54
|
| Rate for Payer: Centivo All Commercial |
$49.80
|
| Rate for Payer: Cigna All Commercial |
$84.26
|
| Rate for Payer: CORVEL All Commercial |
$90.81
|
| Rate for Payer: Coventry All Commercial |
$85.92
|
| Rate for Payer: Encore All Commercial |
$89.88
|
| Rate for Payer: Frontpath All Commercial |
$89.83
|
| Rate for Payer: Humana ChoiceCare |
$84.33
|
| Rate for Payer: Humana Medicare |
$49.80
|
| Rate for Payer: Lucent All Commercial |
$49.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$73.23
|
| Rate for Payer: PHP All Commercial |
$74.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.08
|
| Rate for Payer: Sagamore Health Network All Products |
$75.38
|
| Rate for Payer: Signature Care EPO |
$81.04
|
| Rate for Payer: Signature Care PPO |
$85.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.99
|
| Rate for Payer: United Healthcare Commercial |
$76.94
|
| Rate for Payer: United Healthcare Medicare |
$32.22
|
|
|
HC CAPTIVATOR 27MM
|
Facility
IP
|
$97.64
|
|
| Hospital Charge Code |
41608211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.23 |
| Max. Negotiated Rate |
$90.81 |
| Rate for Payer: Aetna Commercial |
$84.36
|
| Rate for Payer: Cash Price |
$60.54
|
| Rate for Payer: Cigna All Commercial |
$84.26
|
| Rate for Payer: CORVEL All Commercial |
$90.81
|
| Rate for Payer: Coventry All Commercial |
$85.92
|
| Rate for Payer: Encore All Commercial |
$89.88
|
| Rate for Payer: Frontpath All Commercial |
$89.83
|
| Rate for Payer: Humana ChoiceCare |
$84.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.88
|
| Rate for Payer: PHCS All Commercial |
$73.23
|
| Rate for Payer: PHP All Commercial |
$74.05
|
| Rate for Payer: Sagamore Health Network All Products |
$75.38
|
| Rate for Payer: Signature Care EPO |
$81.04
|
| Rate for Payer: Signature Care PPO |
$85.92
|
| Rate for Payer: United Healthcare Commercial |
$76.94
|
|
|
HC CARBO DEF TRANSFERRI
|
Facility
IP
|
$103.20
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
63001481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$95.98 |
| Rate for Payer: Aetna Commercial |
$89.17
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Cigna All Commercial |
$89.06
|
| Rate for Payer: CORVEL All Commercial |
$95.98
|
| Rate for Payer: Coventry All Commercial |
$90.82
|
| Rate for Payer: Encore All Commercial |
$95.00
|
| Rate for Payer: Frontpath All Commercial |
$94.95
|
| Rate for Payer: Humana ChoiceCare |
$89.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.88
|
| Rate for Payer: PHCS All Commercial |
$77.40
|
| Rate for Payer: PHP All Commercial |
$78.27
|
| Rate for Payer: Sagamore Health Network All Products |
$79.67
|
| Rate for Payer: Signature Care EPO |
$85.66
|
| Rate for Payer: Signature Care PPO |
$90.82
|
| Rate for Payer: United Healthcare Commercial |
$81.32
|
|
|
HC CARBO DEF TRANSFERRI
|
Facility
OP
|
$103.20
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
63001481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$95.98 |
| Rate for Payer: Aetna Commercial |
$87.10
|
| Rate for Payer: Aetna Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.46
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Centivo All Commercial |
$52.63
|
| Rate for Payer: Cigna All Commercial |
$89.06
|
| Rate for Payer: CORVEL All Commercial |
$95.98
|
| Rate for Payer: Coventry All Commercial |
$90.82
|
| Rate for Payer: Encore All Commercial |
$95.00
|
| Rate for Payer: Frontpath All Commercial |
$94.95
|
| Rate for Payer: Humana ChoiceCare |
$89.14
|
| Rate for Payer: Humana Medicare |
$52.63
|
| Rate for Payer: Lucent All Commercial |
$52.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.88
|
| Rate for Payer: Managed Health Services Medicaid |
$9.95
|
| Rate for Payer: MDWise Medicaid |
$9.95
|
| Rate for Payer: PHCS All Commercial |
$77.40
|
| Rate for Payer: PHP All Commercial |
$78.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.25
|
| Rate for Payer: Sagamore Health Network All Products |
$79.67
|
| Rate for Payer: Signature Care EPO |
$85.66
|
| Rate for Payer: Signature Care PPO |
$90.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.72
|
| Rate for Payer: United Healthcare Commercial |
$81.32
|
| Rate for Payer: United Healthcare Medicare |
$34.06
|
|
|
HC CARBOXY HGB
|
Facility
IP
|
$176.15
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
63001164
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.12 |
| Max. Negotiated Rate |
$163.82 |
| Rate for Payer: Aetna Commercial |
$152.20
|
| Rate for Payer: Cash Price |
$109.22
|
| Rate for Payer: Cigna All Commercial |
$152.02
|
| Rate for Payer: CORVEL All Commercial |
$163.82
|
| Rate for Payer: Coventry All Commercial |
$155.02
|
| Rate for Payer: Encore All Commercial |
$162.15
|
| Rate for Payer: Frontpath All Commercial |
$162.06
|
| Rate for Payer: Humana ChoiceCare |
$152.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.54
|
| Rate for Payer: PHCS All Commercial |
$132.12
|
| Rate for Payer: PHP All Commercial |
$133.60
|
| Rate for Payer: Sagamore Health Network All Products |
$135.99
|
| Rate for Payer: Signature Care EPO |
$146.21
|
| Rate for Payer: Signature Care PPO |
$155.02
|
| Rate for Payer: United Healthcare Commercial |
$138.81
|
|
|
HC CARBOXY HGB
|
Facility
OP
|
$176.15
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
63001164
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$163.82 |
| Rate for Payer: Aetna Commercial |
$148.67
|
| Rate for Payer: Aetna Medicare |
$58.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$101.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.94
|
| Rate for Payer: Cash Price |
$109.22
|
| Rate for Payer: Cash Price |
$109.22
|
| Rate for Payer: Centivo All Commercial |
$89.84
|
| Rate for Payer: Cigna All Commercial |
$152.02
|
| Rate for Payer: CORVEL All Commercial |
$163.82
|
| Rate for Payer: Coventry All Commercial |
$155.02
|
| Rate for Payer: Encore All Commercial |
$162.15
|
| Rate for Payer: Frontpath All Commercial |
$162.06
|
| Rate for Payer: Humana ChoiceCare |
$152.14
|
| Rate for Payer: Humana Medicare |
$89.84
|
| Rate for Payer: Lucent All Commercial |
$89.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.54
|
| Rate for Payer: Managed Health Services Medicaid |
$12.32
|
| Rate for Payer: MDWise Medicaid |
$12.32
|
| Rate for Payer: PHCS All Commercial |
$132.12
|
| Rate for Payer: PHP All Commercial |
$133.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.70
|
| Rate for Payer: Sagamore Health Network All Products |
$135.99
|
| Rate for Payer: Signature Care EPO |
$146.21
|
| Rate for Payer: Signature Care PPO |
$155.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$149.73
|
| Rate for Payer: United Healthcare Commercial |
$138.81
|
| Rate for Payer: United Healthcare Medicare |
$58.13
|
|
|
HC CARDIAC DOPPLER
|
Facility
OP
|
$708.90
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
00863320
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$233.94 |
| Max. Negotiated Rate |
$788.70 |
| Rate for Payer: Aetna Commercial |
$598.31
|
| Rate for Payer: Aetna Medicare |
$233.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$233.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$407.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$443.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$269.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$257.33
|
| Rate for Payer: Cash Price |
$439.52
|
| Rate for Payer: Cash Price |
$439.52
|
| Rate for Payer: Centivo All Commercial |
$361.54
|
| Rate for Payer: Cigna All Commercial |
$611.78
|
| Rate for Payer: CORVEL All Commercial |
$659.28
|
| Rate for Payer: Coventry All Commercial |
$623.83
|
| Rate for Payer: Encore All Commercial |
$652.54
|
| Rate for Payer: Frontpath All Commercial |
$652.19
|
| Rate for Payer: Humana ChoiceCare |
$612.28
|
| Rate for Payer: Humana Medicare |
$361.54
|
| Rate for Payer: Lucent All Commercial |
$361.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$638.01
|
| Rate for Payer: Managed Health Services Medicaid |
$788.70
|
| Rate for Payer: MDWise Medicaid |
$788.70
|
| Rate for Payer: PHCS All Commercial |
$531.68
|
| Rate for Payer: PHP All Commercial |
$537.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$276.47
|
| Rate for Payer: Sagamore Health Network All Products |
$547.27
|
| Rate for Payer: Signature Care EPO |
$588.39
|
| Rate for Payer: Signature Care PPO |
$623.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$602.56
|
| Rate for Payer: United Healthcare Commercial |
$558.61
|
| Rate for Payer: United Healthcare Medicare |
$233.94
|
|
|
HC CARDIAC DOPPLER
|
Facility
IP
|
$708.90
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
00863320
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$531.68 |
| Max. Negotiated Rate |
$659.28 |
| Rate for Payer: Aetna Commercial |
$612.49
|
| Rate for Payer: Cash Price |
$439.52
|
| Rate for Payer: Cigna All Commercial |
$611.78
|
| Rate for Payer: CORVEL All Commercial |
$659.28
|
| Rate for Payer: Coventry All Commercial |
$623.83
|
| Rate for Payer: Encore All Commercial |
$652.54
|
| Rate for Payer: Frontpath All Commercial |
$652.19
|
| Rate for Payer: Humana ChoiceCare |
$612.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$638.01
|
| Rate for Payer: PHCS All Commercial |
$531.68
|
| Rate for Payer: PHP All Commercial |
$537.63
|
| Rate for Payer: Sagamore Health Network All Products |
$547.27
|
| Rate for Payer: Signature Care EPO |
$588.39
|
| Rate for Payer: Signature Care PPO |
$623.83
|
| Rate for Payer: United Healthcare Commercial |
$558.61
|
|
|
HC CARDIAC DOPPLER - LIMITED
|
Facility
OP
|
$535.50
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
00863321
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$788.70 |
| Rate for Payer: Aetna Commercial |
$451.96
|
| Rate for Payer: Aetna Medicare |
$176.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$176.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$307.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$334.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$203.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$194.39
|
| Rate for Payer: Cash Price |
$332.01
|
| Rate for Payer: Cash Price |
$332.01
|
| Rate for Payer: Centivo All Commercial |
$273.10
|
| Rate for Payer: Cigna All Commercial |
$462.14
|
| Rate for Payer: CORVEL All Commercial |
$498.02
|
| Rate for Payer: Coventry All Commercial |
$471.24
|
| Rate for Payer: Encore All Commercial |
$492.93
|
| Rate for Payer: Frontpath All Commercial |
$492.66
|
| Rate for Payer: Humana ChoiceCare |
$462.51
|
| Rate for Payer: Humana Medicare |
$273.10
|
| Rate for Payer: Lucent All Commercial |
$273.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$481.95
|
| Rate for Payer: Managed Health Services Medicaid |
$788.70
|
| Rate for Payer: MDWise Medicaid |
$788.70
|
| Rate for Payer: PHCS All Commercial |
$401.62
|
| Rate for Payer: PHP All Commercial |
$406.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$208.84
|
| Rate for Payer: Sagamore Health Network All Products |
$413.41
|
| Rate for Payer: Signature Care EPO |
$444.46
|
| Rate for Payer: Signature Care PPO |
$471.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$455.18
|
| Rate for Payer: United Healthcare Commercial |
$421.97
|
| Rate for Payer: United Healthcare Medicare |
$176.72
|
|
|
HC CARDIAC DOPPLER - LIMITED
|
Facility
IP
|
$535.50
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
00863321
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$401.62 |
| Max. Negotiated Rate |
$498.02 |
| Rate for Payer: Aetna Commercial |
$462.67
|
| Rate for Payer: Cash Price |
$332.01
|
| Rate for Payer: Cigna All Commercial |
$462.14
|
| Rate for Payer: CORVEL All Commercial |
$498.02
|
| Rate for Payer: Coventry All Commercial |
$471.24
|
| Rate for Payer: Encore All Commercial |
$492.93
|
| Rate for Payer: Frontpath All Commercial |
$492.66
|
| Rate for Payer: Humana ChoiceCare |
$462.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$481.95
|
| Rate for Payer: PHCS All Commercial |
$401.62
|
| Rate for Payer: PHP All Commercial |
$406.12
|
| Rate for Payer: Sagamore Health Network All Products |
$413.41
|
| Rate for Payer: Signature Care EPO |
$444.46
|
| Rate for Payer: Signature Care PPO |
$471.24
|
| Rate for Payer: United Healthcare Commercial |
$421.97
|
|
|
HC CARDIAC REHAB II; 1-36
|
Facility
OP
|
$243.98
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
01609063
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$240.28 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Medicare |
$80.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$140.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$152.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$240.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.57
|
| Rate for Payer: Cash Price |
$151.27
|
| Rate for Payer: Cash Price |
$151.27
|
| Rate for Payer: Centivo All Commercial |
$124.43
|
| Rate for Payer: Cigna All Commercial |
$210.56
|
| Rate for Payer: CORVEL All Commercial |
$226.91
|
| Rate for Payer: Coventry All Commercial |
$214.71
|
| Rate for Payer: Encore All Commercial |
$224.59
|
| Rate for Payer: Frontpath All Commercial |
$224.47
|
| Rate for Payer: Humana ChoiceCare |
$210.73
|
| Rate for Payer: Humana Medicare |
$124.43
|
| Rate for Payer: Lucent All Commercial |
$124.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.59
|
| Rate for Payer: Managed Health Services Medicaid |
$240.28
|
| Rate for Payer: MDWise Medicaid |
$240.28
|
| Rate for Payer: PHCS All Commercial |
$182.99
|
| Rate for Payer: PHP All Commercial |
$185.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.15
|
| Rate for Payer: Sagamore Health Network All Products |
$188.36
|
| Rate for Payer: Signature Care EPO |
$202.51
|
| Rate for Payer: Signature Care PPO |
$214.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$207.39
|
| Rate for Payer: United Healthcare Commercial |
$192.26
|
| Rate for Payer: United Healthcare Medicare |
$80.51
|
|
|
HC CARDIAC REHAB II; 1-36
|
Facility
IP
|
$243.98
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
01609063
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$182.99 |
| Max. Negotiated Rate |
$226.91 |
| Rate for Payer: Aetna Commercial |
$210.80
|
| Rate for Payer: Cash Price |
$151.27
|
| Rate for Payer: Cigna All Commercial |
$210.56
|
| Rate for Payer: CORVEL All Commercial |
$226.91
|
| Rate for Payer: Coventry All Commercial |
$214.71
|
| Rate for Payer: Encore All Commercial |
$224.59
|
| Rate for Payer: Frontpath All Commercial |
$224.47
|
| Rate for Payer: Humana ChoiceCare |
$210.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.59
|
| Rate for Payer: PHCS All Commercial |
$182.99
|
| Rate for Payer: PHP All Commercial |
$185.04
|
| Rate for Payer: Sagamore Health Network All Products |
$188.36
|
| Rate for Payer: Signature Care EPO |
$202.51
|
| Rate for Payer: Signature Care PPO |
$214.71
|
| Rate for Payer: United Healthcare Commercial |
$192.26
|
|
|
HC CARDIAC REHAB II; 37+
|
Facility
OP
|
$236.00
|
|
|
Service Code
|
CPT 93798 KX
|
| Hospital Charge Code |
01603798
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$219.48 |
| Rate for Payer: Aetna Commercial |
$199.18
|
| Rate for Payer: Aetna Medicare |
$77.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$135.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$147.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.67
|
| Rate for Payer: Cash Price |
$146.32
|
| Rate for Payer: Centivo All Commercial |
$120.36
|
| Rate for Payer: Cigna All Commercial |
$203.67
|
| Rate for Payer: CORVEL All Commercial |
$219.48
|
| Rate for Payer: Coventry All Commercial |
$207.68
|
| Rate for Payer: Encore All Commercial |
$217.24
|
| Rate for Payer: Frontpath All Commercial |
$217.12
|
| Rate for Payer: Humana ChoiceCare |
$203.83
|
| Rate for Payer: Humana Medicare |
$120.36
|
| Rate for Payer: Lucent All Commercial |
$120.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.40
|
| Rate for Payer: PHCS All Commercial |
$177.00
|
| Rate for Payer: PHP All Commercial |
$178.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.04
|
| Rate for Payer: Sagamore Health Network All Products |
$182.19
|
| Rate for Payer: Signature Care EPO |
$195.88
|
| Rate for Payer: Signature Care PPO |
$207.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.60
|
| Rate for Payer: United Healthcare Commercial |
$185.97
|
| Rate for Payer: United Healthcare Medicare |
$77.88
|
|
