|
HC JEVITY 1.5CAL 8OZ
|
Facility
IP
|
$2.36
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
41602457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna All Commercial |
$2.04
|
| Rate for Payer: CORVEL All Commercial |
$2.19
|
| Rate for Payer: Coventry All Commercial |
$2.08
|
| Rate for Payer: Encore All Commercial |
$2.17
|
| Rate for Payer: Frontpath All Commercial |
$2.17
|
| Rate for Payer: Humana ChoiceCare |
$2.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.12
|
| Rate for Payer: PHCS All Commercial |
$1.77
|
| Rate for Payer: PHP All Commercial |
$1.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1.82
|
| Rate for Payer: Signature Care EPO |
$1.96
|
| Rate for Payer: Signature Care PPO |
$2.08
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
|
|
HC JO-1 IGG ANTIBODY
|
Facility
OP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$131.32
|
| Rate for Payer: Aetna Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.48
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Centivo All Commercial |
$79.35
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Humana Medicare |
$79.35
|
| Rate for Payer: Lucent All Commercial |
$79.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.68
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.25
|
| Rate for Payer: United Healthcare Commercial |
$122.61
|
| Rate for Payer: United Healthcare Medicare |
$51.34
|
|
|
HC JO-1 IGG ANTIBODY
|
Facility
IP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$134.43
|
| Rate for Payer: Cash Price |
$96.47
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: United Healthcare Commercial |
$122.61
|
|
|
HC K2 SPICE COMPANY
|
Facility
OP
|
$159.12
|
|
| Hospital Charge Code |
63002223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.76
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Humana Medicare |
$81.15
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.06
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.25
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
| Rate for Payer: United Healthcare Medicare |
$52.51
|
|
|
HC K2 SPICE COMPANY
|
Facility
IP
|
$159.12
|
|
| Hospital Charge Code |
63002223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cigna All Commercial |
$137.32
|
| Rate for Payer: CORVEL All Commercial |
$147.98
|
| Rate for Payer: Coventry All Commercial |
$140.03
|
| Rate for Payer: Encore All Commercial |
$146.47
|
| Rate for Payer: Frontpath All Commercial |
$146.39
|
| Rate for Payer: Humana ChoiceCare |
$137.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.21
|
| Rate for Payer: PHCS All Commercial |
$119.34
|
| Rate for Payer: PHP All Commercial |
$120.68
|
| Rate for Payer: Sagamore Health Network All Products |
$122.84
|
| Rate for Payer: Signature Care EPO |
$132.07
|
| Rate for Payer: Signature Care PPO |
$140.03
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
|
|
HC KAP/LAM FREE LIGHT CHAIN, 24 HR
|
Facility
OP
|
$171.36
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
63001643
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$144.63
|
| Rate for Payer: Aetna Medicare |
$56.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.20
|
| Rate for Payer: Cash Price |
$106.24
|
| Rate for Payer: Cash Price |
$106.24
|
| Rate for Payer: Centivo All Commercial |
$87.39
|
| Rate for Payer: Cigna All Commercial |
$147.88
|
| Rate for Payer: CORVEL All Commercial |
$159.36
|
| Rate for Payer: Coventry All Commercial |
$150.80
|
| Rate for Payer: Encore All Commercial |
$157.74
|
| Rate for Payer: Frontpath All Commercial |
$157.65
|
| Rate for Payer: Humana ChoiceCare |
$148.00
|
| Rate for Payer: Humana Medicare |
$87.39
|
| Rate for Payer: Lucent All Commercial |
$87.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.22
|
| Rate for Payer: Managed Health Services Medicaid |
$13.60
|
| Rate for Payer: MDWise Medicaid |
$13.60
|
| Rate for Payer: PHCS All Commercial |
$128.52
|
| Rate for Payer: PHP All Commercial |
$129.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.83
|
| Rate for Payer: Sagamore Health Network All Products |
$132.29
|
| Rate for Payer: Signature Care EPO |
$142.23
|
| Rate for Payer: Signature Care PPO |
$150.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.66
|
| Rate for Payer: United Healthcare Commercial |
$135.03
|
| Rate for Payer: United Healthcare Medicare |
$56.55
|
|
|
HC KAP/LAM FREE LIGHT CHAIN, 24 HR
|
Facility
IP
|
$171.36
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
63001643
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$148.06
|
| Rate for Payer: Cash Price |
$106.24
|
| Rate for Payer: Cigna All Commercial |
$147.88
|
| Rate for Payer: CORVEL All Commercial |
$159.36
|
| Rate for Payer: Coventry All Commercial |
$150.80
|
| Rate for Payer: Encore All Commercial |
$157.74
|
| Rate for Payer: Frontpath All Commercial |
$157.65
|
| Rate for Payer: Humana ChoiceCare |
$148.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.22
|
| Rate for Payer: PHCS All Commercial |
$128.52
|
| Rate for Payer: PHP All Commercial |
$129.96
|
| Rate for Payer: Sagamore Health Network All Products |
$132.29
|
| Rate for Payer: Signature Care EPO |
$142.23
|
| Rate for Payer: Signature Care PPO |
$150.80
|
| Rate for Payer: United Healthcare Commercial |
$135.03
|
|
|
HC KAP/LAM FREE LIGHT CHAIN QT, SERUM
|
Facility
OP
|
$130.08
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
63001642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$120.97 |
| Rate for Payer: Aetna Commercial |
$109.79
|
| Rate for Payer: Aetna Medicare |
$42.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.22
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Centivo All Commercial |
$66.34
|
| Rate for Payer: Cigna All Commercial |
$112.26
|
| Rate for Payer: CORVEL All Commercial |
$120.97
|
| Rate for Payer: Coventry All Commercial |
$114.47
|
| Rate for Payer: Encore All Commercial |
$119.74
|
| Rate for Payer: Frontpath All Commercial |
$119.67
|
| Rate for Payer: Humana ChoiceCare |
$112.35
|
| Rate for Payer: Humana Medicare |
$66.34
|
| Rate for Payer: Lucent All Commercial |
$66.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.07
|
| Rate for Payer: Managed Health Services Medicaid |
$13.60
|
| Rate for Payer: MDWise Medicaid |
$13.60
|
| Rate for Payer: PHCS All Commercial |
$97.56
|
| Rate for Payer: PHP All Commercial |
$98.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.73
|
| Rate for Payer: Sagamore Health Network All Products |
$100.42
|
| Rate for Payer: Signature Care EPO |
$107.97
|
| Rate for Payer: Signature Care PPO |
$114.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.57
|
| Rate for Payer: United Healthcare Commercial |
$102.50
|
| Rate for Payer: United Healthcare Medicare |
$42.93
|
|
|
HC KAP/LAM FREE LIGHT CHAIN QT, SERUM
|
Facility
IP
|
$130.08
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
63001642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.56 |
| Max. Negotiated Rate |
$120.97 |
| Rate for Payer: Aetna Commercial |
$112.39
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cigna All Commercial |
$112.26
|
| Rate for Payer: CORVEL All Commercial |
$120.97
|
| Rate for Payer: Coventry All Commercial |
$114.47
|
| Rate for Payer: Encore All Commercial |
$119.74
|
| Rate for Payer: Frontpath All Commercial |
$119.67
|
| Rate for Payer: Humana ChoiceCare |
$112.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.07
|
| Rate for Payer: PHCS All Commercial |
$97.56
|
| Rate for Payer: PHP All Commercial |
$98.65
|
| Rate for Payer: Sagamore Health Network All Products |
$100.42
|
| Rate for Payer: Signature Care EPO |
$107.97
|
| Rate for Payer: Signature Care PPO |
$114.47
|
| Rate for Payer: United Healthcare Commercial |
$102.50
|
|
|
HC KCI ATS VAC MACHINE - PER DAY
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
01891229
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$229.81 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$264.74
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
|
|
HC KCI ATS VAC MACHINE - PER DAY
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
01891229
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Aetna Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.23
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Centivo All Commercial |
$156.27
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Humana Medicare |
$156.27
|
| Rate for Payer: Lucent All Commercial |
$156.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.50
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.45
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
| Rate for Payer: United Healthcare Medicare |
$101.11
|
|
|
HC KEPPRA
|
Facility
OP
|
$243.47
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
63001375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$226.43 |
| Rate for Payer: Aetna Commercial |
$205.49
|
| Rate for Payer: Aetna Medicare |
$80.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$139.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$152.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.38
|
| Rate for Payer: Cash Price |
$150.95
|
| Rate for Payer: Cash Price |
$150.95
|
| Rate for Payer: Centivo All Commercial |
$124.17
|
| Rate for Payer: Cigna All Commercial |
$210.12
|
| Rate for Payer: CORVEL All Commercial |
$226.43
|
| Rate for Payer: Coventry All Commercial |
$214.26
|
| Rate for Payer: Encore All Commercial |
$224.12
|
| Rate for Payer: Frontpath All Commercial |
$224.00
|
| Rate for Payer: Humana ChoiceCare |
$210.29
|
| Rate for Payer: Humana Medicare |
$124.17
|
| Rate for Payer: Lucent All Commercial |
$124.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.13
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$182.61
|
| Rate for Payer: PHP All Commercial |
$184.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.95
|
| Rate for Payer: Sagamore Health Network All Products |
$187.96
|
| Rate for Payer: Signature Care EPO |
$202.08
|
| Rate for Payer: Signature Care PPO |
$214.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$206.95
|
| Rate for Payer: United Healthcare Commercial |
$191.86
|
| Rate for Payer: United Healthcare Medicare |
$80.35
|
|
|
HC KEPPRA
|
Facility
IP
|
$243.47
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
63001375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$226.43 |
| Rate for Payer: Aetna Commercial |
$210.36
|
| Rate for Payer: Cash Price |
$150.95
|
| Rate for Payer: Cigna All Commercial |
$210.12
|
| Rate for Payer: CORVEL All Commercial |
$226.43
|
| Rate for Payer: Coventry All Commercial |
$214.26
|
| Rate for Payer: Encore All Commercial |
$224.12
|
| Rate for Payer: Frontpath All Commercial |
$224.00
|
| Rate for Payer: Humana ChoiceCare |
$210.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.13
|
| Rate for Payer: PHCS All Commercial |
$182.61
|
| Rate for Payer: PHP All Commercial |
$184.65
|
| Rate for Payer: Sagamore Health Network All Products |
$187.96
|
| Rate for Payer: Signature Care EPO |
$202.08
|
| Rate for Payer: Signature Care PPO |
$214.26
|
| Rate for Payer: United Healthcare Commercial |
$191.86
|
|
|
HC KIT 3-WRENCH ACCESS 437-246
|
Facility
OP
|
$356.40
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
41607588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.61 |
| Max. Negotiated Rate |
$331.45 |
| Rate for Payer: Aetna Commercial |
$300.80
|
| Rate for Payer: Aetna Medicare |
$117.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$204.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$222.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.37
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Centivo All Commercial |
$181.76
|
| Rate for Payer: Cigna All Commercial |
$307.57
|
| Rate for Payer: CORVEL All Commercial |
$331.45
|
| Rate for Payer: Coventry All Commercial |
$313.63
|
| Rate for Payer: Encore All Commercial |
$328.07
|
| Rate for Payer: Frontpath All Commercial |
$327.89
|
| Rate for Payer: Humana ChoiceCare |
$307.82
|
| Rate for Payer: Humana Medicare |
$181.76
|
| Rate for Payer: Lucent All Commercial |
$181.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$267.30
|
| Rate for Payer: PHP All Commercial |
$270.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.00
|
| Rate for Payer: Sagamore Health Network All Products |
$275.14
|
| Rate for Payer: Signature Care EPO |
$295.81
|
| Rate for Payer: Signature Care PPO |
$313.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$302.94
|
| Rate for Payer: United Healthcare Commercial |
$280.84
|
| Rate for Payer: United Healthcare Medicare |
$117.61
|
|
|
HC KIT 3-WRENCH ACCESS 437-246
|
Facility
IP
|
$356.40
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
41607588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.30 |
| Max. Negotiated Rate |
$331.45 |
| Rate for Payer: Aetna Commercial |
$307.93
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Cigna All Commercial |
$307.57
|
| Rate for Payer: CORVEL All Commercial |
$331.45
|
| Rate for Payer: Coventry All Commercial |
$313.63
|
| Rate for Payer: Encore All Commercial |
$328.07
|
| Rate for Payer: Frontpath All Commercial |
$327.89
|
| Rate for Payer: Humana ChoiceCare |
$307.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.76
|
| Rate for Payer: PHCS All Commercial |
$267.30
|
| Rate for Payer: PHP All Commercial |
$270.29
|
| Rate for Payer: Sagamore Health Network All Products |
$275.14
|
| Rate for Payer: Signature Care EPO |
$295.81
|
| Rate for Payer: Signature Care PPO |
$313.63
|
| Rate for Payer: United Healthcare Commercial |
$280.84
|
|
|
HC KIT ACM FEM BREAK NOZZLE
|
Facility
IP
|
$869.18
|
|
| Hospital Charge Code |
41602413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$651.88 |
| Max. Negotiated Rate |
$808.34 |
| Rate for Payer: Aetna Commercial |
$750.97
|
| Rate for Payer: Cash Price |
$538.89
|
| Rate for Payer: Cigna All Commercial |
$750.10
|
| Rate for Payer: CORVEL All Commercial |
$808.34
|
| Rate for Payer: Coventry All Commercial |
$764.88
|
| Rate for Payer: Encore All Commercial |
$800.08
|
| Rate for Payer: Frontpath All Commercial |
$799.65
|
| Rate for Payer: Humana ChoiceCare |
$750.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$782.26
|
| Rate for Payer: PHCS All Commercial |
$651.88
|
| Rate for Payer: PHP All Commercial |
$659.19
|
| Rate for Payer: Sagamore Health Network All Products |
$671.01
|
| Rate for Payer: Signature Care EPO |
$721.42
|
| Rate for Payer: Signature Care PPO |
$764.88
|
| Rate for Payer: United Healthcare Commercial |
$684.91
|
|
|
HC KIT ACM FEM BREAK NOZZLE
|
Facility
OP
|
$869.18
|
|
| Hospital Charge Code |
41602413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$808.34 |
| Rate for Payer: Aetna Commercial |
$733.59
|
| Rate for Payer: Aetna Medicare |
$286.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$286.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$499.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$543.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$329.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$315.51
|
| Rate for Payer: Cash Price |
$538.89
|
| Rate for Payer: Cash Price |
$538.89
|
| Rate for Payer: Centivo All Commercial |
$443.28
|
| Rate for Payer: Cigna All Commercial |
$750.10
|
| Rate for Payer: CORVEL All Commercial |
$808.34
|
| Rate for Payer: Coventry All Commercial |
$764.88
|
| Rate for Payer: Encore All Commercial |
$800.08
|
| Rate for Payer: Frontpath All Commercial |
$799.65
|
| Rate for Payer: Humana ChoiceCare |
$750.71
|
| Rate for Payer: Humana Medicare |
$443.28
|
| Rate for Payer: Lucent All Commercial |
$443.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$782.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$651.88
|
| Rate for Payer: PHP All Commercial |
$659.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$338.98
|
| Rate for Payer: Sagamore Health Network All Products |
$671.01
|
| Rate for Payer: Signature Care EPO |
$721.42
|
| Rate for Payer: Signature Care PPO |
$764.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$738.80
|
| Rate for Payer: United Healthcare Commercial |
$684.91
|
| Rate for Payer: United Healthcare Medicare |
$286.83
|
|
|
HC KIT CAP & SLEEVE
|
Facility
OP
|
$356.40
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
41607586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.61 |
| Max. Negotiated Rate |
$331.45 |
| Rate for Payer: Aetna Commercial |
$300.80
|
| Rate for Payer: Aetna Medicare |
$117.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$204.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$222.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.37
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Centivo All Commercial |
$181.76
|
| Rate for Payer: Cigna All Commercial |
$307.57
|
| Rate for Payer: CORVEL All Commercial |
$331.45
|
| Rate for Payer: Coventry All Commercial |
$313.63
|
| Rate for Payer: Encore All Commercial |
$328.07
|
| Rate for Payer: Frontpath All Commercial |
$327.89
|
| Rate for Payer: Humana ChoiceCare |
$307.82
|
| Rate for Payer: Humana Medicare |
$181.76
|
| Rate for Payer: Lucent All Commercial |
$181.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$267.30
|
| Rate for Payer: PHP All Commercial |
$270.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.00
|
| Rate for Payer: Sagamore Health Network All Products |
$275.14
|
| Rate for Payer: Signature Care EPO |
$295.81
|
| Rate for Payer: Signature Care PPO |
$313.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$302.94
|
| Rate for Payer: United Healthcare Commercial |
$280.84
|
| Rate for Payer: United Healthcare Medicare |
$117.61
|
|
|
HC KIT CAP & SLEEVE
|
Facility
IP
|
$356.40
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
41607586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.30 |
| Max. Negotiated Rate |
$331.45 |
| Rate for Payer: Aetna Commercial |
$307.93
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Cigna All Commercial |
$307.57
|
| Rate for Payer: CORVEL All Commercial |
$331.45
|
| Rate for Payer: Coventry All Commercial |
$313.63
|
| Rate for Payer: Encore All Commercial |
$328.07
|
| Rate for Payer: Frontpath All Commercial |
$327.89
|
| Rate for Payer: Humana ChoiceCare |
$307.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.76
|
| Rate for Payer: PHCS All Commercial |
$267.30
|
| Rate for Payer: PHP All Commercial |
$270.29
|
| Rate for Payer: Sagamore Health Network All Products |
$275.14
|
| Rate for Payer: Signature Care EPO |
$295.81
|
| Rate for Payer: Signature Care PPO |
$313.63
|
| Rate for Payer: United Healthcare Commercial |
$280.84
|
|
|
HC KIT CATH 14 FR URINE METER
|
Facility
OP
|
$97.15
|
|
| Hospital Charge Code |
41608104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$81.99
|
| Rate for Payer: Aetna Medicare |
$32.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.27
|
| Rate for Payer: Cash Price |
$60.23
|
| Rate for Payer: Cash Price |
$60.23
|
| Rate for Payer: Centivo All Commercial |
$49.55
|
| Rate for Payer: Cigna All Commercial |
$83.84
|
| Rate for Payer: CORVEL All Commercial |
$90.35
|
| Rate for Payer: Coventry All Commercial |
$85.49
|
| Rate for Payer: Encore All Commercial |
$89.43
|
| Rate for Payer: Frontpath All Commercial |
$89.38
|
| Rate for Payer: Humana ChoiceCare |
$83.91
|
| Rate for Payer: Humana Medicare |
$49.55
|
| Rate for Payer: Lucent All Commercial |
$49.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$72.86
|
| Rate for Payer: PHP All Commercial |
$73.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.89
|
| Rate for Payer: Sagamore Health Network All Products |
$75.00
|
| Rate for Payer: Signature Care EPO |
$80.63
|
| Rate for Payer: Signature Care PPO |
$85.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.58
|
| Rate for Payer: United Healthcare Commercial |
$76.55
|
| Rate for Payer: United Healthcare Medicare |
$32.06
|
|
|
HC KIT CATH 14 FR URINE METER
|
Facility
IP
|
$97.15
|
|
| Hospital Charge Code |
41608104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.86 |
| Max. Negotiated Rate |
$90.35 |
| Rate for Payer: Aetna Commercial |
$83.94
|
| Rate for Payer: Cash Price |
$60.23
|
| Rate for Payer: Cigna All Commercial |
$83.84
|
| Rate for Payer: CORVEL All Commercial |
$90.35
|
| Rate for Payer: Coventry All Commercial |
$85.49
|
| Rate for Payer: Encore All Commercial |
$89.43
|
| Rate for Payer: Frontpath All Commercial |
$89.38
|
| Rate for Payer: Humana ChoiceCare |
$83.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.44
|
| Rate for Payer: PHCS All Commercial |
$72.86
|
| Rate for Payer: PHP All Commercial |
$73.68
|
| Rate for Payer: Sagamore Health Network All Products |
$75.00
|
| Rate for Payer: Signature Care EPO |
$80.63
|
| Rate for Payer: Signature Care PPO |
$85.49
|
| Rate for Payer: United Healthcare Commercial |
$76.55
|
|
|
HC KIT CATH ARGYLE PERITONEAL 2 CUFF
|
Facility
OP
|
$889.69
|
|
| Hospital Charge Code |
41602177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$827.41 |
| Rate for Payer: Aetna Commercial |
$750.90
|
| Rate for Payer: Aetna Medicare |
$293.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$293.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$510.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$556.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$337.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$322.96
|
| Rate for Payer: Cash Price |
$551.61
|
| Rate for Payer: Cash Price |
$551.61
|
| Rate for Payer: Centivo All Commercial |
$453.74
|
| Rate for Payer: Cigna All Commercial |
$767.80
|
| Rate for Payer: CORVEL All Commercial |
$827.41
|
| Rate for Payer: Coventry All Commercial |
$782.93
|
| Rate for Payer: Encore All Commercial |
$818.96
|
| Rate for Payer: Frontpath All Commercial |
$818.51
|
| Rate for Payer: Humana ChoiceCare |
$768.43
|
| Rate for Payer: Humana Medicare |
$453.74
|
| Rate for Payer: Lucent All Commercial |
$453.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$800.72
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$667.27
|
| Rate for Payer: PHP All Commercial |
$674.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$346.98
|
| Rate for Payer: Sagamore Health Network All Products |
$686.84
|
| Rate for Payer: Signature Care EPO |
$738.44
|
| Rate for Payer: Signature Care PPO |
$782.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$756.24
|
| Rate for Payer: United Healthcare Commercial |
$701.08
|
| Rate for Payer: United Healthcare Medicare |
$293.60
|
|
|
HC KIT CATH ARGYLE PERITONEAL 2 CUFF
|
Facility
IP
|
$889.69
|
|
| Hospital Charge Code |
41602177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$667.27 |
| Max. Negotiated Rate |
$827.41 |
| Rate for Payer: Aetna Commercial |
$768.69
|
| Rate for Payer: Cash Price |
$551.61
|
| Rate for Payer: Cigna All Commercial |
$767.80
|
| Rate for Payer: CORVEL All Commercial |
$827.41
|
| Rate for Payer: Coventry All Commercial |
$782.93
|
| Rate for Payer: Encore All Commercial |
$818.96
|
| Rate for Payer: Frontpath All Commercial |
$818.51
|
| Rate for Payer: Humana ChoiceCare |
$768.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$800.72
|
| Rate for Payer: PHCS All Commercial |
$667.27
|
| Rate for Payer: PHP All Commercial |
$674.74
|
| Rate for Payer: Sagamore Health Network All Products |
$686.84
|
| Rate for Payer: Signature Care EPO |
$738.44
|
| Rate for Payer: Signature Care PPO |
$782.93
|
| Rate for Payer: United Healthcare Commercial |
$701.08
|
|
|
HC KIT CATH PED 2-LUMEN
|
Facility
OP
|
$211.68
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41602323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.85 |
| Max. Negotiated Rate |
$196.86 |
| Rate for Payer: Aetna Commercial |
$178.66
|
| Rate for Payer: Aetna Medicare |
$69.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.84
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Centivo All Commercial |
$107.96
|
| Rate for Payer: Cigna All Commercial |
$182.68
|
| Rate for Payer: CORVEL All Commercial |
$196.86
|
| Rate for Payer: Coventry All Commercial |
$186.28
|
| Rate for Payer: Encore All Commercial |
$194.85
|
| Rate for Payer: Frontpath All Commercial |
$194.75
|
| Rate for Payer: Humana ChoiceCare |
$182.83
|
| Rate for Payer: Humana Medicare |
$107.96
|
| Rate for Payer: Lucent All Commercial |
$107.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$158.76
|
| Rate for Payer: PHP All Commercial |
$160.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.56
|
| Rate for Payer: Sagamore Health Network All Products |
$163.42
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.93
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
| Rate for Payer: United Healthcare Medicare |
$69.85
|
|
|
HC KIT CATH PED 2-LUMEN
|
Facility
IP
|
$211.68
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41602323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$196.86 |
| Rate for Payer: Aetna Commercial |
$182.89
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cigna All Commercial |
$182.68
|
| Rate for Payer: CORVEL All Commercial |
$196.86
|
| Rate for Payer: Coventry All Commercial |
$186.28
|
| Rate for Payer: Encore All Commercial |
$194.85
|
| Rate for Payer: Frontpath All Commercial |
$194.75
|
| Rate for Payer: Humana ChoiceCare |
$182.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.51
|
| Rate for Payer: PHCS All Commercial |
$158.76
|
| Rate for Payer: PHP All Commercial |
$160.54
|
| Rate for Payer: Sagamore Health Network All Products |
$163.42
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.28
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
|
