|
HC BK VIRUS QT-PCR-URINE
|
Facility
|
OP
|
$497.05
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
63002053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$462.26 |
| Rate for Payer: Aetna Commercial |
$419.51
|
| Rate for Payer: Aetna Medicare |
$159.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$154.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$228.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$228.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.96
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Centivo All Commercial |
$270.40
|
| Rate for Payer: Cigna All Commercial |
$428.95
|
| Rate for Payer: CORVEL All Commercial |
$462.26
|
| Rate for Payer: Coventry All Commercial |
$437.40
|
| Rate for Payer: Encore All Commercial |
$457.53
|
| Rate for Payer: Frontpath All Commercial |
$457.29
|
| Rate for Payer: Humana ChoiceCare |
$429.30
|
| Rate for Payer: Humana Medicare |
$159.06
|
| Rate for Payer: Lucent All Commercial |
$270.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.35
|
| Rate for Payer: Managed Health Services Medicaid |
$42.84
|
| Rate for Payer: MDWise Medicaid |
$42.84
|
| Rate for Payer: PHCS All Commercial |
$372.79
|
| Rate for Payer: PHP All Commercial |
$376.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$193.85
|
| Rate for Payer: Sagamore Health Network All Products |
$383.72
|
| Rate for Payer: Signature Care EPO |
$412.55
|
| Rate for Payer: Signature Care PPO |
$437.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$422.49
|
| Rate for Payer: United Healthcare Commercial |
$391.68
|
| Rate for Payer: United Healthcare Medicare |
$159.06
|
|
|
HC BLACK GRANUFOAM KIT LG
|
Facility
|
IP
|
$367.79
|
|
| Hospital Charge Code |
41606589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.84 |
| Max. Negotiated Rate |
$342.04 |
| Rate for Payer: Aetna Commercial |
$317.77
|
| Rate for Payer: Cash Price |
$220.67
|
| Rate for Payer: Cigna All Commercial |
$317.40
|
| Rate for Payer: CORVEL All Commercial |
$342.04
|
| Rate for Payer: Coventry All Commercial |
$323.66
|
| Rate for Payer: Encore All Commercial |
$338.55
|
| Rate for Payer: Frontpath All Commercial |
$338.37
|
| Rate for Payer: Humana ChoiceCare |
$317.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$331.01
|
| Rate for Payer: PHCS All Commercial |
$275.84
|
| Rate for Payer: PHP All Commercial |
$278.93
|
| Rate for Payer: Sagamore Health Network All Products |
$283.93
|
| Rate for Payer: Signature Care EPO |
$305.27
|
| Rate for Payer: Signature Care PPO |
$323.66
|
| Rate for Payer: United Healthcare Commercial |
$289.82
|
|
|
HC BLACK GRANUFOAM KIT LG
|
Facility
|
OP
|
$367.79
|
|
| Hospital Charge Code |
41606589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$342.04 |
| Rate for Payer: Aetna Commercial |
$310.41
|
| Rate for Payer: Aetna Medicare |
$117.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$211.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$229.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.46
|
| Rate for Payer: Cash Price |
$220.67
|
| Rate for Payer: Cash Price |
$220.67
|
| Rate for Payer: Centivo All Commercial |
$200.08
|
| Rate for Payer: Cigna All Commercial |
$317.40
|
| Rate for Payer: CORVEL All Commercial |
$342.04
|
| Rate for Payer: Coventry All Commercial |
$323.66
|
| Rate for Payer: Encore All Commercial |
$338.55
|
| Rate for Payer: Frontpath All Commercial |
$338.37
|
| Rate for Payer: Humana ChoiceCare |
$317.66
|
| Rate for Payer: Humana Medicare |
$117.69
|
| Rate for Payer: Lucent All Commercial |
$200.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$331.01
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$275.84
|
| Rate for Payer: PHP All Commercial |
$278.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$143.44
|
| Rate for Payer: Sagamore Health Network All Products |
$283.93
|
| Rate for Payer: Signature Care EPO |
$305.27
|
| Rate for Payer: Signature Care PPO |
$323.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$312.62
|
| Rate for Payer: United Healthcare Commercial |
$289.82
|
| Rate for Payer: United Healthcare Medicare |
$117.69
|
|
|
HC BLADDER SCAN RESIDUAL BEDSIDE
|
Facility
|
OP
|
$533.51
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
1681798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$496.16 |
| Rate for Payer: Aetna Commercial |
$450.28
|
| Rate for Payer: Aetna Medicare |
$170.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$165.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$306.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$333.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.80
|
| Rate for Payer: Cash Price |
$320.11
|
| Rate for Payer: Cash Price |
$320.11
|
| Rate for Payer: Centivo All Commercial |
$290.23
|
| Rate for Payer: Cigna All Commercial |
$460.42
|
| Rate for Payer: CORVEL All Commercial |
$496.16
|
| Rate for Payer: Coventry All Commercial |
$469.49
|
| Rate for Payer: Encore All Commercial |
$491.10
|
| Rate for Payer: Frontpath All Commercial |
$490.83
|
| Rate for Payer: Humana ChoiceCare |
$460.79
|
| Rate for Payer: Humana Medicare |
$170.72
|
| Rate for Payer: Lucent All Commercial |
$290.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$480.16
|
| Rate for Payer: Managed Health Services Medicaid |
$21.86
|
| Rate for Payer: MDWise Medicaid |
$21.86
|
| Rate for Payer: PHCS All Commercial |
$400.13
|
| Rate for Payer: PHP All Commercial |
$404.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$208.07
|
| Rate for Payer: Sagamore Health Network All Products |
$411.87
|
| Rate for Payer: Signature Care EPO |
$442.81
|
| Rate for Payer: Signature Care PPO |
$469.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$453.48
|
| Rate for Payer: United Healthcare Commercial |
$420.41
|
| Rate for Payer: United Healthcare Medicare |
$170.72
|
|
|
HC BLADDER SCAN RESIDUAL BEDSIDE
|
Facility
|
IP
|
$533.51
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
1681798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.13 |
| Max. Negotiated Rate |
$496.16 |
| Rate for Payer: Aetna Commercial |
$460.95
|
| Rate for Payer: Cash Price |
$320.11
|
| Rate for Payer: Cigna All Commercial |
$460.42
|
| Rate for Payer: CORVEL All Commercial |
$496.16
|
| Rate for Payer: Coventry All Commercial |
$469.49
|
| Rate for Payer: Encore All Commercial |
$491.10
|
| Rate for Payer: Frontpath All Commercial |
$490.83
|
| Rate for Payer: Humana ChoiceCare |
$460.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$480.16
|
| Rate for Payer: PHCS All Commercial |
$400.13
|
| Rate for Payer: PHP All Commercial |
$404.61
|
| Rate for Payer: Sagamore Health Network All Products |
$411.87
|
| Rate for Payer: Signature Care EPO |
$442.81
|
| Rate for Payer: Signature Care PPO |
$469.49
|
| Rate for Payer: United Healthcare Commercial |
$420.41
|
|
|
HC BLADE ECTR STANDARD
|
Facility
|
IP
|
$1,385.00
|
|
| Hospital Charge Code |
41602477
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,038.75 |
| Max. Negotiated Rate |
$1,288.05 |
| Rate for Payer: Aetna Commercial |
$1,196.64
|
| Rate for Payer: Cash Price |
$831.00
|
| Rate for Payer: Cigna All Commercial |
$1,195.26
|
| Rate for Payer: CORVEL All Commercial |
$1,288.05
|
| Rate for Payer: Coventry All Commercial |
$1,218.80
|
| Rate for Payer: Encore All Commercial |
$1,274.89
|
| Rate for Payer: Frontpath All Commercial |
$1,274.20
|
| Rate for Payer: Humana ChoiceCare |
$1,196.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,246.50
|
| Rate for Payer: PHCS All Commercial |
$1,038.75
|
| Rate for Payer: PHP All Commercial |
$1,050.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,069.22
|
| Rate for Payer: Signature Care EPO |
$1,149.55
|
| Rate for Payer: Signature Care PPO |
$1,218.80
|
| Rate for Payer: United Healthcare Commercial |
$1,091.38
|
|
|
HC BLADE ECTR STANDARD
|
Facility
|
OP
|
$1,385.00
|
|
| Hospital Charge Code |
41602477
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$1,288.05 |
| Rate for Payer: Aetna Commercial |
$1,168.94
|
| Rate for Payer: Aetna Medicare |
$443.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$429.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$795.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$865.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$509.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$487.52
|
| Rate for Payer: Cash Price |
$831.00
|
| Rate for Payer: Cash Price |
$831.00
|
| Rate for Payer: Centivo All Commercial |
$753.44
|
| Rate for Payer: Cigna All Commercial |
$1,195.26
|
| Rate for Payer: CORVEL All Commercial |
$1,288.05
|
| Rate for Payer: Coventry All Commercial |
$1,218.80
|
| Rate for Payer: Encore All Commercial |
$1,274.89
|
| Rate for Payer: Frontpath All Commercial |
$1,274.20
|
| Rate for Payer: Humana ChoiceCare |
$1,196.22
|
| Rate for Payer: Humana Medicare |
$443.20
|
| Rate for Payer: Lucent All Commercial |
$753.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,246.50
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$1,038.75
|
| Rate for Payer: PHP All Commercial |
$1,050.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$540.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,069.22
|
| Rate for Payer: Signature Care EPO |
$1,149.55
|
| Rate for Payer: Signature Care PPO |
$1,218.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,177.25
|
| Rate for Payer: United Healthcare Commercial |
$1,091.38
|
| Rate for Payer: United Healthcare Medicare |
$443.20
|
|
|
HC BLADE GLIDESCOPE GVL 3
|
Facility
|
IP
|
$151.90
|
|
| Hospital Charge Code |
41601226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.92 |
| Max. Negotiated Rate |
$141.27 |
| Rate for Payer: Aetna Commercial |
$131.24
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cigna All Commercial |
$131.09
|
| Rate for Payer: CORVEL All Commercial |
$141.27
|
| Rate for Payer: Coventry All Commercial |
$133.67
|
| Rate for Payer: Encore All Commercial |
$139.82
|
| Rate for Payer: Frontpath All Commercial |
$139.75
|
| Rate for Payer: Humana ChoiceCare |
$131.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.71
|
| Rate for Payer: PHCS All Commercial |
$113.92
|
| Rate for Payer: PHP All Commercial |
$115.20
|
| Rate for Payer: Sagamore Health Network All Products |
$117.27
|
| Rate for Payer: Signature Care EPO |
$126.08
|
| Rate for Payer: Signature Care PPO |
$133.67
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
|
|
HC BLADE GLIDESCOPE GVL 3
|
Facility
|
OP
|
$151.90
|
|
| Hospital Charge Code |
41601226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$141.27 |
| Rate for Payer: Aetna Commercial |
$128.20
|
| Rate for Payer: Aetna Medicare |
$48.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$87.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.47
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Centivo All Commercial |
$82.63
|
| Rate for Payer: Cigna All Commercial |
$131.09
|
| Rate for Payer: CORVEL All Commercial |
$141.27
|
| Rate for Payer: Coventry All Commercial |
$133.67
|
| Rate for Payer: Encore All Commercial |
$139.82
|
| Rate for Payer: Frontpath All Commercial |
$139.75
|
| Rate for Payer: Humana ChoiceCare |
$131.20
|
| Rate for Payer: Humana Medicare |
$48.61
|
| Rate for Payer: Lucent All Commercial |
$82.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.71
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$113.92
|
| Rate for Payer: PHP All Commercial |
$115.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.24
|
| Rate for Payer: Sagamore Health Network All Products |
$117.27
|
| Rate for Payer: Signature Care EPO |
$126.08
|
| Rate for Payer: Signature Care PPO |
$133.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.12
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Medicare |
$48.61
|
|
|
HC BLADE GLIDESCOPE GVL 4
|
Facility
|
IP
|
$151.90
|
|
| Hospital Charge Code |
41601227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.92 |
| Max. Negotiated Rate |
$141.27 |
| Rate for Payer: Aetna Commercial |
$131.24
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cigna All Commercial |
$131.09
|
| Rate for Payer: CORVEL All Commercial |
$141.27
|
| Rate for Payer: Coventry All Commercial |
$133.67
|
| Rate for Payer: Encore All Commercial |
$139.82
|
| Rate for Payer: Frontpath All Commercial |
$139.75
|
| Rate for Payer: Humana ChoiceCare |
$131.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.71
|
| Rate for Payer: PHCS All Commercial |
$113.92
|
| Rate for Payer: PHP All Commercial |
$115.20
|
| Rate for Payer: Sagamore Health Network All Products |
$117.27
|
| Rate for Payer: Signature Care EPO |
$126.08
|
| Rate for Payer: Signature Care PPO |
$133.67
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
|
|
HC BLADE GLIDESCOPE GVL 4
|
Facility
|
OP
|
$151.90
|
|
| Hospital Charge Code |
41601227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$141.27 |
| Rate for Payer: Aetna Commercial |
$128.20
|
| Rate for Payer: Aetna Medicare |
$48.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$87.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.47
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Centivo All Commercial |
$82.63
|
| Rate for Payer: Cigna All Commercial |
$131.09
|
| Rate for Payer: CORVEL All Commercial |
$141.27
|
| Rate for Payer: Coventry All Commercial |
$133.67
|
| Rate for Payer: Encore All Commercial |
$139.82
|
| Rate for Payer: Frontpath All Commercial |
$139.75
|
| Rate for Payer: Humana ChoiceCare |
$131.20
|
| Rate for Payer: Humana Medicare |
$48.61
|
| Rate for Payer: Lucent All Commercial |
$82.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.71
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$113.92
|
| Rate for Payer: PHP All Commercial |
$115.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.24
|
| Rate for Payer: Sagamore Health Network All Products |
$117.27
|
| Rate for Payer: Signature Care EPO |
$126.08
|
| Rate for Payer: Signature Care PPO |
$133.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.12
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Medicare |
$48.61
|
|
|
HC BLADE SAW LONG NARR
|
Facility
|
OP
|
$237.30
|
|
| Hospital Charge Code |
41601238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$220.69 |
| Rate for Payer: Aetna Commercial |
$200.28
|
| Rate for Payer: Aetna Medicare |
$75.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$136.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.53
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Centivo All Commercial |
$129.09
|
| Rate for Payer: Cigna All Commercial |
$204.79
|
| Rate for Payer: CORVEL All Commercial |
$220.69
|
| Rate for Payer: Coventry All Commercial |
$208.82
|
| Rate for Payer: Encore All Commercial |
$218.43
|
| Rate for Payer: Frontpath All Commercial |
$218.32
|
| Rate for Payer: Humana ChoiceCare |
$204.96
|
| Rate for Payer: Humana Medicare |
$75.94
|
| Rate for Payer: Lucent All Commercial |
$129.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.57
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$177.97
|
| Rate for Payer: PHP All Commercial |
$179.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.55
|
| Rate for Payer: Sagamore Health Network All Products |
$183.20
|
| Rate for Payer: Signature Care EPO |
$196.96
|
| Rate for Payer: Signature Care PPO |
$208.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$201.71
|
| Rate for Payer: United Healthcare Commercial |
$186.99
|
| Rate for Payer: United Healthcare Medicare |
$75.94
|
|
|
HC BLADE SAW LONG NARR
|
Facility
|
IP
|
$237.30
|
|
| Hospital Charge Code |
41601238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.97 |
| Max. Negotiated Rate |
$220.69 |
| Rate for Payer: Aetna Commercial |
$205.03
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cigna All Commercial |
$204.79
|
| Rate for Payer: CORVEL All Commercial |
$220.69
|
| Rate for Payer: Coventry All Commercial |
$208.82
|
| Rate for Payer: Encore All Commercial |
$218.43
|
| Rate for Payer: Frontpath All Commercial |
$218.32
|
| Rate for Payer: Humana ChoiceCare |
$204.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.57
|
| Rate for Payer: PHCS All Commercial |
$177.97
|
| Rate for Payer: PHP All Commercial |
$179.97
|
| Rate for Payer: Sagamore Health Network All Products |
$183.20
|
| Rate for Payer: Signature Care EPO |
$196.96
|
| Rate for Payer: Signature Care PPO |
$208.82
|
| Rate for Payer: United Healthcare Commercial |
$186.99
|
|
|
HC BLADE SAW MED NARR
|
Facility
|
OP
|
$229.39
|
|
| Hospital Charge Code |
41601237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$213.33 |
| Rate for Payer: Aetna Commercial |
$193.61
|
| Rate for Payer: Aetna Medicare |
$73.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$131.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.75
|
| Rate for Payer: Cash Price |
$137.63
|
| Rate for Payer: Cash Price |
$137.63
|
| Rate for Payer: Centivo All Commercial |
$124.79
|
| Rate for Payer: Cigna All Commercial |
$197.96
|
| Rate for Payer: CORVEL All Commercial |
$213.33
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Encore All Commercial |
$211.15
|
| Rate for Payer: Frontpath All Commercial |
$211.04
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Humana Medicare |
$73.40
|
| Rate for Payer: Lucent All Commercial |
$124.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.45
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$172.04
|
| Rate for Payer: PHP All Commercial |
$173.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.46
|
| Rate for Payer: Sagamore Health Network All Products |
$177.09
|
| Rate for Payer: Signature Care EPO |
$190.39
|
| Rate for Payer: Signature Care PPO |
$201.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194.98
|
| Rate for Payer: United Healthcare Commercial |
$180.76
|
| Rate for Payer: United Healthcare Medicare |
$73.40
|
|
|
HC BLADE SAW MED NARR
|
Facility
|
IP
|
$229.39
|
|
| Hospital Charge Code |
41601237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$213.33 |
| Rate for Payer: Aetna Commercial |
$198.19
|
| Rate for Payer: Cash Price |
$137.63
|
| Rate for Payer: Cigna All Commercial |
$197.96
|
| Rate for Payer: CORVEL All Commercial |
$213.33
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Encore All Commercial |
$211.15
|
| Rate for Payer: Frontpath All Commercial |
$211.04
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.45
|
| Rate for Payer: PHCS All Commercial |
$172.04
|
| Rate for Payer: PHP All Commercial |
$173.97
|
| Rate for Payer: Sagamore Health Network All Products |
$177.09
|
| Rate for Payer: Signature Care EPO |
$190.39
|
| Rate for Payer: Signature Care PPO |
$201.86
|
| Rate for Payer: United Healthcare Commercial |
$180.76
|
|
|
HC BLADE SAW PREC THIN 9X.38X18.5
|
Facility
|
IP
|
$229.39
|
|
| Hospital Charge Code |
41601899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$213.33 |
| Rate for Payer: Aetna Commercial |
$198.19
|
| Rate for Payer: Cash Price |
$137.63
|
| Rate for Payer: Cigna All Commercial |
$197.96
|
| Rate for Payer: CORVEL All Commercial |
$213.33
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Encore All Commercial |
$211.15
|
| Rate for Payer: Frontpath All Commercial |
$211.04
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.45
|
| Rate for Payer: PHCS All Commercial |
$172.04
|
| Rate for Payer: PHP All Commercial |
$173.97
|
| Rate for Payer: Sagamore Health Network All Products |
$177.09
|
| Rate for Payer: Signature Care EPO |
$190.39
|
| Rate for Payer: Signature Care PPO |
$201.86
|
| Rate for Payer: United Healthcare Commercial |
$180.76
|
|
|
HC BLADE SAW PREC THIN 9X.38X18.5
|
Facility
|
OP
|
$229.39
|
|
| Hospital Charge Code |
41601899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$213.33 |
| Rate for Payer: Aetna Commercial |
$193.61
|
| Rate for Payer: Aetna Medicare |
$73.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$131.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.75
|
| Rate for Payer: Cash Price |
$137.63
|
| Rate for Payer: Cash Price |
$137.63
|
| Rate for Payer: Centivo All Commercial |
$124.79
|
| Rate for Payer: Cigna All Commercial |
$197.96
|
| Rate for Payer: CORVEL All Commercial |
$213.33
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Encore All Commercial |
$211.15
|
| Rate for Payer: Frontpath All Commercial |
$211.04
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Humana Medicare |
$73.40
|
| Rate for Payer: Lucent All Commercial |
$124.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.45
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$172.04
|
| Rate for Payer: PHP All Commercial |
$173.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.46
|
| Rate for Payer: Sagamore Health Network All Products |
$177.09
|
| Rate for Payer: Signature Care EPO |
$190.39
|
| Rate for Payer: Signature Care PPO |
$201.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194.98
|
| Rate for Payer: United Healthcare Commercial |
$180.76
|
| Rate for Payer: United Healthcare Medicare |
$73.40
|
|
|
HC BLADE SAW PREC THIN 9X.51X25
|
Facility
|
IP
|
$234.01
|
|
| Hospital Charge Code |
41602105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.51 |
| Max. Negotiated Rate |
$217.63 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Cash Price |
$140.41
|
| Rate for Payer: Cigna All Commercial |
$201.95
|
| Rate for Payer: CORVEL All Commercial |
$217.63
|
| Rate for Payer: Coventry All Commercial |
$205.93
|
| Rate for Payer: Encore All Commercial |
$215.41
|
| Rate for Payer: Frontpath All Commercial |
$215.29
|
| Rate for Payer: Humana ChoiceCare |
$202.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.61
|
| Rate for Payer: PHCS All Commercial |
$175.51
|
| Rate for Payer: PHP All Commercial |
$177.47
|
| Rate for Payer: Sagamore Health Network All Products |
$180.66
|
| Rate for Payer: Signature Care EPO |
$194.23
|
| Rate for Payer: Signature Care PPO |
$205.93
|
| Rate for Payer: United Healthcare Commercial |
$184.40
|
|
|
HC BLADE SAW PREC THIN 9X.51X25
|
Facility
|
OP
|
$234.01
|
|
| Hospital Charge Code |
41602105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$217.63 |
| Rate for Payer: Aetna Commercial |
$197.50
|
| Rate for Payer: Aetna Medicare |
$74.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$134.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.37
|
| Rate for Payer: Cash Price |
$140.41
|
| Rate for Payer: Cash Price |
$140.41
|
| Rate for Payer: Centivo All Commercial |
$127.30
|
| Rate for Payer: Cigna All Commercial |
$201.95
|
| Rate for Payer: CORVEL All Commercial |
$217.63
|
| Rate for Payer: Coventry All Commercial |
$205.93
|
| Rate for Payer: Encore All Commercial |
$215.41
|
| Rate for Payer: Frontpath All Commercial |
$215.29
|
| Rate for Payer: Humana ChoiceCare |
$202.11
|
| Rate for Payer: Humana Medicare |
$74.88
|
| Rate for Payer: Lucent All Commercial |
$127.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.61
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$175.51
|
| Rate for Payer: PHP All Commercial |
$177.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.26
|
| Rate for Payer: Sagamore Health Network All Products |
$180.66
|
| Rate for Payer: Signature Care EPO |
$194.23
|
| Rate for Payer: Signature Care PPO |
$205.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.91
|
| Rate for Payer: United Healthcare Commercial |
$184.40
|
| Rate for Payer: United Healthcare Medicare |
$74.88
|
|
|
HC BLADE SAW SAG 19.5X1.27
|
Facility
|
IP
|
$770.00
|
|
| Hospital Charge Code |
41602411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC BLADE SAW SAG 19.5X1.27
|
Facility
|
OP
|
$770.00
|
|
| Hospital Charge Code |
41602411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$246.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$238.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$283.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$271.04
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Centivo All Commercial |
$418.88
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$246.40
|
| Rate for Payer: Lucent All Commercial |
$418.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$246.40
|
|
|
HC BLANKET BAIR HUGGER FULL UNDER
|
Facility
|
IP
|
$164.99
|
|
| Hospital Charge Code |
41601787
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$123.74 |
| Max. Negotiated Rate |
$153.44 |
| Rate for Payer: Aetna Commercial |
$142.55
|
| Rate for Payer: Cash Price |
$98.99
|
| Rate for Payer: Cigna All Commercial |
$142.39
|
| Rate for Payer: CORVEL All Commercial |
$153.44
|
| Rate for Payer: Coventry All Commercial |
$145.19
|
| Rate for Payer: Encore All Commercial |
$151.87
|
| Rate for Payer: Frontpath All Commercial |
$151.79
|
| Rate for Payer: Humana ChoiceCare |
$142.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.49
|
| Rate for Payer: PHCS All Commercial |
$123.74
|
| Rate for Payer: PHP All Commercial |
$125.13
|
| Rate for Payer: Sagamore Health Network All Products |
$127.37
|
| Rate for Payer: Signature Care EPO |
$136.94
|
| Rate for Payer: Signature Care PPO |
$145.19
|
| Rate for Payer: United Healthcare Commercial |
$130.01
|
|
|
HC BLANKET BAIR HUGGER FULL UNDER
|
Facility
|
OP
|
$164.99
|
|
| Hospital Charge Code |
41601787
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$153.44 |
| Rate for Payer: Aetna Commercial |
$139.25
|
| Rate for Payer: Aetna Medicare |
$52.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$94.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.08
|
| Rate for Payer: Cash Price |
$98.99
|
| Rate for Payer: Cash Price |
$98.99
|
| Rate for Payer: Centivo All Commercial |
$89.75
|
| Rate for Payer: Cigna All Commercial |
$142.39
|
| Rate for Payer: CORVEL All Commercial |
$153.44
|
| Rate for Payer: Coventry All Commercial |
$145.19
|
| Rate for Payer: Encore All Commercial |
$151.87
|
| Rate for Payer: Frontpath All Commercial |
$151.79
|
| Rate for Payer: Humana ChoiceCare |
$142.50
|
| Rate for Payer: Humana Medicare |
$52.80
|
| Rate for Payer: Lucent All Commercial |
$89.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.49
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$123.74
|
| Rate for Payer: PHP All Commercial |
$125.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.35
|
| Rate for Payer: Sagamore Health Network All Products |
$127.37
|
| Rate for Payer: Signature Care EPO |
$136.94
|
| Rate for Payer: Signature Care PPO |
$145.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.24
|
| Rate for Payer: United Healthcare Commercial |
$130.01
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
|
|
HC BLANKET BAIR HUGGER LOWER BODY
|
Facility
|
IP
|
$40.81
|
|
| Hospital Charge Code |
41604332
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: Cash Price |
$24.49
|
| Rate for Payer: Cigna All Commercial |
$35.22
|
| Rate for Payer: CORVEL All Commercial |
$37.95
|
| Rate for Payer: Coventry All Commercial |
$35.91
|
| Rate for Payer: Encore All Commercial |
$37.57
|
| Rate for Payer: Frontpath All Commercial |
$37.55
|
| Rate for Payer: Humana ChoiceCare |
$35.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.73
|
| Rate for Payer: PHCS All Commercial |
$30.61
|
| Rate for Payer: PHP All Commercial |
$30.95
|
| Rate for Payer: Sagamore Health Network All Products |
$31.51
|
| Rate for Payer: Signature Care EPO |
$33.87
|
| Rate for Payer: Signature Care PPO |
$35.91
|
| Rate for Payer: United Healthcare Commercial |
$32.16
|
|
|
HC BLANKET BAIR HUGGER LOWER BODY
|
Facility
|
OP
|
$40.81
|
|
| Hospital Charge Code |
41604332
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Aetna Commercial |
$34.44
|
| Rate for Payer: Aetna Medicare |
$13.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.37
|
| Rate for Payer: Cash Price |
$24.49
|
| Rate for Payer: Cash Price |
$24.49
|
| Rate for Payer: Centivo All Commercial |
$22.20
|
| Rate for Payer: Cigna All Commercial |
$35.22
|
| Rate for Payer: CORVEL All Commercial |
$37.95
|
| Rate for Payer: Coventry All Commercial |
$35.91
|
| Rate for Payer: Encore All Commercial |
$37.57
|
| Rate for Payer: Frontpath All Commercial |
$37.55
|
| Rate for Payer: Humana ChoiceCare |
$35.25
|
| Rate for Payer: Humana Medicare |
$13.06
|
| Rate for Payer: Lucent All Commercial |
$22.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.73
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$30.61
|
| Rate for Payer: PHP All Commercial |
$30.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.92
|
| Rate for Payer: Sagamore Health Network All Products |
$31.51
|
| Rate for Payer: Signature Care EPO |
$33.87
|
| Rate for Payer: Signature Care PPO |
$35.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.69
|
| Rate for Payer: United Healthcare Commercial |
$32.16
|
| Rate for Payer: United Healthcare Medicare |
$13.06
|
|
