|
HC KIT MYOSURE REG
|
Facility
IP
|
$5,040.00
|
|
| Hospital Charge Code |
41602823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,780.00 |
| Max. Negotiated Rate |
$4,687.20 |
| Rate for Payer: Aetna Commercial |
$4,354.56
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cigna All Commercial |
$4,349.52
|
| Rate for Payer: CORVEL All Commercial |
$4,687.20
|
| Rate for Payer: Coventry All Commercial |
$4,435.20
|
| Rate for Payer: Encore All Commercial |
$4,639.32
|
| Rate for Payer: Frontpath All Commercial |
$4,636.80
|
| Rate for Payer: Humana ChoiceCare |
$4,353.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,536.00
|
| Rate for Payer: PHCS All Commercial |
$3,780.00
|
| Rate for Payer: PHP All Commercial |
$3,822.34
|
| Rate for Payer: Sagamore Health Network All Products |
$3,890.88
|
| Rate for Payer: Signature Care EPO |
$4,183.20
|
| Rate for Payer: Signature Care PPO |
$4,435.20
|
| Rate for Payer: United Healthcare Commercial |
$3,971.52
|
|
|
HC KIT MYOSURE REG
|
Facility
OP
|
$5,040.00
|
|
| Hospital Charge Code |
41602823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,687.20 |
| Rate for Payer: Aetna Commercial |
$4,253.76
|
| Rate for Payer: Aetna Medicare |
$1,663.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,663.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,894.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,150.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,912.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,829.52
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Centivo All Commercial |
$2,570.40
|
| Rate for Payer: Cigna All Commercial |
$4,349.52
|
| Rate for Payer: CORVEL All Commercial |
$4,687.20
|
| Rate for Payer: Coventry All Commercial |
$4,435.20
|
| Rate for Payer: Encore All Commercial |
$4,639.32
|
| Rate for Payer: Frontpath All Commercial |
$4,636.80
|
| Rate for Payer: Humana ChoiceCare |
$4,353.05
|
| Rate for Payer: Humana Medicare |
$2,570.40
|
| Rate for Payer: Lucent All Commercial |
$2,570.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,536.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,780.00
|
| Rate for Payer: PHP All Commercial |
$3,822.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,965.60
|
| Rate for Payer: Sagamore Health Network All Products |
$3,890.88
|
| Rate for Payer: Signature Care EPO |
$4,183.20
|
| Rate for Payer: Signature Care PPO |
$4,435.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,284.00
|
| Rate for Payer: United Healthcare Commercial |
$3,971.52
|
| Rate for Payer: United Healthcare Medicare |
$1,663.20
|
|
|
HC KIT NOVASURE ABLATION
|
Facility
OP
|
$4,742.40
|
|
| Hospital Charge Code |
41602097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,410.43 |
| Rate for Payer: Aetna Commercial |
$4,002.59
|
| Rate for Payer: Aetna Medicare |
$1,564.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,564.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,723.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,964.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,799.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,721.49
|
| Rate for Payer: Cash Price |
$2,940.29
|
| Rate for Payer: Cash Price |
$2,940.29
|
| Rate for Payer: Centivo All Commercial |
$2,418.62
|
| Rate for Payer: Cigna All Commercial |
$4,092.69
|
| Rate for Payer: CORVEL All Commercial |
$4,410.43
|
| Rate for Payer: Coventry All Commercial |
$4,173.31
|
| Rate for Payer: Encore All Commercial |
$4,365.38
|
| Rate for Payer: Frontpath All Commercial |
$4,363.01
|
| Rate for Payer: Humana ChoiceCare |
$4,096.01
|
| Rate for Payer: Humana Medicare |
$2,418.62
|
| Rate for Payer: Lucent All Commercial |
$2,418.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,268.16
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,556.80
|
| Rate for Payer: PHP All Commercial |
$3,596.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,849.54
|
| Rate for Payer: Sagamore Health Network All Products |
$3,661.13
|
| Rate for Payer: Signature Care EPO |
$3,936.19
|
| Rate for Payer: Signature Care PPO |
$4,173.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,031.04
|
| Rate for Payer: United Healthcare Commercial |
$3,737.01
|
| Rate for Payer: United Healthcare Medicare |
$1,564.99
|
|
|
HC KIT NOVASURE ABLATION
|
Facility
IP
|
$4,742.40
|
|
| Hospital Charge Code |
41602097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,556.80 |
| Max. Negotiated Rate |
$4,410.43 |
| Rate for Payer: Aetna Commercial |
$4,097.43
|
| Rate for Payer: Cash Price |
$2,940.29
|
| Rate for Payer: Cigna All Commercial |
$4,092.69
|
| Rate for Payer: CORVEL All Commercial |
$4,410.43
|
| Rate for Payer: Coventry All Commercial |
$4,173.31
|
| Rate for Payer: Encore All Commercial |
$4,365.38
|
| Rate for Payer: Frontpath All Commercial |
$4,363.01
|
| Rate for Payer: Humana ChoiceCare |
$4,096.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,268.16
|
| Rate for Payer: PHCS All Commercial |
$3,556.80
|
| Rate for Payer: PHP All Commercial |
$3,596.64
|
| Rate for Payer: Sagamore Health Network All Products |
$3,661.13
|
| Rate for Payer: Signature Care EPO |
$3,936.19
|
| Rate for Payer: Signature Care PPO |
$4,173.31
|
| Rate for Payer: United Healthcare Commercial |
$3,737.01
|
|
|
HC KIT PLUG
|
Facility
IP
|
$131.25
|
|
| Hospital Charge Code |
41607310
|
|
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 PLUG
|
Facility
OP
|
$131.25
|
|
| Hospital Charge Code |
41607310
|
|
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 SUTURE REMOVAL
|
Facility
OP
|
$11.97
|
|
| Hospital Charge Code |
41607850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.35
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Centivo All Commercial |
$6.10
|
| Rate for Payer: Cigna All Commercial |
$10.33
|
| Rate for Payer: CORVEL All Commercial |
$11.13
|
| Rate for Payer: Coventry All Commercial |
$10.53
|
| Rate for Payer: Encore All Commercial |
$11.02
|
| Rate for Payer: Frontpath All Commercial |
$11.01
|
| Rate for Payer: Humana ChoiceCare |
$10.34
|
| Rate for Payer: Humana Medicare |
$6.10
|
| Rate for Payer: Lucent All Commercial |
$6.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.77
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.98
|
| Rate for Payer: PHP All Commercial |
$9.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.67
|
| Rate for Payer: Sagamore Health Network All Products |
$9.24
|
| Rate for Payer: Signature Care EPO |
$9.94
|
| Rate for Payer: Signature Care PPO |
$10.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.17
|
| Rate for Payer: United Healthcare Commercial |
$9.43
|
| Rate for Payer: United Healthcare Medicare |
$3.95
|
|
|
HC KIT SUTURE REMOVAL
|
Facility
IP
|
$11.97
|
|
| Hospital Charge Code |
41607850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$11.13 |
| Rate for Payer: Aetna Commercial |
$10.34
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cigna All Commercial |
$10.33
|
| Rate for Payer: CORVEL All Commercial |
$11.13
|
| Rate for Payer: Coventry All Commercial |
$10.53
|
| Rate for Payer: Encore All Commercial |
$11.02
|
| Rate for Payer: Frontpath All Commercial |
$11.01
|
| Rate for Payer: Humana ChoiceCare |
$10.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.77
|
| Rate for Payer: PHCS All Commercial |
$8.98
|
| Rate for Payer: PHP All Commercial |
$9.08
|
| Rate for Payer: Sagamore Health Network All Products |
$9.24
|
| Rate for Payer: Signature Care EPO |
$9.94
|
| Rate for Payer: Signature Care PPO |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$9.43
|
|
|
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 |
$5.53
|
| 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 SUTURE REMOVAL
|
Facility
OP
|
$8.92
|
|
| Hospital Charge Code |
41605568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Aetna Medicare |
$2.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.24
|
| Rate for Payer: Cash Price |
$5.53
|
| Rate for Payer: Cash Price |
$5.53
|
| Rate for Payer: Centivo All Commercial |
$4.55
|
| 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 |
$4.55
|
| Rate for Payer: Lucent All Commercial |
$4.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$2.94
|
|
|
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 |
$121.68 |
| Max. Negotiated Rate |
$946.55 |
| Rate for Payer: Aetna Commercial |
$859.02
|
| Rate for Payer: Aetna Medicare |
$335.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$335.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$636.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$386.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$369.46
|
| Rate for Payer: Cash Price |
$631.04
|
| Rate for Payer: Cash Price |
$631.04
|
| Rate for Payer: Centivo All Commercial |
$519.08
|
| 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 |
$519.08
|
| Rate for Payer: Lucent All Commercial |
$519.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$916.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$335.87
|
|
|
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 |
$631.04
|
| 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
OP
|
$208.26
|
|
| Hospital Charge Code |
41607716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.73 |
| Max. Negotiated Rate |
$193.68 |
| Rate for Payer: Aetna Commercial |
$175.77
|
| Rate for Payer: Aetna Medicare |
$68.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$119.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$130.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.60
|
| Rate for Payer: Cash Price |
$129.12
|
| Rate for Payer: Cash Price |
$129.12
|
| Rate for Payer: Centivo All Commercial |
$106.21
|
| Rate for Payer: Cigna All Commercial |
$179.73
|
| Rate for Payer: CORVEL All Commercial |
$193.68
|
| Rate for Payer: Coventry All Commercial |
$183.27
|
| Rate for Payer: Encore All Commercial |
$191.70
|
| Rate for Payer: Frontpath All Commercial |
$191.60
|
| Rate for Payer: Humana ChoiceCare |
$179.87
|
| Rate for Payer: Humana Medicare |
$106.21
|
| Rate for Payer: Lucent All Commercial |
$106.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.43
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$156.20
|
| Rate for Payer: PHP All Commercial |
$157.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.22
|
| Rate for Payer: Sagamore Health Network All Products |
$160.78
|
| Rate for Payer: Signature Care EPO |
$172.86
|
| Rate for Payer: Signature Care PPO |
$183.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.02
|
| Rate for Payer: United Healthcare Commercial |
$164.11
|
| Rate for Payer: United Healthcare Medicare |
$68.73
|
|
|
HC KIT ULTRASOUND PIV START
|
Facility
IP
|
$208.26
|
|
| Hospital Charge Code |
41607716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.20 |
| Max. Negotiated Rate |
$193.68 |
| Rate for Payer: Aetna Commercial |
$179.94
|
| Rate for Payer: Cash Price |
$129.12
|
| Rate for Payer: Cigna All Commercial |
$179.73
|
| Rate for Payer: CORVEL All Commercial |
$193.68
|
| Rate for Payer: Coventry All Commercial |
$183.27
|
| Rate for Payer: Encore All Commercial |
$191.70
|
| Rate for Payer: Frontpath All Commercial |
$191.60
|
| Rate for Payer: Humana ChoiceCare |
$179.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.43
|
| Rate for Payer: PHCS All Commercial |
$156.20
|
| Rate for Payer: PHP All Commercial |
$157.94
|
| Rate for Payer: Sagamore Health Network All Products |
$160.78
|
| Rate for Payer: Signature Care EPO |
$172.86
|
| Rate for Payer: Signature Care PPO |
$183.27
|
| Rate for Payer: United Healthcare Commercial |
$164.11
|
|
|
HC KNEE ARTHROGRAM LT
|
Facility
OP
|
$1,089.34
|
|
|
Service Code
|
CPT 73580 LT
|
| Hospital Charge Code |
01616072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$359.48 |
| Max. Negotiated Rate |
$1,013.09 |
| Rate for Payer: Aetna Commercial |
$919.40
|
| Rate for Payer: Aetna Medicare |
$359.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$359.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$625.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$680.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$413.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$395.43
|
| Rate for Payer: Cash Price |
$675.39
|
| Rate for Payer: Centivo All Commercial |
$555.56
|
| Rate for Payer: Cigna All Commercial |
$940.10
|
| Rate for Payer: CORVEL All Commercial |
$1,013.09
|
| Rate for Payer: Coventry All Commercial |
$958.62
|
| Rate for Payer: Encore All Commercial |
$1,002.74
|
| Rate for Payer: Frontpath All Commercial |
$1,002.19
|
| Rate for Payer: Humana ChoiceCare |
$940.86
|
| Rate for Payer: Humana Medicare |
$555.56
|
| Rate for Payer: Lucent All Commercial |
$555.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$980.41
|
| Rate for Payer: PHCS All Commercial |
$817.00
|
| Rate for Payer: PHP All Commercial |
$826.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$424.84
|
| Rate for Payer: Sagamore Health Network All Products |
$840.97
|
| Rate for Payer: Signature Care EPO |
$904.15
|
| Rate for Payer: Signature Care PPO |
$958.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$925.94
|
| Rate for Payer: United Healthcare Commercial |
$858.40
|
| Rate for Payer: United Healthcare Medicare |
$359.48
|
|
|
HC KNEE ARTHROGRAM LT
|
Facility
IP
|
$1,089.34
|
|
|
Service Code
|
CPT 73580 LT
|
| Hospital Charge Code |
01616072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$817.00 |
| Max. Negotiated Rate |
$1,013.09 |
| Rate for Payer: Aetna Commercial |
$941.19
|
| Rate for Payer: Cash Price |
$675.39
|
| Rate for Payer: Cigna All Commercial |
$940.10
|
| Rate for Payer: CORVEL All Commercial |
$1,013.09
|
| Rate for Payer: Coventry All Commercial |
$958.62
|
| Rate for Payer: Encore All Commercial |
$1,002.74
|
| Rate for Payer: Frontpath All Commercial |
$1,002.19
|
| Rate for Payer: Humana ChoiceCare |
$940.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$980.41
|
| Rate for Payer: PHCS All Commercial |
$817.00
|
| Rate for Payer: PHP All Commercial |
$826.16
|
| Rate for Payer: Sagamore Health Network All Products |
$840.97
|
| Rate for Payer: Signature Care EPO |
$904.15
|
| Rate for Payer: Signature Care PPO |
$958.62
|
| Rate for Payer: United Healthcare Commercial |
$858.40
|
|
|
HC KNEE ARTHROGRAM RT
|
Facility
OP
|
$1,089.34
|
|
|
Service Code
|
CPT 73580 RT
|
| Hospital Charge Code |
11616072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$359.48 |
| Max. Negotiated Rate |
$1,013.09 |
| Rate for Payer: Aetna Commercial |
$919.40
|
| Rate for Payer: Aetna Medicare |
$359.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$359.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$625.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$680.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$413.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$395.43
|
| Rate for Payer: Cash Price |
$675.39
|
| Rate for Payer: Centivo All Commercial |
$555.56
|
| Rate for Payer: Cigna All Commercial |
$940.10
|
| Rate for Payer: CORVEL All Commercial |
$1,013.09
|
| Rate for Payer: Coventry All Commercial |
$958.62
|
| Rate for Payer: Encore All Commercial |
$1,002.74
|
| Rate for Payer: Frontpath All Commercial |
$1,002.19
|
| Rate for Payer: Humana ChoiceCare |
$940.86
|
| Rate for Payer: Humana Medicare |
$555.56
|
| Rate for Payer: Lucent All Commercial |
$555.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$980.41
|
| Rate for Payer: PHCS All Commercial |
$817.00
|
| Rate for Payer: PHP All Commercial |
$826.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$424.84
|
| Rate for Payer: Sagamore Health Network All Products |
$840.97
|
| Rate for Payer: Signature Care EPO |
$904.15
|
| Rate for Payer: Signature Care PPO |
$958.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$925.94
|
| Rate for Payer: United Healthcare Commercial |
$858.40
|
| Rate for Payer: United Healthcare Medicare |
$359.48
|
|
|
HC KNEE ARTHROGRAM RT
|
Facility
IP
|
$1,089.34
|
|
|
Service Code
|
CPT 73580 RT
|
| Hospital Charge Code |
11616072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$817.00 |
| Max. Negotiated Rate |
$1,013.09 |
| Rate for Payer: Aetna Commercial |
$941.19
|
| Rate for Payer: Cash Price |
$675.39
|
| Rate for Payer: Cigna All Commercial |
$940.10
|
| Rate for Payer: CORVEL All Commercial |
$1,013.09
|
| Rate for Payer: Coventry All Commercial |
$958.62
|
| Rate for Payer: Encore All Commercial |
$1,002.74
|
| Rate for Payer: Frontpath All Commercial |
$1,002.19
|
| Rate for Payer: Humana ChoiceCare |
$940.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$980.41
|
| Rate for Payer: PHCS All Commercial |
$817.00
|
| Rate for Payer: PHP All Commercial |
$826.16
|
| Rate for Payer: Sagamore Health Network All Products |
$840.97
|
| Rate for Payer: Signature Care EPO |
$904.15
|
| Rate for Payer: Signature Care PPO |
$958.62
|
| Rate for Payer: United Healthcare Commercial |
$858.40
|
|
|
HC KNIFE MANI 2.9 SLIT-ANGLED MSL29
|
Facility
IP
|
$53.55
|
|
| Hospital Charge Code |
41601225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
|
HC KNIFE MANI 2.9 SLIT-ANGLED MSL29
|
Facility
OP
|
$53.55
|
|
| Hospital Charge Code |
41601225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.44
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Centivo All Commercial |
$27.31
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$27.31
|
| Rate for Payer: Lucent All Commercial |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.67
|
|
|
HC KNIFE SAFETY 15 DEGREES SIDEPO
|
Facility
IP
|
$64.89
|
|
| Hospital Charge Code |
41602319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.67 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: Aetna Commercial |
$56.06
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cigna All Commercial |
$56.00
|
| Rate for Payer: CORVEL All Commercial |
$60.35
|
| Rate for Payer: Coventry All Commercial |
$57.10
|
| Rate for Payer: Encore All Commercial |
$59.73
|
| Rate for Payer: Frontpath All Commercial |
$59.70
|
| Rate for Payer: Humana ChoiceCare |
$56.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.40
|
| Rate for Payer: PHCS All Commercial |
$48.67
|
| Rate for Payer: PHP All Commercial |
$49.21
|
| Rate for Payer: Sagamore Health Network All Products |
$50.10
|
| Rate for Payer: Signature Care EPO |
$53.86
|
| Rate for Payer: Signature Care PPO |
$57.10
|
| Rate for Payer: United Healthcare Commercial |
$51.13
|
|
|
HC KNIFE SAFETY 15 DEGREES SIDEPO
|
Facility
OP
|
$64.89
|
|
| Hospital Charge Code |
41602319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$54.77
|
| Rate for Payer: Aetna Medicare |
$21.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.56
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Centivo All Commercial |
$33.09
|
| Rate for Payer: Cigna All Commercial |
$56.00
|
| Rate for Payer: CORVEL All Commercial |
$60.35
|
| Rate for Payer: Coventry All Commercial |
$57.10
|
| Rate for Payer: Encore All Commercial |
$59.73
|
| Rate for Payer: Frontpath All Commercial |
$59.70
|
| Rate for Payer: Humana ChoiceCare |
$56.05
|
| Rate for Payer: Humana Medicare |
$33.09
|
| Rate for Payer: Lucent All Commercial |
$33.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$48.67
|
| Rate for Payer: PHP All Commercial |
$49.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.31
|
| Rate for Payer: Sagamore Health Network All Products |
$50.10
|
| Rate for Payer: Signature Care EPO |
$53.86
|
| Rate for Payer: Signature Care PPO |
$57.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.16
|
| Rate for Payer: United Healthcare Commercial |
$51.13
|
| Rate for Payer: United Healthcare Medicare |
$21.41
|
|
|
HC KNIFE SAFETY 3.2 SLIT
|
Facility
IP
|
$91.00
|
|
| Hospital Charge Code |
41602318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Cash Price |
$56.42
|
| Rate for Payer: Cigna All Commercial |
$78.53
|
| Rate for Payer: CORVEL All Commercial |
$84.63
|
| Rate for Payer: Coventry All Commercial |
$80.08
|
| Rate for Payer: Encore All Commercial |
$83.77
|
| Rate for Payer: Frontpath All Commercial |
$83.72
|
| Rate for Payer: Humana ChoiceCare |
$78.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.90
|
| Rate for Payer: PHCS All Commercial |
$68.25
|
| Rate for Payer: PHP All Commercial |
$69.01
|
| Rate for Payer: Sagamore Health Network All Products |
$70.25
|
| Rate for Payer: Signature Care EPO |
$75.53
|
| Rate for Payer: Signature Care PPO |
$80.08
|
| Rate for Payer: United Healthcare Commercial |
$71.71
|
|
|
HC KNIFE SAFETY 3.2 SLIT
|
Facility
OP
|
$91.00
|
|
| Hospital Charge Code |
41602318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$76.80
|
| Rate for Payer: Aetna Medicare |
$30.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.03
|
| Rate for Payer: Cash Price |
$56.42
|
| Rate for Payer: Cash Price |
$56.42
|
| Rate for Payer: Centivo All Commercial |
$46.41
|
| Rate for Payer: Cigna All Commercial |
$78.53
|
| Rate for Payer: CORVEL All Commercial |
$84.63
|
| Rate for Payer: Coventry All Commercial |
$80.08
|
| Rate for Payer: Encore All Commercial |
$83.77
|
| Rate for Payer: Frontpath All Commercial |
$83.72
|
| Rate for Payer: Humana ChoiceCare |
$78.60
|
| Rate for Payer: Humana Medicare |
$46.41
|
| Rate for Payer: Lucent All Commercial |
$46.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$68.25
|
| Rate for Payer: PHP All Commercial |
$69.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.49
|
| Rate for Payer: Sagamore Health Network All Products |
$70.25
|
| Rate for Payer: Signature Care EPO |
$75.53
|
| Rate for Payer: Signature Care PPO |
$80.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.35
|
| Rate for Payer: United Healthcare Commercial |
$71.71
|
| Rate for Payer: United Healthcare Medicare |
$30.03
|
|
|
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 |
$45.64
|
| 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 |
$58.01
|
|
