|
HC RED CELL - LEUKOREDUCED
|
Facility
|
IP
|
$1,219.92
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
1370017
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$914.94 |
| Max. Negotiated Rate |
$1,134.53 |
| Rate for Payer: Aetna Commercial |
$1,054.01
|
| Rate for Payer: Cash Price |
$731.95
|
| Rate for Payer: Cigna All Commercial |
$1,052.79
|
| Rate for Payer: CORVEL All Commercial |
$1,134.53
|
| Rate for Payer: Coventry All Commercial |
$1,073.53
|
| Rate for Payer: Encore All Commercial |
$1,122.94
|
| Rate for Payer: Frontpath All Commercial |
$1,122.33
|
| Rate for Payer: Humana ChoiceCare |
$1,053.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,097.93
|
| Rate for Payer: PHCS All Commercial |
$914.94
|
| Rate for Payer: PHP All Commercial |
$925.19
|
| Rate for Payer: Sagamore Health Network All Products |
$941.78
|
| Rate for Payer: Signature Care EPO |
$1,012.53
|
| Rate for Payer: Signature Care PPO |
$1,073.53
|
| Rate for Payer: United Healthcare Commercial |
$961.30
|
|
|
HC REFLEX:JAK2 EXON 12, 13, 14 AND 15 MUTATION ANALYSIS
|
Facility
|
OP
|
$471.75
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
63044091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.24 |
| Max. Negotiated Rate |
$438.73 |
| Rate for Payer: Aetna Commercial |
$398.16
|
| Rate for Payer: Aetna Medicare |
$150.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$185.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$216.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$216.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$185.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$166.06
|
| Rate for Payer: Cash Price |
$283.05
|
| Rate for Payer: Cash Price |
$283.05
|
| Rate for Payer: Centivo All Commercial |
$256.63
|
| Rate for Payer: Cigna All Commercial |
$407.12
|
| Rate for Payer: CORVEL All Commercial |
$438.73
|
| Rate for Payer: Coventry All Commercial |
$415.14
|
| Rate for Payer: Encore All Commercial |
$434.25
|
| Rate for Payer: Frontpath All Commercial |
$434.01
|
| Rate for Payer: Humana ChoiceCare |
$407.45
|
| Rate for Payer: Humana Medicare |
$150.96
|
| Rate for Payer: Lucent All Commercial |
$256.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.57
|
| Rate for Payer: Managed Health Services Medicaid |
$185.20
|
| Rate for Payer: MDWise Medicaid |
$185.20
|
| Rate for Payer: PHCS All Commercial |
$353.81
|
| Rate for Payer: PHP All Commercial |
$357.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$183.98
|
| Rate for Payer: Sagamore Health Network All Products |
$364.19
|
| Rate for Payer: Signature Care EPO |
$391.55
|
| Rate for Payer: Signature Care PPO |
$415.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.99
|
| Rate for Payer: United Healthcare Commercial |
$371.74
|
| Rate for Payer: United Healthcare Medicare |
$150.96
|
|
|
HC REFLEX:JAK2 EXON 12, 13, 14 AND 15 MUTATION ANALYSIS
|
Facility
|
IP
|
$471.75
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
63044091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$353.81 |
| Max. Negotiated Rate |
$438.73 |
| Rate for Payer: Aetna Commercial |
$407.59
|
| Rate for Payer: Cash Price |
$283.05
|
| Rate for Payer: Cigna All Commercial |
$407.12
|
| Rate for Payer: CORVEL All Commercial |
$438.73
|
| Rate for Payer: Coventry All Commercial |
$415.14
|
| Rate for Payer: Encore All Commercial |
$434.25
|
| Rate for Payer: Frontpath All Commercial |
$434.01
|
| Rate for Payer: Humana ChoiceCare |
$407.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.57
|
| Rate for Payer: PHCS All Commercial |
$353.81
|
| Rate for Payer: PHP All Commercial |
$357.78
|
| Rate for Payer: Sagamore Health Network All Products |
$364.19
|
| Rate for Payer: Signature Care EPO |
$391.55
|
| Rate for Payer: Signature Care PPO |
$415.14
|
| Rate for Payer: United Healthcare Commercial |
$371.74
|
|
|
HC REGIONAL ANESTH EA ADD MIN
|
Facility
|
OP
|
$14.03
|
|
| Hospital Charge Code |
1246653
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$11.84
|
| Rate for Payer: Aetna Medicare |
$4.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.94
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Centivo All Commercial |
$7.63
|
| Rate for Payer: Cigna All Commercial |
$12.11
|
| Rate for Payer: CORVEL All Commercial |
$13.05
|
| Rate for Payer: Coventry All Commercial |
$12.35
|
| Rate for Payer: Encore All Commercial |
$12.91
|
| Rate for Payer: Frontpath All Commercial |
$12.91
|
| Rate for Payer: Humana ChoiceCare |
$12.12
|
| Rate for Payer: Humana Medicare |
$4.49
|
| Rate for Payer: Lucent All Commercial |
$7.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.63
|
| Rate for Payer: Managed Health Services Medicaid |
$60.48
|
| Rate for Payer: MDWise Medicaid |
$60.48
|
| Rate for Payer: PHCS All Commercial |
$10.52
|
| Rate for Payer: PHP All Commercial |
$10.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.47
|
| Rate for Payer: Sagamore Health Network All Products |
$10.83
|
| Rate for Payer: Signature Care EPO |
$11.64
|
| Rate for Payer: Signature Care PPO |
$12.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.93
|
| Rate for Payer: United Healthcare Commercial |
$11.06
|
| Rate for Payer: United Healthcare Medicare |
$4.49
|
|
|
HC REGIONAL ANESTH EA ADD MIN
|
Facility
|
IP
|
$14.03
|
|
| Hospital Charge Code |
1246653
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: Aetna Commercial |
$12.12
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cigna All Commercial |
$12.11
|
| Rate for Payer: CORVEL All Commercial |
$13.05
|
| Rate for Payer: Coventry All Commercial |
$12.35
|
| Rate for Payer: Encore All Commercial |
$12.91
|
| Rate for Payer: Frontpath All Commercial |
$12.91
|
| Rate for Payer: Humana ChoiceCare |
$12.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.63
|
| Rate for Payer: PHCS All Commercial |
$10.52
|
| Rate for Payer: PHP All Commercial |
$10.64
|
| Rate for Payer: Sagamore Health Network All Products |
$10.83
|
| Rate for Payer: Signature Care EPO |
$11.64
|
| Rate for Payer: Signature Care PPO |
$12.35
|
| Rate for Payer: United Healthcare Commercial |
$11.06
|
|
|
HC REGIONAL ANESTH INITIAL 15 MIN
|
Facility
|
OP
|
$209.90
|
|
| Hospital Charge Code |
1246652
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$195.21 |
| Rate for Payer: Aetna Commercial |
$177.16
|
| Rate for Payer: Aetna Medicare |
$67.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.88
|
| Rate for Payer: Cash Price |
$125.94
|
| Rate for Payer: Cash Price |
$125.94
|
| Rate for Payer: Centivo All Commercial |
$114.19
|
| Rate for Payer: Cigna All Commercial |
$181.14
|
| Rate for Payer: CORVEL All Commercial |
$195.21
|
| Rate for Payer: Coventry All Commercial |
$184.71
|
| Rate for Payer: Encore All Commercial |
$193.21
|
| Rate for Payer: Frontpath All Commercial |
$193.11
|
| Rate for Payer: Humana ChoiceCare |
$181.29
|
| Rate for Payer: Humana Medicare |
$67.17
|
| Rate for Payer: Lucent All Commercial |
$114.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.91
|
| Rate for Payer: Managed Health Services Medicaid |
$60.48
|
| Rate for Payer: MDWise Medicaid |
$60.48
|
| Rate for Payer: PHCS All Commercial |
$157.43
|
| Rate for Payer: PHP All Commercial |
$159.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.86
|
| Rate for Payer: Sagamore Health Network All Products |
$162.04
|
| Rate for Payer: Signature Care EPO |
$174.22
|
| Rate for Payer: Signature Care PPO |
$184.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.41
|
| Rate for Payer: United Healthcare Commercial |
$165.40
|
| Rate for Payer: United Healthcare Medicare |
$67.17
|
|
|
HC REGIONAL ANESTH INITIAL 15 MIN
|
Facility
|
IP
|
$209.90
|
|
| Hospital Charge Code |
1246652
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$157.43 |
| Max. Negotiated Rate |
$195.21 |
| Rate for Payer: Aetna Commercial |
$181.35
|
| Rate for Payer: Cash Price |
$125.94
|
| Rate for Payer: Cigna All Commercial |
$181.14
|
| Rate for Payer: CORVEL All Commercial |
$195.21
|
| Rate for Payer: Coventry All Commercial |
$184.71
|
| Rate for Payer: Encore All Commercial |
$193.21
|
| Rate for Payer: Frontpath All Commercial |
$193.11
|
| Rate for Payer: Humana ChoiceCare |
$181.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.91
|
| Rate for Payer: PHCS All Commercial |
$157.43
|
| Rate for Payer: PHP All Commercial |
$159.19
|
| Rate for Payer: Sagamore Health Network All Products |
$162.04
|
| Rate for Payer: Signature Care EPO |
$174.22
|
| Rate for Payer: Signature Care PPO |
$184.71
|
| Rate for Payer: United Healthcare Commercial |
$165.40
|
|
|
HC REHAB SWALLOW STUDY (MBS)-SP
|
Facility
|
IP
|
$617.26
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
1748069
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$462.94 |
| Max. Negotiated Rate |
$574.05 |
| Rate for Payer: Aetna Commercial |
$533.31
|
| Rate for Payer: Cash Price |
$370.36
|
| Rate for Payer: Cigna All Commercial |
$532.70
|
| Rate for Payer: CORVEL All Commercial |
$574.05
|
| Rate for Payer: Coventry All Commercial |
$543.19
|
| Rate for Payer: Encore All Commercial |
$568.19
|
| Rate for Payer: Frontpath All Commercial |
$567.88
|
| Rate for Payer: Humana ChoiceCare |
$533.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.53
|
| Rate for Payer: PHCS All Commercial |
$462.94
|
| Rate for Payer: PHP All Commercial |
$468.13
|
| Rate for Payer: Sagamore Health Network All Products |
$476.52
|
| Rate for Payer: Signature Care EPO |
$512.33
|
| Rate for Payer: Signature Care PPO |
$543.19
|
| Rate for Payer: United Healthcare Commercial |
$486.40
|
|
|
HC REHAB SWALLOW STUDY (MBS)-SP
|
Facility
|
OP
|
$617.26
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
1748069
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$574.05 |
| Rate for Payer: Aetna Commercial |
$520.97
|
| Rate for Payer: Aetna Medicare |
$197.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$191.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$354.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$227.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$217.28
|
| Rate for Payer: Cash Price |
$370.36
|
| Rate for Payer: Cash Price |
$370.36
|
| Rate for Payer: Centivo All Commercial |
$335.79
|
| Rate for Payer: Cigna All Commercial |
$532.70
|
| Rate for Payer: CORVEL All Commercial |
$574.05
|
| Rate for Payer: Coventry All Commercial |
$543.19
|
| Rate for Payer: Encore All Commercial |
$568.19
|
| Rate for Payer: Frontpath All Commercial |
$567.88
|
| Rate for Payer: Humana ChoiceCare |
$533.13
|
| Rate for Payer: Humana Medicare |
$197.52
|
| Rate for Payer: Lucent All Commercial |
$335.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$555.53
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$462.94
|
| Rate for Payer: PHP All Commercial |
$468.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.73
|
| Rate for Payer: Sagamore Health Network All Products |
$476.52
|
| Rate for Payer: Signature Care EPO |
$512.33
|
| Rate for Payer: Signature Care PPO |
$543.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$524.67
|
| Rate for Payer: United Healthcare Commercial |
$486.40
|
| Rate for Payer: United Healthcare Medicare |
$197.52
|
|
|
HC RELOAD ENDOHERNIA 4.8
|
Facility
|
OP
|
$306.18
|
|
| Hospital Charge Code |
41601978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$284.75 |
| Rate for Payer: Aetna Commercial |
$258.42
|
| Rate for Payer: Aetna Medicare |
$97.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$175.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.78
|
| Rate for Payer: Cash Price |
$183.71
|
| Rate for Payer: Cash Price |
$183.71
|
| Rate for Payer: Centivo All Commercial |
$166.56
|
| Rate for Payer: Cigna All Commercial |
$264.23
|
| Rate for Payer: CORVEL All Commercial |
$284.75
|
| Rate for Payer: Coventry All Commercial |
$269.44
|
| Rate for Payer: Encore All Commercial |
$281.84
|
| Rate for Payer: Frontpath All Commercial |
$281.69
|
| Rate for Payer: Humana ChoiceCare |
$264.45
|
| Rate for Payer: Humana Medicare |
$97.98
|
| Rate for Payer: Lucent All Commercial |
$166.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.56
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$229.63
|
| Rate for Payer: PHP All Commercial |
$232.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.41
|
| Rate for Payer: Sagamore Health Network All Products |
$236.37
|
| Rate for Payer: Signature Care EPO |
$254.13
|
| Rate for Payer: Signature Care PPO |
$269.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.25
|
| Rate for Payer: United Healthcare Commercial |
$241.27
|
| Rate for Payer: United Healthcare Medicare |
$97.98
|
|
|
HC RELOAD ENDOHERNIA 4.8
|
Facility
|
IP
|
$306.18
|
|
| Hospital Charge Code |
41601978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.63 |
| Max. Negotiated Rate |
$284.75 |
| Rate for Payer: Aetna Commercial |
$264.54
|
| Rate for Payer: Cash Price |
$183.71
|
| Rate for Payer: Cigna All Commercial |
$264.23
|
| Rate for Payer: CORVEL All Commercial |
$284.75
|
| Rate for Payer: Coventry All Commercial |
$269.44
|
| Rate for Payer: Encore All Commercial |
$281.84
|
| Rate for Payer: Frontpath All Commercial |
$281.69
|
| Rate for Payer: Humana ChoiceCare |
$264.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.56
|
| Rate for Payer: PHCS All Commercial |
$229.63
|
| Rate for Payer: PHP All Commercial |
$232.21
|
| Rate for Payer: Sagamore Health Network All Products |
$236.37
|
| Rate for Payer: Signature Care EPO |
$254.13
|
| Rate for Payer: Signature Care PPO |
$269.44
|
| Rate for Payer: United Healthcare Commercial |
$241.27
|
|
|
HC RELOAD GRIP 45MM BLUE
|
Facility
|
IP
|
$1,037.30
|
|
| Hospital Charge Code |
41607900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.98 |
| Max. Negotiated Rate |
$964.69 |
| Rate for Payer: Aetna Commercial |
$896.23
|
| Rate for Payer: Cash Price |
$622.38
|
| Rate for Payer: Cigna All Commercial |
$895.19
|
| Rate for Payer: CORVEL All Commercial |
$964.69
|
| Rate for Payer: Coventry All Commercial |
$912.82
|
| Rate for Payer: Encore All Commercial |
$954.83
|
| Rate for Payer: Frontpath All Commercial |
$954.32
|
| Rate for Payer: Humana ChoiceCare |
$895.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$933.57
|
| Rate for Payer: PHCS All Commercial |
$777.98
|
| Rate for Payer: PHP All Commercial |
$786.69
|
| Rate for Payer: Sagamore Health Network All Products |
$800.80
|
| Rate for Payer: Signature Care EPO |
$860.96
|
| Rate for Payer: Signature Care PPO |
$912.82
|
| Rate for Payer: United Healthcare Commercial |
$817.39
|
|
|
HC RELOAD GRIP 45MM BLUE
|
Facility
|
OP
|
$1,037.30
|
|
| Hospital Charge Code |
41607900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$964.69 |
| Rate for Payer: Aetna Commercial |
$875.48
|
| Rate for Payer: Aetna Medicare |
$331.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$321.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$595.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$648.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$381.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$365.13
|
| Rate for Payer: Cash Price |
$622.38
|
| Rate for Payer: Cash Price |
$622.38
|
| Rate for Payer: Centivo All Commercial |
$564.29
|
| Rate for Payer: Cigna All Commercial |
$895.19
|
| Rate for Payer: CORVEL All Commercial |
$964.69
|
| Rate for Payer: Coventry All Commercial |
$912.82
|
| Rate for Payer: Encore All Commercial |
$954.83
|
| Rate for Payer: Frontpath All Commercial |
$954.32
|
| Rate for Payer: Humana ChoiceCare |
$895.92
|
| Rate for Payer: Humana Medicare |
$331.94
|
| Rate for Payer: Lucent All Commercial |
$564.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$933.57
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$777.98
|
| Rate for Payer: PHP All Commercial |
$786.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$404.55
|
| Rate for Payer: Sagamore Health Network All Products |
$800.80
|
| Rate for Payer: Signature Care EPO |
$860.96
|
| Rate for Payer: Signature Care PPO |
$912.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$881.71
|
| Rate for Payer: United Healthcare Commercial |
$817.39
|
| Rate for Payer: United Healthcare Medicare |
$331.94
|
|
|
HC RELOAD GRIP 60MM BLUE
|
Facility
|
IP
|
$801.17
|
|
| Hospital Charge Code |
41607902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.88 |
| Max. Negotiated Rate |
$745.09 |
| Rate for Payer: Aetna Commercial |
$692.21
|
| Rate for Payer: Cash Price |
$480.70
|
| Rate for Payer: Cigna All Commercial |
$691.41
|
| Rate for Payer: CORVEL All Commercial |
$745.09
|
| Rate for Payer: Coventry All Commercial |
$705.03
|
| Rate for Payer: Encore All Commercial |
$737.48
|
| Rate for Payer: Frontpath All Commercial |
$737.08
|
| Rate for Payer: Humana ChoiceCare |
$691.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$721.05
|
| Rate for Payer: PHCS All Commercial |
$600.88
|
| Rate for Payer: PHP All Commercial |
$607.61
|
| Rate for Payer: Sagamore Health Network All Products |
$618.50
|
| Rate for Payer: Signature Care EPO |
$664.97
|
| Rate for Payer: Signature Care PPO |
$705.03
|
| Rate for Payer: United Healthcare Commercial |
$631.32
|
|
|
HC RELOAD GRIP 60MM BLUE
|
Facility
|
OP
|
$801.17
|
|
| Hospital Charge Code |
41607902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$745.09 |
| Rate for Payer: Aetna Commercial |
$676.19
|
| Rate for Payer: Aetna Medicare |
$256.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$248.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$460.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$294.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.01
|
| Rate for Payer: Cash Price |
$480.70
|
| Rate for Payer: Cash Price |
$480.70
|
| Rate for Payer: Centivo All Commercial |
$435.84
|
| Rate for Payer: Cigna All Commercial |
$691.41
|
| Rate for Payer: CORVEL All Commercial |
$745.09
|
| Rate for Payer: Coventry All Commercial |
$705.03
|
| Rate for Payer: Encore All Commercial |
$737.48
|
| Rate for Payer: Frontpath All Commercial |
$737.08
|
| Rate for Payer: Humana ChoiceCare |
$691.97
|
| Rate for Payer: Humana Medicare |
$256.37
|
| Rate for Payer: Lucent All Commercial |
$435.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$721.05
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$600.88
|
| Rate for Payer: PHP All Commercial |
$607.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.46
|
| Rate for Payer: Sagamore Health Network All Products |
$618.50
|
| Rate for Payer: Signature Care EPO |
$664.97
|
| Rate for Payer: Signature Care PPO |
$705.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.99
|
| Rate for Payer: United Healthcare Commercial |
$631.32
|
| Rate for Payer: United Healthcare Medicare |
$256.37
|
|
|
HC RELOAD GRIP VASC 45MM WHITE
|
Facility
|
IP
|
$1,037.30
|
|
| Hospital Charge Code |
41607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.98 |
| Max. Negotiated Rate |
$964.69 |
| Rate for Payer: Aetna Commercial |
$896.23
|
| Rate for Payer: Cash Price |
$622.38
|
| Rate for Payer: Cigna All Commercial |
$895.19
|
| Rate for Payer: CORVEL All Commercial |
$964.69
|
| Rate for Payer: Coventry All Commercial |
$912.82
|
| Rate for Payer: Encore All Commercial |
$954.83
|
| Rate for Payer: Frontpath All Commercial |
$954.32
|
| Rate for Payer: Humana ChoiceCare |
$895.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$933.57
|
| Rate for Payer: PHCS All Commercial |
$777.98
|
| Rate for Payer: PHP All Commercial |
$786.69
|
| Rate for Payer: Sagamore Health Network All Products |
$800.80
|
| Rate for Payer: Signature Care EPO |
$860.96
|
| Rate for Payer: Signature Care PPO |
$912.82
|
| Rate for Payer: United Healthcare Commercial |
$817.39
|
|
|
HC RELOAD GRIP VASC 45MM WHITE
|
Facility
|
OP
|
$1,037.30
|
|
| Hospital Charge Code |
41607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$964.69 |
| Rate for Payer: Aetna Commercial |
$875.48
|
| Rate for Payer: Aetna Medicare |
$331.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$321.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$595.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$648.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$381.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$365.13
|
| Rate for Payer: Cash Price |
$622.38
|
| Rate for Payer: Cash Price |
$622.38
|
| Rate for Payer: Centivo All Commercial |
$564.29
|
| Rate for Payer: Cigna All Commercial |
$895.19
|
| Rate for Payer: CORVEL All Commercial |
$964.69
|
| Rate for Payer: Coventry All Commercial |
$912.82
|
| Rate for Payer: Encore All Commercial |
$954.83
|
| Rate for Payer: Frontpath All Commercial |
$954.32
|
| Rate for Payer: Humana ChoiceCare |
$895.92
|
| Rate for Payer: Humana Medicare |
$331.94
|
| Rate for Payer: Lucent All Commercial |
$564.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$933.57
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$777.98
|
| Rate for Payer: PHP All Commercial |
$786.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$404.55
|
| Rate for Payer: Sagamore Health Network All Products |
$800.80
|
| Rate for Payer: Signature Care EPO |
$860.96
|
| Rate for Payer: Signature Care PPO |
$912.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$881.71
|
| Rate for Payer: United Healthcare Commercial |
$817.39
|
| Rate for Payer: United Healthcare Medicare |
$331.94
|
|
|
HC RELOAD GRIP VASC 60MM WHITE
|
Facility
|
IP
|
$801.17
|
|
| Hospital Charge Code |
41607901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.88 |
| Max. Negotiated Rate |
$745.09 |
| Rate for Payer: Aetna Commercial |
$692.21
|
| Rate for Payer: Cash Price |
$480.70
|
| Rate for Payer: Cigna All Commercial |
$691.41
|
| Rate for Payer: CORVEL All Commercial |
$745.09
|
| Rate for Payer: Coventry All Commercial |
$705.03
|
| Rate for Payer: Encore All Commercial |
$737.48
|
| Rate for Payer: Frontpath All Commercial |
$737.08
|
| Rate for Payer: Humana ChoiceCare |
$691.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$721.05
|
| Rate for Payer: PHCS All Commercial |
$600.88
|
| Rate for Payer: PHP All Commercial |
$607.61
|
| Rate for Payer: Sagamore Health Network All Products |
$618.50
|
| Rate for Payer: Signature Care EPO |
$664.97
|
| Rate for Payer: Signature Care PPO |
$705.03
|
| Rate for Payer: United Healthcare Commercial |
$631.32
|
|
|
HC RELOAD GRIP VASC 60MM WHITE
|
Facility
|
OP
|
$801.17
|
|
| Hospital Charge Code |
41607901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$745.09 |
| Rate for Payer: Aetna Commercial |
$676.19
|
| Rate for Payer: Aetna Medicare |
$256.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$248.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$460.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$294.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.01
|
| Rate for Payer: Cash Price |
$480.70
|
| Rate for Payer: Cash Price |
$480.70
|
| Rate for Payer: Centivo All Commercial |
$435.84
|
| Rate for Payer: Cigna All Commercial |
$691.41
|
| Rate for Payer: CORVEL All Commercial |
$745.09
|
| Rate for Payer: Coventry All Commercial |
$705.03
|
| Rate for Payer: Encore All Commercial |
$737.48
|
| Rate for Payer: Frontpath All Commercial |
$737.08
|
| Rate for Payer: Humana ChoiceCare |
$691.97
|
| Rate for Payer: Humana Medicare |
$256.37
|
| Rate for Payer: Lucent All Commercial |
$435.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$721.05
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$600.88
|
| Rate for Payer: PHP All Commercial |
$607.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.46
|
| Rate for Payer: Sagamore Health Network All Products |
$618.50
|
| Rate for Payer: Signature Care EPO |
$664.97
|
| Rate for Payer: Signature Care PPO |
$705.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.99
|
| Rate for Payer: United Healthcare Commercial |
$631.32
|
| Rate for Payer: United Healthcare Medicare |
$256.37
|
|
|
HC RELOAD PROX 30MM BLUE
|
Facility
|
IP
|
$586.93
|
|
| Hospital Charge Code |
41607894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$545.84 |
| Rate for Payer: Aetna Commercial |
$507.11
|
| Rate for Payer: Cash Price |
$352.16
|
| Rate for Payer: Cigna All Commercial |
$506.52
|
| Rate for Payer: CORVEL All Commercial |
$545.84
|
| Rate for Payer: Coventry All Commercial |
$516.50
|
| Rate for Payer: Encore All Commercial |
$540.27
|
| Rate for Payer: Frontpath All Commercial |
$539.98
|
| Rate for Payer: Humana ChoiceCare |
$506.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$528.24
|
| Rate for Payer: PHCS All Commercial |
$440.20
|
| Rate for Payer: PHP All Commercial |
$445.13
|
| Rate for Payer: Sagamore Health Network All Products |
$453.11
|
| Rate for Payer: Signature Care EPO |
$487.15
|
| Rate for Payer: Signature Care PPO |
$516.50
|
| Rate for Payer: United Healthcare Commercial |
$462.50
|
|
|
HC RELOAD PROX 30MM BLUE
|
Facility
|
OP
|
$586.93
|
|
| Hospital Charge Code |
41607894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$545.84 |
| Rate for Payer: Aetna Commercial |
$495.37
|
| Rate for Payer: Aetna Medicare |
$187.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$181.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$337.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$366.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$206.60
|
| Rate for Payer: Cash Price |
$352.16
|
| Rate for Payer: Cash Price |
$352.16
|
| Rate for Payer: Centivo All Commercial |
$319.29
|
| Rate for Payer: Cigna All Commercial |
$506.52
|
| Rate for Payer: CORVEL All Commercial |
$545.84
|
| Rate for Payer: Coventry All Commercial |
$516.50
|
| Rate for Payer: Encore All Commercial |
$540.27
|
| Rate for Payer: Frontpath All Commercial |
$539.98
|
| Rate for Payer: Humana ChoiceCare |
$506.93
|
| Rate for Payer: Humana Medicare |
$187.82
|
| Rate for Payer: Lucent All Commercial |
$319.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$528.24
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$440.20
|
| Rate for Payer: PHP All Commercial |
$445.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.90
|
| Rate for Payer: Sagamore Health Network All Products |
$453.11
|
| Rate for Payer: Signature Care EPO |
$487.15
|
| Rate for Payer: Signature Care PPO |
$516.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$498.89
|
| Rate for Payer: United Healthcare Commercial |
$462.50
|
| Rate for Payer: United Healthcare Medicare |
$187.82
|
|
|
HC RELOAD PROX 60MM BLUE
|
Facility
|
OP
|
$297.69
|
|
| Hospital Charge Code |
41607893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$276.85 |
| Rate for Payer: Aetna Commercial |
$251.25
|
| Rate for Payer: Aetna Medicare |
$95.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$170.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$186.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$109.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$104.79
|
| Rate for Payer: Cash Price |
$178.61
|
| Rate for Payer: Cash Price |
$178.61
|
| Rate for Payer: Centivo All Commercial |
$161.94
|
| Rate for Payer: Cigna All Commercial |
$256.91
|
| Rate for Payer: CORVEL All Commercial |
$276.85
|
| Rate for Payer: Coventry All Commercial |
$261.97
|
| Rate for Payer: Encore All Commercial |
$274.02
|
| Rate for Payer: Frontpath All Commercial |
$273.87
|
| Rate for Payer: Humana ChoiceCare |
$257.11
|
| Rate for Payer: Humana Medicare |
$95.26
|
| Rate for Payer: Lucent All Commercial |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.92
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$223.27
|
| Rate for Payer: PHP All Commercial |
$225.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.10
|
| Rate for Payer: Sagamore Health Network All Products |
$229.82
|
| Rate for Payer: Signature Care EPO |
$247.08
|
| Rate for Payer: Signature Care PPO |
$261.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$253.04
|
| Rate for Payer: United Healthcare Commercial |
$234.58
|
| Rate for Payer: United Healthcare Medicare |
$95.26
|
|
|
HC RELOAD PROX 60MM BLUE
|
Facility
|
IP
|
$297.69
|
|
| Hospital Charge Code |
41607893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.27 |
| Max. Negotiated Rate |
$276.85 |
| Rate for Payer: Aetna Commercial |
$257.20
|
| Rate for Payer: Cash Price |
$178.61
|
| Rate for Payer: Cigna All Commercial |
$256.91
|
| Rate for Payer: CORVEL All Commercial |
$276.85
|
| Rate for Payer: Coventry All Commercial |
$261.97
|
| Rate for Payer: Encore All Commercial |
$274.02
|
| Rate for Payer: Frontpath All Commercial |
$273.87
|
| Rate for Payer: Humana ChoiceCare |
$257.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.92
|
| Rate for Payer: PHCS All Commercial |
$223.27
|
| Rate for Payer: PHP All Commercial |
$225.77
|
| Rate for Payer: Sagamore Health Network All Products |
$229.82
|
| Rate for Payer: Signature Care EPO |
$247.08
|
| Rate for Payer: Signature Care PPO |
$261.97
|
| Rate for Payer: United Healthcare Commercial |
$234.58
|
|
|
HC RELOAD PROX 60MM BLUE
|
Facility
|
IP
|
$496.72
|
|
| Hospital Charge Code |
41607892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$461.95 |
| Rate for Payer: Aetna Commercial |
$429.17
|
| Rate for Payer: Cash Price |
$298.03
|
| Rate for Payer: Cigna All Commercial |
$428.67
|
| Rate for Payer: CORVEL All Commercial |
$461.95
|
| Rate for Payer: Coventry All Commercial |
$437.11
|
| Rate for Payer: Encore All Commercial |
$457.23
|
| Rate for Payer: Frontpath All Commercial |
$456.98
|
| Rate for Payer: Humana ChoiceCare |
$429.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.05
|
| Rate for Payer: PHCS All Commercial |
$372.54
|
| Rate for Payer: PHP All Commercial |
$376.71
|
| Rate for Payer: Sagamore Health Network All Products |
$383.47
|
| Rate for Payer: Signature Care EPO |
$412.28
|
| Rate for Payer: Signature Care PPO |
$437.11
|
| Rate for Payer: United Healthcare Commercial |
$391.42
|
|
|
HC RELOAD PROX 60MM BLUE
|
Facility
|
OP
|
$496.72
|
|
| Hospital Charge Code |
41607892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$461.95 |
| Rate for Payer: Aetna Commercial |
$419.23
|
| Rate for Payer: Aetna Medicare |
$158.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$153.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$285.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$310.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.85
|
| Rate for Payer: Cash Price |
$298.03
|
| Rate for Payer: Cash Price |
$298.03
|
| Rate for Payer: Centivo All Commercial |
$270.22
|
| Rate for Payer: Cigna All Commercial |
$428.67
|
| Rate for Payer: CORVEL All Commercial |
$461.95
|
| Rate for Payer: Coventry All Commercial |
$437.11
|
| Rate for Payer: Encore All Commercial |
$457.23
|
| Rate for Payer: Frontpath All Commercial |
$456.98
|
| Rate for Payer: Humana ChoiceCare |
$429.02
|
| Rate for Payer: Humana Medicare |
$158.95
|
| Rate for Payer: Lucent All Commercial |
$270.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.05
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$372.54
|
| Rate for Payer: PHP All Commercial |
$376.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$193.72
|
| Rate for Payer: Sagamore Health Network All Products |
$383.47
|
| Rate for Payer: Signature Care EPO |
$412.28
|
| Rate for Payer: Signature Care PPO |
$437.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$422.21
|
| Rate for Payer: United Healthcare Commercial |
$391.42
|
| Rate for Payer: United Healthcare Medicare |
$158.95
|
|
