|
HC DRAIN/INJ MAJOR JOINT/BURSA W/O US
|
Facility
IP
|
$361.52
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
01680610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.14 |
| Max. Negotiated Rate |
$336.21 |
| Rate for Payer: Aetna Commercial |
$312.35
|
| Rate for Payer: Cash Price |
$224.14
|
| Rate for Payer: Cigna All Commercial |
$311.99
|
| Rate for Payer: CORVEL All Commercial |
$336.21
|
| Rate for Payer: Coventry All Commercial |
$318.14
|
| Rate for Payer: Encore All Commercial |
$332.78
|
| Rate for Payer: Frontpath All Commercial |
$332.60
|
| Rate for Payer: Humana ChoiceCare |
$312.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.37
|
| Rate for Payer: PHCS All Commercial |
$271.14
|
| Rate for Payer: PHP All Commercial |
$274.18
|
| Rate for Payer: Sagamore Health Network All Products |
$279.09
|
| Rate for Payer: Signature Care EPO |
$300.06
|
| Rate for Payer: Signature Care PPO |
$318.14
|
| Rate for Payer: United Healthcare Commercial |
$284.88
|
|
|
HC DRAIN/INJ MAJOR JOINT/BURSA W/O US
|
Facility
OP
|
$361.52
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
01680610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.30 |
| Max. Negotiated Rate |
$336.21 |
| Rate for Payer: Aetna Commercial |
$305.12
|
| Rate for Payer: Aetna Medicare |
$119.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$207.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.23
|
| Rate for Payer: Cash Price |
$224.14
|
| Rate for Payer: Cash Price |
$224.14
|
| Rate for Payer: Centivo All Commercial |
$184.37
|
| Rate for Payer: Cigna All Commercial |
$311.99
|
| Rate for Payer: CORVEL All Commercial |
$336.21
|
| Rate for Payer: Coventry All Commercial |
$318.14
|
| Rate for Payer: Encore All Commercial |
$332.78
|
| Rate for Payer: Frontpath All Commercial |
$332.60
|
| Rate for Payer: Humana ChoiceCare |
$312.24
|
| Rate for Payer: Humana Medicare |
$184.37
|
| Rate for Payer: Lucent All Commercial |
$184.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.37
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$271.14
|
| Rate for Payer: PHP All Commercial |
$274.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.99
|
| Rate for Payer: Sagamore Health Network All Products |
$279.09
|
| Rate for Payer: Signature Care EPO |
$300.06
|
| Rate for Payer: Signature Care PPO |
$318.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.29
|
| Rate for Payer: United Healthcare Commercial |
$284.88
|
| Rate for Payer: United Healthcare Medicare |
$119.30
|
|
|
HC DRAIN JP KIT RESERVOIR & 10MM
|
Facility
OP
|
$77.53
|
|
| Hospital Charge Code |
41602306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.58 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$65.44
|
| Rate for Payer: Aetna Medicare |
$25.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.14
|
| Rate for Payer: Cash Price |
$48.07
|
| Rate for Payer: Cash Price |
$48.07
|
| Rate for Payer: Centivo All Commercial |
$39.54
|
| Rate for Payer: Cigna All Commercial |
$66.91
|
| Rate for Payer: CORVEL All Commercial |
$72.10
|
| Rate for Payer: Coventry All Commercial |
$68.23
|
| Rate for Payer: Encore All Commercial |
$71.37
|
| Rate for Payer: Frontpath All Commercial |
$71.33
|
| Rate for Payer: Humana ChoiceCare |
$66.96
|
| Rate for Payer: Humana Medicare |
$39.54
|
| Rate for Payer: Lucent All Commercial |
$39.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.78
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$58.15
|
| Rate for Payer: PHP All Commercial |
$58.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.24
|
| Rate for Payer: Sagamore Health Network All Products |
$59.85
|
| Rate for Payer: Signature Care EPO |
$64.35
|
| Rate for Payer: Signature Care PPO |
$68.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.90
|
| Rate for Payer: United Healthcare Commercial |
$61.09
|
| Rate for Payer: United Healthcare Medicare |
$25.58
|
|
|
HC DRAIN JP KIT RESERVOIR & 10MM
|
Facility
IP
|
$77.53
|
|
| Hospital Charge Code |
41602306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Cash Price |
$48.07
|
| Rate for Payer: Cigna All Commercial |
$66.91
|
| Rate for Payer: CORVEL All Commercial |
$72.10
|
| Rate for Payer: Coventry All Commercial |
$68.23
|
| Rate for Payer: Encore All Commercial |
$71.37
|
| Rate for Payer: Frontpath All Commercial |
$71.33
|
| Rate for Payer: Humana ChoiceCare |
$66.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.78
|
| Rate for Payer: PHCS All Commercial |
$58.15
|
| Rate for Payer: PHP All Commercial |
$58.80
|
| Rate for Payer: Sagamore Health Network All Products |
$59.85
|
| Rate for Payer: Signature Care EPO |
$64.35
|
| Rate for Payer: Signature Care PPO |
$68.23
|
| Rate for Payer: United Healthcare Commercial |
$61.09
|
|
|
HC DRAIN T TUBE 10FR
|
Facility
IP
|
$53.63
|
|
| Hospital Charge Code |
41602089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cigna All Commercial |
$46.28
|
| Rate for Payer: CORVEL All Commercial |
$49.88
|
| Rate for Payer: Coventry All Commercial |
$47.19
|
| Rate for Payer: Encore All Commercial |
$49.37
|
| Rate for Payer: Frontpath All Commercial |
$49.34
|
| Rate for Payer: Humana ChoiceCare |
$46.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.27
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$40.67
|
| Rate for Payer: Sagamore Health Network All Products |
$41.40
|
| Rate for Payer: Signature Care EPO |
$44.51
|
| Rate for Payer: Signature Care PPO |
$47.19
|
| Rate for Payer: United Healthcare Commercial |
$42.26
|
|
|
HC DRAIN T TUBE 10FR
|
Facility
OP
|
$53.63
|
|
| Hospital Charge Code |
41602089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.26
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.47
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Centivo All Commercial |
$27.35
|
| Rate for Payer: Cigna All Commercial |
$46.28
|
| Rate for Payer: CORVEL All Commercial |
$49.88
|
| Rate for Payer: Coventry All Commercial |
$47.19
|
| Rate for Payer: Encore All Commercial |
$49.37
|
| Rate for Payer: Frontpath All Commercial |
$49.34
|
| Rate for Payer: Humana ChoiceCare |
$46.32
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent All Commercial |
$27.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$40.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.92
|
| Rate for Payer: Sagamore Health Network All Products |
$41.40
|
| Rate for Payer: Signature Care EPO |
$44.51
|
| Rate for Payer: Signature Care PPO |
$47.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.59
|
| Rate for Payer: United Healthcare Commercial |
$42.26
|
| Rate for Payer: United Healthcare Medicare |
$17.70
|
|
|
HC DRAIN T TUBE 12FR
|
Facility
IP
|
$53.63
|
|
| Hospital Charge Code |
41602090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cigna All Commercial |
$46.28
|
| Rate for Payer: CORVEL All Commercial |
$49.88
|
| Rate for Payer: Coventry All Commercial |
$47.19
|
| Rate for Payer: Encore All Commercial |
$49.37
|
| Rate for Payer: Frontpath All Commercial |
$49.34
|
| Rate for Payer: Humana ChoiceCare |
$46.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.27
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$40.67
|
| Rate for Payer: Sagamore Health Network All Products |
$41.40
|
| Rate for Payer: Signature Care EPO |
$44.51
|
| Rate for Payer: Signature Care PPO |
$47.19
|
| Rate for Payer: United Healthcare Commercial |
$42.26
|
|
|
HC DRAIN T TUBE 12FR
|
Facility
OP
|
$53.63
|
|
| Hospital Charge Code |
41602090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.26
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.47
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Centivo All Commercial |
$27.35
|
| Rate for Payer: Cigna All Commercial |
$46.28
|
| Rate for Payer: CORVEL All Commercial |
$49.88
|
| Rate for Payer: Coventry All Commercial |
$47.19
|
| Rate for Payer: Encore All Commercial |
$49.37
|
| Rate for Payer: Frontpath All Commercial |
$49.34
|
| Rate for Payer: Humana ChoiceCare |
$46.32
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent All Commercial |
$27.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$40.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.92
|
| Rate for Payer: Sagamore Health Network All Products |
$41.40
|
| Rate for Payer: Signature Care EPO |
$44.51
|
| Rate for Payer: Signature Care PPO |
$47.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.59
|
| Rate for Payer: United Healthcare Commercial |
$42.26
|
| Rate for Payer: United Healthcare Medicare |
$17.70
|
|
|
HC DRAIN T TUBE 14F
|
Facility
IP
|
$53.63
|
|
| Hospital Charge Code |
41602077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cigna All Commercial |
$46.28
|
| Rate for Payer: CORVEL All Commercial |
$49.88
|
| Rate for Payer: Coventry All Commercial |
$47.19
|
| Rate for Payer: Encore All Commercial |
$49.37
|
| Rate for Payer: Frontpath All Commercial |
$49.34
|
| Rate for Payer: Humana ChoiceCare |
$46.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.27
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$40.67
|
| Rate for Payer: Sagamore Health Network All Products |
$41.40
|
| Rate for Payer: Signature Care EPO |
$44.51
|
| Rate for Payer: Signature Care PPO |
$47.19
|
| Rate for Payer: United Healthcare Commercial |
$42.26
|
|
|
HC DRAIN T TUBE 14F
|
Facility
OP
|
$53.63
|
|
| Hospital Charge Code |
41602077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.26
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.47
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Centivo All Commercial |
$27.35
|
| Rate for Payer: Cigna All Commercial |
$46.28
|
| Rate for Payer: CORVEL All Commercial |
$49.88
|
| Rate for Payer: Coventry All Commercial |
$47.19
|
| Rate for Payer: Encore All Commercial |
$49.37
|
| Rate for Payer: Frontpath All Commercial |
$49.34
|
| Rate for Payer: Humana ChoiceCare |
$46.32
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent All Commercial |
$27.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$40.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.92
|
| Rate for Payer: Sagamore Health Network All Products |
$41.40
|
| Rate for Payer: Signature Care EPO |
$44.51
|
| Rate for Payer: Signature Care PPO |
$47.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.59
|
| Rate for Payer: United Healthcare Commercial |
$42.26
|
| Rate for Payer: United Healthcare Medicare |
$17.70
|
|
|
HC DRAIN T TUBE 18F
|
Facility
OP
|
$53.63
|
|
| Hospital Charge Code |
41602302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.26
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.47
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Centivo All Commercial |
$27.35
|
| Rate for Payer: Cigna All Commercial |
$46.28
|
| Rate for Payer: CORVEL All Commercial |
$49.88
|
| Rate for Payer: Coventry All Commercial |
$47.19
|
| Rate for Payer: Encore All Commercial |
$49.37
|
| Rate for Payer: Frontpath All Commercial |
$49.34
|
| Rate for Payer: Humana ChoiceCare |
$46.32
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent All Commercial |
$27.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$40.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.92
|
| Rate for Payer: Sagamore Health Network All Products |
$41.40
|
| Rate for Payer: Signature Care EPO |
$44.51
|
| Rate for Payer: Signature Care PPO |
$47.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.59
|
| Rate for Payer: United Healthcare Commercial |
$42.26
|
| Rate for Payer: United Healthcare Medicare |
$17.70
|
|
|
HC DRAIN T TUBE 18F
|
Facility
IP
|
$53.63
|
|
| Hospital Charge Code |
41602302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cigna All Commercial |
$46.28
|
| Rate for Payer: CORVEL All Commercial |
$49.88
|
| Rate for Payer: Coventry All Commercial |
$47.19
|
| Rate for Payer: Encore All Commercial |
$49.37
|
| Rate for Payer: Frontpath All Commercial |
$49.34
|
| Rate for Payer: Humana ChoiceCare |
$46.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.27
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$40.67
|
| Rate for Payer: Sagamore Health Network All Products |
$41.40
|
| Rate for Payer: Signature Care EPO |
$44.51
|
| Rate for Payer: Signature Care PPO |
$47.19
|
| Rate for Payer: United Healthcare Commercial |
$42.26
|
|
|
HC DRAIN T TUBE 19FR
|
Facility
OP
|
$72.38
|
|
| Hospital Charge Code |
41607928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$61.09
|
| Rate for Payer: Aetna Medicare |
$23.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.27
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Centivo All Commercial |
$36.91
|
| Rate for Payer: Cigna All Commercial |
$62.46
|
| Rate for Payer: CORVEL All Commercial |
$67.31
|
| Rate for Payer: Coventry All Commercial |
$63.69
|
| Rate for Payer: Encore All Commercial |
$66.63
|
| Rate for Payer: Frontpath All Commercial |
$66.59
|
| Rate for Payer: Humana ChoiceCare |
$62.51
|
| Rate for Payer: Humana Medicare |
$36.91
|
| Rate for Payer: Lucent All Commercial |
$36.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.14
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$54.28
|
| Rate for Payer: PHP All Commercial |
$54.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.23
|
| Rate for Payer: Sagamore Health Network All Products |
$55.88
|
| Rate for Payer: Signature Care EPO |
$60.08
|
| Rate for Payer: Signature Care PPO |
$63.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.52
|
| Rate for Payer: United Healthcare Commercial |
$57.04
|
| Rate for Payer: United Healthcare Medicare |
$23.89
|
|
|
HC DRAIN T TUBE 19FR
|
Facility
IP
|
$72.38
|
|
| Hospital Charge Code |
41607928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.28 |
| Max. Negotiated Rate |
$67.31 |
| Rate for Payer: Aetna Commercial |
$62.54
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cigna All Commercial |
$62.46
|
| Rate for Payer: CORVEL All Commercial |
$67.31
|
| Rate for Payer: Coventry All Commercial |
$63.69
|
| Rate for Payer: Encore All Commercial |
$66.63
|
| Rate for Payer: Frontpath All Commercial |
$66.59
|
| Rate for Payer: Humana ChoiceCare |
$62.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.14
|
| Rate for Payer: PHCS All Commercial |
$54.28
|
| Rate for Payer: PHP All Commercial |
$54.89
|
| Rate for Payer: Sagamore Health Network All Products |
$55.88
|
| Rate for Payer: Signature Care EPO |
$60.08
|
| Rate for Payer: Signature Care PPO |
$63.69
|
| Rate for Payer: United Healthcare Commercial |
$57.04
|
|
|
HC DRAIN T TUBE 20 FR
|
Facility
OP
|
$43.07
|
|
| Hospital Charge Code |
41602312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$36.35
|
| Rate for Payer: Aetna Medicare |
$14.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.63
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Centivo All Commercial |
$21.97
|
| Rate for Payer: Cigna All Commercial |
$37.17
|
| Rate for Payer: CORVEL All Commercial |
$40.06
|
| Rate for Payer: Coventry All Commercial |
$37.90
|
| Rate for Payer: Encore All Commercial |
$39.65
|
| Rate for Payer: Frontpath All Commercial |
$39.62
|
| Rate for Payer: Humana ChoiceCare |
$37.20
|
| Rate for Payer: Humana Medicare |
$21.97
|
| Rate for Payer: Lucent All Commercial |
$21.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$32.30
|
| Rate for Payer: PHP All Commercial |
$32.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.80
|
| Rate for Payer: Sagamore Health Network All Products |
$33.25
|
| Rate for Payer: Signature Care EPO |
$35.75
|
| Rate for Payer: Signature Care PPO |
$37.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.61
|
| Rate for Payer: United Healthcare Commercial |
$33.94
|
| Rate for Payer: United Healthcare Medicare |
$14.21
|
|
|
HC DRAIN T TUBE 20 FR
|
Facility
IP
|
$43.07
|
|
| Hospital Charge Code |
41602312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$40.06 |
| Rate for Payer: Aetna Commercial |
$37.21
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna All Commercial |
$37.17
|
| Rate for Payer: CORVEL All Commercial |
$40.06
|
| Rate for Payer: Coventry All Commercial |
$37.90
|
| Rate for Payer: Encore All Commercial |
$39.65
|
| Rate for Payer: Frontpath All Commercial |
$39.62
|
| Rate for Payer: Humana ChoiceCare |
$37.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.76
|
| Rate for Payer: PHCS All Commercial |
$32.30
|
| Rate for Payer: PHP All Commercial |
$32.66
|
| Rate for Payer: Sagamore Health Network All Products |
$33.25
|
| Rate for Payer: Signature Care EPO |
$35.75
|
| Rate for Payer: Signature Care PPO |
$37.90
|
| Rate for Payer: United Healthcare Commercial |
$33.94
|
|
|
HC DRAIN T TUBE 8 FR
|
Facility
IP
|
$53.63
|
|
| Hospital Charge Code |
41602088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cigna All Commercial |
$46.28
|
| Rate for Payer: CORVEL All Commercial |
$49.88
|
| Rate for Payer: Coventry All Commercial |
$47.19
|
| Rate for Payer: Encore All Commercial |
$49.37
|
| Rate for Payer: Frontpath All Commercial |
$49.34
|
| Rate for Payer: Humana ChoiceCare |
$46.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.27
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$40.67
|
| Rate for Payer: Sagamore Health Network All Products |
$41.40
|
| Rate for Payer: Signature Care EPO |
$44.51
|
| Rate for Payer: Signature Care PPO |
$47.19
|
| Rate for Payer: United Healthcare Commercial |
$42.26
|
|
|
HC DRAIN T TUBE 8 FR
|
Facility
OP
|
$53.63
|
|
| Hospital Charge Code |
41602088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.26
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.47
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Centivo All Commercial |
$27.35
|
| Rate for Payer: Cigna All Commercial |
$46.28
|
| Rate for Payer: CORVEL All Commercial |
$49.88
|
| Rate for Payer: Coventry All Commercial |
$47.19
|
| Rate for Payer: Encore All Commercial |
$49.37
|
| Rate for Payer: Frontpath All Commercial |
$49.34
|
| Rate for Payer: Humana ChoiceCare |
$46.32
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent All Commercial |
$27.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.22
|
| Rate for Payer: PHP All Commercial |
$40.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.92
|
| Rate for Payer: Sagamore Health Network All Products |
$41.40
|
| Rate for Payer: Signature Care EPO |
$44.51
|
| Rate for Payer: Signature Care PPO |
$47.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.59
|
| Rate for Payer: United Healthcare Commercial |
$42.26
|
| Rate for Payer: United Healthcare Medicare |
$17.70
|
|
|
HC DRAIN WOUND 10MMX20CM
|
Facility
IP
|
$38.89
|
|
| Hospital Charge Code |
41602214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$36.17 |
| Rate for Payer: Aetna Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cigna All Commercial |
$33.56
|
| Rate for Payer: CORVEL All Commercial |
$36.17
|
| Rate for Payer: Coventry All Commercial |
$34.22
|
| Rate for Payer: Encore All Commercial |
$35.80
|
| Rate for Payer: Frontpath All Commercial |
$35.78
|
| Rate for Payer: Humana ChoiceCare |
$33.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: PHCS All Commercial |
$29.17
|
| Rate for Payer: PHP All Commercial |
$29.49
|
| Rate for Payer: Sagamore Health Network All Products |
$30.02
|
| Rate for Payer: Signature Care EPO |
$32.28
|
| Rate for Payer: Signature Care PPO |
$34.22
|
| Rate for Payer: United Healthcare Commercial |
$30.65
|
|
|
HC DRAIN WOUND 10MMX20CM
|
Facility
OP
|
$38.89
|
|
| Hospital Charge Code |
41602214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$32.82
|
| Rate for Payer: Aetna Medicare |
$12.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.12
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Centivo All Commercial |
$19.83
|
| Rate for Payer: Cigna All Commercial |
$33.56
|
| Rate for Payer: CORVEL All Commercial |
$36.17
|
| Rate for Payer: Coventry All Commercial |
$34.22
|
| Rate for Payer: Encore All Commercial |
$35.80
|
| Rate for Payer: Frontpath All Commercial |
$35.78
|
| Rate for Payer: Humana ChoiceCare |
$33.59
|
| Rate for Payer: Humana Medicare |
$19.83
|
| Rate for Payer: Lucent All Commercial |
$19.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.17
|
| Rate for Payer: PHP All Commercial |
$29.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.17
|
| Rate for Payer: Sagamore Health Network All Products |
$30.02
|
| Rate for Payer: Signature Care EPO |
$32.28
|
| Rate for Payer: Signature Care PPO |
$34.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.06
|
| Rate for Payer: United Healthcare Commercial |
$30.65
|
| Rate for Payer: United Healthcare Medicare |
$12.83
|
|
|
HC DRAPE MINI CARM
|
Facility
OP
|
$45.36
|
|
| Hospital Charge Code |
41608014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$38.28
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.47
|
| Rate for Payer: Cash Price |
$28.12
|
| Rate for Payer: Cash Price |
$28.12
|
| Rate for Payer: Centivo All Commercial |
$23.13
|
| Rate for Payer: Cigna All Commercial |
$39.15
|
| Rate for Payer: CORVEL All Commercial |
$42.18
|
| Rate for Payer: Coventry All Commercial |
$39.92
|
| Rate for Payer: Encore All Commercial |
$41.75
|
| Rate for Payer: Frontpath All Commercial |
$41.73
|
| Rate for Payer: Humana ChoiceCare |
$39.18
|
| Rate for Payer: Humana Medicare |
$23.13
|
| Rate for Payer: Lucent All Commercial |
$23.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$34.02
|
| Rate for Payer: PHP All Commercial |
$34.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.69
|
| Rate for Payer: Sagamore Health Network All Products |
$35.02
|
| Rate for Payer: Signature Care EPO |
$37.65
|
| Rate for Payer: Signature Care PPO |
$39.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.56
|
| Rate for Payer: United Healthcare Commercial |
$35.74
|
| Rate for Payer: United Healthcare Medicare |
$14.97
|
|
|
HC DRAPE MINI CARM
|
Facility
IP
|
$45.36
|
|
| Hospital Charge Code |
41608014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.02 |
| Max. Negotiated Rate |
$42.18 |
| Rate for Payer: Aetna Commercial |
$39.19
|
| Rate for Payer: Cash Price |
$28.12
|
| Rate for Payer: Cigna All Commercial |
$39.15
|
| Rate for Payer: CORVEL All Commercial |
$42.18
|
| Rate for Payer: Coventry All Commercial |
$39.92
|
| Rate for Payer: Encore All Commercial |
$41.75
|
| Rate for Payer: Frontpath All Commercial |
$41.73
|
| Rate for Payer: Humana ChoiceCare |
$39.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.82
|
| Rate for Payer: PHCS All Commercial |
$34.02
|
| Rate for Payer: PHP All Commercial |
$34.40
|
| Rate for Payer: Sagamore Health Network All Products |
$35.02
|
| Rate for Payer: Signature Care EPO |
$37.65
|
| Rate for Payer: Signature Care PPO |
$39.92
|
| Rate for Payer: United Healthcare Commercial |
$35.74
|
|
|
HC DRAW PICC & CENTRAL
|
Facility
IP
|
$163.30
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
01269001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$151.87 |
| Rate for Payer: Aetna Commercial |
$141.09
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna All Commercial |
$140.93
|
| Rate for Payer: CORVEL All Commercial |
$151.87
|
| Rate for Payer: Coventry All Commercial |
$143.71
|
| Rate for Payer: Encore All Commercial |
$150.32
|
| Rate for Payer: Frontpath All Commercial |
$150.24
|
| Rate for Payer: Humana ChoiceCare |
$141.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.97
|
| Rate for Payer: PHCS All Commercial |
$122.48
|
| Rate for Payer: PHP All Commercial |
$123.85
|
| Rate for Payer: Sagamore Health Network All Products |
$126.07
|
| Rate for Payer: Signature Care EPO |
$135.54
|
| Rate for Payer: Signature Care PPO |
$143.71
|
| Rate for Payer: United Healthcare Commercial |
$128.68
|
|
|
HC DRAW PICC & CENTRAL
|
Facility
OP
|
$163.30
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
01269001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$151.87 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna Medicare |
$53.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.28
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Centivo All Commercial |
$83.28
|
| Rate for Payer: Cigna All Commercial |
$140.93
|
| Rate for Payer: CORVEL All Commercial |
$151.87
|
| Rate for Payer: Coventry All Commercial |
$143.71
|
| Rate for Payer: Encore All Commercial |
$150.32
|
| Rate for Payer: Frontpath All Commercial |
$150.24
|
| Rate for Payer: Humana ChoiceCare |
$141.04
|
| Rate for Payer: Humana Medicare |
$83.28
|
| Rate for Payer: Lucent All Commercial |
$83.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.97
|
| Rate for Payer: PHCS All Commercial |
$122.48
|
| Rate for Payer: PHP All Commercial |
$123.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.69
|
| Rate for Payer: Sagamore Health Network All Products |
$126.07
|
| Rate for Payer: Signature Care EPO |
$135.54
|
| Rate for Payer: Signature Care PPO |
$143.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.81
|
| Rate for Payer: United Healthcare Commercial |
$128.68
|
| Rate for Payer: United Healthcare Medicare |
$53.89
|
|
|
HC DRESSING ADH ALLEVYN 5X5
|
Facility
IP
|
$30.25
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
41601038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.69 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna Commercial |
$26.14
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cigna All Commercial |
$26.11
|
| Rate for Payer: CORVEL All Commercial |
$28.13
|
| Rate for Payer: Coventry All Commercial |
$26.62
|
| Rate for Payer: Encore All Commercial |
$27.85
|
| Rate for Payer: Frontpath All Commercial |
$27.83
|
| Rate for Payer: Humana ChoiceCare |
$26.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.22
|
| Rate for Payer: PHCS All Commercial |
$22.69
|
| Rate for Payer: PHP All Commercial |
$22.94
|
| Rate for Payer: Sagamore Health Network All Products |
$23.35
|
| Rate for Payer: Signature Care EPO |
$25.11
|
| Rate for Payer: Signature Care PPO |
$26.62
|
| Rate for Payer: United Healthcare Commercial |
$23.84
|
|
