|
HC DNASE-B ANTIBODY
|
Facility
IP
|
$111.75
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
63001872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.81 |
| Max. Negotiated Rate |
$103.93 |
| Rate for Payer: Aetna Commercial |
$96.55
|
| Rate for Payer: Cash Price |
$69.29
|
| Rate for Payer: Cigna All Commercial |
$96.44
|
| Rate for Payer: CORVEL All Commercial |
$103.93
|
| Rate for Payer: Coventry All Commercial |
$98.34
|
| Rate for Payer: Encore All Commercial |
$102.87
|
| Rate for Payer: Frontpath All Commercial |
$102.81
|
| Rate for Payer: Humana ChoiceCare |
$96.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.58
|
| Rate for Payer: PHCS All Commercial |
$83.81
|
| Rate for Payer: PHP All Commercial |
$84.75
|
| Rate for Payer: Sagamore Health Network All Products |
$86.27
|
| Rate for Payer: Signature Care EPO |
$92.75
|
| Rate for Payer: Signature Care PPO |
$98.34
|
| Rate for Payer: United Healthcare Commercial |
$88.06
|
|
|
HC DOSIMETRY-BASIC
|
Facility
IP
|
$772.26
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
01547300
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$579.20 |
| Max. Negotiated Rate |
$718.20 |
| Rate for Payer: Aetna Commercial |
$667.23
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cigna All Commercial |
$666.46
|
| Rate for Payer: CORVEL All Commercial |
$718.20
|
| Rate for Payer: Coventry All Commercial |
$679.59
|
| Rate for Payer: Encore All Commercial |
$710.87
|
| Rate for Payer: Frontpath All Commercial |
$710.48
|
| Rate for Payer: Humana ChoiceCare |
$667.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.04
|
| Rate for Payer: PHCS All Commercial |
$579.20
|
| Rate for Payer: PHP All Commercial |
$585.68
|
| Rate for Payer: Sagamore Health Network All Products |
$596.19
|
| Rate for Payer: Signature Care EPO |
$640.98
|
| Rate for Payer: Signature Care PPO |
$679.59
|
| Rate for Payer: United Healthcare Commercial |
$608.54
|
|
|
HC DOSIMETRY-BASIC
|
Facility
OP
|
$772.26
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
01547300
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.34 |
| Max. Negotiated Rate |
$718.20 |
| Rate for Payer: Aetna Commercial |
$651.79
|
| Rate for Payer: Aetna Medicare |
$254.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$443.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$482.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$94.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$293.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$280.33
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Centivo All Commercial |
$393.85
|
| Rate for Payer: Cigna All Commercial |
$666.46
|
| Rate for Payer: CORVEL All Commercial |
$718.20
|
| Rate for Payer: Coventry All Commercial |
$679.59
|
| Rate for Payer: Encore All Commercial |
$710.87
|
| Rate for Payer: Frontpath All Commercial |
$710.48
|
| Rate for Payer: Humana ChoiceCare |
$667.00
|
| Rate for Payer: Humana Medicare |
$393.85
|
| Rate for Payer: Lucent All Commercial |
$393.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.04
|
| Rate for Payer: Managed Health Services Medicaid |
$94.34
|
| Rate for Payer: MDWise Medicaid |
$94.34
|
| Rate for Payer: PHCS All Commercial |
$579.20
|
| Rate for Payer: PHP All Commercial |
$585.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$301.18
|
| Rate for Payer: Sagamore Health Network All Products |
$596.19
|
| Rate for Payer: Signature Care EPO |
$640.98
|
| Rate for Payer: Signature Care PPO |
$679.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$656.42
|
| Rate for Payer: United Healthcare Commercial |
$608.54
|
| Rate for Payer: United Healthcare Medicare |
$254.85
|
|
|
HC DOSIMETRY-BASIC 11+
|
Facility
OP
|
$772.26
|
|
|
Service Code
|
CPT 77300 59
|
| Hospital Charge Code |
01548300
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$254.85 |
| Max. Negotiated Rate |
$718.20 |
| Rate for Payer: Aetna Commercial |
$651.79
|
| Rate for Payer: Aetna Medicare |
$254.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$443.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$482.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$293.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$280.33
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Centivo All Commercial |
$393.85
|
| Rate for Payer: Cigna All Commercial |
$666.46
|
| Rate for Payer: CORVEL All Commercial |
$718.20
|
| Rate for Payer: Coventry All Commercial |
$679.59
|
| Rate for Payer: Encore All Commercial |
$710.87
|
| Rate for Payer: Frontpath All Commercial |
$710.48
|
| Rate for Payer: Humana ChoiceCare |
$667.00
|
| Rate for Payer: Humana Medicare |
$393.85
|
| Rate for Payer: Lucent All Commercial |
$393.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.04
|
| Rate for Payer: PHCS All Commercial |
$579.20
|
| Rate for Payer: PHP All Commercial |
$585.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$301.18
|
| Rate for Payer: Sagamore Health Network All Products |
$596.19
|
| Rate for Payer: Signature Care EPO |
$640.98
|
| Rate for Payer: Signature Care PPO |
$679.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$656.42
|
| Rate for Payer: United Healthcare Commercial |
$608.54
|
| Rate for Payer: United Healthcare Medicare |
$254.85
|
|
|
HC DOSIMETRY-BASIC 11+
|
Facility
IP
|
$772.26
|
|
|
Service Code
|
CPT 77300 59
|
| Hospital Charge Code |
01548300
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$579.20 |
| Max. Negotiated Rate |
$718.20 |
| Rate for Payer: Aetna Commercial |
$667.23
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cigna All Commercial |
$666.46
|
| Rate for Payer: CORVEL All Commercial |
$718.20
|
| Rate for Payer: Coventry All Commercial |
$679.59
|
| Rate for Payer: Encore All Commercial |
$710.87
|
| Rate for Payer: Frontpath All Commercial |
$710.48
|
| Rate for Payer: Humana ChoiceCare |
$667.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.04
|
| Rate for Payer: PHCS All Commercial |
$579.20
|
| Rate for Payer: PHP All Commercial |
$585.68
|
| Rate for Payer: Sagamore Health Network All Products |
$596.19
|
| Rate for Payer: Signature Care EPO |
$640.98
|
| Rate for Payer: Signature Care PPO |
$679.59
|
| Rate for Payer: United Healthcare Commercial |
$608.54
|
|
|
HC DOSIMETRY-SPECIAL
|
Facility
OP
|
$901.68
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
01547331
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$49.92 |
| Max. Negotiated Rate |
$838.56 |
| Rate for Payer: Aetna Commercial |
$761.02
|
| Rate for Payer: Aetna Medicare |
$297.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$297.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$517.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$563.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$49.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$342.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$327.31
|
| Rate for Payer: Cash Price |
$559.04
|
| Rate for Payer: Cash Price |
$559.04
|
| Rate for Payer: Centivo All Commercial |
$459.86
|
| Rate for Payer: Cigna All Commercial |
$778.15
|
| Rate for Payer: CORVEL All Commercial |
$838.56
|
| Rate for Payer: Coventry All Commercial |
$793.48
|
| Rate for Payer: Encore All Commercial |
$830.00
|
| Rate for Payer: Frontpath All Commercial |
$829.55
|
| Rate for Payer: Humana ChoiceCare |
$778.78
|
| Rate for Payer: Humana Medicare |
$459.86
|
| Rate for Payer: Lucent All Commercial |
$459.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$811.51
|
| Rate for Payer: Managed Health Services Medicaid |
$49.92
|
| Rate for Payer: MDWise Medicaid |
$49.92
|
| Rate for Payer: PHCS All Commercial |
$676.26
|
| Rate for Payer: PHP All Commercial |
$683.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$351.66
|
| Rate for Payer: Sagamore Health Network All Products |
$696.10
|
| Rate for Payer: Signature Care EPO |
$748.39
|
| Rate for Payer: Signature Care PPO |
$793.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$766.43
|
| Rate for Payer: United Healthcare Commercial |
$710.52
|
| Rate for Payer: United Healthcare Medicare |
$297.55
|
|
|
HC DOSIMETRY-SPECIAL
|
Facility
IP
|
$901.68
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
01547331
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$676.26 |
| Max. Negotiated Rate |
$838.56 |
| Rate for Payer: Aetna Commercial |
$779.05
|
| Rate for Payer: Cash Price |
$559.04
|
| Rate for Payer: Cigna All Commercial |
$778.15
|
| Rate for Payer: CORVEL All Commercial |
$838.56
|
| Rate for Payer: Coventry All Commercial |
$793.48
|
| Rate for Payer: Encore All Commercial |
$830.00
|
| Rate for Payer: Frontpath All Commercial |
$829.55
|
| Rate for Payer: Humana ChoiceCare |
$778.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$811.51
|
| Rate for Payer: PHCS All Commercial |
$676.26
|
| Rate for Payer: PHP All Commercial |
$683.83
|
| Rate for Payer: Sagamore Health Network All Products |
$696.10
|
| Rate for Payer: Signature Care EPO |
$748.39
|
| Rate for Payer: Signature Care PPO |
$793.48
|
| Rate for Payer: United Healthcare Commercial |
$710.52
|
|
|
HC DRAINABLE POUCH
|
Facility
IP
|
$18.14
|
|
| Hospital Charge Code |
41601409
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$16.87 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna All Commercial |
$15.65
|
| Rate for Payer: CORVEL All Commercial |
$16.87
|
| Rate for Payer: Coventry All Commercial |
$15.96
|
| Rate for Payer: Encore All Commercial |
$16.70
|
| Rate for Payer: Frontpath All Commercial |
$16.69
|
| Rate for Payer: Humana ChoiceCare |
$15.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.33
|
| Rate for Payer: PHCS All Commercial |
$13.60
|
| Rate for Payer: PHP All Commercial |
$13.76
|
| Rate for Payer: Sagamore Health Network All Products |
$14.00
|
| Rate for Payer: Signature Care EPO |
$15.06
|
| Rate for Payer: Signature Care PPO |
$15.96
|
| Rate for Payer: United Healthcare Commercial |
$14.29
|
|
|
HC DRAINABLE POUCH
|
Facility
OP
|
$18.14
|
|
| Hospital Charge Code |
41601409
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$15.31
|
| Rate for Payer: Aetna Medicare |
$5.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.58
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Centivo All Commercial |
$9.25
|
| Rate for Payer: Cigna All Commercial |
$15.65
|
| Rate for Payer: CORVEL All Commercial |
$16.87
|
| Rate for Payer: Coventry All Commercial |
$15.96
|
| Rate for Payer: Encore All Commercial |
$16.70
|
| Rate for Payer: Frontpath All Commercial |
$16.69
|
| Rate for Payer: Humana ChoiceCare |
$15.67
|
| Rate for Payer: Humana Medicare |
$9.25
|
| Rate for Payer: Lucent All Commercial |
$9.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.33
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$13.60
|
| Rate for Payer: PHP All Commercial |
$13.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.07
|
| Rate for Payer: Sagamore Health Network All Products |
$14.00
|
| Rate for Payer: Signature Care EPO |
$15.06
|
| Rate for Payer: Signature Care PPO |
$15.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.42
|
| Rate for Payer: United Healthcare Commercial |
$14.29
|
| Rate for Payer: United Healthcare Medicare |
$5.99
|
|
|
HC DRAINABLE POUCH & BAR
|
Facility
IP
|
$31.47
|
|
| Hospital Charge Code |
41601441
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Aetna Commercial |
$27.19
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cigna All Commercial |
$27.16
|
| Rate for Payer: CORVEL All Commercial |
$29.27
|
| Rate for Payer: Coventry All Commercial |
$27.69
|
| Rate for Payer: Encore All Commercial |
$28.97
|
| Rate for Payer: Frontpath All Commercial |
$28.95
|
| Rate for Payer: Humana ChoiceCare |
$27.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.32
|
| Rate for Payer: PHCS All Commercial |
$23.60
|
| Rate for Payer: PHP All Commercial |
$23.87
|
| Rate for Payer: Sagamore Health Network All Products |
$24.29
|
| Rate for Payer: Signature Care EPO |
$26.12
|
| Rate for Payer: Signature Care PPO |
$27.69
|
| Rate for Payer: United Healthcare Commercial |
$24.80
|
|
|
HC DRAINABLE POUCH & BAR
|
Facility
OP
|
$31.47
|
|
| Hospital Charge Code |
41601441
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$26.56
|
| Rate for Payer: Aetna Medicare |
$10.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.42
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Centivo All Commercial |
$16.05
|
| Rate for Payer: Cigna All Commercial |
$27.16
|
| Rate for Payer: CORVEL All Commercial |
$29.27
|
| Rate for Payer: Coventry All Commercial |
$27.69
|
| Rate for Payer: Encore All Commercial |
$28.97
|
| Rate for Payer: Frontpath All Commercial |
$28.95
|
| Rate for Payer: Humana ChoiceCare |
$27.18
|
| Rate for Payer: Humana Medicare |
$16.05
|
| Rate for Payer: Lucent All Commercial |
$16.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.32
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$23.60
|
| Rate for Payer: PHP All Commercial |
$23.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.27
|
| Rate for Payer: Sagamore Health Network All Products |
$24.29
|
| Rate for Payer: Signature Care EPO |
$26.12
|
| Rate for Payer: Signature Care PPO |
$27.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.75
|
| Rate for Payer: United Healthcare Commercial |
$24.80
|
| Rate for Payer: United Healthcare Medicare |
$10.39
|
|
|
HC DRAIN BLAKE 10FR W/TROCAR
|
Facility
IP
|
$506.57
|
|
| Hospital Charge Code |
41601910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.93 |
| Max. Negotiated Rate |
$471.11 |
| Rate for Payer: Aetna Commercial |
$437.68
|
| Rate for Payer: Cash Price |
$314.07
|
| Rate for Payer: Cigna All Commercial |
$437.17
|
| Rate for Payer: CORVEL All Commercial |
$471.11
|
| Rate for Payer: Coventry All Commercial |
$445.78
|
| Rate for Payer: Encore All Commercial |
$466.30
|
| Rate for Payer: Frontpath All Commercial |
$466.04
|
| Rate for Payer: Humana ChoiceCare |
$437.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$455.91
|
| Rate for Payer: PHCS All Commercial |
$379.93
|
| Rate for Payer: PHP All Commercial |
$384.18
|
| Rate for Payer: Sagamore Health Network All Products |
$391.07
|
| Rate for Payer: Signature Care EPO |
$420.45
|
| Rate for Payer: Signature Care PPO |
$445.78
|
| Rate for Payer: United Healthcare Commercial |
$399.18
|
|
|
HC DRAIN BLAKE 10FR W/TROCAR
|
Facility
OP
|
$506.57
|
|
| Hospital Charge Code |
41601910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$471.11 |
| Rate for Payer: Aetna Commercial |
$427.55
|
| Rate for Payer: Aetna Medicare |
$167.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$167.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$290.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$316.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.88
|
| Rate for Payer: Cash Price |
$314.07
|
| Rate for Payer: Cash Price |
$314.07
|
| Rate for Payer: Centivo All Commercial |
$258.35
|
| Rate for Payer: Cigna All Commercial |
$437.17
|
| Rate for Payer: CORVEL All Commercial |
$471.11
|
| Rate for Payer: Coventry All Commercial |
$445.78
|
| Rate for Payer: Encore All Commercial |
$466.30
|
| Rate for Payer: Frontpath All Commercial |
$466.04
|
| Rate for Payer: Humana ChoiceCare |
$437.52
|
| Rate for Payer: Humana Medicare |
$258.35
|
| Rate for Payer: Lucent All Commercial |
$258.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$455.91
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$379.93
|
| Rate for Payer: PHP All Commercial |
$384.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$197.56
|
| Rate for Payer: Sagamore Health Network All Products |
$391.07
|
| Rate for Payer: Signature Care EPO |
$420.45
|
| Rate for Payer: Signature Care PPO |
$445.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$430.58
|
| Rate for Payer: United Healthcare Commercial |
$399.18
|
| Rate for Payer: United Healthcare Medicare |
$167.17
|
|
|
HC DRAIN BLAKE 15FR W/TROCAR
|
Facility
IP
|
$612.95
|
|
| Hospital Charge Code |
41601199
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$459.71 |
| Max. Negotiated Rate |
$570.04 |
| Rate for Payer: Aetna Commercial |
$529.59
|
| Rate for Payer: Cash Price |
$380.03
|
| Rate for Payer: Cigna All Commercial |
$528.98
|
| Rate for Payer: CORVEL All Commercial |
$570.04
|
| Rate for Payer: Coventry All Commercial |
$539.40
|
| Rate for Payer: Encore All Commercial |
$564.22
|
| Rate for Payer: Frontpath All Commercial |
$563.91
|
| Rate for Payer: Humana ChoiceCare |
$529.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.66
|
| Rate for Payer: PHCS All Commercial |
$459.71
|
| Rate for Payer: PHP All Commercial |
$464.86
|
| Rate for Payer: Sagamore Health Network All Products |
$473.20
|
| Rate for Payer: Signature Care EPO |
$508.75
|
| Rate for Payer: Signature Care PPO |
$539.40
|
| Rate for Payer: United Healthcare Commercial |
$483.00
|
|
|
HC DRAIN BLAKE 15FR W/TROCAR
|
Facility
OP
|
$612.95
|
|
| Hospital Charge Code |
41601199
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$570.04 |
| Rate for Payer: Aetna Commercial |
$517.33
|
| Rate for Payer: Aetna Medicare |
$202.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$352.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$383.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$232.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$222.50
|
| Rate for Payer: Cash Price |
$380.03
|
| Rate for Payer: Cash Price |
$380.03
|
| Rate for Payer: Centivo All Commercial |
$312.60
|
| Rate for Payer: Cigna All Commercial |
$528.98
|
| Rate for Payer: CORVEL All Commercial |
$570.04
|
| Rate for Payer: Coventry All Commercial |
$539.40
|
| Rate for Payer: Encore All Commercial |
$564.22
|
| Rate for Payer: Frontpath All Commercial |
$563.91
|
| Rate for Payer: Humana ChoiceCare |
$529.40
|
| Rate for Payer: Humana Medicare |
$312.60
|
| Rate for Payer: Lucent All Commercial |
$312.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.66
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$459.71
|
| Rate for Payer: PHP All Commercial |
$464.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$239.05
|
| Rate for Payer: Sagamore Health Network All Products |
$473.20
|
| Rate for Payer: Signature Care EPO |
$508.75
|
| Rate for Payer: Signature Care PPO |
$539.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$521.01
|
| Rate for Payer: United Healthcare Commercial |
$483.00
|
| Rate for Payer: United Healthcare Medicare |
$202.27
|
|
|
HC DRAIN BLAKE 19FR W/TROCAR
|
Facility
OP
|
$470.76
|
|
| Hospital Charge Code |
41601909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$437.81 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Aetna Medicare |
$155.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$155.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$270.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$178.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$170.89
|
| Rate for Payer: Cash Price |
$291.87
|
| Rate for Payer: Cash Price |
$291.87
|
| Rate for Payer: Centivo All Commercial |
$240.09
|
| Rate for Payer: Cigna All Commercial |
$406.27
|
| Rate for Payer: CORVEL All Commercial |
$437.81
|
| Rate for Payer: Coventry All Commercial |
$414.27
|
| Rate for Payer: Encore All Commercial |
$433.33
|
| Rate for Payer: Frontpath All Commercial |
$433.10
|
| Rate for Payer: Humana ChoiceCare |
$406.60
|
| Rate for Payer: Humana Medicare |
$240.09
|
| Rate for Payer: Lucent All Commercial |
$240.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$423.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$353.07
|
| Rate for Payer: PHP All Commercial |
$357.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$183.60
|
| Rate for Payer: Sagamore Health Network All Products |
$363.43
|
| Rate for Payer: Signature Care EPO |
$390.73
|
| Rate for Payer: Signature Care PPO |
$414.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.15
|
| Rate for Payer: United Healthcare Commercial |
$370.96
|
| Rate for Payer: United Healthcare Medicare |
$155.35
|
|
|
HC DRAIN BLAKE 19FR W/TROCAR
|
Facility
IP
|
$470.76
|
|
| Hospital Charge Code |
41601909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.07 |
| Max. Negotiated Rate |
$437.81 |
| Rate for Payer: Aetna Commercial |
$406.74
|
| Rate for Payer: Cash Price |
$291.87
|
| Rate for Payer: Cigna All Commercial |
$406.27
|
| Rate for Payer: CORVEL All Commercial |
$437.81
|
| Rate for Payer: Coventry All Commercial |
$414.27
|
| Rate for Payer: Encore All Commercial |
$433.33
|
| Rate for Payer: Frontpath All Commercial |
$433.10
|
| Rate for Payer: Humana ChoiceCare |
$406.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$423.68
|
| Rate for Payer: PHCS All Commercial |
$353.07
|
| Rate for Payer: PHP All Commercial |
$357.02
|
| Rate for Payer: Sagamore Health Network All Products |
$363.43
|
| Rate for Payer: Signature Care EPO |
$390.73
|
| Rate for Payer: Signature Care PPO |
$414.27
|
| Rate for Payer: United Healthcare Commercial |
$370.96
|
|
|
HC DRAIN CHEST SINGLE COLL DRY
|
Facility
OP
|
$158.92
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
41607140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna Commercial |
$134.13
|
| Rate for Payer: Aetna Medicare |
$52.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.69
|
| Rate for Payer: Cash Price |
$98.53
|
| Rate for Payer: Cash Price |
$98.53
|
| Rate for Payer: Centivo All Commercial |
$81.05
|
| Rate for Payer: Cigna All Commercial |
$137.15
|
| Rate for Payer: CORVEL All Commercial |
$147.80
|
| Rate for Payer: Coventry All Commercial |
$139.85
|
| Rate for Payer: Encore All Commercial |
$146.29
|
| Rate for Payer: Frontpath All Commercial |
$146.21
|
| Rate for Payer: Humana ChoiceCare |
$137.26
|
| Rate for Payer: Humana Medicare |
$81.05
|
| Rate for Payer: Lucent All Commercial |
$81.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$119.19
|
| Rate for Payer: PHP All Commercial |
$120.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.98
|
| Rate for Payer: Sagamore Health Network All Products |
$122.69
|
| Rate for Payer: Signature Care EPO |
$131.90
|
| Rate for Payer: Signature Care PPO |
$139.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.08
|
| Rate for Payer: United Healthcare Commercial |
$125.23
|
| Rate for Payer: United Healthcare Medicare |
$52.44
|
|
|
HC DRAIN CHEST SINGLE COLL DRY
|
Facility
IP
|
$158.92
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
41607140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.19 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna Commercial |
$137.31
|
| Rate for Payer: Cash Price |
$98.53
|
| Rate for Payer: Cigna All Commercial |
$137.15
|
| Rate for Payer: CORVEL All Commercial |
$147.80
|
| Rate for Payer: Coventry All Commercial |
$139.85
|
| Rate for Payer: Encore All Commercial |
$146.29
|
| Rate for Payer: Frontpath All Commercial |
$146.21
|
| Rate for Payer: Humana ChoiceCare |
$137.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.03
|
| Rate for Payer: PHCS All Commercial |
$119.19
|
| Rate for Payer: PHP All Commercial |
$120.52
|
| Rate for Payer: Sagamore Health Network All Products |
$122.69
|
| Rate for Payer: Signature Care EPO |
$131.90
|
| Rate for Payer: Signature Care PPO |
$139.85
|
| Rate for Payer: United Healthcare Commercial |
$125.23
|
|
|
HC DRAIN HEMOVAC 400 ML 1/4"
|
Facility
IP
|
$312.62
|
|
| Hospital Charge Code |
41602439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.46 |
| Max. Negotiated Rate |
$290.74 |
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Cash Price |
$193.82
|
| Rate for Payer: Cigna All Commercial |
$269.79
|
| Rate for Payer: CORVEL All Commercial |
$290.74
|
| Rate for Payer: Coventry All Commercial |
$275.11
|
| Rate for Payer: Encore All Commercial |
$287.77
|
| Rate for Payer: Frontpath All Commercial |
$287.61
|
| Rate for Payer: Humana ChoiceCare |
$270.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.36
|
| Rate for Payer: PHCS All Commercial |
$234.46
|
| Rate for Payer: PHP All Commercial |
$237.09
|
| Rate for Payer: Sagamore Health Network All Products |
$241.34
|
| Rate for Payer: Signature Care EPO |
$259.47
|
| Rate for Payer: Signature Care PPO |
$275.11
|
| Rate for Payer: United Healthcare Commercial |
$246.34
|
|
|
HC DRAIN HEMOVAC 400 ML 1/4"
|
Facility
OP
|
$312.62
|
|
| Hospital Charge Code |
41602439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.16 |
| Max. Negotiated Rate |
$290.74 |
| Rate for Payer: Aetna Commercial |
$263.85
|
| Rate for Payer: Aetna Medicare |
$103.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$179.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.48
|
| Rate for Payer: Cash Price |
$193.82
|
| Rate for Payer: Cash Price |
$193.82
|
| Rate for Payer: Centivo All Commercial |
$159.44
|
| Rate for Payer: Cigna All Commercial |
$269.79
|
| Rate for Payer: CORVEL All Commercial |
$290.74
|
| Rate for Payer: Coventry All Commercial |
$275.11
|
| Rate for Payer: Encore All Commercial |
$287.77
|
| Rate for Payer: Frontpath All Commercial |
$287.61
|
| Rate for Payer: Humana ChoiceCare |
$270.01
|
| Rate for Payer: Humana Medicare |
$159.44
|
| Rate for Payer: Lucent All Commercial |
$159.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.36
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$234.46
|
| Rate for Payer: PHP All Commercial |
$237.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.92
|
| Rate for Payer: Sagamore Health Network All Products |
$241.34
|
| Rate for Payer: Signature Care EPO |
$259.47
|
| Rate for Payer: Signature Care PPO |
$275.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$265.73
|
| Rate for Payer: United Healthcare Commercial |
$246.34
|
| Rate for Payer: United Healthcare Medicare |
$103.16
|
|
|
HC DRAIN HEMOVAC 400 ML 1/8"
|
Facility
OP
|
$122.50
|
|
| Hospital Charge Code |
41602438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$103.39
|
| Rate for Payer: Aetna Medicare |
$40.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.47
|
| Rate for Payer: Cash Price |
$75.95
|
| Rate for Payer: Cash Price |
$75.95
|
| Rate for Payer: Centivo All Commercial |
$62.48
|
| Rate for Payer: Cigna All Commercial |
$105.72
|
| Rate for Payer: CORVEL All Commercial |
$113.92
|
| Rate for Payer: Coventry All Commercial |
$107.80
|
| Rate for Payer: Encore All Commercial |
$112.76
|
| Rate for Payer: Frontpath All Commercial |
$112.70
|
| Rate for Payer: Humana ChoiceCare |
$105.80
|
| Rate for Payer: Humana Medicare |
$62.48
|
| Rate for Payer: Lucent All Commercial |
$62.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$91.88
|
| Rate for Payer: PHP All Commercial |
$92.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.78
|
| Rate for Payer: Sagamore Health Network All Products |
$94.57
|
| Rate for Payer: Signature Care EPO |
$101.68
|
| Rate for Payer: Signature Care PPO |
$107.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.12
|
| Rate for Payer: United Healthcare Commercial |
$96.53
|
| Rate for Payer: United Healthcare Medicare |
$40.42
|
|
|
HC DRAIN HEMOVAC 400 ML 1/8"
|
Facility
IP
|
$122.50
|
|
| Hospital Charge Code |
41602438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.88 |
| Max. Negotiated Rate |
$113.92 |
| Rate for Payer: Aetna Commercial |
$105.84
|
| Rate for Payer: Cash Price |
$75.95
|
| Rate for Payer: Cigna All Commercial |
$105.72
|
| Rate for Payer: CORVEL All Commercial |
$113.92
|
| Rate for Payer: Coventry All Commercial |
$107.80
|
| Rate for Payer: Encore All Commercial |
$112.76
|
| Rate for Payer: Frontpath All Commercial |
$112.70
|
| Rate for Payer: Humana ChoiceCare |
$105.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.25
|
| Rate for Payer: PHCS All Commercial |
$91.88
|
| Rate for Payer: PHP All Commercial |
$92.90
|
| Rate for Payer: Sagamore Health Network All Products |
$94.57
|
| Rate for Payer: Signature Care EPO |
$101.68
|
| Rate for Payer: Signature Care PPO |
$107.80
|
| Rate for Payer: United Healthcare Commercial |
$96.53
|
|
|
HC DRAIN HEMOVAC 400 ML 3/16"
|
Facility
OP
|
$140.00
|
|
| Hospital Charge Code |
41602437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$118.16
|
| Rate for Payer: Aetna Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.82
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Centivo All Commercial |
$71.40
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.92
|
| Rate for Payer: Humana Medicare |
$71.40
|
| Rate for Payer: Lucent All Commercial |
$71.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.60
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
|
|
HC DRAIN HEMOVAC 400 ML 3/16"
|
Facility
IP
|
$140.00
|
|
| Hospital Charge Code |
41602437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$120.96
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.18
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
|
