|
HC KIT COLLECTION FEE
|
Facility
|
IP
|
$27.29
|
|
| Hospital Charge Code |
63002224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Cigna All Commercial |
$23.55
|
| Rate for Payer: CORVEL All Commercial |
$25.38
|
| Rate for Payer: Coventry All Commercial |
$24.02
|
| Rate for Payer: Encore All Commercial |
$25.12
|
| Rate for Payer: Frontpath All Commercial |
$25.11
|
| Rate for Payer: Humana ChoiceCare |
$23.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.56
|
| Rate for Payer: PHCS All Commercial |
$20.47
|
| Rate for Payer: PHP All Commercial |
$20.70
|
| Rate for Payer: Sagamore Health Network All Products |
$21.07
|
| Rate for Payer: Signature Care EPO |
$22.65
|
| Rate for Payer: Signature Care PPO |
$24.02
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
|
|
HC KIT ENDOVIVE REPLACEMENT 20 FR
|
Facility
|
OP
|
$273.00
|
|
| Hospital Charge Code |
41602092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$230.41
|
| Rate for Payer: Aetna Medicare |
$87.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$156.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.10
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Centivo All Commercial |
$148.51
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Humana Medicare |
$87.36
|
| Rate for Payer: Lucent All Commercial |
$148.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.47
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.05
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
| Rate for Payer: United Healthcare Medicare |
$87.36
|
|
|
HC KIT ENDOVIVE REPLACEMENT 20 FR
|
Facility
|
IP
|
$273.00
|
|
| Hospital Charge Code |
41602092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
|
|
HC KIT ENDOVIVE STANDARD 1/2 PEG
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
41602165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$413.56
|
| Rate for Payer: Aetna Medicare |
$156.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$151.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$281.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$306.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.48
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Centivo All Commercial |
$266.56
|
| 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 |
$451.05
|
| Rate for Payer: Frontpath All Commercial |
$450.80
|
| Rate for Payer: Humana ChoiceCare |
$423.21
|
| Rate for Payer: Humana Medicare |
$156.80
|
| Rate for Payer: Lucent All Commercial |
$266.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$156.80
|
|
|
HC KIT ENDOVIVE STANDARD 1/2 PEG
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
41602165
|
|
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 |
$294.00
|
| 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 |
$451.05
|
| 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 KIT LACERATION TRAY
|
Facility
|
IP
|
$51.14
|
|
| Hospital Charge Code |
41607784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$47.56 |
| Rate for Payer: Aetna Commercial |
$44.18
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna All Commercial |
$44.13
|
| Rate for Payer: CORVEL All Commercial |
$47.56
|
| Rate for Payer: Coventry All Commercial |
$45.00
|
| Rate for Payer: Encore All Commercial |
$47.07
|
| Rate for Payer: Frontpath All Commercial |
$47.05
|
| Rate for Payer: Humana ChoiceCare |
$44.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.03
|
| Rate for Payer: PHCS All Commercial |
$38.35
|
| Rate for Payer: PHP All Commercial |
$38.78
|
| Rate for Payer: Sagamore Health Network All Products |
$39.48
|
| Rate for Payer: Signature Care EPO |
$42.45
|
| Rate for Payer: Signature Care PPO |
$45.00
|
| Rate for Payer: United Healthcare Commercial |
$40.30
|
|
|
HC KIT LACERATION TRAY
|
Facility
|
OP
|
$51.14
|
|
| Hospital Charge Code |
41607784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.85 |
| Max. Negotiated Rate |
$47.56 |
| Rate for Payer: Aetna Commercial |
$43.16
|
| Rate for Payer: Aetna Medicare |
$16.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.00
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Centivo All Commercial |
$27.82
|
| Rate for Payer: Cigna All Commercial |
$44.13
|
| Rate for Payer: CORVEL All Commercial |
$47.56
|
| Rate for Payer: Coventry All Commercial |
$45.00
|
| Rate for Payer: Encore All Commercial |
$47.07
|
| Rate for Payer: Frontpath All Commercial |
$47.05
|
| Rate for Payer: Humana ChoiceCare |
$44.17
|
| Rate for Payer: Humana Medicare |
$16.36
|
| Rate for Payer: Lucent All Commercial |
$27.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.03
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$38.35
|
| Rate for Payer: PHP All Commercial |
$38.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.94
|
| Rate for Payer: Sagamore Health Network All Products |
$39.48
|
| Rate for Payer: Signature Care EPO |
$42.45
|
| Rate for Payer: Signature Care PPO |
$45.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.47
|
| Rate for Payer: United Healthcare Commercial |
$40.30
|
| Rate for Payer: United Healthcare Medicare |
$16.36
|
|
|
HC KIT LACERATION TRAY
|
Facility
|
OP
|
$71.30
|
|
| Hospital Charge Code |
41608031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$60.18
|
| Rate for Payer: Aetna Medicare |
$22.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$40.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.10
|
| Rate for Payer: Cash Price |
$42.78
|
| Rate for Payer: Cash Price |
$42.78
|
| Rate for Payer: Centivo All Commercial |
$38.79
|
| Rate for Payer: Cigna All Commercial |
$61.53
|
| Rate for Payer: CORVEL All Commercial |
$66.31
|
| Rate for Payer: Coventry All Commercial |
$62.74
|
| Rate for Payer: Encore All Commercial |
$65.63
|
| Rate for Payer: Frontpath All Commercial |
$65.60
|
| Rate for Payer: Humana ChoiceCare |
$61.58
|
| Rate for Payer: Humana Medicare |
$22.82
|
| Rate for Payer: Lucent All Commercial |
$38.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.17
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$53.48
|
| Rate for Payer: PHP All Commercial |
$54.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.81
|
| Rate for Payer: Sagamore Health Network All Products |
$55.04
|
| Rate for Payer: Signature Care EPO |
$59.18
|
| Rate for Payer: Signature Care PPO |
$62.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$56.18
|
| Rate for Payer: United Healthcare Medicare |
$22.82
|
|
|
HC KIT LACERATION TRAY
|
Facility
|
IP
|
$71.30
|
|
| Hospital Charge Code |
41608031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Cash Price |
$42.78
|
| Rate for Payer: Cigna All Commercial |
$61.53
|
| Rate for Payer: CORVEL All Commercial |
$66.31
|
| Rate for Payer: Coventry All Commercial |
$62.74
|
| Rate for Payer: Encore All Commercial |
$65.63
|
| Rate for Payer: Frontpath All Commercial |
$65.60
|
| Rate for Payer: Humana ChoiceCare |
$61.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.17
|
| Rate for Payer: PHCS All Commercial |
$53.48
|
| Rate for Payer: PHP All Commercial |
$54.07
|
| Rate for Payer: Sagamore Health Network All Products |
$55.04
|
| Rate for Payer: Signature Care EPO |
$59.18
|
| Rate for Payer: Signature Care PPO |
$62.74
|
| Rate for Payer: United Healthcare Commercial |
$56.18
|
|
|
HC KIT LD CAP IS1 DF4 4.75
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
41607299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$227.85 |
| Rate for Payer: Aetna Commercial |
$211.68
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna All Commercial |
$211.44
|
| Rate for Payer: CORVEL All Commercial |
$227.85
|
| Rate for Payer: Coventry All Commercial |
$215.60
|
| Rate for Payer: Encore All Commercial |
$225.52
|
| Rate for Payer: Frontpath All Commercial |
$225.40
|
| Rate for Payer: Humana ChoiceCare |
$211.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.50
|
| Rate for Payer: PHCS All Commercial |
$183.75
|
| Rate for Payer: PHP All Commercial |
$185.81
|
| Rate for Payer: Sagamore Health Network All Products |
$189.14
|
| Rate for Payer: Signature Care EPO |
$203.35
|
| Rate for Payer: Signature Care PPO |
$215.60
|
| Rate for Payer: United Healthcare Commercial |
$193.06
|
|
|
HC KIT LD CAP IS1 DF4 4.75
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
41607299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$227.85 |
| Rate for Payer: Aetna Commercial |
$206.78
|
| Rate for Payer: Aetna Medicare |
$78.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$140.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.24
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Centivo All Commercial |
$133.28
|
| Rate for Payer: Cigna All Commercial |
$211.44
|
| Rate for Payer: CORVEL All Commercial |
$227.85
|
| Rate for Payer: Coventry All Commercial |
$215.60
|
| Rate for Payer: Encore All Commercial |
$225.52
|
| Rate for Payer: Frontpath All Commercial |
$225.40
|
| Rate for Payer: Humana ChoiceCare |
$211.61
|
| Rate for Payer: Humana Medicare |
$78.40
|
| Rate for Payer: Lucent All Commercial |
$133.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$183.75
|
| Rate for Payer: PHP All Commercial |
$185.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.55
|
| Rate for Payer: Sagamore Health Network All Products |
$189.14
|
| Rate for Payer: Signature Care EPO |
$203.35
|
| Rate for Payer: Signature Care PPO |
$215.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.25
|
| Rate for Payer: United Healthcare Commercial |
$193.06
|
| Rate for Payer: United Healthcare Medicare |
$78.40
|
|
|
HC KIT SUTURE REMOVAL
|
Facility
|
OP
|
$8.92
|
|
| Hospital Charge Code |
41605568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.14
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Centivo All Commercial |
$4.85
|
| Rate for Payer: Cigna All Commercial |
$7.70
|
| Rate for Payer: CORVEL All Commercial |
$8.30
|
| Rate for Payer: Coventry All Commercial |
$7.85
|
| Rate for Payer: Encore All Commercial |
$8.21
|
| Rate for Payer: Frontpath All Commercial |
$8.21
|
| Rate for Payer: Humana ChoiceCare |
$7.70
|
| Rate for Payer: Humana Medicare |
$2.85
|
| Rate for Payer: Lucent All Commercial |
$4.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.03
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$6.69
|
| Rate for Payer: PHP All Commercial |
$6.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.48
|
| Rate for Payer: Sagamore Health Network All Products |
$6.89
|
| Rate for Payer: Signature Care EPO |
$7.40
|
| Rate for Payer: Signature Care PPO |
$7.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.58
|
| Rate for Payer: United Healthcare Commercial |
$7.03
|
| Rate for Payer: United Healthcare Medicare |
$2.85
|
|
|
HC KIT SUTURE REMOVAL
|
Facility
|
IP
|
$8.92
|
|
| Hospital Charge Code |
41605568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Aetna Commercial |
$7.71
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cigna All Commercial |
$7.70
|
| Rate for Payer: CORVEL All Commercial |
$8.30
|
| Rate for Payer: Coventry All Commercial |
$7.85
|
| Rate for Payer: Encore All Commercial |
$8.21
|
| Rate for Payer: Frontpath All Commercial |
$8.21
|
| Rate for Payer: Humana ChoiceCare |
$7.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.03
|
| Rate for Payer: PHCS All Commercial |
$6.69
|
| Rate for Payer: PHP All Commercial |
$6.76
|
| Rate for Payer: Sagamore Health Network All Products |
$6.89
|
| Rate for Payer: Signature Care EPO |
$7.40
|
| Rate for Payer: Signature Care PPO |
$7.85
|
| Rate for Payer: United Healthcare Commercial |
$7.03
|
|
|
HC KIT TRIPLE LUMEN 16CM 7FR
|
Facility
|
OP
|
$1,017.80
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41607072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$946.55 |
| Rate for Payer: Aetna Commercial |
$859.02
|
| Rate for Payer: Aetna Medicare |
$325.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$315.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$636.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$374.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$358.27
|
| Rate for Payer: Cash Price |
$610.68
|
| Rate for Payer: Cash Price |
$610.68
|
| Rate for Payer: Centivo All Commercial |
$553.68
|
| Rate for Payer: Cigna All Commercial |
$878.36
|
| Rate for Payer: CORVEL All Commercial |
$946.55
|
| Rate for Payer: Coventry All Commercial |
$895.66
|
| Rate for Payer: Encore All Commercial |
$936.88
|
| Rate for Payer: Frontpath All Commercial |
$936.38
|
| Rate for Payer: Humana ChoiceCare |
$879.07
|
| Rate for Payer: Humana Medicare |
$325.70
|
| Rate for Payer: Lucent All Commercial |
$553.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$916.02
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$763.35
|
| Rate for Payer: PHP All Commercial |
$771.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$396.94
|
| Rate for Payer: Sagamore Health Network All Products |
$785.74
|
| Rate for Payer: Signature Care EPO |
$844.77
|
| Rate for Payer: Signature Care PPO |
$895.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$865.13
|
| Rate for Payer: United Healthcare Commercial |
$802.03
|
| Rate for Payer: United Healthcare Medicare |
$325.70
|
|
|
HC KIT TRIPLE LUMEN 16CM 7FR
|
Facility
|
IP
|
$1,017.80
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41607072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$763.35 |
| Max. Negotiated Rate |
$946.55 |
| Rate for Payer: Aetna Commercial |
$879.38
|
| Rate for Payer: Cash Price |
$610.68
|
| Rate for Payer: Cigna All Commercial |
$878.36
|
| Rate for Payer: CORVEL All Commercial |
$946.55
|
| Rate for Payer: Coventry All Commercial |
$895.66
|
| Rate for Payer: Encore All Commercial |
$936.88
|
| Rate for Payer: Frontpath All Commercial |
$936.38
|
| Rate for Payer: Humana ChoiceCare |
$879.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$916.02
|
| Rate for Payer: PHCS All Commercial |
$763.35
|
| Rate for Payer: PHP All Commercial |
$771.90
|
| Rate for Payer: Sagamore Health Network All Products |
$785.74
|
| Rate for Payer: Signature Care EPO |
$844.77
|
| Rate for Payer: Signature Care PPO |
$895.66
|
| Rate for Payer: United Healthcare Commercial |
$802.03
|
|
|
HC KIT ULTRASOUND PIV START
|
Facility
|
IP
|
$210.34
|
|
| Hospital Charge Code |
41607716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.75 |
| Max. Negotiated Rate |
$195.62 |
| Rate for Payer: Aetna Commercial |
$181.73
|
| Rate for Payer: Cash Price |
$126.20
|
| Rate for Payer: Cigna All Commercial |
$181.52
|
| Rate for Payer: CORVEL All Commercial |
$195.62
|
| Rate for Payer: Coventry All Commercial |
$185.10
|
| Rate for Payer: Encore All Commercial |
$193.62
|
| Rate for Payer: Frontpath All Commercial |
$193.51
|
| Rate for Payer: Humana ChoiceCare |
$181.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.31
|
| Rate for Payer: PHCS All Commercial |
$157.75
|
| Rate for Payer: PHP All Commercial |
$159.52
|
| Rate for Payer: Sagamore Health Network All Products |
$162.38
|
| Rate for Payer: Signature Care EPO |
$174.58
|
| Rate for Payer: Signature Care PPO |
$185.10
|
| Rate for Payer: United Healthcare Commercial |
$165.75
|
|
|
HC KIT ULTRASOUND PIV START
|
Facility
|
OP
|
$210.34
|
|
| Hospital Charge Code |
41607716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$195.62 |
| Rate for Payer: Aetna Commercial |
$177.53
|
| Rate for Payer: Aetna Medicare |
$67.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.04
|
| Rate for Payer: Cash Price |
$126.20
|
| Rate for Payer: Cash Price |
$126.20
|
| Rate for Payer: Centivo All Commercial |
$114.42
|
| Rate for Payer: Cigna All Commercial |
$181.52
|
| Rate for Payer: CORVEL All Commercial |
$195.62
|
| Rate for Payer: Coventry All Commercial |
$185.10
|
| Rate for Payer: Encore All Commercial |
$193.62
|
| Rate for Payer: Frontpath All Commercial |
$193.51
|
| Rate for Payer: Humana ChoiceCare |
$181.67
|
| Rate for Payer: Humana Medicare |
$67.31
|
| Rate for Payer: Lucent All Commercial |
$114.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.31
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$157.75
|
| Rate for Payer: PHP All Commercial |
$159.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.03
|
| Rate for Payer: Sagamore Health Network All Products |
$162.38
|
| Rate for Payer: Signature Care EPO |
$174.58
|
| Rate for Payer: Signature Care PPO |
$185.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.79
|
| Rate for Payer: United Healthcare Commercial |
$165.75
|
| Rate for Payer: United Healthcare Medicare |
$67.31
|
|
|
HC KOH PREP
|
Facility
|
OP
|
$73.61
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
63001209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$68.46 |
| Rate for Payer: Aetna Commercial |
$62.13
|
| Rate for Payer: Aetna Medicare |
$23.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.91
|
| Rate for Payer: Cash Price |
$44.17
|
| Rate for Payer: Cash Price |
$44.17
|
| Rate for Payer: Centivo All Commercial |
$40.04
|
| Rate for Payer: Cigna All Commercial |
$63.53
|
| Rate for Payer: CORVEL All Commercial |
$68.46
|
| Rate for Payer: Coventry All Commercial |
$64.78
|
| Rate for Payer: Encore All Commercial |
$67.76
|
| Rate for Payer: Frontpath All Commercial |
$67.72
|
| Rate for Payer: Humana ChoiceCare |
$63.58
|
| Rate for Payer: Humana Medicare |
$23.56
|
| Rate for Payer: Lucent All Commercial |
$40.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.25
|
| Rate for Payer: Managed Health Services Medicaid |
$5.82
|
| Rate for Payer: MDWise Medicaid |
$5.82
|
| Rate for Payer: PHCS All Commercial |
$55.21
|
| Rate for Payer: PHP All Commercial |
$55.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.71
|
| Rate for Payer: Sagamore Health Network All Products |
$56.83
|
| Rate for Payer: Signature Care EPO |
$61.10
|
| Rate for Payer: Signature Care PPO |
$64.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.57
|
| Rate for Payer: United Healthcare Commercial |
$58.00
|
| Rate for Payer: United Healthcare Medicare |
$23.56
|
|
|
HC KOH PREP
|
Facility
|
IP
|
$73.61
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
63001209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.21 |
| Max. Negotiated Rate |
$68.46 |
| Rate for Payer: Aetna Commercial |
$63.60
|
| Rate for Payer: Cash Price |
$44.17
|
| Rate for Payer: Cigna All Commercial |
$63.53
|
| Rate for Payer: CORVEL All Commercial |
$68.46
|
| Rate for Payer: Coventry All Commercial |
$64.78
|
| Rate for Payer: Encore All Commercial |
$67.76
|
| Rate for Payer: Frontpath All Commercial |
$67.72
|
| Rate for Payer: Humana ChoiceCare |
$63.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.25
|
| Rate for Payer: PHCS All Commercial |
$55.21
|
| Rate for Payer: PHP All Commercial |
$55.83
|
| Rate for Payer: Sagamore Health Network All Products |
$56.83
|
| Rate for Payer: Signature Care EPO |
$61.10
|
| Rate for Payer: Signature Care PPO |
$64.78
|
| Rate for Payer: United Healthcare Commercial |
$58.00
|
|
|
HC K-WIRE .062, 15.2CM DIAMOND BOTH ENDS
|
Facility
|
IP
|
$49.58
|
|
| Hospital Charge Code |
41601825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$46.11 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Cash Price |
$29.75
|
| Rate for Payer: Cigna All Commercial |
$42.79
|
| Rate for Payer: CORVEL All Commercial |
$46.11
|
| Rate for Payer: Coventry All Commercial |
$43.63
|
| Rate for Payer: Encore All Commercial |
$45.64
|
| Rate for Payer: Frontpath All Commercial |
$45.61
|
| Rate for Payer: Humana ChoiceCare |
$42.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.62
|
| Rate for Payer: PHCS All Commercial |
$37.19
|
| Rate for Payer: PHP All Commercial |
$37.60
|
| Rate for Payer: Sagamore Health Network All Products |
$38.28
|
| Rate for Payer: Signature Care EPO |
$41.15
|
| Rate for Payer: Signature Care PPO |
$43.63
|
| Rate for Payer: United Healthcare Commercial |
$39.07
|
|
|
HC K-WIRE .062, 15.2CM DIAMOND BOTH ENDS
|
Facility
|
OP
|
$49.58
|
|
| Hospital Charge Code |
41601825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$46.11 |
| Rate for Payer: Aetna Commercial |
$41.85
|
| Rate for Payer: Aetna Medicare |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.45
|
| Rate for Payer: Cash Price |
$29.75
|
| Rate for Payer: Cash Price |
$29.75
|
| Rate for Payer: Centivo All Commercial |
$26.97
|
| Rate for Payer: Cigna All Commercial |
$42.79
|
| Rate for Payer: CORVEL All Commercial |
$46.11
|
| Rate for Payer: Coventry All Commercial |
$43.63
|
| Rate for Payer: Encore All Commercial |
$45.64
|
| Rate for Payer: Frontpath All Commercial |
$45.61
|
| Rate for Payer: Humana ChoiceCare |
$42.82
|
| Rate for Payer: Humana Medicare |
$15.87
|
| Rate for Payer: Lucent All Commercial |
$26.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.62
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$37.19
|
| Rate for Payer: PHP All Commercial |
$37.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.34
|
| Rate for Payer: Sagamore Health Network All Products |
$38.28
|
| Rate for Payer: Signature Care EPO |
$41.15
|
| Rate for Payer: Signature Care PPO |
$43.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.14
|
| Rate for Payer: United Healthcare Commercial |
$39.07
|
| Rate for Payer: United Healthcare Medicare |
$15.87
|
|
|
HC LABOR HOUR <24 HR
|
Facility
|
IP
|
$19.27
|
|
| Hospital Charge Code |
1028002
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC LABOR HOUR <24 HR
|
Facility
|
OP
|
$19.27
|
|
| Hospital Charge Code |
1028002
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$138.06 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$138.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$138.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.78
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Centivo All Commercial |
$10.48
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$6.17
|
| Rate for Payer: Lucent All Commercial |
$10.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$138.06
|
| Rate for Payer: MDWise Medicaid |
$138.06
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.17
|
|
|
HC LABOR HOUR INITIAL
|
Facility
|
OP
|
$1,201.16
|
|
| Hospital Charge Code |
1028003
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$1,117.08 |
| Rate for Payer: Aetna Commercial |
$1,013.78
|
| Rate for Payer: Aetna Medicare |
$384.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$138.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$372.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$689.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$750.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$138.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$442.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$422.81
|
| Rate for Payer: Cash Price |
$720.70
|
| Rate for Payer: Cash Price |
$720.70
|
| Rate for Payer: Centivo All Commercial |
$653.43
|
| Rate for Payer: Cigna All Commercial |
$1,036.60
|
| Rate for Payer: CORVEL All Commercial |
$1,117.08
|
| Rate for Payer: Coventry All Commercial |
$1,057.02
|
| Rate for Payer: Encore All Commercial |
$1,105.67
|
| Rate for Payer: Frontpath All Commercial |
$1,105.07
|
| Rate for Payer: Humana ChoiceCare |
$1,037.44
|
| Rate for Payer: Humana Medicare |
$384.37
|
| Rate for Payer: Lucent All Commercial |
$653.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.04
|
| Rate for Payer: Managed Health Services Medicaid |
$138.06
|
| Rate for Payer: MDWise Medicaid |
$138.06
|
| Rate for Payer: PHCS All Commercial |
$900.87
|
| Rate for Payer: PHP All Commercial |
$910.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$468.45
|
| Rate for Payer: Sagamore Health Network All Products |
$927.30
|
| Rate for Payer: Signature Care EPO |
$996.96
|
| Rate for Payer: Signature Care PPO |
$1,057.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,020.99
|
| Rate for Payer: United Healthcare Commercial |
$946.51
|
| Rate for Payer: United Healthcare Medicare |
$384.37
|
|
|
HC LABOR HOUR INITIAL
|
Facility
|
IP
|
$1,201.16
|
|
| Hospital Charge Code |
1028003
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$900.87 |
| Max. Negotiated Rate |
$1,117.08 |
| Rate for Payer: Aetna Commercial |
$1,037.80
|
| Rate for Payer: Cash Price |
$720.70
|
| Rate for Payer: Cigna All Commercial |
$1,036.60
|
| Rate for Payer: CORVEL All Commercial |
$1,117.08
|
| Rate for Payer: Coventry All Commercial |
$1,057.02
|
| Rate for Payer: Encore All Commercial |
$1,105.67
|
| Rate for Payer: Frontpath All Commercial |
$1,105.07
|
| Rate for Payer: Humana ChoiceCare |
$1,037.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.04
|
| Rate for Payer: PHCS All Commercial |
$900.87
|
| Rate for Payer: PHP All Commercial |
$910.96
|
| Rate for Payer: Sagamore Health Network All Products |
$927.30
|
| Rate for Payer: Signature Care EPO |
$996.96
|
| Rate for Payer: Signature Care PPO |
$1,057.02
|
| Rate for Payer: United Healthcare Commercial |
$946.51
|
|
