|
HC AEROSOL/MDI INSTRUCTION
|
Facility
|
IP
|
$91.76
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
1604664
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Aetna Commercial |
$79.28
|
| Rate for Payer: Cash Price |
$55.06
|
| Rate for Payer: Cigna All Commercial |
$79.19
|
| Rate for Payer: CORVEL All Commercial |
$85.34
|
| Rate for Payer: Coventry All Commercial |
$80.75
|
| Rate for Payer: Encore All Commercial |
$84.47
|
| Rate for Payer: Frontpath All Commercial |
$84.42
|
| Rate for Payer: Humana ChoiceCare |
$79.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.58
|
| Rate for Payer: PHCS All Commercial |
$68.82
|
| Rate for Payer: PHP All Commercial |
$69.59
|
| Rate for Payer: Sagamore Health Network All Products |
$70.84
|
| Rate for Payer: Signature Care EPO |
$76.16
|
| Rate for Payer: Signature Care PPO |
$80.75
|
| Rate for Payer: United Healthcare Commercial |
$72.31
|
|
|
HC AEROSOL/MDI INSTRUCTION
|
Facility
|
OP
|
$91.76
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
1604664
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Aetna Commercial |
$77.45
|
| Rate for Payer: Aetna Medicare |
$29.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.30
|
| Rate for Payer: Cash Price |
$55.06
|
| Rate for Payer: Cash Price |
$55.06
|
| Rate for Payer: Centivo All Commercial |
$49.92
|
| Rate for Payer: Cigna All Commercial |
$79.19
|
| Rate for Payer: CORVEL All Commercial |
$85.34
|
| Rate for Payer: Coventry All Commercial |
$80.75
|
| Rate for Payer: Encore All Commercial |
$84.47
|
| Rate for Payer: Frontpath All Commercial |
$84.42
|
| Rate for Payer: Humana ChoiceCare |
$79.25
|
| Rate for Payer: Humana Medicare |
$29.36
|
| Rate for Payer: Lucent All Commercial |
$49.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.58
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$68.82
|
| Rate for Payer: PHP All Commercial |
$69.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.79
|
| Rate for Payer: Sagamore Health Network All Products |
$70.84
|
| Rate for Payer: Signature Care EPO |
$76.16
|
| Rate for Payer: Signature Care PPO |
$80.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$72.31
|
| Rate for Payer: United Healthcare Medicare |
$29.36
|
|
|
HC AEROSOL TX SUBSEQUENT
|
Facility
|
OP
|
$169.33
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
1706002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Aetna Medicare |
$54.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Centivo All Commercial |
$92.12
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Humana Medicare |
$54.19
|
| Rate for Payer: Lucent All Commercial |
$92.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.04
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.93
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
| Rate for Payer: United Healthcare Medicare |
$54.19
|
|
|
HC AEROSOL TX SUBSEQUENT
|
Facility
|
IP
|
$169.33
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
1706002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
|
|
HC AFP-TM
|
Facility
|
OP
|
$214.72
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
63001155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$199.69 |
| Rate for Payer: Aetna Commercial |
$181.22
|
| Rate for Payer: Aetna Medicare |
$68.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$98.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.58
|
| Rate for Payer: Cash Price |
$128.83
|
| Rate for Payer: Cash Price |
$128.83
|
| Rate for Payer: Centivo All Commercial |
$116.81
|
| Rate for Payer: Cigna All Commercial |
$185.30
|
| Rate for Payer: CORVEL All Commercial |
$199.69
|
| Rate for Payer: Coventry All Commercial |
$188.95
|
| Rate for Payer: Encore All Commercial |
$197.65
|
| Rate for Payer: Frontpath All Commercial |
$197.54
|
| Rate for Payer: Humana ChoiceCare |
$185.45
|
| Rate for Payer: Humana Medicare |
$68.71
|
| Rate for Payer: Lucent All Commercial |
$116.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.25
|
| Rate for Payer: Managed Health Services Medicaid |
$16.77
|
| Rate for Payer: MDWise Medicaid |
$16.77
|
| Rate for Payer: PHCS All Commercial |
$161.04
|
| Rate for Payer: PHP All Commercial |
$162.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.74
|
| Rate for Payer: Sagamore Health Network All Products |
$165.76
|
| Rate for Payer: Signature Care EPO |
$178.22
|
| Rate for Payer: Signature Care PPO |
$188.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.51
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
| Rate for Payer: United Healthcare Medicare |
$68.71
|
|
|
HC AFP-TM
|
Facility
|
IP
|
$214.72
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
63001155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.04 |
| Max. Negotiated Rate |
$199.69 |
| Rate for Payer: Aetna Commercial |
$185.52
|
| Rate for Payer: Cash Price |
$128.83
|
| Rate for Payer: Cigna All Commercial |
$185.30
|
| Rate for Payer: CORVEL All Commercial |
$199.69
|
| Rate for Payer: Coventry All Commercial |
$188.95
|
| Rate for Payer: Encore All Commercial |
$197.65
|
| Rate for Payer: Frontpath All Commercial |
$197.54
|
| Rate for Payer: Humana ChoiceCare |
$185.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.25
|
| Rate for Payer: PHCS All Commercial |
$161.04
|
| Rate for Payer: PHP All Commercial |
$162.84
|
| Rate for Payer: Sagamore Health Network All Products |
$165.76
|
| Rate for Payer: Signature Care EPO |
$178.22
|
| Rate for Payer: Signature Care PPO |
$188.95
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
|
|
HC AIRWAY LMA MERCURY MED SIZE 1.5
|
Facility
|
IP
|
$57.82
|
|
| Hospital Charge Code |
41601924
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.37 |
| Max. Negotiated Rate |
$53.77 |
| Rate for Payer: Aetna Commercial |
$49.96
|
| Rate for Payer: Cash Price |
$34.69
|
| Rate for Payer: Cigna All Commercial |
$49.90
|
| Rate for Payer: CORVEL All Commercial |
$53.77
|
| Rate for Payer: Coventry All Commercial |
$50.88
|
| Rate for Payer: Encore All Commercial |
$53.22
|
| Rate for Payer: Frontpath All Commercial |
$53.19
|
| Rate for Payer: Humana ChoiceCare |
$49.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.04
|
| Rate for Payer: PHCS All Commercial |
$43.37
|
| Rate for Payer: PHP All Commercial |
$43.85
|
| Rate for Payer: Sagamore Health Network All Products |
$44.64
|
| Rate for Payer: Signature Care EPO |
$47.99
|
| Rate for Payer: Signature Care PPO |
$50.88
|
| Rate for Payer: United Healthcare Commercial |
$45.56
|
|
|
HC AIRWAY LMA MERCURY MED SIZE 1.5
|
Facility
|
OP
|
$57.82
|
|
| Hospital Charge Code |
41601924
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$53.77 |
| Rate for Payer: Aetna Commercial |
$48.80
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.35
|
| Rate for Payer: Cash Price |
$34.69
|
| Rate for Payer: Cash Price |
$34.69
|
| Rate for Payer: Centivo All Commercial |
$31.45
|
| Rate for Payer: Cigna All Commercial |
$49.90
|
| Rate for Payer: CORVEL All Commercial |
$53.77
|
| Rate for Payer: Coventry All Commercial |
$50.88
|
| Rate for Payer: Encore All Commercial |
$53.22
|
| Rate for Payer: Frontpath All Commercial |
$53.19
|
| Rate for Payer: Humana ChoiceCare |
$49.94
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Lucent All Commercial |
$31.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.04
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$43.37
|
| Rate for Payer: PHP All Commercial |
$43.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.55
|
| Rate for Payer: Sagamore Health Network All Products |
$44.64
|
| Rate for Payer: Signature Care EPO |
$47.99
|
| Rate for Payer: Signature Care PPO |
$50.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.15
|
| Rate for Payer: United Healthcare Commercial |
$45.56
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
|
|
HC AIRWAY LMA SUPREME #3
|
Facility
|
OP
|
$83.65
|
|
| Hospital Charge Code |
41601204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.93 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: Aetna Medicare |
$26.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.44
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Centivo All Commercial |
$45.51
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Humana Medicare |
$26.77
|
| Rate for Payer: Lucent All Commercial |
$45.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.10
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
| Rate for Payer: United Healthcare Medicare |
$26.77
|
|
|
HC AIRWAY LMA SUPREME #3
|
Facility
|
IP
|
$83.65
|
|
| Hospital Charge Code |
41601204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
|
|
HC AIRWAY LMA SUPREME #4
|
Facility
|
IP
|
$83.65
|
|
| Hospital Charge Code |
41601205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
|
|
HC AIRWAY LMA SUPREME #4
|
Facility
|
OP
|
$83.65
|
|
| Hospital Charge Code |
41601205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.93 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: Aetna Medicare |
$26.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.44
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Centivo All Commercial |
$45.51
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Humana Medicare |
$26.77
|
| Rate for Payer: Lucent All Commercial |
$45.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.10
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
| Rate for Payer: United Healthcare Medicare |
$26.77
|
|
|
HC AIRWAY LMA SUPREME #5
|
Facility
|
OP
|
$83.65
|
|
| Hospital Charge Code |
41601206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.93 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: Aetna Medicare |
$26.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.44
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Centivo All Commercial |
$45.51
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Humana Medicare |
$26.77
|
| Rate for Payer: Lucent All Commercial |
$45.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.10
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
| Rate for Payer: United Healthcare Medicare |
$26.77
|
|
|
HC AIRWAY LMA SUPREME #5
|
Facility
|
IP
|
$83.65
|
|
| Hospital Charge Code |
41601206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
|
|
HC AIRWAY LMA UNIQUE #3 CHILD
|
Facility
|
IP
|
$38.50
|
|
| Hospital Charge Code |
41601207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.95
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
|
|
HC AIRWAY LMA UNIQUE #3 CHILD
|
Facility
|
OP
|
$38.50
|
|
| Hospital Charge Code |
41601207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Centivo All Commercial |
$20.94
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Humana Medicare |
$12.32
|
| Rate for Payer: Lucent All Commercial |
$20.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.02
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.95
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.73
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
|
|
HC AIRWAY LMA UNIQUE #4 ADULT
|
Facility
|
IP
|
$38.50
|
|
| Hospital Charge Code |
41601208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.95
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
|
|
HC AIRWAY LMA UNIQUE #4 ADULT
|
Facility
|
OP
|
$38.50
|
|
| Hospital Charge Code |
41601208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Centivo All Commercial |
$20.94
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Humana Medicare |
$12.32
|
| Rate for Payer: Lucent All Commercial |
$20.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.02
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.95
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.73
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
|
|
HC AIRWAY LMA UNIQUE #5 ADULT
|
Facility
|
OP
|
$38.50
|
|
| Hospital Charge Code |
41601209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Centivo All Commercial |
$20.94
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Humana Medicare |
$12.32
|
| Rate for Payer: Lucent All Commercial |
$20.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.02
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.95
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.73
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
|
|
HC AIRWAY LMA UNIQUE #5 ADULT
|
Facility
|
IP
|
$38.50
|
|
| Hospital Charge Code |
41601209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.95
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
|
|
HC AIRWAY NASOPHARYNGEAL 18FR
|
Facility
|
IP
|
$23.98
|
|
| Hospital Charge Code |
41603470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Aetna Commercial |
$20.72
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cigna All Commercial |
$20.69
|
| Rate for Payer: CORVEL All Commercial |
$22.30
|
| Rate for Payer: Coventry All Commercial |
$21.10
|
| Rate for Payer: Encore All Commercial |
$22.07
|
| Rate for Payer: Frontpath All Commercial |
$22.06
|
| Rate for Payer: Humana ChoiceCare |
$20.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.58
|
| Rate for Payer: PHCS All Commercial |
$17.98
|
| Rate for Payer: PHP All Commercial |
$18.19
|
| Rate for Payer: Sagamore Health Network All Products |
$18.51
|
| Rate for Payer: Signature Care EPO |
$19.90
|
| Rate for Payer: Signature Care PPO |
$21.10
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
|
|
HC AIRWAY NASOPHARYNGEAL 18FR
|
Facility
|
OP
|
$23.98
|
|
| Hospital Charge Code |
41603470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$20.24
|
| Rate for Payer: Aetna Medicare |
$7.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.44
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centivo All Commercial |
$13.05
|
| Rate for Payer: Cigna All Commercial |
$20.69
|
| Rate for Payer: CORVEL All Commercial |
$22.30
|
| Rate for Payer: Coventry All Commercial |
$21.10
|
| Rate for Payer: Encore All Commercial |
$22.07
|
| Rate for Payer: Frontpath All Commercial |
$22.06
|
| Rate for Payer: Humana ChoiceCare |
$20.71
|
| Rate for Payer: Humana Medicare |
$7.67
|
| Rate for Payer: Lucent All Commercial |
$13.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.58
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.98
|
| Rate for Payer: PHP All Commercial |
$18.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.35
|
| Rate for Payer: Sagamore Health Network All Products |
$18.51
|
| Rate for Payer: Signature Care EPO |
$19.90
|
| Rate for Payer: Signature Care PPO |
$21.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.38
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
| Rate for Payer: United Healthcare Medicare |
$7.67
|
|
|
HC AIRWAY NASOPHARYNGEAL 26FR
|
Facility
|
OP
|
$17.71
|
|
| Hospital Charge Code |
41601004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.95
|
| Rate for Payer: Aetna Medicare |
$5.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.23
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Centivo All Commercial |
$9.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Humana Medicare |
$5.67
|
| Rate for Payer: Lucent All Commercial |
$9.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.91
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.05
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
| Rate for Payer: United Healthcare Medicare |
$5.67
|
|
|
HC AIRWAY NASOPHARYNGEAL 26FR
|
Facility
|
IP
|
$17.71
|
|
| Hospital Charge Code |
41601004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
|
|
HC AIRWAY NASOPHARYNGEAL 28FR
|
Facility
|
IP
|
$17.71
|
|
| Hospital Charge Code |
41601005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
|
