|
HC EXTRACTOR VACUUM
|
Facility
OP
|
$224.07
|
|
| Hospital Charge Code |
41603542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$208.39 |
| Rate for Payer: Aetna Commercial |
$189.12
|
| Rate for Payer: Aetna Medicare |
$73.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$128.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.34
|
| Rate for Payer: Cash Price |
$138.92
|
| Rate for Payer: Cash Price |
$138.92
|
| Rate for Payer: Centivo All Commercial |
$114.28
|
| Rate for Payer: Cigna All Commercial |
$193.37
|
| Rate for Payer: CORVEL All Commercial |
$208.39
|
| Rate for Payer: Coventry All Commercial |
$197.18
|
| Rate for Payer: Encore All Commercial |
$206.26
|
| Rate for Payer: Frontpath All Commercial |
$206.14
|
| Rate for Payer: Humana ChoiceCare |
$193.53
|
| Rate for Payer: Humana Medicare |
$114.28
|
| Rate for Payer: Lucent All Commercial |
$114.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$201.66
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$168.05
|
| Rate for Payer: PHP All Commercial |
$169.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.39
|
| Rate for Payer: Sagamore Health Network All Products |
$172.98
|
| Rate for Payer: Signature Care EPO |
$185.98
|
| Rate for Payer: Signature Care PPO |
$197.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$190.46
|
| Rate for Payer: United Healthcare Commercial |
$176.57
|
| Rate for Payer: United Healthcare Medicare |
$73.94
|
|
|
HC EYE BURR - DISPOSABLE
|
Facility
IP
|
$152.24
|
|
| Hospital Charge Code |
41601387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.18 |
| Max. Negotiated Rate |
$141.58 |
| Rate for Payer: Aetna Commercial |
$131.54
|
| Rate for Payer: Cash Price |
$94.39
|
| Rate for Payer: Cigna All Commercial |
$131.38
|
| Rate for Payer: CORVEL All Commercial |
$141.58
|
| Rate for Payer: Coventry All Commercial |
$133.97
|
| Rate for Payer: Encore All Commercial |
$140.14
|
| Rate for Payer: Frontpath All Commercial |
$140.06
|
| Rate for Payer: Humana ChoiceCare |
$131.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.02
|
| Rate for Payer: PHCS All Commercial |
$114.18
|
| Rate for Payer: PHP All Commercial |
$115.46
|
| Rate for Payer: Sagamore Health Network All Products |
$117.53
|
| Rate for Payer: Signature Care EPO |
$126.36
|
| Rate for Payer: Signature Care PPO |
$133.97
|
| Rate for Payer: United Healthcare Commercial |
$119.97
|
|
|
HC EYE BURR - DISPOSABLE
|
Facility
OP
|
$152.24
|
|
| Hospital Charge Code |
41601387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.24 |
| Max. Negotiated Rate |
$141.58 |
| Rate for Payer: Aetna Commercial |
$128.49
|
| Rate for Payer: Aetna Medicare |
$50.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$87.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.26
|
| Rate for Payer: Cash Price |
$94.39
|
| Rate for Payer: Cash Price |
$94.39
|
| Rate for Payer: Centivo All Commercial |
$77.64
|
| Rate for Payer: Cigna All Commercial |
$131.38
|
| Rate for Payer: CORVEL All Commercial |
$141.58
|
| Rate for Payer: Coventry All Commercial |
$133.97
|
| Rate for Payer: Encore All Commercial |
$140.14
|
| Rate for Payer: Frontpath All Commercial |
$140.06
|
| Rate for Payer: Humana ChoiceCare |
$131.49
|
| Rate for Payer: Humana Medicare |
$77.64
|
| Rate for Payer: Lucent All Commercial |
$77.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$114.18
|
| Rate for Payer: PHP All Commercial |
$115.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.37
|
| Rate for Payer: Sagamore Health Network All Products |
$117.53
|
| Rate for Payer: Signature Care EPO |
$126.36
|
| Rate for Payer: Signature Care PPO |
$133.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.40
|
| Rate for Payer: United Healthcare Commercial |
$119.97
|
| Rate for Payer: United Healthcare Medicare |
$50.24
|
|
|
HC EYE - CULTURE
|
Facility
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.22
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Centivo All Commercial |
$111.30
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$111.30
|
| Rate for Payer: Lucent All Commercial |
$111.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$72.02
|
|
|
HC EYE - CULTURE
|
Facility
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
|
|
HC FACTOR II ACTIVITY
|
Facility
OP
|
$212.71
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
63001732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$197.82 |
| Rate for Payer: Aetna Commercial |
$179.53
|
| Rate for Payer: Aetna Medicare |
$70.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$122.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.21
|
| Rate for Payer: Cash Price |
$131.88
|
| Rate for Payer: Cash Price |
$131.88
|
| Rate for Payer: Centivo All Commercial |
$108.48
|
| Rate for Payer: Cigna All Commercial |
$183.57
|
| Rate for Payer: CORVEL All Commercial |
$197.82
|
| Rate for Payer: Coventry All Commercial |
$187.19
|
| Rate for Payer: Encore All Commercial |
$195.80
|
| Rate for Payer: Frontpath All Commercial |
$195.69
|
| Rate for Payer: Humana ChoiceCare |
$183.72
|
| Rate for Payer: Humana Medicare |
$108.48
|
| Rate for Payer: Lucent All Commercial |
$108.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.44
|
| Rate for Payer: Managed Health Services Medicaid |
$12.98
|
| Rate for Payer: MDWise Medicaid |
$12.98
|
| Rate for Payer: PHCS All Commercial |
$159.53
|
| Rate for Payer: PHP All Commercial |
$161.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.96
|
| Rate for Payer: Sagamore Health Network All Products |
$164.21
|
| Rate for Payer: Signature Care EPO |
$176.55
|
| Rate for Payer: Signature Care PPO |
$187.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$180.80
|
| Rate for Payer: United Healthcare Commercial |
$167.62
|
| Rate for Payer: United Healthcare Medicare |
$70.19
|
|
|
HC FACTOR II ACTIVITY
|
Facility
IP
|
$212.71
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
63001732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.53 |
| Max. Negotiated Rate |
$197.82 |
| Rate for Payer: Aetna Commercial |
$183.78
|
| Rate for Payer: Cash Price |
$131.88
|
| Rate for Payer: Cigna All Commercial |
$183.57
|
| Rate for Payer: CORVEL All Commercial |
$197.82
|
| Rate for Payer: Coventry All Commercial |
$187.19
|
| Rate for Payer: Encore All Commercial |
$195.80
|
| Rate for Payer: Frontpath All Commercial |
$195.69
|
| Rate for Payer: Humana ChoiceCare |
$183.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.44
|
| Rate for Payer: PHCS All Commercial |
$159.53
|
| Rate for Payer: PHP All Commercial |
$161.32
|
| Rate for Payer: Sagamore Health Network All Products |
$164.21
|
| Rate for Payer: Signature Care EPO |
$176.55
|
| Rate for Payer: Signature Care PPO |
$187.19
|
| Rate for Payer: United Healthcare Commercial |
$167.62
|
|
|
HC FACTOR VII ASSAY
|
Facility
OP
|
$257.43
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
63001733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$239.41 |
| Rate for Payer: Aetna Commercial |
$217.27
|
| Rate for Payer: Aetna Medicare |
$84.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$147.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$160.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.45
|
| Rate for Payer: Cash Price |
$159.61
|
| Rate for Payer: Cash Price |
$159.61
|
| Rate for Payer: Centivo All Commercial |
$131.29
|
| Rate for Payer: Cigna All Commercial |
$222.16
|
| Rate for Payer: CORVEL All Commercial |
$239.41
|
| Rate for Payer: Coventry All Commercial |
$226.54
|
| Rate for Payer: Encore All Commercial |
$236.96
|
| Rate for Payer: Frontpath All Commercial |
$236.83
|
| Rate for Payer: Humana ChoiceCare |
$222.34
|
| Rate for Payer: Humana Medicare |
$131.29
|
| Rate for Payer: Lucent All Commercial |
$131.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.68
|
| Rate for Payer: Managed Health Services Medicaid |
$17.90
|
| Rate for Payer: MDWise Medicaid |
$17.90
|
| Rate for Payer: PHCS All Commercial |
$193.07
|
| Rate for Payer: PHP All Commercial |
$195.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.40
|
| Rate for Payer: Sagamore Health Network All Products |
$198.73
|
| Rate for Payer: Signature Care EPO |
$213.66
|
| Rate for Payer: Signature Care PPO |
$226.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$218.81
|
| Rate for Payer: United Healthcare Commercial |
$202.85
|
| Rate for Payer: United Healthcare Medicare |
$84.95
|
|
|
HC FACTOR VII ASSAY
|
Facility
IP
|
$257.43
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
63001733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$193.07 |
| Max. Negotiated Rate |
$239.41 |
| Rate for Payer: Aetna Commercial |
$222.42
|
| Rate for Payer: Cash Price |
$159.61
|
| Rate for Payer: Cigna All Commercial |
$222.16
|
| Rate for Payer: CORVEL All Commercial |
$239.41
|
| Rate for Payer: Coventry All Commercial |
$226.54
|
| Rate for Payer: Encore All Commercial |
$236.96
|
| Rate for Payer: Frontpath All Commercial |
$236.83
|
| Rate for Payer: Humana ChoiceCare |
$222.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.68
|
| Rate for Payer: PHCS All Commercial |
$193.07
|
| Rate for Payer: PHP All Commercial |
$195.23
|
| Rate for Payer: Sagamore Health Network All Products |
$198.73
|
| Rate for Payer: Signature Care EPO |
$213.66
|
| Rate for Payer: Signature Care PPO |
$226.54
|
| Rate for Payer: United Healthcare Commercial |
$202.85
|
|
|
HC FACTOR VIII ASSAY
|
Facility
OP
|
$309.87
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
63001735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna Commercial |
$261.53
|
| Rate for Payer: Aetna Medicare |
$102.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$177.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.48
|
| Rate for Payer: Cash Price |
$192.12
|
| Rate for Payer: Cash Price |
$192.12
|
| Rate for Payer: Centivo All Commercial |
$158.03
|
| Rate for Payer: Cigna All Commercial |
$267.41
|
| Rate for Payer: CORVEL All Commercial |
$288.18
|
| Rate for Payer: Coventry All Commercial |
$272.68
|
| Rate for Payer: Encore All Commercial |
$285.23
|
| Rate for Payer: Frontpath All Commercial |
$285.08
|
| Rate for Payer: Humana ChoiceCare |
$267.63
|
| Rate for Payer: Humana Medicare |
$158.03
|
| Rate for Payer: Lucent All Commercial |
$158.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.88
|
| Rate for Payer: Managed Health Services Medicaid |
$17.90
|
| Rate for Payer: MDWise Medicaid |
$17.90
|
| Rate for Payer: PHCS All Commercial |
$232.40
|
| Rate for Payer: PHP All Commercial |
$235.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$120.85
|
| Rate for Payer: Sagamore Health Network All Products |
$239.22
|
| Rate for Payer: Signature Care EPO |
$257.19
|
| Rate for Payer: Signature Care PPO |
$272.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$263.39
|
| Rate for Payer: United Healthcare Commercial |
$244.17
|
| Rate for Payer: United Healthcare Medicare |
$102.26
|
|
|
HC FACTOR VIII ASSAY
|
Facility
IP
|
$309.87
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
63001735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna Commercial |
$267.72
|
| Rate for Payer: Cash Price |
$192.12
|
| Rate for Payer: Cigna All Commercial |
$267.41
|
| Rate for Payer: CORVEL All Commercial |
$288.18
|
| Rate for Payer: Coventry All Commercial |
$272.68
|
| Rate for Payer: Encore All Commercial |
$285.23
|
| Rate for Payer: Frontpath All Commercial |
$285.08
|
| Rate for Payer: Humana ChoiceCare |
$267.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.88
|
| Rate for Payer: PHCS All Commercial |
$232.40
|
| Rate for Payer: PHP All Commercial |
$235.00
|
| Rate for Payer: Sagamore Health Network All Products |
$239.22
|
| Rate for Payer: Signature Care EPO |
$257.19
|
| Rate for Payer: Signature Care PPO |
$272.68
|
| Rate for Payer: United Healthcare Commercial |
$244.17
|
|
|
HC FACTOR V LEIDEN GENE ANALYSIS
|
Facility
IP
|
$940.75
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
63001145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$705.56 |
| Max. Negotiated Rate |
$874.89 |
| Rate for Payer: Aetna Commercial |
$812.80
|
| Rate for Payer: Cash Price |
$583.26
|
| Rate for Payer: Cigna All Commercial |
$811.86
|
| Rate for Payer: CORVEL All Commercial |
$874.89
|
| Rate for Payer: Coventry All Commercial |
$827.86
|
| Rate for Payer: Encore All Commercial |
$865.96
|
| Rate for Payer: Frontpath All Commercial |
$865.49
|
| Rate for Payer: Humana ChoiceCare |
$812.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$846.67
|
| Rate for Payer: PHCS All Commercial |
$705.56
|
| Rate for Payer: PHP All Commercial |
$713.46
|
| Rate for Payer: Sagamore Health Network All Products |
$726.26
|
| Rate for Payer: Signature Care EPO |
$780.82
|
| Rate for Payer: Signature Care PPO |
$827.86
|
| Rate for Payer: United Healthcare Commercial |
$741.31
|
|
|
HC FACTOR V LEIDEN GENE ANALYSIS
|
Facility
OP
|
$940.75
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
63001145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$310.45 |
| Max. Negotiated Rate |
$874.89 |
| Rate for Payer: Aetna Commercial |
$793.99
|
| Rate for Payer: Aetna Medicare |
$310.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$310.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$540.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$588.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$357.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$341.49
|
| Rate for Payer: Cash Price |
$583.26
|
| Rate for Payer: Centivo All Commercial |
$479.78
|
| Rate for Payer: Cigna All Commercial |
$811.86
|
| Rate for Payer: CORVEL All Commercial |
$874.89
|
| Rate for Payer: Coventry All Commercial |
$827.86
|
| Rate for Payer: Encore All Commercial |
$865.96
|
| Rate for Payer: Frontpath All Commercial |
$865.49
|
| Rate for Payer: Humana ChoiceCare |
$812.52
|
| Rate for Payer: Humana Medicare |
$479.78
|
| Rate for Payer: Lucent All Commercial |
$479.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$846.67
|
| Rate for Payer: PHCS All Commercial |
$705.56
|
| Rate for Payer: PHP All Commercial |
$713.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$366.89
|
| Rate for Payer: Sagamore Health Network All Products |
$726.26
|
| Rate for Payer: Signature Care EPO |
$780.82
|
| Rate for Payer: Signature Care PPO |
$827.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$799.63
|
| Rate for Payer: United Healthcare Commercial |
$741.31
|
| Rate for Payer: United Healthcare Medicare |
$310.45
|
|
|
HC FACTOR X ACTIVITY
|
Facility
OP
|
$580.60
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
63001738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$539.96 |
| Rate for Payer: Aetna Commercial |
$490.03
|
| Rate for Payer: Aetna Medicare |
$191.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$191.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$333.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$362.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.76
|
| Rate for Payer: Cash Price |
$359.98
|
| Rate for Payer: Cash Price |
$359.98
|
| Rate for Payer: Centivo All Commercial |
$296.11
|
| Rate for Payer: Cigna All Commercial |
$501.06
|
| Rate for Payer: CORVEL All Commercial |
$539.96
|
| Rate for Payer: Coventry All Commercial |
$510.93
|
| Rate for Payer: Encore All Commercial |
$534.45
|
| Rate for Payer: Frontpath All Commercial |
$534.16
|
| Rate for Payer: Humana ChoiceCare |
$501.47
|
| Rate for Payer: Humana Medicare |
$296.11
|
| Rate for Payer: Lucent All Commercial |
$296.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$522.54
|
| Rate for Payer: Managed Health Services Medicaid |
$17.90
|
| Rate for Payer: MDWise Medicaid |
$17.90
|
| Rate for Payer: PHCS All Commercial |
$435.45
|
| Rate for Payer: PHP All Commercial |
$440.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.44
|
| Rate for Payer: Sagamore Health Network All Products |
$448.23
|
| Rate for Payer: Signature Care EPO |
$481.90
|
| Rate for Payer: Signature Care PPO |
$510.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$493.51
|
| Rate for Payer: United Healthcare Commercial |
$457.52
|
| Rate for Payer: United Healthcare Medicare |
$191.60
|
|
|
HC FACTOR X ACTIVITY
|
Facility
IP
|
$580.60
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
63001738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$435.45 |
| Max. Negotiated Rate |
$539.96 |
| Rate for Payer: Aetna Commercial |
$501.64
|
| Rate for Payer: Cash Price |
$359.98
|
| Rate for Payer: Cigna All Commercial |
$501.06
|
| Rate for Payer: CORVEL All Commercial |
$539.96
|
| Rate for Payer: Coventry All Commercial |
$510.93
|
| Rate for Payer: Encore All Commercial |
$534.45
|
| Rate for Payer: Frontpath All Commercial |
$534.16
|
| Rate for Payer: Humana ChoiceCare |
$501.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$522.54
|
| Rate for Payer: PHCS All Commercial |
$435.45
|
| Rate for Payer: PHP All Commercial |
$440.33
|
| Rate for Payer: Sagamore Health Network All Products |
$448.23
|
| Rate for Payer: Signature Care EPO |
$481.90
|
| Rate for Payer: Signature Care PPO |
$510.93
|
| Rate for Payer: United Healthcare Commercial |
$457.52
|
|
|
HC FACTOR XI ASSAY
|
Facility
OP
|
$343.79
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
63001739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$319.73 |
| Rate for Payer: Aetna Commercial |
$290.16
|
| Rate for Payer: Aetna Medicare |
$113.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$197.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.80
|
| Rate for Payer: Cash Price |
$213.15
|
| Rate for Payer: Cash Price |
$213.15
|
| Rate for Payer: Centivo All Commercial |
$175.33
|
| Rate for Payer: Cigna All Commercial |
$296.69
|
| Rate for Payer: CORVEL All Commercial |
$319.73
|
| Rate for Payer: Coventry All Commercial |
$302.54
|
| Rate for Payer: Encore All Commercial |
$316.46
|
| Rate for Payer: Frontpath All Commercial |
$316.29
|
| Rate for Payer: Humana ChoiceCare |
$296.93
|
| Rate for Payer: Humana Medicare |
$175.33
|
| Rate for Payer: Lucent All Commercial |
$175.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.41
|
| Rate for Payer: Managed Health Services Medicaid |
$17.90
|
| Rate for Payer: MDWise Medicaid |
$17.90
|
| Rate for Payer: PHCS All Commercial |
$257.84
|
| Rate for Payer: PHP All Commercial |
$260.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$134.08
|
| Rate for Payer: Sagamore Health Network All Products |
$265.41
|
| Rate for Payer: Signature Care EPO |
$285.35
|
| Rate for Payer: Signature Care PPO |
$302.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$292.22
|
| Rate for Payer: United Healthcare Commercial |
$270.91
|
| Rate for Payer: United Healthcare Medicare |
$113.45
|
|
|
HC FACTOR XI ASSAY
|
Facility
IP
|
$343.79
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
63001739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.84 |
| Max. Negotiated Rate |
$319.73 |
| Rate for Payer: Aetna Commercial |
$297.04
|
| Rate for Payer: Cash Price |
$213.15
|
| Rate for Payer: Cigna All Commercial |
$296.69
|
| Rate for Payer: CORVEL All Commercial |
$319.73
|
| Rate for Payer: Coventry All Commercial |
$302.54
|
| Rate for Payer: Encore All Commercial |
$316.46
|
| Rate for Payer: Frontpath All Commercial |
$316.29
|
| Rate for Payer: Humana ChoiceCare |
$296.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.41
|
| Rate for Payer: PHCS All Commercial |
$257.84
|
| Rate for Payer: PHP All Commercial |
$260.73
|
| Rate for Payer: Sagamore Health Network All Products |
$265.41
|
| Rate for Payer: Signature Care EPO |
$285.35
|
| Rate for Payer: Signature Care PPO |
$302.54
|
| Rate for Payer: United Healthcare Commercial |
$270.91
|
|
|
HC FALCON ROTATBALE RETRIEVAL BASKET
|
Facility
OP
|
$805.00
|
|
| Hospital Charge Code |
41601219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$748.65 |
| Rate for Payer: Aetna Commercial |
$679.42
|
| Rate for Payer: Aetna Medicare |
$265.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$265.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$462.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$503.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$305.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$292.22
|
| Rate for Payer: Cash Price |
$499.10
|
| Rate for Payer: Cash Price |
$499.10
|
| Rate for Payer: Centivo All Commercial |
$410.55
|
| Rate for Payer: Cigna All Commercial |
$694.72
|
| Rate for Payer: CORVEL All Commercial |
$748.65
|
| Rate for Payer: Coventry All Commercial |
$708.40
|
| Rate for Payer: Encore All Commercial |
$741.00
|
| Rate for Payer: Frontpath All Commercial |
$740.60
|
| Rate for Payer: Humana ChoiceCare |
$695.28
|
| Rate for Payer: Humana Medicare |
$410.55
|
| Rate for Payer: Lucent All Commercial |
$410.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$724.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$603.75
|
| Rate for Payer: PHP All Commercial |
$610.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$313.95
|
| Rate for Payer: Sagamore Health Network All Products |
$621.46
|
| Rate for Payer: Signature Care EPO |
$668.15
|
| Rate for Payer: Signature Care PPO |
$708.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$684.25
|
| Rate for Payer: United Healthcare Commercial |
$634.34
|
| Rate for Payer: United Healthcare Medicare |
$265.65
|
|
|
HC FALCON ROTATBALE RETRIEVAL BASKET
|
Facility
IP
|
$805.00
|
|
| Hospital Charge Code |
41601219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$603.75 |
| Max. Negotiated Rate |
$748.65 |
| Rate for Payer: Aetna Commercial |
$695.52
|
| Rate for Payer: Cash Price |
$499.10
|
| Rate for Payer: Cigna All Commercial |
$694.72
|
| Rate for Payer: CORVEL All Commercial |
$748.65
|
| Rate for Payer: Coventry All Commercial |
$708.40
|
| Rate for Payer: Encore All Commercial |
$741.00
|
| Rate for Payer: Frontpath All Commercial |
$740.60
|
| Rate for Payer: Humana ChoiceCare |
$695.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$724.50
|
| Rate for Payer: PHCS All Commercial |
$603.75
|
| Rate for Payer: PHP All Commercial |
$610.51
|
| Rate for Payer: Sagamore Health Network All Products |
$621.46
|
| Rate for Payer: Signature Care EPO |
$668.15
|
| Rate for Payer: Signature Care PPO |
$708.40
|
| Rate for Payer: United Healthcare Commercial |
$634.34
|
|
|
HC FAST FIX 360 CURVED
|
Facility
OP
|
$1,926.00
|
|
| Hospital Charge Code |
41602502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,791.18 |
| Rate for Payer: Aetna Commercial |
$1,625.54
|
| Rate for Payer: Aetna Medicare |
$635.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,106.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$699.14
|
| Rate for Payer: Cash Price |
$1,194.12
|
| Rate for Payer: Cash Price |
$1,194.12
|
| Rate for Payer: Centivo All Commercial |
$982.26
|
| Rate for Payer: Cigna All Commercial |
$1,662.14
|
| Rate for Payer: CORVEL All Commercial |
$1,791.18
|
| Rate for Payer: Coventry All Commercial |
$1,694.88
|
| Rate for Payer: Encore All Commercial |
$1,772.88
|
| Rate for Payer: Frontpath All Commercial |
$1,771.92
|
| Rate for Payer: Humana ChoiceCare |
$1,663.49
|
| Rate for Payer: Humana Medicare |
$982.26
|
| Rate for Payer: Lucent All Commercial |
$982.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,733.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,444.50
|
| Rate for Payer: PHP All Commercial |
$1,460.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$751.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.87
|
| Rate for Payer: Signature Care EPO |
$1,598.58
|
| Rate for Payer: Signature Care PPO |
$1,694.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,637.10
|
| Rate for Payer: United Healthcare Commercial |
$1,517.69
|
| Rate for Payer: United Healthcare Medicare |
$635.58
|
|
|
HC FAST FIX 360 CURVED
|
Facility
IP
|
$1,926.00
|
|
| Hospital Charge Code |
41602502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.50 |
| Max. Negotiated Rate |
$1,791.18 |
| Rate for Payer: Aetna Commercial |
$1,664.06
|
| Rate for Payer: Cash Price |
$1,194.12
|
| Rate for Payer: Cigna All Commercial |
$1,662.14
|
| Rate for Payer: CORVEL All Commercial |
$1,791.18
|
| Rate for Payer: Coventry All Commercial |
$1,694.88
|
| Rate for Payer: Encore All Commercial |
$1,772.88
|
| Rate for Payer: Frontpath All Commercial |
$1,771.92
|
| Rate for Payer: Humana ChoiceCare |
$1,663.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,733.40
|
| Rate for Payer: PHCS All Commercial |
$1,444.50
|
| Rate for Payer: PHP All Commercial |
$1,460.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.87
|
| Rate for Payer: Signature Care EPO |
$1,598.58
|
| Rate for Payer: Signature Care PPO |
$1,694.88
|
| Rate for Payer: United Healthcare Commercial |
$1,517.69
|
|
|
HC FAST FIX 360 KPSC AND CANNULA
|
Facility
OP
|
$910.00
|
|
| Hospital Charge Code |
41601250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$846.30 |
| Rate for Payer: Aetna Commercial |
$768.04
|
| Rate for Payer: Aetna Medicare |
$300.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$300.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$522.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$568.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$345.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$330.33
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Centivo All Commercial |
$464.10
|
| Rate for Payer: Cigna All Commercial |
$785.33
|
| Rate for Payer: CORVEL All Commercial |
$846.30
|
| Rate for Payer: Coventry All Commercial |
$800.80
|
| Rate for Payer: Encore All Commercial |
$837.66
|
| Rate for Payer: Frontpath All Commercial |
$837.20
|
| Rate for Payer: Humana ChoiceCare |
$785.97
|
| Rate for Payer: Humana Medicare |
$464.10
|
| Rate for Payer: Lucent All Commercial |
$464.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$819.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$682.50
|
| Rate for Payer: PHP All Commercial |
$690.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$354.90
|
| Rate for Payer: Sagamore Health Network All Products |
$702.52
|
| Rate for Payer: Signature Care EPO |
$755.30
|
| Rate for Payer: Signature Care PPO |
$800.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$773.50
|
| Rate for Payer: United Healthcare Commercial |
$717.08
|
| Rate for Payer: United Healthcare Medicare |
$300.30
|
|
|
HC FAST FIX 360 KPSC AND CANNULA
|
Facility
IP
|
$910.00
|
|
| Hospital Charge Code |
41601250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$682.50 |
| Max. Negotiated Rate |
$846.30 |
| Rate for Payer: Aetna Commercial |
$786.24
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Cigna All Commercial |
$785.33
|
| Rate for Payer: CORVEL All Commercial |
$846.30
|
| Rate for Payer: Coventry All Commercial |
$800.80
|
| Rate for Payer: Encore All Commercial |
$837.66
|
| Rate for Payer: Frontpath All Commercial |
$837.20
|
| Rate for Payer: Humana ChoiceCare |
$785.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$819.00
|
| Rate for Payer: PHCS All Commercial |
$682.50
|
| Rate for Payer: PHP All Commercial |
$690.14
|
| Rate for Payer: Sagamore Health Network All Products |
$702.52
|
| Rate for Payer: Signature Care EPO |
$755.30
|
| Rate for Payer: Signature Care PPO |
$800.80
|
| Rate for Payer: United Healthcare Commercial |
$717.08
|
|
|
HC FAST FIX 360 STRAIGHT
|
Facility
IP
|
$2,008.80
|
|
| Hospital Charge Code |
41601251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.60 |
| Max. Negotiated Rate |
$1,868.18 |
| Rate for Payer: Aetna Commercial |
$1,735.60
|
| Rate for Payer: Cash Price |
$1,245.46
|
| Rate for Payer: Cigna All Commercial |
$1,733.59
|
| Rate for Payer: CORVEL All Commercial |
$1,868.18
|
| Rate for Payer: Coventry All Commercial |
$1,767.74
|
| Rate for Payer: Encore All Commercial |
$1,849.10
|
| Rate for Payer: Frontpath All Commercial |
$1,848.10
|
| Rate for Payer: Humana ChoiceCare |
$1,735.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,807.92
|
| Rate for Payer: PHCS All Commercial |
$1,506.60
|
| Rate for Payer: PHP All Commercial |
$1,523.47
|
| Rate for Payer: Sagamore Health Network All Products |
$1,550.79
|
| Rate for Payer: Signature Care EPO |
$1,667.30
|
| Rate for Payer: Signature Care PPO |
$1,767.74
|
| Rate for Payer: United Healthcare Commercial |
$1,582.93
|
|
|
HC FAST FIX 360 STRAIGHT
|
Facility
OP
|
$2,008.80
|
|
| Hospital Charge Code |
41601251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,868.18 |
| Rate for Payer: Aetna Commercial |
$1,695.43
|
| Rate for Payer: Aetna Medicare |
$662.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$662.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,153.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,255.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$762.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$729.19
|
| Rate for Payer: Cash Price |
$1,245.46
|
| Rate for Payer: Cash Price |
$1,245.46
|
| Rate for Payer: Centivo All Commercial |
$1,024.49
|
| Rate for Payer: Cigna All Commercial |
$1,733.59
|
| Rate for Payer: CORVEL All Commercial |
$1,868.18
|
| Rate for Payer: Coventry All Commercial |
$1,767.74
|
| Rate for Payer: Encore All Commercial |
$1,849.10
|
| Rate for Payer: Frontpath All Commercial |
$1,848.10
|
| Rate for Payer: Humana ChoiceCare |
$1,735.00
|
| Rate for Payer: Humana Medicare |
$1,024.49
|
| Rate for Payer: Lucent All Commercial |
$1,024.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,807.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,506.60
|
| Rate for Payer: PHP All Commercial |
$1,523.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$783.43
|
| Rate for Payer: Sagamore Health Network All Products |
$1,550.79
|
| Rate for Payer: Signature Care EPO |
$1,667.30
|
| Rate for Payer: Signature Care PPO |
$1,767.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,707.48
|
| Rate for Payer: United Healthcare Commercial |
$1,582.93
|
| Rate for Payer: United Healthcare Medicare |
$662.90
|
|
