|
HC COLLAR BUTTON SHEEHY
|
Facility
OP
|
$107.80
|
|
| Hospital Charge Code |
41602433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$90.98
|
| Rate for Payer: Aetna Medicare |
$35.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.13
|
| Rate for Payer: Cash Price |
$66.84
|
| Rate for Payer: Cash Price |
$66.84
|
| Rate for Payer: Centivo All Commercial |
$54.98
|
| Rate for Payer: Cigna All Commercial |
$93.03
|
| Rate for Payer: CORVEL All Commercial |
$100.25
|
| Rate for Payer: Coventry All Commercial |
$94.86
|
| Rate for Payer: Encore All Commercial |
$99.23
|
| Rate for Payer: Frontpath All Commercial |
$99.18
|
| Rate for Payer: Humana ChoiceCare |
$93.11
|
| Rate for Payer: Humana Medicare |
$54.98
|
| Rate for Payer: Lucent All Commercial |
$54.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$80.85
|
| Rate for Payer: PHP All Commercial |
$81.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.04
|
| Rate for Payer: Sagamore Health Network All Products |
$83.22
|
| Rate for Payer: Signature Care EPO |
$89.47
|
| Rate for Payer: Signature Care PPO |
$94.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.63
|
| Rate for Payer: United Healthcare Commercial |
$84.95
|
| Rate for Payer: United Healthcare Medicare |
$35.57
|
|
|
HC COLLAR BUTTON SHEEHY
|
Facility
IP
|
$107.80
|
|
| Hospital Charge Code |
41602433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.85 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna Commercial |
$93.14
|
| Rate for Payer: Cash Price |
$66.84
|
| Rate for Payer: Cigna All Commercial |
$93.03
|
| Rate for Payer: CORVEL All Commercial |
$100.25
|
| Rate for Payer: Coventry All Commercial |
$94.86
|
| Rate for Payer: Encore All Commercial |
$99.23
|
| Rate for Payer: Frontpath All Commercial |
$99.18
|
| Rate for Payer: Humana ChoiceCare |
$93.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.02
|
| Rate for Payer: PHCS All Commercial |
$80.85
|
| Rate for Payer: PHP All Commercial |
$81.76
|
| Rate for Payer: Sagamore Health Network All Products |
$83.22
|
| Rate for Payer: Signature Care EPO |
$89.47
|
| Rate for Payer: Signature Care PPO |
$94.86
|
| Rate for Payer: United Healthcare Commercial |
$84.95
|
|
|
HC COLLAR CERV NECKLESS
|
Facility
OP
|
$47.18
|
|
| Hospital Charge Code |
41601841
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$39.82
|
| Rate for Payer: Aetna Medicare |
$15.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.13
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Centivo All Commercial |
$24.06
|
| Rate for Payer: Cigna All Commercial |
$40.72
|
| Rate for Payer: CORVEL All Commercial |
$43.88
|
| Rate for Payer: Coventry All Commercial |
$41.52
|
| Rate for Payer: Encore All Commercial |
$43.43
|
| Rate for Payer: Frontpath All Commercial |
$43.41
|
| Rate for Payer: Humana ChoiceCare |
$40.75
|
| Rate for Payer: Humana Medicare |
$24.06
|
| Rate for Payer: Lucent All Commercial |
$24.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.46
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$35.38
|
| Rate for Payer: PHP All Commercial |
$35.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.40
|
| Rate for Payer: Sagamore Health Network All Products |
$36.42
|
| Rate for Payer: Signature Care EPO |
$39.16
|
| Rate for Payer: Signature Care PPO |
$41.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.10
|
| Rate for Payer: United Healthcare Commercial |
$37.18
|
| Rate for Payer: United Healthcare Medicare |
$15.57
|
|
|
HC COLLAR CERV NECKLESS
|
Facility
IP
|
$47.18
|
|
| Hospital Charge Code |
41601841
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$40.76
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna All Commercial |
$40.72
|
| Rate for Payer: CORVEL All Commercial |
$43.88
|
| Rate for Payer: Coventry All Commercial |
$41.52
|
| Rate for Payer: Encore All Commercial |
$43.43
|
| Rate for Payer: Frontpath All Commercial |
$43.41
|
| Rate for Payer: Humana ChoiceCare |
$40.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.46
|
| Rate for Payer: PHCS All Commercial |
$35.38
|
| Rate for Payer: PHP All Commercial |
$35.78
|
| Rate for Payer: Sagamore Health Network All Products |
$36.42
|
| Rate for Payer: Signature Care EPO |
$39.16
|
| Rate for Payer: Signature Care PPO |
$41.52
|
| Rate for Payer: United Healthcare Commercial |
$37.18
|
|
|
HC COLLAR CERV REG
|
Facility
IP
|
$53.13
|
|
| Hospital Charge Code |
41601842
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.85 |
| Max. Negotiated Rate |
$49.41 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Cash Price |
$32.94
|
| Rate for Payer: Cigna All Commercial |
$45.85
|
| Rate for Payer: CORVEL All Commercial |
$49.41
|
| Rate for Payer: Coventry All Commercial |
$46.75
|
| Rate for Payer: Encore All Commercial |
$48.91
|
| Rate for Payer: Frontpath All Commercial |
$48.88
|
| Rate for Payer: Humana ChoiceCare |
$45.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.82
|
| Rate for Payer: PHCS All Commercial |
$39.85
|
| Rate for Payer: PHP All Commercial |
$40.29
|
| Rate for Payer: Sagamore Health Network All Products |
$41.02
|
| Rate for Payer: Signature Care EPO |
$44.10
|
| Rate for Payer: Signature Care PPO |
$46.75
|
| Rate for Payer: United Healthcare Commercial |
$41.87
|
|
|
HC COLLAR CERV REG
|
Facility
OP
|
$53.13
|
|
| Hospital Charge Code |
41601842
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.53 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$44.84
|
| Rate for Payer: Aetna Medicare |
$17.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.29
|
| Rate for Payer: Cash Price |
$32.94
|
| Rate for Payer: Cash Price |
$32.94
|
| Rate for Payer: Centivo All Commercial |
$27.10
|
| Rate for Payer: Cigna All Commercial |
$45.85
|
| Rate for Payer: CORVEL All Commercial |
$49.41
|
| Rate for Payer: Coventry All Commercial |
$46.75
|
| Rate for Payer: Encore All Commercial |
$48.91
|
| Rate for Payer: Frontpath All Commercial |
$48.88
|
| Rate for Payer: Humana ChoiceCare |
$45.89
|
| Rate for Payer: Humana Medicare |
$27.10
|
| Rate for Payer: Lucent All Commercial |
$27.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.82
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$39.85
|
| Rate for Payer: PHP All Commercial |
$40.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.72
|
| Rate for Payer: Sagamore Health Network All Products |
$41.02
|
| Rate for Payer: Signature Care EPO |
$44.10
|
| Rate for Payer: Signature Care PPO |
$46.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.16
|
| Rate for Payer: United Healthcare Commercial |
$41.87
|
| Rate for Payer: United Healthcare Medicare |
$17.53
|
|
|
HC COLLAR CERV SHORT
|
Facility
IP
|
$39.55
|
|
| Hospital Charge Code |
41602229
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$36.78 |
| Rate for Payer: Aetna Commercial |
$34.17
|
| Rate for Payer: Cash Price |
$24.52
|
| Rate for Payer: Cigna All Commercial |
$34.13
|
| Rate for Payer: CORVEL All Commercial |
$36.78
|
| Rate for Payer: Coventry All Commercial |
$34.80
|
| Rate for Payer: Encore All Commercial |
$36.41
|
| Rate for Payer: Frontpath All Commercial |
$36.39
|
| Rate for Payer: Humana ChoiceCare |
$34.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.60
|
| Rate for Payer: PHCS All Commercial |
$29.66
|
| Rate for Payer: PHP All Commercial |
$29.99
|
| Rate for Payer: Sagamore Health Network All Products |
$30.53
|
| Rate for Payer: Signature Care EPO |
$32.83
|
| Rate for Payer: Signature Care PPO |
$34.80
|
| Rate for Payer: United Healthcare Commercial |
$31.17
|
|
|
HC COLLAR CERV SHORT
|
Facility
OP
|
$39.55
|
|
| Hospital Charge Code |
41602229
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$33.38
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.36
|
| Rate for Payer: Cash Price |
$24.52
|
| Rate for Payer: Cash Price |
$24.52
|
| Rate for Payer: Centivo All Commercial |
$20.17
|
| Rate for Payer: Cigna All Commercial |
$34.13
|
| Rate for Payer: CORVEL All Commercial |
$36.78
|
| Rate for Payer: Coventry All Commercial |
$34.80
|
| Rate for Payer: Encore All Commercial |
$36.41
|
| Rate for Payer: Frontpath All Commercial |
$36.39
|
| Rate for Payer: Humana ChoiceCare |
$34.16
|
| Rate for Payer: Humana Medicare |
$20.17
|
| Rate for Payer: Lucent All Commercial |
$20.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.60
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$29.66
|
| Rate for Payer: PHP All Commercial |
$29.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.42
|
| Rate for Payer: Sagamore Health Network All Products |
$30.53
|
| Rate for Payer: Signature Care EPO |
$32.83
|
| Rate for Payer: Signature Care PPO |
$34.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.62
|
| Rate for Payer: United Healthcare Commercial |
$31.17
|
| Rate for Payer: United Healthcare Medicare |
$13.05
|
|
|
HC COLLAR EXTRICATION TALL
|
Facility
OP
|
$50.75
|
|
| Hospital Charge Code |
41602215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$42.83
|
| Rate for Payer: Aetna Medicare |
$16.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.42
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Centivo All Commercial |
$25.88
|
| Rate for Payer: Cigna All Commercial |
$43.80
|
| Rate for Payer: CORVEL All Commercial |
$47.20
|
| Rate for Payer: Coventry All Commercial |
$44.66
|
| Rate for Payer: Encore All Commercial |
$46.72
|
| Rate for Payer: Frontpath All Commercial |
$46.69
|
| Rate for Payer: Humana ChoiceCare |
$43.83
|
| Rate for Payer: Humana Medicare |
$25.88
|
| Rate for Payer: Lucent All Commercial |
$25.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$38.06
|
| Rate for Payer: PHP All Commercial |
$38.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.79
|
| Rate for Payer: Sagamore Health Network All Products |
$39.18
|
| Rate for Payer: Signature Care EPO |
$42.12
|
| Rate for Payer: Signature Care PPO |
$44.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.14
|
| Rate for Payer: United Healthcare Commercial |
$39.99
|
| Rate for Payer: United Healthcare Medicare |
$16.75
|
|
|
HC COLLAR EXTRICATION TALL
|
Facility
IP
|
$50.75
|
|
| Hospital Charge Code |
41602215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.06 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Aetna Commercial |
$43.85
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cigna All Commercial |
$43.80
|
| Rate for Payer: CORVEL All Commercial |
$47.20
|
| Rate for Payer: Coventry All Commercial |
$44.66
|
| Rate for Payer: Encore All Commercial |
$46.72
|
| Rate for Payer: Frontpath All Commercial |
$46.69
|
| Rate for Payer: Humana ChoiceCare |
$43.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.68
|
| Rate for Payer: PHCS All Commercial |
$38.06
|
| Rate for Payer: PHP All Commercial |
$38.49
|
| Rate for Payer: Sagamore Health Network All Products |
$39.18
|
| Rate for Payer: Signature Care EPO |
$42.12
|
| Rate for Payer: Signature Care PPO |
$44.66
|
| Rate for Payer: United Healthcare Commercial |
$39.99
|
|
|
HC COLLAR PHIL INFANT
|
Facility
IP
|
$121.59
|
|
| Hospital Charge Code |
41602225
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.19 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$105.05
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$113.08
|
| Rate for Payer: Coventry All Commercial |
$107.00
|
| Rate for Payer: Encore All Commercial |
$111.92
|
| Rate for Payer: Frontpath All Commercial |
$111.86
|
| Rate for Payer: Humana ChoiceCare |
$105.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.43
|
| Rate for Payer: PHCS All Commercial |
$91.19
|
| Rate for Payer: PHP All Commercial |
$92.21
|
| Rate for Payer: Sagamore Health Network All Products |
$93.87
|
| Rate for Payer: Signature Care EPO |
$100.92
|
| Rate for Payer: Signature Care PPO |
$107.00
|
| Rate for Payer: United Healthcare Commercial |
$95.81
|
|
|
HC COLLAR PHIL INFANT
|
Facility
OP
|
$121.59
|
|
| Hospital Charge Code |
41602225
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$102.62
|
| Rate for Payer: Aetna Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.14
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Centivo All Commercial |
$62.01
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$113.08
|
| Rate for Payer: Coventry All Commercial |
$107.00
|
| Rate for Payer: Encore All Commercial |
$111.92
|
| Rate for Payer: Frontpath All Commercial |
$111.86
|
| Rate for Payer: Humana ChoiceCare |
$105.02
|
| Rate for Payer: Humana Medicare |
$62.01
|
| Rate for Payer: Lucent All Commercial |
$62.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.43
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$91.19
|
| Rate for Payer: PHP All Commercial |
$92.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.42
|
| Rate for Payer: Sagamore Health Network All Products |
$93.87
|
| Rate for Payer: Signature Care EPO |
$100.92
|
| Rate for Payer: Signature Care PPO |
$107.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.35
|
| Rate for Payer: United Healthcare Commercial |
$95.81
|
| Rate for Payer: United Healthcare Medicare |
$40.12
|
|
|
HC COLLAR PHIL LG
|
Facility
IP
|
$121.59
|
|
| Hospital Charge Code |
41602226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.19 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$105.05
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$113.08
|
| Rate for Payer: Coventry All Commercial |
$107.00
|
| Rate for Payer: Encore All Commercial |
$111.92
|
| Rate for Payer: Frontpath All Commercial |
$111.86
|
| Rate for Payer: Humana ChoiceCare |
$105.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.43
|
| Rate for Payer: PHCS All Commercial |
$91.19
|
| Rate for Payer: PHP All Commercial |
$92.21
|
| Rate for Payer: Sagamore Health Network All Products |
$93.87
|
| Rate for Payer: Signature Care EPO |
$100.92
|
| Rate for Payer: Signature Care PPO |
$107.00
|
| Rate for Payer: United Healthcare Commercial |
$95.81
|
|
|
HC COLLAR PHIL LG
|
Facility
OP
|
$121.59
|
|
| Hospital Charge Code |
41602226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$102.62
|
| Rate for Payer: Aetna Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.14
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Centivo All Commercial |
$62.01
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$113.08
|
| Rate for Payer: Coventry All Commercial |
$107.00
|
| Rate for Payer: Encore All Commercial |
$111.92
|
| Rate for Payer: Frontpath All Commercial |
$111.86
|
| Rate for Payer: Humana ChoiceCare |
$105.02
|
| Rate for Payer: Humana Medicare |
$62.01
|
| Rate for Payer: Lucent All Commercial |
$62.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.43
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$91.19
|
| Rate for Payer: PHP All Commercial |
$92.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.42
|
| Rate for Payer: Sagamore Health Network All Products |
$93.87
|
| Rate for Payer: Signature Care EPO |
$100.92
|
| Rate for Payer: Signature Care PPO |
$107.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.35
|
| Rate for Payer: United Healthcare Commercial |
$95.81
|
| Rate for Payer: United Healthcare Medicare |
$40.12
|
|
|
HC COLLAR PHIL MED
|
Facility
OP
|
$121.59
|
|
| Hospital Charge Code |
41601840
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$102.62
|
| Rate for Payer: Aetna Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.14
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Centivo All Commercial |
$62.01
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$113.08
|
| Rate for Payer: Coventry All Commercial |
$107.00
|
| Rate for Payer: Encore All Commercial |
$111.92
|
| Rate for Payer: Frontpath All Commercial |
$111.86
|
| Rate for Payer: Humana ChoiceCare |
$105.02
|
| Rate for Payer: Humana Medicare |
$62.01
|
| Rate for Payer: Lucent All Commercial |
$62.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.43
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$91.19
|
| Rate for Payer: PHP All Commercial |
$92.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.42
|
| Rate for Payer: Sagamore Health Network All Products |
$93.87
|
| Rate for Payer: Signature Care EPO |
$100.92
|
| Rate for Payer: Signature Care PPO |
$107.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.35
|
| Rate for Payer: United Healthcare Commercial |
$95.81
|
| Rate for Payer: United Healthcare Medicare |
$40.12
|
|
|
HC COLLAR PHIL MED
|
Facility
IP
|
$121.59
|
|
| Hospital Charge Code |
41601840
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.19 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$105.05
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$113.08
|
| Rate for Payer: Coventry All Commercial |
$107.00
|
| Rate for Payer: Encore All Commercial |
$111.92
|
| Rate for Payer: Frontpath All Commercial |
$111.86
|
| Rate for Payer: Humana ChoiceCare |
$105.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.43
|
| Rate for Payer: PHCS All Commercial |
$91.19
|
| Rate for Payer: PHP All Commercial |
$92.21
|
| Rate for Payer: Sagamore Health Network All Products |
$93.87
|
| Rate for Payer: Signature Care EPO |
$100.92
|
| Rate for Payer: Signature Care PPO |
$107.00
|
| Rate for Payer: United Healthcare Commercial |
$95.81
|
|
|
HC COLLAR PHIL PED
|
Facility
IP
|
$121.59
|
|
| Hospital Charge Code |
41602227
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.19 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$105.05
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$113.08
|
| Rate for Payer: Coventry All Commercial |
$107.00
|
| Rate for Payer: Encore All Commercial |
$111.92
|
| Rate for Payer: Frontpath All Commercial |
$111.86
|
| Rate for Payer: Humana ChoiceCare |
$105.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.43
|
| Rate for Payer: PHCS All Commercial |
$91.19
|
| Rate for Payer: PHP All Commercial |
$92.21
|
| Rate for Payer: Sagamore Health Network All Products |
$93.87
|
| Rate for Payer: Signature Care EPO |
$100.92
|
| Rate for Payer: Signature Care PPO |
$107.00
|
| Rate for Payer: United Healthcare Commercial |
$95.81
|
|
|
HC COLLAR PHIL PED
|
Facility
OP
|
$121.59
|
|
| Hospital Charge Code |
41602227
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$102.62
|
| Rate for Payer: Aetna Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.14
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Centivo All Commercial |
$62.01
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$113.08
|
| Rate for Payer: Coventry All Commercial |
$107.00
|
| Rate for Payer: Encore All Commercial |
$111.92
|
| Rate for Payer: Frontpath All Commercial |
$111.86
|
| Rate for Payer: Humana ChoiceCare |
$105.02
|
| Rate for Payer: Humana Medicare |
$62.01
|
| Rate for Payer: Lucent All Commercial |
$62.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.43
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$91.19
|
| Rate for Payer: PHP All Commercial |
$92.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.42
|
| Rate for Payer: Sagamore Health Network All Products |
$93.87
|
| Rate for Payer: Signature Care EPO |
$100.92
|
| Rate for Payer: Signature Care PPO |
$107.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.35
|
| Rate for Payer: United Healthcare Commercial |
$95.81
|
| Rate for Payer: United Healthcare Medicare |
$40.12
|
|
|
HC COLLAR PHIL SM
|
Facility
OP
|
$121.59
|
|
| Hospital Charge Code |
41602228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$102.62
|
| Rate for Payer: Aetna Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.14
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Centivo All Commercial |
$62.01
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$113.08
|
| Rate for Payer: Coventry All Commercial |
$107.00
|
| Rate for Payer: Encore All Commercial |
$111.92
|
| Rate for Payer: Frontpath All Commercial |
$111.86
|
| Rate for Payer: Humana ChoiceCare |
$105.02
|
| Rate for Payer: Humana Medicare |
$62.01
|
| Rate for Payer: Lucent All Commercial |
$62.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.43
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$91.19
|
| Rate for Payer: PHP All Commercial |
$92.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.42
|
| Rate for Payer: Sagamore Health Network All Products |
$93.87
|
| Rate for Payer: Signature Care EPO |
$100.92
|
| Rate for Payer: Signature Care PPO |
$107.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.35
|
| Rate for Payer: United Healthcare Commercial |
$95.81
|
| Rate for Payer: United Healthcare Medicare |
$40.12
|
|
|
HC COLLAR PHIL SM
|
Facility
IP
|
$121.59
|
|
| Hospital Charge Code |
41602228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.19 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$105.05
|
| Rate for Payer: Cash Price |
$75.39
|
| Rate for Payer: Cigna All Commercial |
$104.93
|
| Rate for Payer: CORVEL All Commercial |
$113.08
|
| Rate for Payer: Coventry All Commercial |
$107.00
|
| Rate for Payer: Encore All Commercial |
$111.92
|
| Rate for Payer: Frontpath All Commercial |
$111.86
|
| Rate for Payer: Humana ChoiceCare |
$105.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.43
|
| Rate for Payer: PHCS All Commercial |
$91.19
|
| Rate for Payer: PHP All Commercial |
$92.21
|
| Rate for Payer: Sagamore Health Network All Products |
$93.87
|
| Rate for Payer: Signature Care EPO |
$100.92
|
| Rate for Payer: Signature Care PPO |
$107.00
|
| Rate for Payer: United Healthcare Commercial |
$95.81
|
|
|
HC COLONY COUNT
|
Facility
OP
|
$74.05
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
63001075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Aetna Commercial |
$62.50
|
| Rate for Payer: Aetna Medicare |
$24.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.88
|
| Rate for Payer: Cash Price |
$45.91
|
| Rate for Payer: Cash Price |
$45.91
|
| Rate for Payer: Centivo All Commercial |
$37.77
|
| Rate for Payer: Cigna All Commercial |
$63.91
|
| Rate for Payer: CORVEL All Commercial |
$68.87
|
| Rate for Payer: Coventry All Commercial |
$65.17
|
| Rate for Payer: Encore All Commercial |
$68.16
|
| Rate for Payer: Frontpath All Commercial |
$68.13
|
| Rate for Payer: Humana ChoiceCare |
$63.96
|
| Rate for Payer: Humana Medicare |
$37.77
|
| Rate for Payer: Lucent All Commercial |
$37.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.65
|
| Rate for Payer: Managed Health Services Medicaid |
$8.07
|
| Rate for Payer: MDWise Medicaid |
$8.07
|
| Rate for Payer: PHCS All Commercial |
$55.54
|
| Rate for Payer: PHP All Commercial |
$56.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.88
|
| Rate for Payer: Sagamore Health Network All Products |
$57.17
|
| Rate for Payer: Signature Care EPO |
$61.46
|
| Rate for Payer: Signature Care PPO |
$65.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.94
|
| Rate for Payer: United Healthcare Commercial |
$58.35
|
| Rate for Payer: United Healthcare Medicare |
$24.44
|
|
|
HC COLONY COUNT
|
Facility
IP
|
$74.05
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
63001075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.54 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Aetna Commercial |
$63.98
|
| Rate for Payer: Cash Price |
$45.91
|
| Rate for Payer: Cigna All Commercial |
$63.91
|
| Rate for Payer: CORVEL All Commercial |
$68.87
|
| Rate for Payer: Coventry All Commercial |
$65.17
|
| Rate for Payer: Encore All Commercial |
$68.16
|
| Rate for Payer: Frontpath All Commercial |
$68.13
|
| Rate for Payer: Humana ChoiceCare |
$63.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.65
|
| Rate for Payer: PHCS All Commercial |
$55.54
|
| Rate for Payer: PHP All Commercial |
$56.16
|
| Rate for Payer: Sagamore Health Network All Products |
$57.17
|
| Rate for Payer: Signature Care EPO |
$61.46
|
| Rate for Payer: Signature Care PPO |
$65.17
|
| Rate for Payer: United Healthcare Commercial |
$58.35
|
|
|
HC COLOR FLOW DOPPLER
|
Facility
OP
|
$629.34
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
00863325
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$207.68 |
| Max. Negotiated Rate |
$788.70 |
| Rate for Payer: Aetna Commercial |
$531.16
|
| Rate for Payer: Aetna Medicare |
$207.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$207.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$361.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$238.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.45
|
| Rate for Payer: Cash Price |
$390.19
|
| Rate for Payer: Cash Price |
$390.19
|
| Rate for Payer: Centivo All Commercial |
$320.96
|
| Rate for Payer: Cigna All Commercial |
$543.12
|
| Rate for Payer: CORVEL All Commercial |
$585.29
|
| Rate for Payer: Coventry All Commercial |
$553.82
|
| Rate for Payer: Encore All Commercial |
$579.31
|
| Rate for Payer: Frontpath All Commercial |
$578.99
|
| Rate for Payer: Humana ChoiceCare |
$543.56
|
| Rate for Payer: Humana Medicare |
$320.96
|
| Rate for Payer: Lucent All Commercial |
$320.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.41
|
| Rate for Payer: Managed Health Services Medicaid |
$788.70
|
| Rate for Payer: MDWise Medicaid |
$788.70
|
| Rate for Payer: PHCS All Commercial |
$472.00
|
| Rate for Payer: PHP All Commercial |
$477.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.44
|
| Rate for Payer: Sagamore Health Network All Products |
$485.85
|
| Rate for Payer: Signature Care EPO |
$522.35
|
| Rate for Payer: Signature Care PPO |
$553.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$534.94
|
| Rate for Payer: United Healthcare Commercial |
$495.92
|
| Rate for Payer: United Healthcare Medicare |
$207.68
|
|
|
HC COLOR FLOW DOPPLER
|
Facility
IP
|
$629.34
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
00863325
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$472.00 |
| Max. Negotiated Rate |
$585.29 |
| Rate for Payer: Aetna Commercial |
$543.75
|
| Rate for Payer: Cash Price |
$390.19
|
| Rate for Payer: Cigna All Commercial |
$543.12
|
| Rate for Payer: CORVEL All Commercial |
$585.29
|
| Rate for Payer: Coventry All Commercial |
$553.82
|
| Rate for Payer: Encore All Commercial |
$579.31
|
| Rate for Payer: Frontpath All Commercial |
$578.99
|
| Rate for Payer: Humana ChoiceCare |
$543.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.41
|
| Rate for Payer: PHCS All Commercial |
$472.00
|
| Rate for Payer: PHP All Commercial |
$477.29
|
| Rate for Payer: Sagamore Health Network All Products |
$485.85
|
| Rate for Payer: Signature Care EPO |
$522.35
|
| Rate for Payer: Signature Care PPO |
$553.82
|
| Rate for Payer: United Healthcare Commercial |
$495.92
|
|
|
HC COLOR FLOW DOPPLER- LIMITED
|
Facility
IP
|
$629.85
|
|
|
Service Code
|
CPT 93325 52
|
| Hospital Charge Code |
00864325
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$472.39 |
| Max. Negotiated Rate |
$585.76 |
| Rate for Payer: Aetna Commercial |
$544.19
|
| Rate for Payer: Cash Price |
$390.51
|
| Rate for Payer: Cigna All Commercial |
$543.56
|
| Rate for Payer: CORVEL All Commercial |
$585.76
|
| Rate for Payer: Coventry All Commercial |
$554.27
|
| Rate for Payer: Encore All Commercial |
$579.78
|
| Rate for Payer: Frontpath All Commercial |
$579.46
|
| Rate for Payer: Humana ChoiceCare |
$544.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.86
|
| Rate for Payer: PHCS All Commercial |
$472.39
|
| Rate for Payer: PHP All Commercial |
$477.68
|
| Rate for Payer: Sagamore Health Network All Products |
$486.24
|
| Rate for Payer: Signature Care EPO |
$522.78
|
| Rate for Payer: Signature Care PPO |
$554.27
|
| Rate for Payer: United Healthcare Commercial |
$496.32
|
|
