|
HC ENDO TUBE ENDOTROL 6.0
|
Facility
IP
|
$62.02
|
|
| Hospital Charge Code |
41602481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.52 |
| Max. Negotiated Rate |
$57.68 |
| Rate for Payer: Aetna Commercial |
$53.59
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Cigna All Commercial |
$53.52
|
| Rate for Payer: CORVEL All Commercial |
$57.68
|
| Rate for Payer: Coventry All Commercial |
$54.58
|
| Rate for Payer: Encore All Commercial |
$57.09
|
| Rate for Payer: Frontpath All Commercial |
$57.06
|
| Rate for Payer: Humana ChoiceCare |
$53.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.82
|
| Rate for Payer: PHCS All Commercial |
$46.52
|
| Rate for Payer: PHP All Commercial |
$47.04
|
| Rate for Payer: Sagamore Health Network All Products |
$47.88
|
| Rate for Payer: Signature Care EPO |
$51.48
|
| Rate for Payer: Signature Care PPO |
$54.58
|
| Rate for Payer: United Healthcare Commercial |
$48.87
|
|
|
HC ENDO TUBE ENDOTROL 6.0
|
Facility
OP
|
$62.02
|
|
| Hospital Charge Code |
41602481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$52.34
|
| Rate for Payer: Aetna Medicare |
$20.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.51
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Centivo All Commercial |
$31.63
|
| Rate for Payer: Cigna All Commercial |
$53.52
|
| Rate for Payer: CORVEL All Commercial |
$57.68
|
| Rate for Payer: Coventry All Commercial |
$54.58
|
| Rate for Payer: Encore All Commercial |
$57.09
|
| Rate for Payer: Frontpath All Commercial |
$57.06
|
| Rate for Payer: Humana ChoiceCare |
$53.57
|
| Rate for Payer: Humana Medicare |
$31.63
|
| Rate for Payer: Lucent All Commercial |
$31.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$46.52
|
| Rate for Payer: PHP All Commercial |
$47.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.19
|
| Rate for Payer: Sagamore Health Network All Products |
$47.88
|
| Rate for Payer: Signature Care EPO |
$51.48
|
| Rate for Payer: Signature Care PPO |
$54.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.72
|
| Rate for Payer: United Healthcare Commercial |
$48.87
|
| Rate for Payer: United Healthcare Medicare |
$20.47
|
|
|
HC ENDO TUBE ENDOTROL 7.0
|
Facility
IP
|
$62.02
|
|
| Hospital Charge Code |
41602482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.52 |
| Max. Negotiated Rate |
$57.68 |
| Rate for Payer: Aetna Commercial |
$53.59
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Cigna All Commercial |
$53.52
|
| Rate for Payer: CORVEL All Commercial |
$57.68
|
| Rate for Payer: Coventry All Commercial |
$54.58
|
| Rate for Payer: Encore All Commercial |
$57.09
|
| Rate for Payer: Frontpath All Commercial |
$57.06
|
| Rate for Payer: Humana ChoiceCare |
$53.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.82
|
| Rate for Payer: PHCS All Commercial |
$46.52
|
| Rate for Payer: PHP All Commercial |
$47.04
|
| Rate for Payer: Sagamore Health Network All Products |
$47.88
|
| Rate for Payer: Signature Care EPO |
$51.48
|
| Rate for Payer: Signature Care PPO |
$54.58
|
| Rate for Payer: United Healthcare Commercial |
$48.87
|
|
|
HC ENDO TUBE ENDOTROL 7.0
|
Facility
OP
|
$62.02
|
|
| Hospital Charge Code |
41602482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$52.34
|
| Rate for Payer: Aetna Medicare |
$20.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.51
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Centivo All Commercial |
$31.63
|
| Rate for Payer: Cigna All Commercial |
$53.52
|
| Rate for Payer: CORVEL All Commercial |
$57.68
|
| Rate for Payer: Coventry All Commercial |
$54.58
|
| Rate for Payer: Encore All Commercial |
$57.09
|
| Rate for Payer: Frontpath All Commercial |
$57.06
|
| Rate for Payer: Humana ChoiceCare |
$53.57
|
| Rate for Payer: Humana Medicare |
$31.63
|
| Rate for Payer: Lucent All Commercial |
$31.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$46.52
|
| Rate for Payer: PHP All Commercial |
$47.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.19
|
| Rate for Payer: Sagamore Health Network All Products |
$47.88
|
| Rate for Payer: Signature Care EPO |
$51.48
|
| Rate for Payer: Signature Care PPO |
$54.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.72
|
| Rate for Payer: United Healthcare Commercial |
$48.87
|
| Rate for Payer: United Healthcare Medicare |
$20.47
|
|
|
HC ENDO TUBE ENDOTROL 8.0
|
Facility
IP
|
$62.02
|
|
| Hospital Charge Code |
41602483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.52 |
| Max. Negotiated Rate |
$57.68 |
| Rate for Payer: Aetna Commercial |
$53.59
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Cigna All Commercial |
$53.52
|
| Rate for Payer: CORVEL All Commercial |
$57.68
|
| Rate for Payer: Coventry All Commercial |
$54.58
|
| Rate for Payer: Encore All Commercial |
$57.09
|
| Rate for Payer: Frontpath All Commercial |
$57.06
|
| Rate for Payer: Humana ChoiceCare |
$53.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.82
|
| Rate for Payer: PHCS All Commercial |
$46.52
|
| Rate for Payer: PHP All Commercial |
$47.04
|
| Rate for Payer: Sagamore Health Network All Products |
$47.88
|
| Rate for Payer: Signature Care EPO |
$51.48
|
| Rate for Payer: Signature Care PPO |
$54.58
|
| Rate for Payer: United Healthcare Commercial |
$48.87
|
|
|
HC ENDO TUBE ENDOTROL 8.0
|
Facility
OP
|
$62.02
|
|
| Hospital Charge Code |
41602483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$52.34
|
| Rate for Payer: Aetna Medicare |
$20.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.51
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Centivo All Commercial |
$31.63
|
| Rate for Payer: Cigna All Commercial |
$53.52
|
| Rate for Payer: CORVEL All Commercial |
$57.68
|
| Rate for Payer: Coventry All Commercial |
$54.58
|
| Rate for Payer: Encore All Commercial |
$57.09
|
| Rate for Payer: Frontpath All Commercial |
$57.06
|
| Rate for Payer: Humana ChoiceCare |
$53.57
|
| Rate for Payer: Humana Medicare |
$31.63
|
| Rate for Payer: Lucent All Commercial |
$31.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$46.52
|
| Rate for Payer: PHP All Commercial |
$47.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.19
|
| Rate for Payer: Sagamore Health Network All Products |
$47.88
|
| Rate for Payer: Signature Care EPO |
$51.48
|
| Rate for Payer: Signature Care PPO |
$54.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.72
|
| Rate for Payer: United Healthcare Commercial |
$48.87
|
| Rate for Payer: United Healthcare Medicare |
$20.47
|
|
|
HC ENDO TUBE INTER HI LO 3.0
|
Facility
IP
|
$11.90
|
|
| Hospital Charge Code |
41602478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cigna All Commercial |
$10.27
|
| Rate for Payer: CORVEL All Commercial |
$11.07
|
| Rate for Payer: Coventry All Commercial |
$10.47
|
| Rate for Payer: Encore All Commercial |
$10.95
|
| Rate for Payer: Frontpath All Commercial |
$10.95
|
| Rate for Payer: Humana ChoiceCare |
$10.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.71
|
| Rate for Payer: PHCS All Commercial |
$8.92
|
| Rate for Payer: PHP All Commercial |
$9.02
|
| Rate for Payer: Sagamore Health Network All Products |
$9.19
|
| Rate for Payer: Signature Care EPO |
$9.88
|
| Rate for Payer: Signature Care PPO |
$10.47
|
| Rate for Payer: United Healthcare Commercial |
$9.38
|
|
|
HC ENDO TUBE INTER HI LO 3.0
|
Facility
OP
|
$11.90
|
|
| Hospital Charge Code |
41602478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.32
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Centivo All Commercial |
$6.07
|
| Rate for Payer: Cigna All Commercial |
$10.27
|
| Rate for Payer: CORVEL All Commercial |
$11.07
|
| Rate for Payer: Coventry All Commercial |
$10.47
|
| Rate for Payer: Encore All Commercial |
$10.95
|
| Rate for Payer: Frontpath All Commercial |
$10.95
|
| Rate for Payer: Humana ChoiceCare |
$10.28
|
| Rate for Payer: Humana Medicare |
$6.07
|
| Rate for Payer: Lucent All Commercial |
$6.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.92
|
| Rate for Payer: PHP All Commercial |
$9.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.64
|
| Rate for Payer: Sagamore Health Network All Products |
$9.19
|
| Rate for Payer: Signature Care EPO |
$9.88
|
| Rate for Payer: Signature Care PPO |
$10.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.12
|
| Rate for Payer: United Healthcare Commercial |
$9.38
|
| Rate for Payer: United Healthcare Medicare |
$3.93
|
|
|
HC ENDO TUBE INTER HI LO 4.0
|
Facility
IP
|
$11.90
|
|
| Hospital Charge Code |
41602479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cigna All Commercial |
$10.27
|
| Rate for Payer: CORVEL All Commercial |
$11.07
|
| Rate for Payer: Coventry All Commercial |
$10.47
|
| Rate for Payer: Encore All Commercial |
$10.95
|
| Rate for Payer: Frontpath All Commercial |
$10.95
|
| Rate for Payer: Humana ChoiceCare |
$10.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.71
|
| Rate for Payer: PHCS All Commercial |
$8.92
|
| Rate for Payer: PHP All Commercial |
$9.02
|
| Rate for Payer: Sagamore Health Network All Products |
$9.19
|
| Rate for Payer: Signature Care EPO |
$9.88
|
| Rate for Payer: Signature Care PPO |
$10.47
|
| Rate for Payer: United Healthcare Commercial |
$9.38
|
|
|
HC ENDO TUBE INTER HI LO 4.0
|
Facility
OP
|
$11.90
|
|
| Hospital Charge Code |
41602479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.32
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Centivo All Commercial |
$6.07
|
| Rate for Payer: Cigna All Commercial |
$10.27
|
| Rate for Payer: CORVEL All Commercial |
$11.07
|
| Rate for Payer: Coventry All Commercial |
$10.47
|
| Rate for Payer: Encore All Commercial |
$10.95
|
| Rate for Payer: Frontpath All Commercial |
$10.95
|
| Rate for Payer: Humana ChoiceCare |
$10.28
|
| Rate for Payer: Humana Medicare |
$6.07
|
| Rate for Payer: Lucent All Commercial |
$6.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.92
|
| Rate for Payer: PHP All Commercial |
$9.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.64
|
| Rate for Payer: Sagamore Health Network All Products |
$9.19
|
| Rate for Payer: Signature Care EPO |
$9.88
|
| Rate for Payer: Signature Care PPO |
$10.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.12
|
| Rate for Payer: United Healthcare Commercial |
$9.38
|
| Rate for Payer: United Healthcare Medicare |
$3.93
|
|
|
HC ENDO TUBE INTER HI LO 4.5
|
Facility
IP
|
$11.25
|
|
| Hospital Charge Code |
41602480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cigna All Commercial |
$9.71
|
| Rate for Payer: CORVEL All Commercial |
$10.46
|
| Rate for Payer: Coventry All Commercial |
$9.90
|
| Rate for Payer: Encore All Commercial |
$10.36
|
| Rate for Payer: Frontpath All Commercial |
$10.35
|
| Rate for Payer: Humana ChoiceCare |
$9.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.12
|
| Rate for Payer: PHCS All Commercial |
$8.44
|
| Rate for Payer: PHP All Commercial |
$8.53
|
| Rate for Payer: Sagamore Health Network All Products |
$8.68
|
| Rate for Payer: Signature Care EPO |
$9.34
|
| Rate for Payer: Signature Care PPO |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$8.86
|
|
|
HC ENDO TUBE INTER HI LO 4.5
|
Facility
OP
|
$11.25
|
|
| Hospital Charge Code |
41602480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.08
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Centivo All Commercial |
$5.74
|
| Rate for Payer: Cigna All Commercial |
$9.71
|
| Rate for Payer: CORVEL All Commercial |
$10.46
|
| Rate for Payer: Coventry All Commercial |
$9.90
|
| Rate for Payer: Encore All Commercial |
$10.36
|
| Rate for Payer: Frontpath All Commercial |
$10.35
|
| Rate for Payer: Humana ChoiceCare |
$9.72
|
| Rate for Payer: Humana Medicare |
$5.74
|
| Rate for Payer: Lucent All Commercial |
$5.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.44
|
| Rate for Payer: PHP All Commercial |
$8.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.39
|
| Rate for Payer: Sagamore Health Network All Products |
$8.68
|
| Rate for Payer: Signature Care EPO |
$9.34
|
| Rate for Payer: Signature Care PPO |
$9.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.56
|
| Rate for Payer: United Healthcare Commercial |
$8.86
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
|
|
HC ENDO TUBE PORT CUFF 5.0
|
Facility
OP
|
$9.99
|
|
| Hospital Charge Code |
41601414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.43
|
| Rate for Payer: Aetna Medicare |
$3.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.63
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Centivo All Commercial |
$5.09
|
| Rate for Payer: Cigna All Commercial |
$8.62
|
| Rate for Payer: CORVEL All Commercial |
$9.29
|
| Rate for Payer: Coventry All Commercial |
$8.79
|
| Rate for Payer: Encore All Commercial |
$9.20
|
| Rate for Payer: Frontpath All Commercial |
$9.19
|
| Rate for Payer: Humana ChoiceCare |
$8.63
|
| Rate for Payer: Humana Medicare |
$5.09
|
| Rate for Payer: Lucent All Commercial |
$5.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.99
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.49
|
| Rate for Payer: PHP All Commercial |
$7.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.90
|
| Rate for Payer: Sagamore Health Network All Products |
$7.71
|
| Rate for Payer: Signature Care EPO |
$8.29
|
| Rate for Payer: Signature Care PPO |
$8.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.49
|
| Rate for Payer: United Healthcare Commercial |
$7.87
|
| Rate for Payer: United Healthcare Medicare |
$3.30
|
|
|
HC ENDO TUBE PORT CUFF 5.0
|
Facility
IP
|
$9.99
|
|
| Hospital Charge Code |
41601414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna Commercial |
$8.63
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Cigna All Commercial |
$8.62
|
| Rate for Payer: CORVEL All Commercial |
$9.29
|
| Rate for Payer: Coventry All Commercial |
$8.79
|
| Rate for Payer: Encore All Commercial |
$9.20
|
| Rate for Payer: Frontpath All Commercial |
$9.19
|
| Rate for Payer: Humana ChoiceCare |
$8.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.99
|
| Rate for Payer: PHCS All Commercial |
$7.49
|
| Rate for Payer: PHP All Commercial |
$7.58
|
| Rate for Payer: Sagamore Health Network All Products |
$7.71
|
| Rate for Payer: Signature Care EPO |
$8.29
|
| Rate for Payer: Signature Care PPO |
$8.79
|
| Rate for Payer: United Healthcare Commercial |
$7.87
|
|
|
HC ENDO TUBE PORT CUFF 5.5
|
Facility
OP
|
$10.86
|
|
| Hospital Charge Code |
41601415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.94
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Centivo All Commercial |
$5.54
|
| Rate for Payer: Cigna All Commercial |
$9.37
|
| Rate for Payer: CORVEL All Commercial |
$10.10
|
| Rate for Payer: Coventry All Commercial |
$9.56
|
| Rate for Payer: Encore All Commercial |
$10.00
|
| Rate for Payer: Frontpath All Commercial |
$9.99
|
| Rate for Payer: Humana ChoiceCare |
$9.38
|
| Rate for Payer: Humana Medicare |
$5.54
|
| Rate for Payer: Lucent All Commercial |
$5.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.77
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.14
|
| Rate for Payer: PHP All Commercial |
$8.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.24
|
| Rate for Payer: Sagamore Health Network All Products |
$8.38
|
| Rate for Payer: Signature Care EPO |
$9.01
|
| Rate for Payer: Signature Care PPO |
$9.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.23
|
| Rate for Payer: United Healthcare Commercial |
$8.56
|
| Rate for Payer: United Healthcare Medicare |
$3.58
|
|
|
HC ENDO TUBE PORT CUFF 5.5
|
Facility
IP
|
$10.86
|
|
| Hospital Charge Code |
41601415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Cigna All Commercial |
$9.37
|
| Rate for Payer: CORVEL All Commercial |
$10.10
|
| Rate for Payer: Coventry All Commercial |
$9.56
|
| Rate for Payer: Encore All Commercial |
$10.00
|
| Rate for Payer: Frontpath All Commercial |
$9.99
|
| Rate for Payer: Humana ChoiceCare |
$9.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.77
|
| Rate for Payer: PHCS All Commercial |
$8.14
|
| Rate for Payer: PHP All Commercial |
$8.24
|
| Rate for Payer: Sagamore Health Network All Products |
$8.38
|
| Rate for Payer: Signature Care EPO |
$9.01
|
| Rate for Payer: Signature Care PPO |
$9.56
|
| Rate for Payer: United Healthcare Commercial |
$8.56
|
|
|
HC ENDO TUBE PORT CUFF 6.0
|
Facility
IP
|
$10.86
|
|
| Hospital Charge Code |
41601416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Cigna All Commercial |
$9.37
|
| Rate for Payer: CORVEL All Commercial |
$10.10
|
| Rate for Payer: Coventry All Commercial |
$9.56
|
| Rate for Payer: Encore All Commercial |
$10.00
|
| Rate for Payer: Frontpath All Commercial |
$9.99
|
| Rate for Payer: Humana ChoiceCare |
$9.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.77
|
| Rate for Payer: PHCS All Commercial |
$8.14
|
| Rate for Payer: PHP All Commercial |
$8.24
|
| Rate for Payer: Sagamore Health Network All Products |
$8.38
|
| Rate for Payer: Signature Care EPO |
$9.01
|
| Rate for Payer: Signature Care PPO |
$9.56
|
| Rate for Payer: United Healthcare Commercial |
$8.56
|
|
|
HC ENDO TUBE PORT CUFF 6.0
|
Facility
OP
|
$10.86
|
|
| Hospital Charge Code |
41601416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.94
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Centivo All Commercial |
$5.54
|
| Rate for Payer: Cigna All Commercial |
$9.37
|
| Rate for Payer: CORVEL All Commercial |
$10.10
|
| Rate for Payer: Coventry All Commercial |
$9.56
|
| Rate for Payer: Encore All Commercial |
$10.00
|
| Rate for Payer: Frontpath All Commercial |
$9.99
|
| Rate for Payer: Humana ChoiceCare |
$9.38
|
| Rate for Payer: Humana Medicare |
$5.54
|
| Rate for Payer: Lucent All Commercial |
$5.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.77
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.14
|
| Rate for Payer: PHP All Commercial |
$8.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.24
|
| Rate for Payer: Sagamore Health Network All Products |
$8.38
|
| Rate for Payer: Signature Care EPO |
$9.01
|
| Rate for Payer: Signature Care PPO |
$9.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.23
|
| Rate for Payer: United Healthcare Commercial |
$8.56
|
| Rate for Payer: United Healthcare Medicare |
$3.58
|
|
|
HC ENDO TUBE PORT CUFF 6.5
|
Facility
IP
|
$10.50
|
|
| Hospital Charge Code |
41601046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$9.76 |
| Rate for Payer: Aetna Commercial |
$9.07
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cigna All Commercial |
$9.06
|
| Rate for Payer: CORVEL All Commercial |
$9.76
|
| Rate for Payer: Coventry All Commercial |
$9.24
|
| Rate for Payer: Encore All Commercial |
$9.67
|
| Rate for Payer: Frontpath All Commercial |
$9.66
|
| Rate for Payer: Humana ChoiceCare |
$9.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.45
|
| Rate for Payer: PHCS All Commercial |
$7.88
|
| Rate for Payer: PHP All Commercial |
$7.96
|
| Rate for Payer: Sagamore Health Network All Products |
$8.11
|
| Rate for Payer: Signature Care EPO |
$8.72
|
| Rate for Payer: Signature Care PPO |
$9.24
|
| Rate for Payer: United Healthcare Commercial |
$8.27
|
|
|
HC ENDO TUBE PORT CUFF 6.5
|
Facility
OP
|
$10.50
|
|
| Hospital Charge Code |
41601046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.86
|
| Rate for Payer: Aetna Medicare |
$3.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.81
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Centivo All Commercial |
$5.36
|
| Rate for Payer: Cigna All Commercial |
$9.06
|
| Rate for Payer: CORVEL All Commercial |
$9.76
|
| Rate for Payer: Coventry All Commercial |
$9.24
|
| Rate for Payer: Encore All Commercial |
$9.67
|
| Rate for Payer: Frontpath All Commercial |
$9.66
|
| Rate for Payer: Humana ChoiceCare |
$9.07
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Lucent All Commercial |
$5.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.88
|
| Rate for Payer: PHP All Commercial |
$7.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.10
|
| Rate for Payer: Sagamore Health Network All Products |
$8.11
|
| Rate for Payer: Signature Care EPO |
$8.72
|
| Rate for Payer: Signature Care PPO |
$9.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.92
|
| Rate for Payer: United Healthcare Commercial |
$8.27
|
| Rate for Payer: United Healthcare Medicare |
$3.46
|
|
|
HC ENDO TUBE PORT CUFF 7.0
|
Facility
OP
|
$14.92
|
|
| Hospital Charge Code |
41601047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Aetna Medicare |
$4.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.42
|
| Rate for Payer: Cash Price |
$9.25
|
| Rate for Payer: Cash Price |
$9.25
|
| Rate for Payer: Centivo All Commercial |
$7.61
|
| Rate for Payer: Cigna All Commercial |
$12.88
|
| Rate for Payer: CORVEL All Commercial |
$13.88
|
| Rate for Payer: Coventry All Commercial |
$13.13
|
| Rate for Payer: Encore All Commercial |
$13.73
|
| Rate for Payer: Frontpath All Commercial |
$13.73
|
| Rate for Payer: Humana ChoiceCare |
$12.89
|
| Rate for Payer: Humana Medicare |
$7.61
|
| Rate for Payer: Lucent All Commercial |
$7.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.43
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.19
|
| Rate for Payer: PHP All Commercial |
$11.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.82
|
| Rate for Payer: Sagamore Health Network All Products |
$11.52
|
| Rate for Payer: Signature Care EPO |
$12.38
|
| Rate for Payer: Signature Care PPO |
$13.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.68
|
| Rate for Payer: United Healthcare Commercial |
$11.76
|
| Rate for Payer: United Healthcare Medicare |
$4.92
|
|
|
HC ENDO TUBE PORT CUFF 7.0
|
Facility
IP
|
$14.92
|
|
| Hospital Charge Code |
41601047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$13.88 |
| Rate for Payer: Aetna Commercial |
$12.89
|
| Rate for Payer: Cash Price |
$9.25
|
| Rate for Payer: Cigna All Commercial |
$12.88
|
| Rate for Payer: CORVEL All Commercial |
$13.88
|
| Rate for Payer: Coventry All Commercial |
$13.13
|
| Rate for Payer: Encore All Commercial |
$13.73
|
| Rate for Payer: Frontpath All Commercial |
$13.73
|
| Rate for Payer: Humana ChoiceCare |
$12.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.43
|
| Rate for Payer: PHCS All Commercial |
$11.19
|
| Rate for Payer: PHP All Commercial |
$11.32
|
| Rate for Payer: Sagamore Health Network All Products |
$11.52
|
| Rate for Payer: Signature Care EPO |
$12.38
|
| Rate for Payer: Signature Care PPO |
$13.13
|
| Rate for Payer: United Healthcare Commercial |
$11.76
|
|
|
HC ENDO TUBE PORT CUFF 7.5
|
Facility
IP
|
$15.13
|
|
| Hospital Charge Code |
41601048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$9.38
|
| Rate for Payer: Cigna All Commercial |
$13.06
|
| Rate for Payer: CORVEL All Commercial |
$14.07
|
| Rate for Payer: Coventry All Commercial |
$13.31
|
| Rate for Payer: Encore All Commercial |
$13.93
|
| Rate for Payer: Frontpath All Commercial |
$13.92
|
| Rate for Payer: Humana ChoiceCare |
$13.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.62
|
| Rate for Payer: PHCS All Commercial |
$11.35
|
| Rate for Payer: PHP All Commercial |
$11.47
|
| Rate for Payer: Sagamore Health Network All Products |
$11.68
|
| Rate for Payer: Signature Care EPO |
$12.56
|
| Rate for Payer: Signature Care PPO |
$13.31
|
| Rate for Payer: United Healthcare Commercial |
$11.92
|
|
|
HC ENDO TUBE PORT CUFF 7.5
|
Facility
OP
|
$15.13
|
|
| Hospital Charge Code |
41601048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.77
|
| Rate for Payer: Aetna Medicare |
$4.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.49
|
| Rate for Payer: Cash Price |
$9.38
|
| Rate for Payer: Cash Price |
$9.38
|
| Rate for Payer: Centivo All Commercial |
$7.72
|
| Rate for Payer: Cigna All Commercial |
$13.06
|
| Rate for Payer: CORVEL All Commercial |
$14.07
|
| Rate for Payer: Coventry All Commercial |
$13.31
|
| Rate for Payer: Encore All Commercial |
$13.93
|
| Rate for Payer: Frontpath All Commercial |
$13.92
|
| Rate for Payer: Humana ChoiceCare |
$13.07
|
| Rate for Payer: Humana Medicare |
$7.72
|
| Rate for Payer: Lucent All Commercial |
$7.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.35
|
| Rate for Payer: PHP All Commercial |
$11.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.90
|
| Rate for Payer: Sagamore Health Network All Products |
$11.68
|
| Rate for Payer: Signature Care EPO |
$12.56
|
| Rate for Payer: Signature Care PPO |
$13.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.86
|
| Rate for Payer: United Healthcare Commercial |
$11.92
|
| Rate for Payer: United Healthcare Medicare |
$4.99
|
|
|
HC ENDO TUBE PORT CUFF 8.0
|
Facility
IP
|
$15.28
|
|
| Hospital Charge Code |
41601049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$14.21 |
| Rate for Payer: Aetna Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cigna All Commercial |
$13.19
|
| Rate for Payer: CORVEL All Commercial |
$14.21
|
| Rate for Payer: Coventry All Commercial |
$13.45
|
| Rate for Payer: Encore All Commercial |
$14.07
|
| Rate for Payer: Frontpath All Commercial |
$14.06
|
| Rate for Payer: Humana ChoiceCare |
$13.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.75
|
| Rate for Payer: PHCS All Commercial |
$11.46
|
| Rate for Payer: PHP All Commercial |
$11.59
|
| Rate for Payer: Sagamore Health Network All Products |
$11.80
|
| Rate for Payer: Signature Care EPO |
$12.68
|
| Rate for Payer: Signature Care PPO |
$13.45
|
| Rate for Payer: United Healthcare Commercial |
$12.04
|
|
