|
HC KIT EVICEL 5ML
|
Facility
OP
|
$1,842.98
|
|
| Hospital Charge Code |
41603434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,713.97 |
| Rate for Payer: Aetna Commercial |
$1,555.48
|
| Rate for Payer: Aetna Medicare |
$608.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$608.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,058.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,152.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$699.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$669.00
|
| Rate for Payer: Cash Price |
$1,142.65
|
| Rate for Payer: Cash Price |
$1,142.65
|
| Rate for Payer: Centivo All Commercial |
$939.92
|
| Rate for Payer: Cigna All Commercial |
$1,590.49
|
| Rate for Payer: CORVEL All Commercial |
$1,713.97
|
| Rate for Payer: Coventry All Commercial |
$1,621.82
|
| Rate for Payer: Encore All Commercial |
$1,696.46
|
| Rate for Payer: Frontpath All Commercial |
$1,695.54
|
| Rate for Payer: Humana ChoiceCare |
$1,591.78
|
| Rate for Payer: Humana Medicare |
$939.92
|
| Rate for Payer: Lucent All Commercial |
$939.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,658.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,382.24
|
| Rate for Payer: PHP All Commercial |
$1,397.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$718.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,422.78
|
| Rate for Payer: Signature Care EPO |
$1,529.67
|
| Rate for Payer: Signature Care PPO |
$1,621.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,566.53
|
| Rate for Payer: United Healthcare Commercial |
$1,452.27
|
| Rate for Payer: United Healthcare Medicare |
$608.18
|
|
|
HC KIT GENESYS HTA
|
Facility
OP
|
$5,884.60
|
|
| Hospital Charge Code |
41601925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$5,472.68 |
| Rate for Payer: Aetna Commercial |
$4,966.60
|
| Rate for Payer: Aetna Medicare |
$1,941.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,941.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,379.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,678.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,233.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,136.11
|
| Rate for Payer: Cash Price |
$3,648.45
|
| Rate for Payer: Cash Price |
$3,648.45
|
| Rate for Payer: Centivo All Commercial |
$3,001.15
|
| Rate for Payer: Cigna All Commercial |
$5,078.41
|
| Rate for Payer: CORVEL All Commercial |
$5,472.68
|
| Rate for Payer: Coventry All Commercial |
$5,178.45
|
| Rate for Payer: Encore All Commercial |
$5,416.77
|
| Rate for Payer: Frontpath All Commercial |
$5,413.83
|
| Rate for Payer: Humana ChoiceCare |
$5,082.53
|
| Rate for Payer: Humana Medicare |
$3,001.15
|
| Rate for Payer: Lucent All Commercial |
$3,001.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,296.14
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$4,413.45
|
| Rate for Payer: PHP All Commercial |
$4,462.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,294.99
|
| Rate for Payer: Sagamore Health Network All Products |
$4,542.91
|
| Rate for Payer: Signature Care EPO |
$4,884.22
|
| Rate for Payer: Signature Care PPO |
$5,178.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,001.91
|
| Rate for Payer: United Healthcare Commercial |
$4,637.06
|
| Rate for Payer: United Healthcare Medicare |
$1,941.92
|
|
|
HC KIT GENESYS HTA
|
Facility
IP
|
$5,884.60
|
|
| Hospital Charge Code |
41601925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,413.45 |
| Max. Negotiated Rate |
$5,472.68 |
| Rate for Payer: Aetna Commercial |
$5,084.29
|
| Rate for Payer: Cash Price |
$3,648.45
|
| Rate for Payer: Cigna All Commercial |
$5,078.41
|
| Rate for Payer: CORVEL All Commercial |
$5,472.68
|
| Rate for Payer: Coventry All Commercial |
$5,178.45
|
| Rate for Payer: Encore All Commercial |
$5,416.77
|
| Rate for Payer: Frontpath All Commercial |
$5,413.83
|
| Rate for Payer: Humana ChoiceCare |
$5,082.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,296.14
|
| Rate for Payer: PHCS All Commercial |
$4,413.45
|
| Rate for Payer: PHP All Commercial |
$4,462.88
|
| Rate for Payer: Sagamore Health Network All Products |
$4,542.91
|
| Rate for Payer: Signature Care EPO |
$4,884.22
|
| Rate for Payer: Signature Care PPO |
$5,178.45
|
| Rate for Payer: United Healthcare Commercial |
$4,637.06
|
|
|
HC KIT INTRO 8.5FR
|
Facility
OP
|
$204.05
|
|
| Hospital Charge Code |
41602230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$189.77 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Medicare |
$67.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.07
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Centivo All Commercial |
$104.07
|
| Rate for Payer: Cigna All Commercial |
$176.10
|
| Rate for Payer: CORVEL All Commercial |
$189.77
|
| Rate for Payer: Coventry All Commercial |
$179.56
|
| Rate for Payer: Encore All Commercial |
$187.83
|
| Rate for Payer: Frontpath All Commercial |
$187.73
|
| Rate for Payer: Humana ChoiceCare |
$176.24
|
| Rate for Payer: Humana Medicare |
$104.07
|
| Rate for Payer: Lucent All Commercial |
$104.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$153.04
|
| Rate for Payer: PHP All Commercial |
$154.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.58
|
| Rate for Payer: Sagamore Health Network All Products |
$157.53
|
| Rate for Payer: Signature Care EPO |
$169.36
|
| Rate for Payer: Signature Care PPO |
$179.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.44
|
| Rate for Payer: United Healthcare Commercial |
$160.79
|
| Rate for Payer: United Healthcare Medicare |
$67.34
|
|
|
HC KIT INTRO 8.5FR
|
Facility
IP
|
$204.05
|
|
| Hospital Charge Code |
41602230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.04 |
| Max. Negotiated Rate |
$189.77 |
| Rate for Payer: Aetna Commercial |
$176.30
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cigna All Commercial |
$176.10
|
| Rate for Payer: CORVEL All Commercial |
$189.77
|
| Rate for Payer: Coventry All Commercial |
$179.56
|
| Rate for Payer: Encore All Commercial |
$187.83
|
| Rate for Payer: Frontpath All Commercial |
$187.73
|
| Rate for Payer: Humana ChoiceCare |
$176.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.64
|
| Rate for Payer: PHCS All Commercial |
$153.04
|
| Rate for Payer: PHP All Commercial |
$154.75
|
| Rate for Payer: Sagamore Health Network All Products |
$157.53
|
| Rate for Payer: Signature Care EPO |
$169.36
|
| Rate for Payer: Signature Care PPO |
$179.56
|
| Rate for Payer: United Healthcare Commercial |
$160.79
|
|
|
HC KIT INTRODUCER SHEATH 6FR
|
Facility
IP
|
$120.28
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.21 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Aetna Commercial |
$103.92
|
| Rate for Payer: Cash Price |
$74.57
|
| Rate for Payer: Cigna All Commercial |
$103.80
|
| Rate for Payer: CORVEL All Commercial |
$111.86
|
| Rate for Payer: Coventry All Commercial |
$105.85
|
| Rate for Payer: Encore All Commercial |
$110.72
|
| Rate for Payer: Frontpath All Commercial |
$110.66
|
| Rate for Payer: Humana ChoiceCare |
$103.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.25
|
| Rate for Payer: PHCS All Commercial |
$90.21
|
| Rate for Payer: PHP All Commercial |
$91.22
|
| Rate for Payer: Sagamore Health Network All Products |
$92.86
|
| Rate for Payer: Signature Care EPO |
$99.83
|
| Rate for Payer: Signature Care PPO |
$105.85
|
| Rate for Payer: United Healthcare Commercial |
$94.78
|
|
|
HC KIT INTRODUCER SHEATH 6FR
|
Facility
OP
|
$120.28
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$101.52
|
| Rate for Payer: Aetna Medicare |
$39.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.66
|
| Rate for Payer: Cash Price |
$74.57
|
| Rate for Payer: Cash Price |
$74.57
|
| Rate for Payer: Centivo All Commercial |
$61.34
|
| Rate for Payer: Cigna All Commercial |
$103.80
|
| Rate for Payer: CORVEL All Commercial |
$111.86
|
| Rate for Payer: Coventry All Commercial |
$105.85
|
| Rate for Payer: Encore All Commercial |
$110.72
|
| Rate for Payer: Frontpath All Commercial |
$110.66
|
| Rate for Payer: Humana ChoiceCare |
$103.89
|
| Rate for Payer: Humana Medicare |
$61.34
|
| Rate for Payer: Lucent All Commercial |
$61.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$90.21
|
| Rate for Payer: PHP All Commercial |
$91.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.91
|
| Rate for Payer: Sagamore Health Network All Products |
$92.86
|
| Rate for Payer: Signature Care EPO |
$99.83
|
| Rate for Payer: Signature Care PPO |
$105.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.24
|
| Rate for Payer: United Healthcare Commercial |
$94.78
|
| Rate for Payer: United Healthcare Medicare |
$39.69
|
|
|
HC KIT INTRODUCER SHEATH 7FR
|
Facility
IP
|
$122.17
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$113.62 |
| Rate for Payer: Aetna Commercial |
$105.55
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: Cigna All Commercial |
$105.43
|
| Rate for Payer: CORVEL All Commercial |
$113.62
|
| Rate for Payer: Coventry All Commercial |
$107.51
|
| Rate for Payer: Encore All Commercial |
$112.46
|
| Rate for Payer: Frontpath All Commercial |
$112.40
|
| Rate for Payer: Humana ChoiceCare |
$105.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.95
|
| Rate for Payer: PHCS All Commercial |
$91.63
|
| Rate for Payer: PHP All Commercial |
$92.65
|
| Rate for Payer: Sagamore Health Network All Products |
$94.32
|
| Rate for Payer: Signature Care EPO |
$101.40
|
| Rate for Payer: Signature Care PPO |
$107.51
|
| Rate for Payer: United Healthcare Commercial |
$96.27
|
|
|
HC KIT INTRODUCER SHEATH 7FR
|
Facility
OP
|
$122.17
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$103.11
|
| Rate for Payer: Aetna Medicare |
$40.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.35
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: Centivo All Commercial |
$62.31
|
| Rate for Payer: Cigna All Commercial |
$105.43
|
| Rate for Payer: CORVEL All Commercial |
$113.62
|
| Rate for Payer: Coventry All Commercial |
$107.51
|
| Rate for Payer: Encore All Commercial |
$112.46
|
| Rate for Payer: Frontpath All Commercial |
$112.40
|
| Rate for Payer: Humana ChoiceCare |
$105.52
|
| Rate for Payer: Humana Medicare |
$62.31
|
| Rate for Payer: Lucent All Commercial |
$62.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$91.63
|
| Rate for Payer: PHP All Commercial |
$92.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.65
|
| Rate for Payer: Sagamore Health Network All Products |
$94.32
|
| Rate for Payer: Signature Care EPO |
$101.40
|
| Rate for Payer: Signature Care PPO |
$107.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.84
|
| Rate for Payer: United Healthcare Commercial |
$96.27
|
| Rate for Payer: United Healthcare Medicare |
$40.32
|
|
|
HC KIT LACERATION TRAY
|
Facility
IP
|
$67.14
|
|
| Hospital Charge Code |
41607784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$62.44 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: Cigna All Commercial |
$57.94
|
| Rate for Payer: CORVEL All Commercial |
$62.44
|
| Rate for Payer: Coventry All Commercial |
$59.08
|
| Rate for Payer: Encore All Commercial |
$61.80
|
| Rate for Payer: Frontpath All Commercial |
$61.77
|
| Rate for Payer: Humana ChoiceCare |
$57.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.43
|
| Rate for Payer: PHCS All Commercial |
$50.36
|
| Rate for Payer: PHP All Commercial |
$50.92
|
| Rate for Payer: Sagamore Health Network All Products |
$51.83
|
| Rate for Payer: Signature Care EPO |
$55.73
|
| Rate for Payer: Signature Care PPO |
$59.08
|
| Rate for Payer: United Healthcare Commercial |
$52.91
|
|
|
HC KIT LACERATION TRAY
|
Facility
OP
|
$67.14
|
|
| Hospital Charge Code |
41607784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$56.67
|
| Rate for Payer: Aetna Medicare |
$22.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.37
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: Centivo All Commercial |
$34.24
|
| Rate for Payer: Cigna All Commercial |
$57.94
|
| Rate for Payer: CORVEL All Commercial |
$62.44
|
| Rate for Payer: Coventry All Commercial |
$59.08
|
| Rate for Payer: Encore All Commercial |
$61.80
|
| Rate for Payer: Frontpath All Commercial |
$61.77
|
| Rate for Payer: Humana ChoiceCare |
$57.99
|
| Rate for Payer: Humana Medicare |
$34.24
|
| Rate for Payer: Lucent All Commercial |
$34.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.43
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$50.36
|
| Rate for Payer: PHP All Commercial |
$50.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.18
|
| Rate for Payer: Sagamore Health Network All Products |
$51.83
|
| Rate for Payer: Signature Care EPO |
$55.73
|
| Rate for Payer: Signature Care PPO |
$59.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$57.07
|
| Rate for Payer: United Healthcare Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare |
$22.16
|
|
|
HC KIT LACERATION TRAY
|
Facility
IP
|
$96.40
|
|
| Hospital Charge Code |
41603999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.30 |
| Max. Negotiated Rate |
$89.65 |
| Rate for Payer: Aetna Commercial |
$83.29
|
| Rate for Payer: Cash Price |
$59.77
|
| Rate for Payer: Cigna All Commercial |
$83.19
|
| Rate for Payer: CORVEL All Commercial |
$89.65
|
| Rate for Payer: Coventry All Commercial |
$84.83
|
| Rate for Payer: Encore All Commercial |
$88.74
|
| Rate for Payer: Frontpath All Commercial |
$88.69
|
| Rate for Payer: Humana ChoiceCare |
$83.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.76
|
| Rate for Payer: PHCS All Commercial |
$72.30
|
| Rate for Payer: PHP All Commercial |
$73.11
|
| Rate for Payer: Sagamore Health Network All Products |
$74.42
|
| Rate for Payer: Signature Care EPO |
$80.01
|
| Rate for Payer: Signature Care PPO |
$84.83
|
| Rate for Payer: United Healthcare Commercial |
$75.96
|
|
|
HC KIT LACERATION TRAY
|
Facility
OP
|
$96.40
|
|
| Hospital Charge Code |
41603999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: Aetna Medicare |
$31.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.99
|
| Rate for Payer: Cash Price |
$59.77
|
| Rate for Payer: Cash Price |
$59.77
|
| Rate for Payer: Centivo All Commercial |
$49.16
|
| Rate for Payer: Cigna All Commercial |
$83.19
|
| Rate for Payer: CORVEL All Commercial |
$89.65
|
| Rate for Payer: Coventry All Commercial |
$84.83
|
| Rate for Payer: Encore All Commercial |
$88.74
|
| Rate for Payer: Frontpath All Commercial |
$88.69
|
| Rate for Payer: Humana ChoiceCare |
$83.26
|
| Rate for Payer: Humana Medicare |
$49.16
|
| Rate for Payer: Lucent All Commercial |
$49.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$72.30
|
| Rate for Payer: PHP All Commercial |
$73.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.60
|
| Rate for Payer: Sagamore Health Network All Products |
$74.42
|
| Rate for Payer: Signature Care EPO |
$80.01
|
| Rate for Payer: Signature Care PPO |
$84.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$75.96
|
| Rate for Payer: United Healthcare Medicare |
$31.81
|
|
|
HC KIT LACERATION TRAY
|
Facility
OP
|
$74.90
|
|
| Hospital Charge Code |
41608031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$63.22
|
| Rate for Payer: Aetna Medicare |
$24.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$43.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.19
|
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: Centivo All Commercial |
$38.20
|
| Rate for Payer: Cigna All Commercial |
$64.64
|
| Rate for Payer: CORVEL All Commercial |
$69.66
|
| Rate for Payer: Coventry All Commercial |
$65.91
|
| Rate for Payer: Encore All Commercial |
$68.95
|
| Rate for Payer: Frontpath All Commercial |
$68.91
|
| Rate for Payer: Humana ChoiceCare |
$64.69
|
| Rate for Payer: Humana Medicare |
$38.20
|
| Rate for Payer: Lucent All Commercial |
$38.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.41
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$56.18
|
| Rate for Payer: PHP All Commercial |
$56.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.21
|
| Rate for Payer: Sagamore Health Network All Products |
$57.82
|
| Rate for Payer: Signature Care EPO |
$62.17
|
| Rate for Payer: Signature Care PPO |
$65.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.66
|
| Rate for Payer: United Healthcare Commercial |
$59.02
|
| Rate for Payer: United Healthcare Medicare |
$24.72
|
|
|
HC KIT LACERATION TRAY
|
Facility
IP
|
$74.90
|
|
| Hospital Charge Code |
41608031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$69.66 |
| Rate for Payer: Aetna Commercial |
$64.71
|
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: Cigna All Commercial |
$64.64
|
| Rate for Payer: CORVEL All Commercial |
$69.66
|
| Rate for Payer: Coventry All Commercial |
$65.91
|
| Rate for Payer: Encore All Commercial |
$68.95
|
| Rate for Payer: Frontpath All Commercial |
$68.91
|
| Rate for Payer: Humana ChoiceCare |
$64.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.41
|
| Rate for Payer: PHCS All Commercial |
$56.18
|
| Rate for Payer: PHP All Commercial |
$56.80
|
| Rate for Payer: Sagamore Health Network All Products |
$57.82
|
| Rate for Payer: Signature Care EPO |
$62.17
|
| Rate for Payer: Signature Care PPO |
$65.91
|
| Rate for Payer: United Healthcare Commercial |
$59.02
|
|
|
HC KIT LD CAP IS1 DF4 4.75
|
Facility
OP
|
$131.25
|
|
| Hospital Charge Code |
41607299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.31 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$110.78
|
| Rate for Payer: Aetna Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.64
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Centivo All Commercial |
$66.94
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Humana Medicare |
$66.94
|
| Rate for Payer: Lucent All Commercial |
$66.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.19
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.56
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
|
|
HC KIT LD CAP IS1 DF4 4.75
|
Facility
IP
|
$131.25
|
|
| Hospital Charge Code |
41607299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.44 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
|
|
HC KIT LD REPR
|
Facility
OP
|
$375.00
|
|
| Hospital Charge Code |
41607304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$316.50
|
| Rate for Payer: Aetna Medicare |
$123.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$215.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$234.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.12
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Centivo All Commercial |
$191.25
|
| Rate for Payer: Cigna All Commercial |
$323.62
|
| Rate for Payer: CORVEL All Commercial |
$348.75
|
| Rate for Payer: Coventry All Commercial |
$330.00
|
| Rate for Payer: Encore All Commercial |
$345.19
|
| Rate for Payer: Frontpath All Commercial |
$345.00
|
| Rate for Payer: Humana ChoiceCare |
$323.89
|
| Rate for Payer: Humana Medicare |
$191.25
|
| Rate for Payer: Lucent All Commercial |
$191.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$337.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$281.25
|
| Rate for Payer: PHP All Commercial |
$284.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$146.25
|
| Rate for Payer: Sagamore Health Network All Products |
$289.50
|
| Rate for Payer: Signature Care EPO |
$311.25
|
| Rate for Payer: Signature Care PPO |
$330.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$318.75
|
| Rate for Payer: United Healthcare Commercial |
$295.50
|
| Rate for Payer: United Healthcare Medicare |
$123.75
|
|
|
HC KIT LD REPR
|
Facility
IP
|
$375.00
|
|
| Hospital Charge Code |
41607304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna All Commercial |
$323.62
|
| Rate for Payer: CORVEL All Commercial |
$348.75
|
| Rate for Payer: Coventry All Commercial |
$330.00
|
| Rate for Payer: Encore All Commercial |
$345.19
|
| Rate for Payer: Frontpath All Commercial |
$345.00
|
| Rate for Payer: Humana ChoiceCare |
$323.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$337.50
|
| Rate for Payer: PHCS All Commercial |
$281.25
|
| Rate for Payer: PHP All Commercial |
$284.40
|
| Rate for Payer: Sagamore Health Network All Products |
$289.50
|
| Rate for Payer: Signature Care EPO |
$311.25
|
| Rate for Payer: Signature Care PPO |
$330.00
|
| Rate for Payer: United Healthcare Commercial |
$295.50
|
|
|
HC KIT LUMBAR PUNCTURE PEDIATRIC
|
Facility
OP
|
$129.57
|
|
| Hospital Charge Code |
41605543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.76 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$109.36
|
| Rate for Payer: Aetna Medicare |
$42.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$74.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.03
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Centivo All Commercial |
$66.08
|
| Rate for Payer: Cigna All Commercial |
$111.82
|
| Rate for Payer: CORVEL All Commercial |
$120.50
|
| Rate for Payer: Coventry All Commercial |
$114.02
|
| Rate for Payer: Encore All Commercial |
$119.27
|
| Rate for Payer: Frontpath All Commercial |
$119.20
|
| Rate for Payer: Humana ChoiceCare |
$111.91
|
| Rate for Payer: Humana Medicare |
$66.08
|
| Rate for Payer: Lucent All Commercial |
$66.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.61
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$97.18
|
| Rate for Payer: PHP All Commercial |
$98.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.53
|
| Rate for Payer: Sagamore Health Network All Products |
$100.03
|
| Rate for Payer: Signature Care EPO |
$107.54
|
| Rate for Payer: Signature Care PPO |
$114.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.13
|
| Rate for Payer: United Healthcare Commercial |
$102.10
|
| Rate for Payer: United Healthcare Medicare |
$42.76
|
|
|
HC KIT LUMBAR PUNCTURE PEDIATRIC
|
Facility
IP
|
$129.57
|
|
| Hospital Charge Code |
41605543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Aetna Commercial |
$111.95
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cigna All Commercial |
$111.82
|
| Rate for Payer: CORVEL All Commercial |
$120.50
|
| Rate for Payer: Coventry All Commercial |
$114.02
|
| Rate for Payer: Encore All Commercial |
$119.27
|
| Rate for Payer: Frontpath All Commercial |
$119.20
|
| Rate for Payer: Humana ChoiceCare |
$111.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.61
|
| Rate for Payer: PHCS All Commercial |
$97.18
|
| Rate for Payer: PHP All Commercial |
$98.27
|
| Rate for Payer: Sagamore Health Network All Products |
$100.03
|
| Rate for Payer: Signature Care EPO |
$107.54
|
| Rate for Payer: Signature Care PPO |
$114.02
|
| Rate for Payer: United Healthcare Commercial |
$102.10
|
|
|
HC KIT MICROPUNCTURE 4FR
|
Facility
IP
|
$192.50
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$179.02 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cigna All Commercial |
$166.13
|
| Rate for Payer: CORVEL All Commercial |
$179.02
|
| Rate for Payer: Coventry All Commercial |
$169.40
|
| Rate for Payer: Encore All Commercial |
$177.20
|
| Rate for Payer: Frontpath All Commercial |
$177.10
|
| Rate for Payer: Humana ChoiceCare |
$166.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.25
|
| Rate for Payer: PHCS All Commercial |
$144.38
|
| Rate for Payer: PHP All Commercial |
$145.99
|
| Rate for Payer: Sagamore Health Network All Products |
$148.61
|
| Rate for Payer: Signature Care EPO |
$159.78
|
| Rate for Payer: Signature Care PPO |
$169.40
|
| Rate for Payer: United Healthcare Commercial |
$151.69
|
|
|
HC KIT MICROPUNCTURE 4FR
|
Facility
OP
|
$192.50
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.52 |
| Max. Negotiated Rate |
$179.02 |
| Rate for Payer: Aetna Commercial |
$162.47
|
| Rate for Payer: Aetna Medicare |
$63.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$110.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.88
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Centivo All Commercial |
$98.18
|
| Rate for Payer: Cigna All Commercial |
$166.13
|
| Rate for Payer: CORVEL All Commercial |
$179.02
|
| Rate for Payer: Coventry All Commercial |
$169.40
|
| Rate for Payer: Encore All Commercial |
$177.20
|
| Rate for Payer: Frontpath All Commercial |
$177.10
|
| Rate for Payer: Humana ChoiceCare |
$166.26
|
| Rate for Payer: Humana Medicare |
$98.18
|
| Rate for Payer: Lucent All Commercial |
$98.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$144.38
|
| Rate for Payer: PHP All Commercial |
$145.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.08
|
| Rate for Payer: Sagamore Health Network All Products |
$148.61
|
| Rate for Payer: Signature Care EPO |
$159.78
|
| Rate for Payer: Signature Care PPO |
$169.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$163.62
|
| Rate for Payer: United Healthcare Commercial |
$151.69
|
| Rate for Payer: United Healthcare Medicare |
$63.52
|
|
|
HC KIT MYOSURE LITE
|
Facility
OP
|
$2,958.00
|
|
| Hospital Charge Code |
41602183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,698.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,849.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,122.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,073.75
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Centivo All Commercial |
$1,508.58
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$1,508.58
|
| Rate for Payer: Lucent All Commercial |
$1,508.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$976.14
|
|
|
HC KIT MYOSURE LITE
|
Facility
IP
|
$2,958.00
|
|
| Hospital Charge Code |
41602183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
