|
HC GRIPPER PLUS PAC 19GX1 3/4
|
Facility
IP
|
$37.08
|
|
| Hospital Charge Code |
41603102
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$32.04
|
| Rate for Payer: Cash Price |
$22.99
|
| Rate for Payer: Cigna All Commercial |
$32.00
|
| Rate for Payer: CORVEL All Commercial |
$34.48
|
| Rate for Payer: Coventry All Commercial |
$32.63
|
| Rate for Payer: Encore All Commercial |
$34.13
|
| Rate for Payer: Frontpath All Commercial |
$34.11
|
| Rate for Payer: Humana ChoiceCare |
$32.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.37
|
| Rate for Payer: PHCS All Commercial |
$27.81
|
| Rate for Payer: PHP All Commercial |
$28.12
|
| Rate for Payer: Sagamore Health Network All Products |
$28.63
|
| Rate for Payer: Signature Care EPO |
$30.78
|
| Rate for Payer: Signature Care PPO |
$32.63
|
| Rate for Payer: United Healthcare Commercial |
$29.22
|
|
|
HC GRIPPER PLUS PAC 19GX1 3/4
|
Facility
OP
|
$37.08
|
|
| Hospital Charge Code |
41603102
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.46
|
| Rate for Payer: Cash Price |
$22.99
|
| Rate for Payer: Cash Price |
$22.99
|
| Rate for Payer: Centivo All Commercial |
$18.91
|
| Rate for Payer: Cigna All Commercial |
$32.00
|
| Rate for Payer: CORVEL All Commercial |
$34.48
|
| Rate for Payer: Coventry All Commercial |
$32.63
|
| Rate for Payer: Encore All Commercial |
$34.13
|
| Rate for Payer: Frontpath All Commercial |
$34.11
|
| Rate for Payer: Humana ChoiceCare |
$32.03
|
| Rate for Payer: Humana Medicare |
$18.91
|
| Rate for Payer: Lucent All Commercial |
$18.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.37
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$27.81
|
| Rate for Payer: PHP All Commercial |
$28.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.46
|
| Rate for Payer: Sagamore Health Network All Products |
$28.63
|
| Rate for Payer: Signature Care EPO |
$30.78
|
| Rate for Payer: Signature Care PPO |
$32.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.52
|
| Rate for Payer: United Healthcare Commercial |
$29.22
|
| Rate for Payer: United Healthcare Medicare |
$12.24
|
|
|
HC GRIPPER PLUS PAC 20GX1 1/4
|
Facility
IP
|
$37.08
|
|
| Hospital Charge Code |
41602362
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$32.04
|
| Rate for Payer: Cash Price |
$22.99
|
| Rate for Payer: Cigna All Commercial |
$32.00
|
| Rate for Payer: CORVEL All Commercial |
$34.48
|
| Rate for Payer: Coventry All Commercial |
$32.63
|
| Rate for Payer: Encore All Commercial |
$34.13
|
| Rate for Payer: Frontpath All Commercial |
$34.11
|
| Rate for Payer: Humana ChoiceCare |
$32.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.37
|
| Rate for Payer: PHCS All Commercial |
$27.81
|
| Rate for Payer: PHP All Commercial |
$28.12
|
| Rate for Payer: Sagamore Health Network All Products |
$28.63
|
| Rate for Payer: Signature Care EPO |
$30.78
|
| Rate for Payer: Signature Care PPO |
$32.63
|
| Rate for Payer: United Healthcare Commercial |
$29.22
|
|
|
HC GRIPPER PLUS PAC 20GX1 1/4
|
Facility
OP
|
$37.08
|
|
| Hospital Charge Code |
41602362
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.46
|
| Rate for Payer: Cash Price |
$22.99
|
| Rate for Payer: Cash Price |
$22.99
|
| Rate for Payer: Centivo All Commercial |
$18.91
|
| Rate for Payer: Cigna All Commercial |
$32.00
|
| Rate for Payer: CORVEL All Commercial |
$34.48
|
| Rate for Payer: Coventry All Commercial |
$32.63
|
| Rate for Payer: Encore All Commercial |
$34.13
|
| Rate for Payer: Frontpath All Commercial |
$34.11
|
| Rate for Payer: Humana ChoiceCare |
$32.03
|
| Rate for Payer: Humana Medicare |
$18.91
|
| Rate for Payer: Lucent All Commercial |
$18.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.37
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$27.81
|
| Rate for Payer: PHP All Commercial |
$28.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.46
|
| Rate for Payer: Sagamore Health Network All Products |
$28.63
|
| Rate for Payer: Signature Care EPO |
$30.78
|
| Rate for Payer: Signature Care PPO |
$32.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.52
|
| Rate for Payer: United Healthcare Commercial |
$29.22
|
| Rate for Payer: United Healthcare Medicare |
$12.24
|
|
|
HC GROSS EXAM/DISSECTION PATH
|
Facility
IP
|
$59.74
|
|
|
Service Code
|
CPT 88387
|
| Hospital Charge Code |
63002139
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.81 |
| Max. Negotiated Rate |
$55.56 |
| Rate for Payer: Frontpath All Commercial |
$54.96
|
| Rate for Payer: Aetna Commercial |
$51.62
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cigna All Commercial |
$51.56
|
| Rate for Payer: CORVEL All Commercial |
$55.56
|
| Rate for Payer: Coventry All Commercial |
$52.57
|
| Rate for Payer: Encore All Commercial |
$54.99
|
| Rate for Payer: Humana ChoiceCare |
$51.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.77
|
| Rate for Payer: PHCS All Commercial |
$44.81
|
| Rate for Payer: PHP All Commercial |
$45.31
|
| Rate for Payer: Sagamore Health Network All Products |
$46.12
|
| Rate for Payer: Signature Care EPO |
$49.59
|
| Rate for Payer: Signature Care PPO |
$52.57
|
| Rate for Payer: United Healthcare Commercial |
$47.08
|
|
|
HC GROSS EXAM/DISSECTION PATH
|
Facility
OP
|
$59.74
|
|
|
Service Code
|
CPT 88387
|
| Hospital Charge Code |
63002139
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$55.56 |
| Rate for Payer: Aetna Commercial |
$50.42
|
| Rate for Payer: Aetna Medicare |
$19.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.69
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Centivo All Commercial |
$30.47
|
| Rate for Payer: Cigna All Commercial |
$51.56
|
| Rate for Payer: CORVEL All Commercial |
$55.56
|
| Rate for Payer: Coventry All Commercial |
$52.57
|
| Rate for Payer: Encore All Commercial |
$54.99
|
| Rate for Payer: Frontpath All Commercial |
$54.96
|
| Rate for Payer: Humana ChoiceCare |
$51.60
|
| Rate for Payer: Humana Medicare |
$30.47
|
| Rate for Payer: Lucent All Commercial |
$30.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.77
|
| Rate for Payer: Managed Health Services Medicaid |
$21.76
|
| Rate for Payer: MDWise Medicaid |
$21.76
|
| Rate for Payer: PHCS All Commercial |
$44.81
|
| Rate for Payer: PHP All Commercial |
$45.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.30
|
| Rate for Payer: Sagamore Health Network All Products |
$46.12
|
| Rate for Payer: Signature Care EPO |
$49.59
|
| Rate for Payer: Signature Care PPO |
$52.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50.78
|
| Rate for Payer: United Healthcare Commercial |
$47.08
|
| Rate for Payer: United Healthcare Medicare |
$19.71
|
|
|
HC GROUP B STREP AMPLIFIED DNA PROBE
|
Facility
OP
|
$231.83
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
63003007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$215.60 |
| Rate for Payer: Aetna Commercial |
$195.66
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.15
|
| Rate for Payer: Cash Price |
$143.73
|
| Rate for Payer: Cash Price |
$143.73
|
| Rate for Payer: Centivo All Commercial |
$118.23
|
| Rate for Payer: Cigna All Commercial |
$200.07
|
| Rate for Payer: CORVEL All Commercial |
$215.60
|
| Rate for Payer: Coventry All Commercial |
$204.01
|
| Rate for Payer: Encore All Commercial |
$213.40
|
| Rate for Payer: Frontpath All Commercial |
$213.28
|
| Rate for Payer: Humana ChoiceCare |
$200.23
|
| Rate for Payer: Humana Medicare |
$118.23
|
| Rate for Payer: Lucent All Commercial |
$118.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.64
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$173.87
|
| Rate for Payer: PHP All Commercial |
$175.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.41
|
| Rate for Payer: Sagamore Health Network All Products |
$178.97
|
| Rate for Payer: Signature Care EPO |
$192.42
|
| Rate for Payer: Signature Care PPO |
$204.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$197.05
|
| Rate for Payer: United Healthcare Commercial |
$182.68
|
| Rate for Payer: United Healthcare Medicare |
$76.50
|
|
|
HC GROUP B STREP AMPLIFIED DNA PROBE
|
Facility
IP
|
$231.83
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
63003007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$215.60 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Cash Price |
$143.73
|
| Rate for Payer: Cigna All Commercial |
$200.07
|
| Rate for Payer: CORVEL All Commercial |
$215.60
|
| Rate for Payer: Coventry All Commercial |
$204.01
|
| Rate for Payer: Encore All Commercial |
$213.40
|
| Rate for Payer: Frontpath All Commercial |
$213.28
|
| Rate for Payer: Humana ChoiceCare |
$200.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.64
|
| Rate for Payer: PHCS All Commercial |
$173.87
|
| Rate for Payer: PHP All Commercial |
$175.82
|
| Rate for Payer: Sagamore Health Network All Products |
$178.97
|
| Rate for Payer: Signature Care EPO |
$192.42
|
| Rate for Payer: Signature Care PPO |
$204.01
|
| Rate for Payer: United Healthcare Commercial |
$182.68
|
|
|
HC GTT 1H 3 SPECIMENS
|
Facility
OP
|
$124.54
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
63001135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$115.82 |
| Rate for Payer: Aetna Commercial |
$105.11
|
| Rate for Payer: Aetna Medicare |
$41.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.21
|
| Rate for Payer: Cash Price |
$77.22
|
| Rate for Payer: Cash Price |
$77.22
|
| Rate for Payer: Centivo All Commercial |
$63.52
|
| Rate for Payer: Cigna All Commercial |
$107.48
|
| Rate for Payer: CORVEL All Commercial |
$115.82
|
| Rate for Payer: Coventry All Commercial |
$109.60
|
| Rate for Payer: Encore All Commercial |
$114.64
|
| Rate for Payer: Frontpath All Commercial |
$114.58
|
| Rate for Payer: Humana ChoiceCare |
$107.57
|
| Rate for Payer: Humana Medicare |
$63.52
|
| Rate for Payer: Lucent All Commercial |
$63.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.09
|
| Rate for Payer: Managed Health Services Medicaid |
$12.87
|
| Rate for Payer: MDWise Medicaid |
$12.87
|
| Rate for Payer: PHCS All Commercial |
$93.41
|
| Rate for Payer: PHP All Commercial |
$94.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.57
|
| Rate for Payer: Sagamore Health Network All Products |
$96.15
|
| Rate for Payer: Signature Care EPO |
$103.37
|
| Rate for Payer: Signature Care PPO |
$109.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.86
|
| Rate for Payer: United Healthcare Commercial |
$98.14
|
| Rate for Payer: United Healthcare Medicare |
$41.10
|
|
|
HC GTT 1H 3 SPECIMENS
|
Facility
IP
|
$124.54
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
63001135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.41 |
| Max. Negotiated Rate |
$115.82 |
| Rate for Payer: Aetna Commercial |
$107.60
|
| Rate for Payer: Cash Price |
$77.22
|
| Rate for Payer: Cigna All Commercial |
$107.48
|
| Rate for Payer: CORVEL All Commercial |
$115.82
|
| Rate for Payer: Coventry All Commercial |
$109.60
|
| Rate for Payer: Encore All Commercial |
$114.64
|
| Rate for Payer: Frontpath All Commercial |
$114.58
|
| Rate for Payer: Humana ChoiceCare |
$107.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.09
|
| Rate for Payer: PHCS All Commercial |
$93.41
|
| Rate for Payer: PHP All Commercial |
$94.45
|
| Rate for Payer: Sagamore Health Network All Products |
$96.15
|
| Rate for Payer: Signature Care EPO |
$103.37
|
| Rate for Payer: Signature Care PPO |
$109.60
|
| Rate for Payer: United Healthcare Commercial |
$98.14
|
|
|
HC GUIDE WIRE .35IN 150CM
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41602251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$247.38 |
| Rate for Payer: Aetna Commercial |
$224.50
|
| Rate for Payer: Aetna Medicare |
$87.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$152.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.56
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Centivo All Commercial |
$135.66
|
| Rate for Payer: Cigna All Commercial |
$229.56
|
| Rate for Payer: CORVEL All Commercial |
$247.38
|
| Rate for Payer: Coventry All Commercial |
$234.08
|
| Rate for Payer: Encore All Commercial |
$244.85
|
| Rate for Payer: Frontpath All Commercial |
$244.72
|
| Rate for Payer: Humana ChoiceCare |
$229.74
|
| Rate for Payer: Humana Medicare |
$135.66
|
| Rate for Payer: Lucent All Commercial |
$135.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$199.50
|
| Rate for Payer: PHP All Commercial |
$201.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.74
|
| Rate for Payer: Sagamore Health Network All Products |
$205.35
|
| Rate for Payer: Signature Care EPO |
$220.78
|
| Rate for Payer: Signature Care PPO |
$234.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$226.10
|
| Rate for Payer: United Healthcare Commercial |
$209.61
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
|
|
HC GUIDE WIRE .35IN 150CM
|
Facility
IP
|
$266.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41602251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$247.38 |
| Rate for Payer: Aetna Commercial |
$229.82
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cigna All Commercial |
$229.56
|
| Rate for Payer: CORVEL All Commercial |
$247.38
|
| Rate for Payer: Coventry All Commercial |
$234.08
|
| Rate for Payer: Encore All Commercial |
$244.85
|
| Rate for Payer: Frontpath All Commercial |
$244.72
|
| Rate for Payer: Humana ChoiceCare |
$229.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.40
|
| Rate for Payer: PHCS All Commercial |
$199.50
|
| Rate for Payer: PHP All Commercial |
$201.73
|
| Rate for Payer: Sagamore Health Network All Products |
$205.35
|
| Rate for Payer: Signature Care EPO |
$220.78
|
| Rate for Payer: Signature Care PPO |
$234.08
|
| Rate for Payer: United Healthcare Commercial |
$209.61
|
|
|
HC GUIDEWIRE EMERALD 0.35 150CM
|
Facility
IP
|
$97.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.12 |
| Max. Negotiated Rate |
$90.68 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Cigna All Commercial |
$84.14
|
| Rate for Payer: CORVEL All Commercial |
$90.68
|
| Rate for Payer: Coventry All Commercial |
$85.80
|
| Rate for Payer: Encore All Commercial |
$89.75
|
| Rate for Payer: Frontpath All Commercial |
$89.70
|
| Rate for Payer: Humana ChoiceCare |
$84.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.75
|
| Rate for Payer: PHCS All Commercial |
$73.12
|
| Rate for Payer: PHP All Commercial |
$73.94
|
| Rate for Payer: Sagamore Health Network All Products |
$75.27
|
| Rate for Payer: Signature Care EPO |
$80.92
|
| Rate for Payer: Signature Care PPO |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$76.83
|
|
|
HC GUIDEWIRE EMERALD 0.35 150CM
|
Facility
OP
|
$97.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.18 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$82.29
|
| Rate for Payer: Aetna Medicare |
$32.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.39
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Centivo All Commercial |
$49.72
|
| Rate for Payer: Cigna All Commercial |
$84.14
|
| Rate for Payer: CORVEL All Commercial |
$90.68
|
| Rate for Payer: Coventry All Commercial |
$85.80
|
| Rate for Payer: Encore All Commercial |
$89.75
|
| Rate for Payer: Frontpath All Commercial |
$89.70
|
| Rate for Payer: Humana ChoiceCare |
$84.21
|
| Rate for Payer: Humana Medicare |
$49.72
|
| Rate for Payer: Lucent All Commercial |
$49.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$73.12
|
| Rate for Payer: PHP All Commercial |
$73.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.02
|
| Rate for Payer: Sagamore Health Network All Products |
$75.27
|
| Rate for Payer: Signature Care EPO |
$80.92
|
| Rate for Payer: Signature Care PPO |
$85.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.88
|
| Rate for Payer: United Healthcare Commercial |
$76.83
|
| Rate for Payer: United Healthcare Medicare |
$32.18
|
|
|
HC GUIDEWIRE MID WT 0.014 190CM
|
Facility
OP
|
$1,031.25
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$959.06 |
| Rate for Payer: Aetna Commercial |
$870.38
|
| Rate for Payer: Aetna Medicare |
$340.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$340.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$592.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$644.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$391.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$374.34
|
| Rate for Payer: Cash Price |
$639.38
|
| Rate for Payer: Cash Price |
$639.38
|
| Rate for Payer: Centivo All Commercial |
$525.94
|
| Rate for Payer: Cigna All Commercial |
$889.97
|
| Rate for Payer: CORVEL All Commercial |
$959.06
|
| Rate for Payer: Coventry All Commercial |
$907.50
|
| Rate for Payer: Encore All Commercial |
$949.27
|
| Rate for Payer: Frontpath All Commercial |
$948.75
|
| Rate for Payer: Humana ChoiceCare |
$890.69
|
| Rate for Payer: Humana Medicare |
$525.94
|
| Rate for Payer: Lucent All Commercial |
$525.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$928.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$773.44
|
| Rate for Payer: PHP All Commercial |
$782.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$402.19
|
| Rate for Payer: Sagamore Health Network All Products |
$796.12
|
| Rate for Payer: Signature Care EPO |
$855.94
|
| Rate for Payer: Signature Care PPO |
$907.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$876.56
|
| Rate for Payer: United Healthcare Commercial |
$812.62
|
| Rate for Payer: United Healthcare Medicare |
$340.31
|
|
|
HC GUIDEWIRE MID WT 0.014 190CM
|
Facility
IP
|
$1,031.25
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.44 |
| Max. Negotiated Rate |
$959.06 |
| Rate for Payer: Aetna Commercial |
$891.00
|
| Rate for Payer: Cash Price |
$639.38
|
| Rate for Payer: Cigna All Commercial |
$889.97
|
| Rate for Payer: CORVEL All Commercial |
$959.06
|
| Rate for Payer: Coventry All Commercial |
$907.50
|
| Rate for Payer: Encore All Commercial |
$949.27
|
| Rate for Payer: Frontpath All Commercial |
$948.75
|
| Rate for Payer: Humana ChoiceCare |
$890.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$928.12
|
| Rate for Payer: PHCS All Commercial |
$773.44
|
| Rate for Payer: PHP All Commercial |
$782.10
|
| Rate for Payer: Sagamore Health Network All Products |
$796.12
|
| Rate for Payer: Signature Care EPO |
$855.94
|
| Rate for Payer: Signature Care PPO |
$907.50
|
| Rate for Payer: United Healthcare Commercial |
$812.62
|
|
|
HC GUIDEWIRE X STIFF 0.035X180CM
|
Facility
OP
|
$316.16
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.33 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Aetna Commercial |
$266.84
|
| Rate for Payer: Aetna Medicare |
$104.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$181.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.77
|
| Rate for Payer: Cash Price |
$196.02
|
| Rate for Payer: Cash Price |
$196.02
|
| Rate for Payer: Centivo All Commercial |
$161.24
|
| Rate for Payer: Cigna All Commercial |
$272.85
|
| Rate for Payer: CORVEL All Commercial |
$294.03
|
| Rate for Payer: Coventry All Commercial |
$278.22
|
| Rate for Payer: Encore All Commercial |
$291.03
|
| Rate for Payer: Frontpath All Commercial |
$290.87
|
| Rate for Payer: Humana ChoiceCare |
$273.07
|
| Rate for Payer: Humana Medicare |
$161.24
|
| Rate for Payer: Lucent All Commercial |
$161.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.54
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$237.12
|
| Rate for Payer: PHP All Commercial |
$239.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.30
|
| Rate for Payer: Sagamore Health Network All Products |
$244.08
|
| Rate for Payer: Signature Care EPO |
$262.41
|
| Rate for Payer: Signature Care PPO |
$278.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$268.74
|
| Rate for Payer: United Healthcare Commercial |
$249.13
|
| Rate for Payer: United Healthcare Medicare |
$104.33
|
|
|
HC GUIDEWIRE X STIFF 0.035X180CM
|
Facility
IP
|
$316.16
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.12 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Aetna Commercial |
$273.16
|
| Rate for Payer: Cash Price |
$196.02
|
| Rate for Payer: Cigna All Commercial |
$272.85
|
| Rate for Payer: CORVEL All Commercial |
$294.03
|
| Rate for Payer: Coventry All Commercial |
$278.22
|
| Rate for Payer: Encore All Commercial |
$291.03
|
| Rate for Payer: Frontpath All Commercial |
$290.87
|
| Rate for Payer: Humana ChoiceCare |
$273.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.54
|
| Rate for Payer: PHCS All Commercial |
$237.12
|
| Rate for Payer: PHP All Commercial |
$239.78
|
| Rate for Payer: Sagamore Health Network All Products |
$244.08
|
| Rate for Payer: Signature Care EPO |
$262.41
|
| Rate for Payer: Signature Care PPO |
$278.22
|
| Rate for Payer: United Healthcare Commercial |
$249.13
|
|
|
HC GUIDEWIRE X STIFF 75CM
|
Facility
IP
|
$182.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$169.26 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Cash Price |
$112.84
|
| Rate for Payer: Cigna All Commercial |
$157.07
|
| Rate for Payer: CORVEL All Commercial |
$169.26
|
| Rate for Payer: Coventry All Commercial |
$160.16
|
| Rate for Payer: Encore All Commercial |
$167.53
|
| Rate for Payer: Frontpath All Commercial |
$167.44
|
| Rate for Payer: Humana ChoiceCare |
$157.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$163.80
|
| Rate for Payer: PHCS All Commercial |
$136.50
|
| Rate for Payer: PHP All Commercial |
$138.03
|
| Rate for Payer: Sagamore Health Network All Products |
$140.50
|
| Rate for Payer: Signature Care EPO |
$151.06
|
| Rate for Payer: Signature Care PPO |
$160.16
|
| Rate for Payer: United Healthcare Commercial |
$143.42
|
|
|
HC GUIDEWIRE X STIFF 75CM
|
Facility
OP
|
$182.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$169.26 |
| Rate for Payer: Aetna Commercial |
$153.61
|
| Rate for Payer: Aetna Medicare |
$60.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$104.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.07
|
| Rate for Payer: Cash Price |
$112.84
|
| Rate for Payer: Cash Price |
$112.84
|
| Rate for Payer: Centivo All Commercial |
$92.82
|
| Rate for Payer: Cigna All Commercial |
$157.07
|
| Rate for Payer: CORVEL All Commercial |
$169.26
|
| Rate for Payer: Coventry All Commercial |
$160.16
|
| Rate for Payer: Encore All Commercial |
$167.53
|
| Rate for Payer: Frontpath All Commercial |
$167.44
|
| Rate for Payer: Humana ChoiceCare |
$157.19
|
| Rate for Payer: Humana Medicare |
$92.82
|
| Rate for Payer: Lucent All Commercial |
$92.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$163.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$136.50
|
| Rate for Payer: PHP All Commercial |
$138.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.98
|
| Rate for Payer: Sagamore Health Network All Products |
$140.50
|
| Rate for Payer: Signature Care EPO |
$151.06
|
| Rate for Payer: Signature Care PPO |
$160.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$154.70
|
| Rate for Payer: United Healthcare Commercial |
$143.42
|
| Rate for Payer: United Healthcare Medicare |
$60.06
|
|
|
HC HANDLING FEE
|
Facility
IP
|
$26.52
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
63002145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$24.66 |
| Rate for Payer: Aetna Commercial |
$22.91
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna All Commercial |
$22.89
|
| Rate for Payer: CORVEL All Commercial |
$24.66
|
| Rate for Payer: Coventry All Commercial |
$23.34
|
| Rate for Payer: Encore All Commercial |
$24.41
|
| Rate for Payer: Frontpath All Commercial |
$24.40
|
| Rate for Payer: Humana ChoiceCare |
$22.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.87
|
| Rate for Payer: PHCS All Commercial |
$19.89
|
| Rate for Payer: PHP All Commercial |
$20.11
|
| Rate for Payer: Sagamore Health Network All Products |
$20.47
|
| Rate for Payer: Signature Care EPO |
$22.01
|
| Rate for Payer: Signature Care PPO |
$23.34
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
|
|
HC HANDLING FEE
|
Facility
OP
|
$26.52
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
63002145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$24.66 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Aetna Medicare |
$8.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.63
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Centivo All Commercial |
$13.53
|
| Rate for Payer: Cigna All Commercial |
$22.89
|
| Rate for Payer: CORVEL All Commercial |
$24.66
|
| Rate for Payer: Coventry All Commercial |
$23.34
|
| Rate for Payer: Encore All Commercial |
$24.41
|
| Rate for Payer: Frontpath All Commercial |
$24.40
|
| Rate for Payer: Humana ChoiceCare |
$22.91
|
| Rate for Payer: Humana Medicare |
$13.53
|
| Rate for Payer: Lucent All Commercial |
$13.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.87
|
| Rate for Payer: Managed Health Services Medicaid |
$11.70
|
| Rate for Payer: MDWise Medicaid |
$11.70
|
| Rate for Payer: PHCS All Commercial |
$19.89
|
| Rate for Payer: PHP All Commercial |
$20.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.34
|
| Rate for Payer: Sagamore Health Network All Products |
$20.47
|
| Rate for Payer: Signature Care EPO |
$22.01
|
| Rate for Payer: Signature Care PPO |
$23.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.54
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
| Rate for Payer: United Healthcare Medicare |
$8.75
|
|
|
HC HAPTOGLOBIN
|
Facility
OP
|
$170.20
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
63001276
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$158.28 |
| Rate for Payer: Aetna Commercial |
$143.65
|
| Rate for Payer: Aetna Medicare |
$56.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.78
|
| Rate for Payer: Cash Price |
$105.52
|
| Rate for Payer: Cash Price |
$105.52
|
| Rate for Payer: Centivo All Commercial |
$86.80
|
| Rate for Payer: Cigna All Commercial |
$146.88
|
| Rate for Payer: CORVEL All Commercial |
$158.28
|
| Rate for Payer: Coventry All Commercial |
$149.77
|
| Rate for Payer: Encore All Commercial |
$156.67
|
| Rate for Payer: Frontpath All Commercial |
$156.58
|
| Rate for Payer: Humana ChoiceCare |
$147.00
|
| Rate for Payer: Humana Medicare |
$86.80
|
| Rate for Payer: Lucent All Commercial |
$86.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.18
|
| Rate for Payer: Managed Health Services Medicaid |
$12.58
|
| Rate for Payer: MDWise Medicaid |
$12.58
|
| Rate for Payer: PHCS All Commercial |
$127.65
|
| Rate for Payer: PHP All Commercial |
$129.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.38
|
| Rate for Payer: Sagamore Health Network All Products |
$131.39
|
| Rate for Payer: Signature Care EPO |
$141.26
|
| Rate for Payer: Signature Care PPO |
$149.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144.67
|
| Rate for Payer: United Healthcare Commercial |
$134.12
|
| Rate for Payer: United Healthcare Medicare |
$56.17
|
|
|
HC HAPTOGLOBIN
|
Facility
IP
|
$170.20
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
63001276
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.65 |
| Max. Negotiated Rate |
$158.28 |
| Rate for Payer: Aetna Commercial |
$147.05
|
| Rate for Payer: Cash Price |
$105.52
|
| Rate for Payer: Cigna All Commercial |
$146.88
|
| Rate for Payer: CORVEL All Commercial |
$158.28
|
| Rate for Payer: Coventry All Commercial |
$149.77
|
| Rate for Payer: Encore All Commercial |
$156.67
|
| Rate for Payer: Frontpath All Commercial |
$156.58
|
| Rate for Payer: Humana ChoiceCare |
$147.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.18
|
| Rate for Payer: PHCS All Commercial |
$127.65
|
| Rate for Payer: PHP All Commercial |
$129.08
|
| Rate for Payer: Sagamore Health Network All Products |
$131.39
|
| Rate for Payer: Signature Care EPO |
$141.26
|
| Rate for Payer: Signature Care PPO |
$149.77
|
| Rate for Payer: United Healthcare Commercial |
$134.12
|
|
|
HC HARMONIC 1100 SHEAR 20CM
|
Facility
OP
|
$2,201.40
|
|
| Hospital Charge Code |
41607743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,047.30 |
| Rate for Payer: Aetna Commercial |
$1,857.98
|
| Rate for Payer: Aetna Medicare |
$726.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$726.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,264.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,376.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$835.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$799.11
|
| Rate for Payer: Cash Price |
$1,364.87
|
| Rate for Payer: Cash Price |
$1,364.87
|
| Rate for Payer: Centivo All Commercial |
$1,122.71
|
| Rate for Payer: Cigna All Commercial |
$1,899.81
|
| Rate for Payer: CORVEL All Commercial |
$2,047.30
|
| Rate for Payer: Coventry All Commercial |
$1,937.23
|
| Rate for Payer: Encore All Commercial |
$2,026.39
|
| Rate for Payer: Frontpath All Commercial |
$2,025.29
|
| Rate for Payer: Humana ChoiceCare |
$1,901.35
|
| Rate for Payer: Humana Medicare |
$1,122.71
|
| Rate for Payer: Lucent All Commercial |
$1,122.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,981.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,651.05
|
| Rate for Payer: PHP All Commercial |
$1,669.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$858.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,699.48
|
| Rate for Payer: Signature Care EPO |
$1,827.16
|
| Rate for Payer: Signature Care PPO |
$1,937.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,871.19
|
| Rate for Payer: United Healthcare Commercial |
$1,734.70
|
| Rate for Payer: United Healthcare Medicare |
$726.46
|
|
