|
HC S TRI POLY 0 DEG 36 E
|
Facility
|
OP
|
$2,880.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna Commercial |
$2,430.72
|
| Rate for Payer: Aetna Medicare |
$921.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$892.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,653.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,800.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,059.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,013.76
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Centivo All Commercial |
$1,566.72
|
| Rate for Payer: Cigna All Commercial |
$2,485.44
|
| Rate for Payer: CORVEL All Commercial |
$2,678.40
|
| Rate for Payer: Coventry All Commercial |
$2,534.40
|
| Rate for Payer: Encore All Commercial |
$2,651.04
|
| Rate for Payer: Frontpath All Commercial |
$2,649.60
|
| Rate for Payer: Humana ChoiceCare |
$2,487.46
|
| Rate for Payer: Humana Medicare |
$921.60
|
| Rate for Payer: Lucent All Commercial |
$1,566.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,592.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,160.00
|
| Rate for Payer: PHP All Commercial |
$2,184.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,123.20
|
| Rate for Payer: Sagamore Health Network All Products |
$2,223.36
|
| Rate for Payer: Signature Care EPO |
$2,390.40
|
| Rate for Payer: Signature Care PPO |
$2,534.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare Commercial |
$2,269.44
|
| Rate for Payer: United Healthcare Medicare |
$921.60
|
|
|
HC S TRI POLY 0 DEG 36 E
|
Facility
|
IP
|
$2,880.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.00 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna Commercial |
$2,488.32
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cigna All Commercial |
$2,485.44
|
| Rate for Payer: CORVEL All Commercial |
$2,678.40
|
| Rate for Payer: Coventry All Commercial |
$2,534.40
|
| Rate for Payer: Encore All Commercial |
$2,651.04
|
| Rate for Payer: Frontpath All Commercial |
$2,649.60
|
| Rate for Payer: Humana ChoiceCare |
$2,487.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,592.00
|
| Rate for Payer: PHCS All Commercial |
$2,160.00
|
| Rate for Payer: PHP All Commercial |
$2,184.19
|
| Rate for Payer: Sagamore Health Network All Products |
$2,223.36
|
| Rate for Payer: Signature Care EPO |
$2,390.40
|
| Rate for Payer: Signature Care PPO |
$2,534.40
|
| Rate for Payer: United Healthcare Commercial |
$2,269.44
|
|
|
HC S TUBING INFLOW/OUTFLOW
|
Facility
|
OP
|
$755.09
|
|
| Hospital Charge Code |
41607425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$702.23 |
| Rate for Payer: Aetna Commercial |
$637.30
|
| Rate for Payer: Aetna Medicare |
$241.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$234.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$433.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$472.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$277.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$265.79
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Centivo All Commercial |
$410.77
|
| Rate for Payer: Cigna All Commercial |
$651.64
|
| Rate for Payer: CORVEL All Commercial |
$702.23
|
| Rate for Payer: Coventry All Commercial |
$664.48
|
| Rate for Payer: Encore All Commercial |
$695.06
|
| Rate for Payer: Frontpath All Commercial |
$694.68
|
| Rate for Payer: Humana ChoiceCare |
$652.17
|
| Rate for Payer: Humana Medicare |
$241.63
|
| Rate for Payer: Lucent All Commercial |
$410.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.58
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$566.32
|
| Rate for Payer: PHP All Commercial |
$572.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$294.49
|
| Rate for Payer: Sagamore Health Network All Products |
$582.93
|
| Rate for Payer: Signature Care EPO |
$626.72
|
| Rate for Payer: Signature Care PPO |
$664.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$641.83
|
| Rate for Payer: United Healthcare Commercial |
$595.01
|
| Rate for Payer: United Healthcare Medicare |
$241.63
|
|
|
HC S TUBING INFLOW/OUTFLOW
|
Facility
|
IP
|
$755.09
|
|
| Hospital Charge Code |
41607425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$566.32 |
| Max. Negotiated Rate |
$702.23 |
| Rate for Payer: Aetna Commercial |
$652.40
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cigna All Commercial |
$651.64
|
| Rate for Payer: CORVEL All Commercial |
$702.23
|
| Rate for Payer: Coventry All Commercial |
$664.48
|
| Rate for Payer: Encore All Commercial |
$695.06
|
| Rate for Payer: Frontpath All Commercial |
$694.68
|
| Rate for Payer: Humana ChoiceCare |
$652.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.58
|
| Rate for Payer: PHCS All Commercial |
$566.32
|
| Rate for Payer: PHP All Commercial |
$572.66
|
| Rate for Payer: Sagamore Health Network All Products |
$582.93
|
| Rate for Payer: Signature Care EPO |
$626.72
|
| Rate for Payer: Signature Care PPO |
$664.48
|
| Rate for Payer: United Healthcare Commercial |
$595.01
|
|
|
HC STYLETTE 12FR
|
Facility
|
OP
|
$10.79
|
|
| Hospital Charge Code |
41601127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Medicare |
$3.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Centivo All Commercial |
$5.87
|
| Rate for Payer: Cigna All Commercial |
$9.31
|
| Rate for Payer: CORVEL All Commercial |
$10.03
|
| Rate for Payer: Coventry All Commercial |
$9.50
|
| Rate for Payer: Encore All Commercial |
$9.93
|
| Rate for Payer: Frontpath All Commercial |
$9.93
|
| Rate for Payer: Humana ChoiceCare |
$9.32
|
| Rate for Payer: Humana Medicare |
$3.45
|
| Rate for Payer: Lucent All Commercial |
$5.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.71
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$8.09
|
| Rate for Payer: PHP All Commercial |
$8.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.21
|
| Rate for Payer: Sagamore Health Network All Products |
$8.33
|
| Rate for Payer: Signature Care EPO |
$8.96
|
| Rate for Payer: Signature Care PPO |
$9.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.17
|
| Rate for Payer: United Healthcare Commercial |
$8.50
|
| Rate for Payer: United Healthcare Medicare |
$3.45
|
|
|
HC STYLETTE 12FR
|
Facility
|
IP
|
$10.79
|
|
| Hospital Charge Code |
41601127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$10.03 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cigna All Commercial |
$9.31
|
| Rate for Payer: CORVEL All Commercial |
$10.03
|
| Rate for Payer: Coventry All Commercial |
$9.50
|
| Rate for Payer: Encore All Commercial |
$9.93
|
| Rate for Payer: Frontpath All Commercial |
$9.93
|
| Rate for Payer: Humana ChoiceCare |
$9.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.71
|
| Rate for Payer: PHCS All Commercial |
$8.09
|
| Rate for Payer: PHP All Commercial |
$8.18
|
| Rate for Payer: Sagamore Health Network All Products |
$8.33
|
| Rate for Payer: Signature Care EPO |
$8.96
|
| Rate for Payer: Signature Care PPO |
$9.50
|
| Rate for Payer: United Healthcare Commercial |
$8.50
|
|
|
HC STYLETTE LARGE GREEN
|
Facility
|
IP
|
$15.68
|
|
| Hospital Charge Code |
41601128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cigna All Commercial |
$13.53
|
| Rate for Payer: CORVEL All Commercial |
$14.58
|
| Rate for Payer: Coventry All Commercial |
$13.80
|
| Rate for Payer: Encore All Commercial |
$14.43
|
| Rate for Payer: Frontpath All Commercial |
$14.43
|
| Rate for Payer: Humana ChoiceCare |
$13.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.11
|
| Rate for Payer: PHCS All Commercial |
$11.76
|
| Rate for Payer: PHP All Commercial |
$11.89
|
| Rate for Payer: Sagamore Health Network All Products |
$12.10
|
| Rate for Payer: Signature Care EPO |
$13.01
|
| Rate for Payer: Signature Care PPO |
$13.80
|
| Rate for Payer: United Healthcare Commercial |
$12.36
|
|
|
HC STYLETTE LARGE GREEN
|
Facility
|
OP
|
$15.68
|
|
| Hospital Charge Code |
41601128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$13.23
|
| Rate for Payer: Aetna Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.52
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Centivo All Commercial |
$8.53
|
| Rate for Payer: Cigna All Commercial |
$13.53
|
| Rate for Payer: CORVEL All Commercial |
$14.58
|
| Rate for Payer: Coventry All Commercial |
$13.80
|
| Rate for Payer: Encore All Commercial |
$14.43
|
| Rate for Payer: Frontpath All Commercial |
$14.43
|
| Rate for Payer: Humana ChoiceCare |
$13.54
|
| Rate for Payer: Humana Medicare |
$5.02
|
| Rate for Payer: Lucent All Commercial |
$8.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.11
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$11.76
|
| Rate for Payer: PHP All Commercial |
$11.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.12
|
| Rate for Payer: Sagamore Health Network All Products |
$12.10
|
| Rate for Payer: Signature Care EPO |
$13.01
|
| Rate for Payer: Signature Care PPO |
$13.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.33
|
| Rate for Payer: United Healthcare Commercial |
$12.36
|
| Rate for Payer: United Healthcare Medicare |
$5.02
|
|
|
HC STYLETTE MEDIUM GRAY
|
Facility
|
OP
|
$15.68
|
|
| Hospital Charge Code |
41601129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$13.23
|
| Rate for Payer: Aetna Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.52
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Centivo All Commercial |
$8.53
|
| Rate for Payer: Cigna All Commercial |
$13.53
|
| Rate for Payer: CORVEL All Commercial |
$14.58
|
| Rate for Payer: Coventry All Commercial |
$13.80
|
| Rate for Payer: Encore All Commercial |
$14.43
|
| Rate for Payer: Frontpath All Commercial |
$14.43
|
| Rate for Payer: Humana ChoiceCare |
$13.54
|
| Rate for Payer: Humana Medicare |
$5.02
|
| Rate for Payer: Lucent All Commercial |
$8.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.11
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$11.76
|
| Rate for Payer: PHP All Commercial |
$11.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.12
|
| Rate for Payer: Sagamore Health Network All Products |
$12.10
|
| Rate for Payer: Signature Care EPO |
$13.01
|
| Rate for Payer: Signature Care PPO |
$13.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.33
|
| Rate for Payer: United Healthcare Commercial |
$12.36
|
| Rate for Payer: United Healthcare Medicare |
$5.02
|
|
|
HC STYLETTE MEDIUM GRAY
|
Facility
|
IP
|
$15.68
|
|
| Hospital Charge Code |
41601129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cigna All Commercial |
$13.53
|
| Rate for Payer: CORVEL All Commercial |
$14.58
|
| Rate for Payer: Coventry All Commercial |
$13.80
|
| Rate for Payer: Encore All Commercial |
$14.43
|
| Rate for Payer: Frontpath All Commercial |
$14.43
|
| Rate for Payer: Humana ChoiceCare |
$13.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.11
|
| Rate for Payer: PHCS All Commercial |
$11.76
|
| Rate for Payer: PHP All Commercial |
$11.89
|
| Rate for Payer: Sagamore Health Network All Products |
$12.10
|
| Rate for Payer: Signature Care EPO |
$13.01
|
| Rate for Payer: Signature Care PPO |
$13.80
|
| Rate for Payer: United Healthcare Commercial |
$12.36
|
|
|
HC STYLETTE SMALL BLUE
|
Facility
|
OP
|
$15.68
|
|
| Hospital Charge Code |
41601449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$13.23
|
| Rate for Payer: Aetna Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.52
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Centivo All Commercial |
$8.53
|
| Rate for Payer: Cigna All Commercial |
$13.53
|
| Rate for Payer: CORVEL All Commercial |
$14.58
|
| Rate for Payer: Coventry All Commercial |
$13.80
|
| Rate for Payer: Encore All Commercial |
$14.43
|
| Rate for Payer: Frontpath All Commercial |
$14.43
|
| Rate for Payer: Humana ChoiceCare |
$13.54
|
| Rate for Payer: Humana Medicare |
$5.02
|
| Rate for Payer: Lucent All Commercial |
$8.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.11
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$11.76
|
| Rate for Payer: PHP All Commercial |
$11.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.12
|
| Rate for Payer: Sagamore Health Network All Products |
$12.10
|
| Rate for Payer: Signature Care EPO |
$13.01
|
| Rate for Payer: Signature Care PPO |
$13.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.33
|
| Rate for Payer: United Healthcare Commercial |
$12.36
|
| Rate for Payer: United Healthcare Medicare |
$5.02
|
|
|
HC STYLETTE SMALL BLUE
|
Facility
|
IP
|
$15.68
|
|
| Hospital Charge Code |
41601449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cigna All Commercial |
$13.53
|
| Rate for Payer: CORVEL All Commercial |
$14.58
|
| Rate for Payer: Coventry All Commercial |
$13.80
|
| Rate for Payer: Encore All Commercial |
$14.43
|
| Rate for Payer: Frontpath All Commercial |
$14.43
|
| Rate for Payer: Humana ChoiceCare |
$13.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.11
|
| Rate for Payer: PHCS All Commercial |
$11.76
|
| Rate for Payer: PHP All Commercial |
$11.89
|
| Rate for Payer: Sagamore Health Network All Products |
$12.10
|
| Rate for Payer: Signature Care EPO |
$13.01
|
| Rate for Payer: Signature Care PPO |
$13.80
|
| Rate for Payer: United Healthcare Commercial |
$12.36
|
|
|
HC SUCTION IRRIGATOR
|
Facility
|
OP
|
$404.64
|
|
| Hospital Charge Code |
41601130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$376.32 |
| Rate for Payer: Aetna Commercial |
$341.52
|
| Rate for Payer: Aetna Medicare |
$129.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$232.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.43
|
| Rate for Payer: Cash Price |
$242.78
|
| Rate for Payer: Cash Price |
$242.78
|
| Rate for Payer: Centivo All Commercial |
$220.12
|
| Rate for Payer: Cigna All Commercial |
$349.20
|
| Rate for Payer: CORVEL All Commercial |
$376.32
|
| Rate for Payer: Coventry All Commercial |
$356.08
|
| Rate for Payer: Encore All Commercial |
$372.47
|
| Rate for Payer: Frontpath All Commercial |
$372.27
|
| Rate for Payer: Humana ChoiceCare |
$349.49
|
| Rate for Payer: Humana Medicare |
$129.48
|
| Rate for Payer: Lucent All Commercial |
$220.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$364.18
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$303.48
|
| Rate for Payer: PHP All Commercial |
$306.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$157.81
|
| Rate for Payer: Sagamore Health Network All Products |
$312.38
|
| Rate for Payer: Signature Care EPO |
$335.85
|
| Rate for Payer: Signature Care PPO |
$356.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$343.94
|
| Rate for Payer: United Healthcare Commercial |
$318.86
|
| Rate for Payer: United Healthcare Medicare |
$129.48
|
|
|
HC SUCTION IRRIGATOR
|
Facility
|
IP
|
$404.64
|
|
| Hospital Charge Code |
41601130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.48 |
| Max. Negotiated Rate |
$376.32 |
| Rate for Payer: Aetna Commercial |
$349.61
|
| Rate for Payer: Cash Price |
$242.78
|
| Rate for Payer: Cigna All Commercial |
$349.20
|
| Rate for Payer: CORVEL All Commercial |
$376.32
|
| Rate for Payer: Coventry All Commercial |
$356.08
|
| Rate for Payer: Encore All Commercial |
$372.47
|
| Rate for Payer: Frontpath All Commercial |
$372.27
|
| Rate for Payer: Humana ChoiceCare |
$349.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$364.18
|
| Rate for Payer: PHCS All Commercial |
$303.48
|
| Rate for Payer: PHP All Commercial |
$306.88
|
| Rate for Payer: Sagamore Health Network All Products |
$312.38
|
| Rate for Payer: Signature Care EPO |
$335.85
|
| Rate for Payer: Signature Care PPO |
$356.08
|
| Rate for Payer: United Healthcare Commercial |
$318.86
|
|
|
HC SUPER SHEATH CBDE
|
Facility
|
IP
|
$28.12
|
|
| Hospital Charge Code |
41608365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$26.15 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cigna All Commercial |
$24.27
|
| Rate for Payer: CORVEL All Commercial |
$26.15
|
| Rate for Payer: Coventry All Commercial |
$24.75
|
| Rate for Payer: Encore All Commercial |
$25.88
|
| Rate for Payer: Frontpath All Commercial |
$25.87
|
| Rate for Payer: Humana ChoiceCare |
$24.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.31
|
| Rate for Payer: PHCS All Commercial |
$21.09
|
| Rate for Payer: PHP All Commercial |
$21.33
|
| Rate for Payer: Sagamore Health Network All Products |
$21.71
|
| Rate for Payer: Signature Care EPO |
$23.34
|
| Rate for Payer: Signature Care PPO |
$24.75
|
| Rate for Payer: United Healthcare Commercial |
$22.16
|
|
|
HC SUPER SHEATH CBDE
|
Facility
|
OP
|
$28.12
|
|
| Hospital Charge Code |
41608365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.90
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Centivo All Commercial |
$15.30
|
| Rate for Payer: Cigna All Commercial |
$24.27
|
| Rate for Payer: CORVEL All Commercial |
$26.15
|
| Rate for Payer: Coventry All Commercial |
$24.75
|
| Rate for Payer: Encore All Commercial |
$25.88
|
| Rate for Payer: Frontpath All Commercial |
$25.87
|
| Rate for Payer: Humana ChoiceCare |
$24.29
|
| Rate for Payer: Humana Medicare |
$9.00
|
| Rate for Payer: Lucent All Commercial |
$15.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.31
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$21.09
|
| Rate for Payer: PHP All Commercial |
$21.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.97
|
| Rate for Payer: Sagamore Health Network All Products |
$21.71
|
| Rate for Payer: Signature Care EPO |
$23.34
|
| Rate for Payer: Signature Care PPO |
$24.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.90
|
| Rate for Payer: United Healthcare Commercial |
$22.16
|
| Rate for Payer: United Healthcare Medicare |
$9.00
|
|
|
HC SUPPORT ABD 30-45
|
Facility
|
OP
|
$41.51
|
|
|
Service Code
|
CPT A4461
|
| Hospital Charge Code |
41601233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$38.60 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare |
$13.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.61
|
| Rate for Payer: Cash Price |
$24.91
|
| Rate for Payer: Cash Price |
$24.91
|
| Rate for Payer: Centivo All Commercial |
$22.58
|
| Rate for Payer: Cigna All Commercial |
$35.82
|
| Rate for Payer: CORVEL All Commercial |
$38.60
|
| Rate for Payer: Coventry All Commercial |
$36.53
|
| Rate for Payer: Encore All Commercial |
$38.21
|
| Rate for Payer: Frontpath All Commercial |
$38.19
|
| Rate for Payer: Humana ChoiceCare |
$35.85
|
| Rate for Payer: Humana Medicare |
$13.28
|
| Rate for Payer: Lucent All Commercial |
$22.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.36
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$31.13
|
| Rate for Payer: PHP All Commercial |
$31.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.19
|
| Rate for Payer: Sagamore Health Network All Products |
$32.05
|
| Rate for Payer: Signature Care EPO |
$34.45
|
| Rate for Payer: Signature Care PPO |
$36.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.28
|
| Rate for Payer: United Healthcare Commercial |
$32.71
|
| Rate for Payer: United Healthcare Medicare |
$13.28
|
|
|
HC SUPPORT ABD 30-45
|
Facility
|
IP
|
$41.51
|
|
|
Service Code
|
CPT A4461
|
| Hospital Charge Code |
41601233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$38.60 |
| Rate for Payer: Aetna Commercial |
$35.86
|
| Rate for Payer: Cash Price |
$24.91
|
| Rate for Payer: Cigna All Commercial |
$35.82
|
| Rate for Payer: CORVEL All Commercial |
$38.60
|
| Rate for Payer: Coventry All Commercial |
$36.53
|
| Rate for Payer: Encore All Commercial |
$38.21
|
| Rate for Payer: Frontpath All Commercial |
$38.19
|
| Rate for Payer: Humana ChoiceCare |
$35.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.36
|
| Rate for Payer: PHCS All Commercial |
$31.13
|
| Rate for Payer: PHP All Commercial |
$31.48
|
| Rate for Payer: Sagamore Health Network All Products |
$32.05
|
| Rate for Payer: Signature Care EPO |
$34.45
|
| Rate for Payer: Signature Care PPO |
$36.53
|
| Rate for Payer: United Healthcare Commercial |
$32.71
|
|
|
HC SUPPORT ABD 46-62
|
Facility
|
IP
|
$39.69
|
|
|
Service Code
|
CPT A4461
|
| Hospital Charge Code |
41601234
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$36.91 |
| Rate for Payer: Aetna Commercial |
$34.29
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cigna All Commercial |
$34.25
|
| Rate for Payer: CORVEL All Commercial |
$36.91
|
| Rate for Payer: Coventry All Commercial |
$34.93
|
| Rate for Payer: Encore All Commercial |
$36.53
|
| Rate for Payer: Frontpath All Commercial |
$36.51
|
| Rate for Payer: Humana ChoiceCare |
$34.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.72
|
| Rate for Payer: PHCS All Commercial |
$29.77
|
| Rate for Payer: PHP All Commercial |
$30.10
|
| Rate for Payer: Sagamore Health Network All Products |
$30.64
|
| Rate for Payer: Signature Care EPO |
$32.94
|
| Rate for Payer: Signature Care PPO |
$34.93
|
| Rate for Payer: United Healthcare Commercial |
$31.28
|
|
|
HC SUPPORT ABD 46-62
|
Facility
|
OP
|
$39.69
|
|
|
Service Code
|
CPT A4461
|
| Hospital Charge Code |
41601234
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$36.91 |
| Rate for Payer: Aetna Commercial |
$33.50
|
| Rate for Payer: Aetna Medicare |
$12.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.97
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Centivo All Commercial |
$21.59
|
| Rate for Payer: Cigna All Commercial |
$34.25
|
| Rate for Payer: CORVEL All Commercial |
$36.91
|
| Rate for Payer: Coventry All Commercial |
$34.93
|
| Rate for Payer: Encore All Commercial |
$36.53
|
| Rate for Payer: Frontpath All Commercial |
$36.51
|
| Rate for Payer: Humana ChoiceCare |
$34.28
|
| Rate for Payer: Humana Medicare |
$12.70
|
| Rate for Payer: Lucent All Commercial |
$21.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.72
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$29.77
|
| Rate for Payer: PHP All Commercial |
$30.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.48
|
| Rate for Payer: Sagamore Health Network All Products |
$30.64
|
| Rate for Payer: Signature Care EPO |
$32.94
|
| Rate for Payer: Signature Care PPO |
$34.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.74
|
| Rate for Payer: United Healthcare Commercial |
$31.28
|
| Rate for Payer: United Healthcare Medicare |
$12.70
|
|
|
HC SURGICAL CULTURE
|
Facility
|
IP
|
$372.29
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
63001999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$279.22 |
| Max. Negotiated Rate |
$346.23 |
| Rate for Payer: Aetna Commercial |
$321.66
|
| Rate for Payer: Cash Price |
$223.37
|
| Rate for Payer: Cigna All Commercial |
$321.29
|
| Rate for Payer: CORVEL All Commercial |
$346.23
|
| Rate for Payer: Coventry All Commercial |
$327.62
|
| Rate for Payer: Encore All Commercial |
$342.69
|
| Rate for Payer: Frontpath All Commercial |
$342.51
|
| Rate for Payer: Humana ChoiceCare |
$321.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$335.06
|
| Rate for Payer: PHCS All Commercial |
$279.22
|
| Rate for Payer: PHP All Commercial |
$282.34
|
| Rate for Payer: Sagamore Health Network All Products |
$287.41
|
| Rate for Payer: Signature Care EPO |
$309.00
|
| Rate for Payer: Signature Care PPO |
$327.62
|
| Rate for Payer: United Healthcare Commercial |
$293.36
|
|
|
HC SURGICAL CULTURE
|
Facility
|
OP
|
$372.29
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
63001999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$346.23 |
| Rate for Payer: Aetna Commercial |
$314.21
|
| Rate for Payer: Aetna Medicare |
$119.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$171.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.05
|
| Rate for Payer: Cash Price |
$223.37
|
| Rate for Payer: Cash Price |
$223.37
|
| Rate for Payer: Centivo All Commercial |
$202.53
|
| Rate for Payer: Cigna All Commercial |
$321.29
|
| Rate for Payer: CORVEL All Commercial |
$346.23
|
| Rate for Payer: Coventry All Commercial |
$327.62
|
| Rate for Payer: Encore All Commercial |
$342.69
|
| Rate for Payer: Frontpath All Commercial |
$342.51
|
| Rate for Payer: Humana ChoiceCare |
$321.55
|
| Rate for Payer: Humana Medicare |
$119.13
|
| Rate for Payer: Lucent All Commercial |
$202.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$335.06
|
| Rate for Payer: Managed Health Services Medicaid |
$9.89
|
| Rate for Payer: MDWise Medicaid |
$9.89
|
| Rate for Payer: PHCS All Commercial |
$279.22
|
| Rate for Payer: PHP All Commercial |
$282.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$145.19
|
| Rate for Payer: Sagamore Health Network All Products |
$287.41
|
| Rate for Payer: Signature Care EPO |
$309.00
|
| Rate for Payer: Signature Care PPO |
$327.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$316.45
|
| Rate for Payer: United Healthcare Commercial |
$293.36
|
| Rate for Payer: United Healthcare Medicare |
$119.13
|
|
|
HC SURGICEL 2X14
|
Facility
|
IP
|
$912.10
|
|
| Hospital Charge Code |
41602085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$684.08 |
| Max. Negotiated Rate |
$848.25 |
| Rate for Payer: Aetna Commercial |
$788.05
|
| Rate for Payer: Cash Price |
$547.26
|
| Rate for Payer: Cigna All Commercial |
$787.14
|
| Rate for Payer: CORVEL All Commercial |
$848.25
|
| Rate for Payer: Coventry All Commercial |
$802.65
|
| Rate for Payer: Encore All Commercial |
$839.59
|
| Rate for Payer: Frontpath All Commercial |
$839.13
|
| Rate for Payer: Humana ChoiceCare |
$787.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$820.89
|
| Rate for Payer: PHCS All Commercial |
$684.08
|
| Rate for Payer: PHP All Commercial |
$691.74
|
| Rate for Payer: Sagamore Health Network All Products |
$704.14
|
| Rate for Payer: Signature Care EPO |
$757.04
|
| Rate for Payer: Signature Care PPO |
$802.65
|
| Rate for Payer: United Healthcare Commercial |
$718.73
|
|
|
HC SURGICEL 2X14
|
Facility
|
OP
|
$912.10
|
|
| Hospital Charge Code |
41602085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$848.25 |
| Rate for Payer: Aetna Commercial |
$769.81
|
| Rate for Payer: Aetna Medicare |
$291.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$282.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$523.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$570.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$335.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.06
|
| Rate for Payer: Cash Price |
$547.26
|
| Rate for Payer: Cash Price |
$547.26
|
| Rate for Payer: Centivo All Commercial |
$496.18
|
| Rate for Payer: Cigna All Commercial |
$787.14
|
| Rate for Payer: CORVEL All Commercial |
$848.25
|
| Rate for Payer: Coventry All Commercial |
$802.65
|
| Rate for Payer: Encore All Commercial |
$839.59
|
| Rate for Payer: Frontpath All Commercial |
$839.13
|
| Rate for Payer: Humana ChoiceCare |
$787.78
|
| Rate for Payer: Humana Medicare |
$291.87
|
| Rate for Payer: Lucent All Commercial |
$496.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$820.89
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$684.08
|
| Rate for Payer: PHP All Commercial |
$691.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$355.72
|
| Rate for Payer: Sagamore Health Network All Products |
$704.14
|
| Rate for Payer: Signature Care EPO |
$757.04
|
| Rate for Payer: Signature Care PPO |
$802.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$775.28
|
| Rate for Payer: United Healthcare Commercial |
$718.73
|
| Rate for Payer: United Healthcare Medicare |
$291.87
|
|
|
HC SUT MCRYL+ 2-0 SH 27" MCP417H
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
41607965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.58
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Centivo All Commercial |
$7.07
|
| Rate for Payer: Cigna All Commercial |
$11.22
|
| Rate for Payer: CORVEL All Commercial |
$12.09
|
| Rate for Payer: Coventry All Commercial |
$11.44
|
| Rate for Payer: Encore All Commercial |
$11.97
|
| Rate for Payer: Frontpath All Commercial |
$11.96
|
| Rate for Payer: Humana ChoiceCare |
$11.23
|
| Rate for Payer: Humana Medicare |
$4.16
|
| Rate for Payer: Lucent All Commercial |
$7.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.70
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$9.75
|
| Rate for Payer: PHP All Commercial |
$9.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.07
|
| Rate for Payer: Sagamore Health Network All Products |
$10.04
|
| Rate for Payer: Signature Care EPO |
$10.79
|
| Rate for Payer: Signature Care PPO |
$11.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.05
|
| Rate for Payer: United Healthcare Commercial |
$10.24
|
| Rate for Payer: United Healthcare Medicare |
$4.16
|
|
