|
HC ENDO TUBE PORT CUFF 8.0
|
Facility
OP
|
$15.28
|
|
| Hospital Charge Code |
41601049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.90
|
| Rate for Payer: Aetna Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.55
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Centivo All Commercial |
$7.79
|
| 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: Humana Medicare |
$7.79
|
| Rate for Payer: Lucent All Commercial |
$7.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.46
|
| Rate for Payer: PHP All Commercial |
$11.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.96
|
| 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: Three Rivers Preferred All Commercial |
$12.99
|
| Rate for Payer: United Healthcare Commercial |
$12.04
|
| Rate for Payer: United Healthcare Medicare |
$5.04
|
|
|
HC ENDO TUBE PORT UNCUFF 2.5
|
Facility
IP
|
$11.06
|
|
| Hospital Charge Code |
41601050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$10.29 |
| Rate for Payer: Aetna Commercial |
$9.56
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cigna All Commercial |
$9.54
|
| Rate for Payer: CORVEL All Commercial |
$10.29
|
| Rate for Payer: Coventry All Commercial |
$9.73
|
| Rate for Payer: Encore All Commercial |
$10.18
|
| Rate for Payer: Frontpath All Commercial |
$10.18
|
| Rate for Payer: Humana ChoiceCare |
$9.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.95
|
| Rate for Payer: PHCS All Commercial |
$8.30
|
| Rate for Payer: PHP All Commercial |
$8.39
|
| Rate for Payer: Sagamore Health Network All Products |
$8.54
|
| Rate for Payer: Signature Care EPO |
$9.18
|
| Rate for Payer: Signature Care PPO |
$9.73
|
| Rate for Payer: United Healthcare Commercial |
$8.72
|
|
|
HC ENDO TUBE PORT UNCUFF 2.5
|
Facility
OP
|
$11.06
|
|
| Hospital Charge Code |
41601050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna Medicare |
$3.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.01
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Centivo All Commercial |
$5.64
|
| Rate for Payer: Cigna All Commercial |
$9.54
|
| Rate for Payer: CORVEL All Commercial |
$10.29
|
| Rate for Payer: Coventry All Commercial |
$9.73
|
| Rate for Payer: Encore All Commercial |
$10.18
|
| Rate for Payer: Frontpath All Commercial |
$10.18
|
| Rate for Payer: Humana ChoiceCare |
$9.55
|
| Rate for Payer: Humana Medicare |
$5.64
|
| Rate for Payer: Lucent All Commercial |
$5.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.30
|
| Rate for Payer: PHP All Commercial |
$8.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.31
|
| Rate for Payer: Sagamore Health Network All Products |
$8.54
|
| Rate for Payer: Signature Care EPO |
$9.18
|
| Rate for Payer: Signature Care PPO |
$9.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.40
|
| Rate for Payer: United Healthcare Commercial |
$8.72
|
| Rate for Payer: United Healthcare Medicare |
$3.65
|
|
|
HC ENDO TUBE PORT UNCUFF 3.0
|
Facility
IP
|
$11.06
|
|
| Hospital Charge Code |
41601051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$10.29 |
| Rate for Payer: Aetna Commercial |
$9.56
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cigna All Commercial |
$9.54
|
| Rate for Payer: CORVEL All Commercial |
$10.29
|
| Rate for Payer: Coventry All Commercial |
$9.73
|
| Rate for Payer: Encore All Commercial |
$10.18
|
| Rate for Payer: Frontpath All Commercial |
$10.18
|
| Rate for Payer: Humana ChoiceCare |
$9.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.95
|
| Rate for Payer: PHCS All Commercial |
$8.30
|
| Rate for Payer: PHP All Commercial |
$8.39
|
| Rate for Payer: Sagamore Health Network All Products |
$8.54
|
| Rate for Payer: Signature Care EPO |
$9.18
|
| Rate for Payer: Signature Care PPO |
$9.73
|
| Rate for Payer: United Healthcare Commercial |
$8.72
|
|
|
HC ENDO TUBE PORT UNCUFF 3.0
|
Facility
OP
|
$11.06
|
|
| Hospital Charge Code |
41601051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna Medicare |
$3.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.01
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Centivo All Commercial |
$5.64
|
| Rate for Payer: Cigna All Commercial |
$9.54
|
| Rate for Payer: CORVEL All Commercial |
$10.29
|
| Rate for Payer: Coventry All Commercial |
$9.73
|
| Rate for Payer: Encore All Commercial |
$10.18
|
| Rate for Payer: Frontpath All Commercial |
$10.18
|
| Rate for Payer: Humana ChoiceCare |
$9.55
|
| Rate for Payer: Humana Medicare |
$5.64
|
| Rate for Payer: Lucent All Commercial |
$5.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.30
|
| Rate for Payer: PHP All Commercial |
$8.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.31
|
| Rate for Payer: Sagamore Health Network All Products |
$8.54
|
| Rate for Payer: Signature Care EPO |
$9.18
|
| Rate for Payer: Signature Care PPO |
$9.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.40
|
| Rate for Payer: United Healthcare Commercial |
$8.72
|
| Rate for Payer: United Healthcare Medicare |
$3.65
|
|
|
HC ENDO TUBE PORT UNCUFF 3.5
|
Facility
OP
|
$10.84
|
|
| Hospital Charge Code |
41601052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.15
|
| 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 |
$6.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.93
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Centivo All Commercial |
$5.53
|
| Rate for Payer: Cigna All Commercial |
$9.35
|
| Rate for Payer: CORVEL All Commercial |
$10.08
|
| Rate for Payer: Coventry All Commercial |
$9.54
|
| Rate for Payer: Encore All Commercial |
$9.98
|
| Rate for Payer: Frontpath All Commercial |
$9.97
|
| Rate for Payer: Humana ChoiceCare |
$9.36
|
| Rate for Payer: Humana Medicare |
$5.53
|
| Rate for Payer: Lucent All Commercial |
$5.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.13
|
| Rate for Payer: PHP All Commercial |
$8.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.23
|
| Rate for Payer: Sagamore Health Network All Products |
$8.37
|
| Rate for Payer: Signature Care EPO |
$9.00
|
| Rate for Payer: Signature Care PPO |
$9.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$8.54
|
| Rate for Payer: United Healthcare Medicare |
$3.58
|
|
|
HC ENDO TUBE PORT UNCUFF 3.5
|
Facility
IP
|
$10.84
|
|
| Hospital Charge Code |
41601052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna Commercial |
$9.37
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cigna All Commercial |
$9.35
|
| Rate for Payer: CORVEL All Commercial |
$10.08
|
| Rate for Payer: Coventry All Commercial |
$9.54
|
| Rate for Payer: Encore All Commercial |
$9.98
|
| Rate for Payer: Frontpath All Commercial |
$9.97
|
| Rate for Payer: Humana ChoiceCare |
$9.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.76
|
| Rate for Payer: PHCS All Commercial |
$8.13
|
| Rate for Payer: PHP All Commercial |
$8.22
|
| Rate for Payer: Sagamore Health Network All Products |
$8.37
|
| Rate for Payer: Signature Care EPO |
$9.00
|
| Rate for Payer: Signature Care PPO |
$9.54
|
| Rate for Payer: United Healthcare Commercial |
$8.54
|
|
|
HC ENDO TUBE PORT UNCUFF 4.0
|
Facility
IP
|
$10.58
|
|
| Hospital Charge Code |
41601413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$9.84 |
| Rate for Payer: Aetna Commercial |
$9.14
|
| Rate for Payer: Cash Price |
$6.56
|
| Rate for Payer: Cigna All Commercial |
$9.13
|
| Rate for Payer: CORVEL All Commercial |
$9.84
|
| Rate for Payer: Coventry All Commercial |
$9.31
|
| Rate for Payer: Encore All Commercial |
$9.74
|
| Rate for Payer: Frontpath All Commercial |
$9.73
|
| Rate for Payer: Humana ChoiceCare |
$9.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.52
|
| Rate for Payer: PHCS All Commercial |
$7.94
|
| Rate for Payer: PHP All Commercial |
$8.02
|
| Rate for Payer: Sagamore Health Network All Products |
$8.17
|
| Rate for Payer: Signature Care EPO |
$8.78
|
| Rate for Payer: Signature Care PPO |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$8.34
|
|
|
HC ENDO TUBE PORT UNCUFF 4.0
|
Facility
OP
|
$10.58
|
|
| Hospital Charge Code |
41601413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: Aetna Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.84
|
| Rate for Payer: Cash Price |
$6.56
|
| Rate for Payer: Cash Price |
$6.56
|
| Rate for Payer: Centivo All Commercial |
$5.40
|
| Rate for Payer: Cigna All Commercial |
$9.13
|
| Rate for Payer: CORVEL All Commercial |
$9.84
|
| Rate for Payer: Coventry All Commercial |
$9.31
|
| Rate for Payer: Encore All Commercial |
$9.74
|
| Rate for Payer: Frontpath All Commercial |
$9.73
|
| Rate for Payer: Humana ChoiceCare |
$9.14
|
| Rate for Payer: Humana Medicare |
$5.40
|
| Rate for Payer: Lucent All Commercial |
$5.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.52
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.94
|
| Rate for Payer: PHP All Commercial |
$8.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.13
|
| Rate for Payer: Sagamore Health Network All Products |
$8.17
|
| Rate for Payer: Signature Care EPO |
$8.78
|
| Rate for Payer: Signature Care PPO |
$9.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.99
|
| Rate for Payer: United Healthcare Commercial |
$8.34
|
| Rate for Payer: United Healthcare Medicare |
$3.49
|
|
|
HC ENDO TUBE PORT UNCUFF 4.5
|
Facility
IP
|
$10.84
|
|
| Hospital Charge Code |
41601053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna Commercial |
$9.37
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cigna All Commercial |
$9.35
|
| Rate for Payer: CORVEL All Commercial |
$10.08
|
| Rate for Payer: Coventry All Commercial |
$9.54
|
| Rate for Payer: Encore All Commercial |
$9.98
|
| Rate for Payer: Frontpath All Commercial |
$9.97
|
| Rate for Payer: Humana ChoiceCare |
$9.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.76
|
| Rate for Payer: PHCS All Commercial |
$8.13
|
| Rate for Payer: PHP All Commercial |
$8.22
|
| Rate for Payer: Sagamore Health Network All Products |
$8.37
|
| Rate for Payer: Signature Care EPO |
$9.00
|
| Rate for Payer: Signature Care PPO |
$9.54
|
| Rate for Payer: United Healthcare Commercial |
$8.54
|
|
|
HC ENDO TUBE PORT UNCUFF 4.5
|
Facility
OP
|
$10.84
|
|
| Hospital Charge Code |
41601053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.15
|
| 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 |
$6.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.93
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Centivo All Commercial |
$5.53
|
| Rate for Payer: Cigna All Commercial |
$9.35
|
| Rate for Payer: CORVEL All Commercial |
$10.08
|
| Rate for Payer: Coventry All Commercial |
$9.54
|
| Rate for Payer: Encore All Commercial |
$9.98
|
| Rate for Payer: Frontpath All Commercial |
$9.97
|
| Rate for Payer: Humana ChoiceCare |
$9.36
|
| Rate for Payer: Humana Medicare |
$5.53
|
| Rate for Payer: Lucent All Commercial |
$5.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.13
|
| Rate for Payer: PHP All Commercial |
$8.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.23
|
| Rate for Payer: Sagamore Health Network All Products |
$8.37
|
| Rate for Payer: Signature Care EPO |
$9.00
|
| Rate for Payer: Signature Care PPO |
$9.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$8.54
|
| Rate for Payer: United Healthcare Medicare |
$3.58
|
|
|
HC ENDO TUBE PORT UNCUFFED 5.0
|
Facility
IP
|
$10.70
|
|
| Hospital Charge Code |
41601054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$9.95 |
| Rate for Payer: Aetna Commercial |
$9.24
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cigna All Commercial |
$9.23
|
| Rate for Payer: CORVEL All Commercial |
$9.95
|
| Rate for Payer: Coventry All Commercial |
$9.42
|
| Rate for Payer: Encore All Commercial |
$9.85
|
| Rate for Payer: Frontpath All Commercial |
$9.84
|
| Rate for Payer: Humana ChoiceCare |
$9.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.63
|
| Rate for Payer: PHCS All Commercial |
$8.02
|
| Rate for Payer: PHP All Commercial |
$8.11
|
| Rate for Payer: Sagamore Health Network All Products |
$8.26
|
| Rate for Payer: Signature Care EPO |
$8.88
|
| Rate for Payer: Signature Care PPO |
$9.42
|
| Rate for Payer: United Healthcare Commercial |
$8.43
|
|
|
HC ENDO TUBE PORT UNCUFFED 5.0
|
Facility
OP
|
$10.70
|
|
| Hospital Charge Code |
41601054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna Medicare |
$3.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.88
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Centivo All Commercial |
$5.46
|
| Rate for Payer: Cigna All Commercial |
$9.23
|
| Rate for Payer: CORVEL All Commercial |
$9.95
|
| Rate for Payer: Coventry All Commercial |
$9.42
|
| Rate for Payer: Encore All Commercial |
$9.85
|
| Rate for Payer: Frontpath All Commercial |
$9.84
|
| Rate for Payer: Humana ChoiceCare |
$9.24
|
| Rate for Payer: Humana Medicare |
$5.46
|
| Rate for Payer: Lucent All Commercial |
$5.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.02
|
| Rate for Payer: PHP All Commercial |
$8.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.17
|
| Rate for Payer: Sagamore Health Network All Products |
$8.26
|
| Rate for Payer: Signature Care EPO |
$8.88
|
| Rate for Payer: Signature Care PPO |
$9.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.10
|
| Rate for Payer: United Healthcare Commercial |
$8.43
|
| Rate for Payer: United Healthcare Medicare |
$3.53
|
|
|
HC ENDOVIVE KIT 20FR
|
Facility
IP
|
$490.00
|
|
| Hospital Charge Code |
41608336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$423.36
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cigna All Commercial |
$422.87
|
| Rate for Payer: CORVEL All Commercial |
$455.70
|
| Rate for Payer: Coventry All Commercial |
$431.20
|
| Rate for Payer: Encore All Commercial |
$451.04
|
| Rate for Payer: Frontpath All Commercial |
$450.80
|
| Rate for Payer: Humana ChoiceCare |
$423.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.00
|
| Rate for Payer: PHCS All Commercial |
$367.50
|
| Rate for Payer: PHP All Commercial |
$371.62
|
| Rate for Payer: Sagamore Health Network All Products |
$378.28
|
| Rate for Payer: Signature Care EPO |
$406.70
|
| Rate for Payer: Signature Care PPO |
$431.20
|
| Rate for Payer: United Healthcare Commercial |
$386.12
|
|
|
HC ENDOVIVE KIT 20FR
|
Facility
OP
|
$490.00
|
|
| Hospital Charge Code |
41608336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$413.56
|
| Rate for Payer: Aetna Medicare |
$161.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$281.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$306.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$185.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$177.87
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Centivo All Commercial |
$249.90
|
| Rate for Payer: Cigna All Commercial |
$422.87
|
| Rate for Payer: CORVEL All Commercial |
$455.70
|
| Rate for Payer: Coventry All Commercial |
$431.20
|
| Rate for Payer: Encore All Commercial |
$451.04
|
| Rate for Payer: Frontpath All Commercial |
$450.80
|
| Rate for Payer: Humana ChoiceCare |
$423.21
|
| Rate for Payer: Humana Medicare |
$249.90
|
| Rate for Payer: Lucent All Commercial |
$249.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$367.50
|
| Rate for Payer: PHP All Commercial |
$371.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.10
|
| Rate for Payer: Sagamore Health Network All Products |
$378.28
|
| Rate for Payer: Signature Care EPO |
$406.70
|
| Rate for Payer: Signature Care PPO |
$431.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$416.50
|
| Rate for Payer: United Healthcare Commercial |
$386.12
|
| Rate for Payer: United Healthcare Medicare |
$161.70
|
|
|
HC ENSEAL 25 CURVED
|
Facility
OP
|
$2,287.28
|
|
| Hospital Charge Code |
41607439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,127.17 |
| Rate for Payer: Aetna Commercial |
$1,930.46
|
| Rate for Payer: Aetna Medicare |
$754.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$754.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,313.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,429.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$868.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$830.28
|
| Rate for Payer: Cash Price |
$1,418.11
|
| Rate for Payer: Cash Price |
$1,418.11
|
| Rate for Payer: Centivo All Commercial |
$1,166.51
|
| Rate for Payer: Cigna All Commercial |
$1,973.92
|
| Rate for Payer: CORVEL All Commercial |
$2,127.17
|
| Rate for Payer: Coventry All Commercial |
$2,012.81
|
| Rate for Payer: Encore All Commercial |
$2,105.44
|
| Rate for Payer: Frontpath All Commercial |
$2,104.30
|
| Rate for Payer: Humana ChoiceCare |
$1,975.52
|
| Rate for Payer: Humana Medicare |
$1,166.51
|
| Rate for Payer: Lucent All Commercial |
$1,166.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,058.55
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,715.46
|
| Rate for Payer: PHP All Commercial |
$1,734.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$892.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,765.78
|
| Rate for Payer: Signature Care EPO |
$1,898.44
|
| Rate for Payer: Signature Care PPO |
$2,012.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,944.19
|
| Rate for Payer: United Healthcare Commercial |
$1,802.38
|
| Rate for Payer: United Healthcare Medicare |
$754.80
|
|
|
HC ENSEAL 25 CURVED
|
Facility
IP
|
$2,287.28
|
|
| Hospital Charge Code |
41607439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,715.46 |
| Max. Negotiated Rate |
$2,127.17 |
| Rate for Payer: Aetna Commercial |
$1,976.21
|
| Rate for Payer: Cash Price |
$1,418.11
|
| Rate for Payer: Cigna All Commercial |
$1,973.92
|
| Rate for Payer: CORVEL All Commercial |
$2,127.17
|
| Rate for Payer: Coventry All Commercial |
$2,012.81
|
| Rate for Payer: Encore All Commercial |
$2,105.44
|
| Rate for Payer: Frontpath All Commercial |
$2,104.30
|
| Rate for Payer: Humana ChoiceCare |
$1,975.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,058.55
|
| Rate for Payer: PHCS All Commercial |
$1,715.46
|
| Rate for Payer: PHP All Commercial |
$1,734.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,765.78
|
| Rate for Payer: Signature Care EPO |
$1,898.44
|
| Rate for Payer: Signature Care PPO |
$2,012.81
|
| Rate for Payer: United Healthcare Commercial |
$1,802.38
|
|
|
HC ENSEAL 37 CURVED
|
Facility
OP
|
$1,800.07
|
|
| Hospital Charge Code |
41607440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,674.07 |
| Rate for Payer: Aetna Commercial |
$1,519.26
|
| Rate for Payer: Aetna Medicare |
$594.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$594.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,033.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,125.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$683.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$653.43
|
| Rate for Payer: Cash Price |
$1,116.04
|
| Rate for Payer: Cash Price |
$1,116.04
|
| Rate for Payer: Centivo All Commercial |
$918.04
|
| Rate for Payer: Cigna All Commercial |
$1,553.46
|
| Rate for Payer: CORVEL All Commercial |
$1,674.07
|
| Rate for Payer: Coventry All Commercial |
$1,584.06
|
| Rate for Payer: Encore All Commercial |
$1,656.96
|
| Rate for Payer: Frontpath All Commercial |
$1,656.06
|
| Rate for Payer: Humana ChoiceCare |
$1,554.72
|
| Rate for Payer: Humana Medicare |
$918.04
|
| Rate for Payer: Lucent All Commercial |
$918.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,620.06
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,350.05
|
| Rate for Payer: PHP All Commercial |
$1,365.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$702.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,389.65
|
| Rate for Payer: Signature Care EPO |
$1,494.06
|
| Rate for Payer: Signature Care PPO |
$1,584.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,530.06
|
| Rate for Payer: United Healthcare Commercial |
$1,418.46
|
| Rate for Payer: United Healthcare Medicare |
$594.02
|
|
|
HC ENSEAL 37 CURVED
|
Facility
IP
|
$1,800.07
|
|
| Hospital Charge Code |
41607440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,350.05 |
| Max. Negotiated Rate |
$1,674.07 |
| Rate for Payer: Aetna Commercial |
$1,555.26
|
| Rate for Payer: Cash Price |
$1,116.04
|
| Rate for Payer: Cigna All Commercial |
$1,553.46
|
| Rate for Payer: CORVEL All Commercial |
$1,674.07
|
| Rate for Payer: Coventry All Commercial |
$1,584.06
|
| Rate for Payer: Encore All Commercial |
$1,656.96
|
| Rate for Payer: Frontpath All Commercial |
$1,656.06
|
| Rate for Payer: Humana ChoiceCare |
$1,554.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,620.06
|
| Rate for Payer: PHCS All Commercial |
$1,350.05
|
| Rate for Payer: PHP All Commercial |
$1,365.17
|
| Rate for Payer: Sagamore Health Network All Products |
$1,389.65
|
| Rate for Payer: Signature Care EPO |
$1,494.06
|
| Rate for Payer: Signature Care PPO |
$1,584.06
|
| Rate for Payer: United Healthcare Commercial |
$1,418.46
|
|
|
HC ENTAMOEBA HISTOLCYTICA AG
|
Facility
OP
|
$74.65
|
|
|
Service Code
|
CPT 87336
|
| Hospital Charge Code |
63002028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$69.43 |
| Rate for Payer: Aetna Commercial |
$63.01
|
| Rate for Payer: Aetna Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.10
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Centivo All Commercial |
$38.07
|
| Rate for Payer: Cigna All Commercial |
$64.43
|
| Rate for Payer: CORVEL All Commercial |
$69.43
|
| Rate for Payer: Coventry All Commercial |
$65.70
|
| Rate for Payer: Encore All Commercial |
$68.72
|
| Rate for Payer: Frontpath All Commercial |
$68.68
|
| Rate for Payer: Humana ChoiceCare |
$64.48
|
| Rate for Payer: Humana Medicare |
$38.07
|
| Rate for Payer: Lucent All Commercial |
$38.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.19
|
| Rate for Payer: Managed Health Services Medicaid |
$16.00
|
| Rate for Payer: MDWise Medicaid |
$16.00
|
| Rate for Payer: PHCS All Commercial |
$55.99
|
| Rate for Payer: PHP All Commercial |
$56.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.11
|
| Rate for Payer: Sagamore Health Network All Products |
$57.63
|
| Rate for Payer: Signature Care EPO |
$61.96
|
| Rate for Payer: Signature Care PPO |
$65.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.46
|
| Rate for Payer: United Healthcare Commercial |
$58.83
|
| Rate for Payer: United Healthcare Medicare |
$24.64
|
|
|
HC ENTAMOEBA HISTOLCYTICA AG
|
Facility
IP
|
$74.65
|
|
|
Service Code
|
CPT 87336
|
| Hospital Charge Code |
63002028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.99 |
| Max. Negotiated Rate |
$69.43 |
| Rate for Payer: Aetna Commercial |
$64.50
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cigna All Commercial |
$64.43
|
| Rate for Payer: CORVEL All Commercial |
$69.43
|
| Rate for Payer: Coventry All Commercial |
$65.70
|
| Rate for Payer: Encore All Commercial |
$68.72
|
| Rate for Payer: Frontpath All Commercial |
$68.68
|
| Rate for Payer: Humana ChoiceCare |
$64.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.19
|
| Rate for Payer: PHCS All Commercial |
$55.99
|
| Rate for Payer: PHP All Commercial |
$56.62
|
| Rate for Payer: Sagamore Health Network All Products |
$57.63
|
| Rate for Payer: Signature Care EPO |
$61.96
|
| Rate for Payer: Signature Care PPO |
$65.70
|
| Rate for Payer: United Healthcare Commercial |
$58.83
|
|
|
HC ENT - CULTURE
|
Facility
IP
|
$178.50
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
|
|
HC ENT - CULTURE
|
Facility
OP
|
$178.50
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.80
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Centivo All Commercial |
$91.04
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Humana Medicare |
$91.04
|
| Rate for Payer: Lucent All Commercial |
$91.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.72
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
| Rate for Payer: United Healthcare Medicare |
$58.90
|
|
|
HC ENTEROVIRUS ANTIBODY
|
Facility
OP
|
$21.01
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
63001935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$19.54 |
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Aetna Medicare |
$6.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.63
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Centivo All Commercial |
$10.72
|
| Rate for Payer: Cigna All Commercial |
$18.13
|
| Rate for Payer: CORVEL All Commercial |
$19.54
|
| Rate for Payer: Coventry All Commercial |
$18.49
|
| Rate for Payer: Encore All Commercial |
$19.34
|
| Rate for Payer: Frontpath All Commercial |
$19.33
|
| Rate for Payer: Humana ChoiceCare |
$18.15
|
| Rate for Payer: Humana Medicare |
$10.72
|
| Rate for Payer: Lucent All Commercial |
$10.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.91
|
| Rate for Payer: Managed Health Services Medicaid |
$13.03
|
| Rate for Payer: MDWise Medicaid |
$13.03
|
| Rate for Payer: PHCS All Commercial |
$15.76
|
| Rate for Payer: PHP All Commercial |
$15.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.19
|
| Rate for Payer: Sagamore Health Network All Products |
$16.22
|
| Rate for Payer: Signature Care EPO |
$17.44
|
| Rate for Payer: Signature Care PPO |
$18.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.86
|
| Rate for Payer: United Healthcare Commercial |
$16.56
|
| Rate for Payer: United Healthcare Medicare |
$6.93
|
|
|
HC ENTEROVIRUS ANTIBODY
|
Facility
IP
|
$21.01
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
63001935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$19.54 |
| Rate for Payer: Aetna Commercial |
$18.15
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Cigna All Commercial |
$18.13
|
| Rate for Payer: CORVEL All Commercial |
$19.54
|
| Rate for Payer: Coventry All Commercial |
$18.49
|
| Rate for Payer: Encore All Commercial |
$19.34
|
| Rate for Payer: Frontpath All Commercial |
$19.33
|
| Rate for Payer: Humana ChoiceCare |
$18.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.91
|
| Rate for Payer: PHCS All Commercial |
$15.76
|
| Rate for Payer: PHP All Commercial |
$15.94
|
| Rate for Payer: Sagamore Health Network All Products |
$16.22
|
| Rate for Payer: Signature Care EPO |
$17.44
|
| Rate for Payer: Signature Care PPO |
$18.49
|
| Rate for Payer: United Healthcare Commercial |
$16.56
|
|
