|
HC POTASSIUM URINE
|
Facility
IP
|
$100.42
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
63001152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.31 |
| Max. Negotiated Rate |
$93.39 |
| Rate for Payer: Aetna Commercial |
$86.76
|
| Rate for Payer: Cash Price |
$62.26
|
| Rate for Payer: Cigna All Commercial |
$86.66
|
| Rate for Payer: CORVEL All Commercial |
$93.39
|
| Rate for Payer: Coventry All Commercial |
$88.37
|
| Rate for Payer: Encore All Commercial |
$92.44
|
| Rate for Payer: Frontpath All Commercial |
$92.39
|
| Rate for Payer: Humana ChoiceCare |
$86.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.38
|
| Rate for Payer: PHCS All Commercial |
$75.31
|
| Rate for Payer: PHP All Commercial |
$76.16
|
| Rate for Payer: Sagamore Health Network All Products |
$77.52
|
| Rate for Payer: Signature Care EPO |
$83.35
|
| Rate for Payer: Signature Care PPO |
$88.37
|
| Rate for Payer: United Healthcare Commercial |
$79.13
|
|
|
HC POUCH AND CONVES WAFER 1 1/4 I
|
Facility
IP
|
$19.84
|
|
| Hospital Charge Code |
41602244
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cigna All Commercial |
$17.12
|
| Rate for Payer: CORVEL All Commercial |
$18.45
|
| Rate for Payer: Coventry All Commercial |
$17.46
|
| Rate for Payer: Encore All Commercial |
$18.26
|
| Rate for Payer: Frontpath All Commercial |
$18.25
|
| Rate for Payer: Humana ChoiceCare |
$17.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.86
|
| Rate for Payer: PHCS All Commercial |
$14.88
|
| Rate for Payer: PHP All Commercial |
$15.05
|
| Rate for Payer: Sagamore Health Network All Products |
$15.32
|
| Rate for Payer: Signature Care EPO |
$16.47
|
| Rate for Payer: Signature Care PPO |
$17.46
|
| Rate for Payer: United Healthcare Commercial |
$15.63
|
|
|
HC POUCH AND CONVES WAFER 1 1/4 I
|
Facility
OP
|
$19.84
|
|
| Hospital Charge Code |
41602244
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna Medicare |
$6.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.20
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Centivo All Commercial |
$10.12
|
| Rate for Payer: Cigna All Commercial |
$17.12
|
| Rate for Payer: CORVEL All Commercial |
$18.45
|
| Rate for Payer: Coventry All Commercial |
$17.46
|
| Rate for Payer: Encore All Commercial |
$18.26
|
| Rate for Payer: Frontpath All Commercial |
$18.25
|
| Rate for Payer: Humana ChoiceCare |
$17.14
|
| Rate for Payer: Humana Medicare |
$10.12
|
| Rate for Payer: Lucent All Commercial |
$10.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.86
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$14.88
|
| Rate for Payer: PHP All Commercial |
$15.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.74
|
| Rate for Payer: Sagamore Health Network All Products |
$15.32
|
| Rate for Payer: Signature Care EPO |
$16.47
|
| Rate for Payer: Signature Care PPO |
$17.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.86
|
| Rate for Payer: United Healthcare Commercial |
$15.63
|
| Rate for Payer: United Healthcare Medicare |
$6.55
|
|
|
HC POUCH CLAMP OSTOMY
|
Facility
IP
|
$2.32
|
|
| Hospital Charge Code |
41601034
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna All Commercial |
$2.00
|
| Rate for Payer: CORVEL All Commercial |
$2.16
|
| Rate for Payer: Coventry All Commercial |
$2.04
|
| Rate for Payer: Encore All Commercial |
$2.14
|
| Rate for Payer: Frontpath All Commercial |
$2.13
|
| Rate for Payer: Humana ChoiceCare |
$2.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.09
|
| Rate for Payer: PHCS All Commercial |
$1.74
|
| Rate for Payer: PHP All Commercial |
$1.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1.79
|
| Rate for Payer: Signature Care EPO |
$1.93
|
| Rate for Payer: Signature Care PPO |
$2.04
|
| Rate for Payer: United Healthcare Commercial |
$1.83
|
|
|
HC POUCH CLAMP OSTOMY
|
Facility
OP
|
$2.32
|
|
| Hospital Charge Code |
41601034
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$1.96
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.84
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Centivo All Commercial |
$1.18
|
| Rate for Payer: Cigna All Commercial |
$2.00
|
| Rate for Payer: CORVEL All Commercial |
$2.16
|
| Rate for Payer: Coventry All Commercial |
$2.04
|
| Rate for Payer: Encore All Commercial |
$2.14
|
| Rate for Payer: Frontpath All Commercial |
$2.13
|
| Rate for Payer: Humana ChoiceCare |
$2.00
|
| Rate for Payer: Humana Medicare |
$1.18
|
| Rate for Payer: Lucent All Commercial |
$1.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.09
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$1.74
|
| Rate for Payer: PHP All Commercial |
$1.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1.79
|
| Rate for Payer: Signature Care EPO |
$1.93
|
| Rate for Payer: Signature Care PPO |
$2.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$1.83
|
| Rate for Payer: United Healthcare Medicare |
$0.77
|
|
|
HC POUCH DRAINABLE WITH FLANGE 10
|
Facility
IP
|
$5.70
|
|
| Hospital Charge Code |
41602243
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Aetna Commercial |
$4.92
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cigna All Commercial |
$4.92
|
| Rate for Payer: CORVEL All Commercial |
$5.30
|
| Rate for Payer: Coventry All Commercial |
$5.02
|
| Rate for Payer: Encore All Commercial |
$5.25
|
| Rate for Payer: Frontpath All Commercial |
$5.24
|
| Rate for Payer: Humana ChoiceCare |
$4.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.13
|
| Rate for Payer: PHCS All Commercial |
$4.28
|
| Rate for Payer: PHP All Commercial |
$4.32
|
| Rate for Payer: Sagamore Health Network All Products |
$4.40
|
| Rate for Payer: Signature Care EPO |
$4.73
|
| Rate for Payer: Signature Care PPO |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$4.49
|
|
|
HC POUCH DRAINABLE WITH FLANGE 10
|
Facility
OP
|
$5.70
|
|
| Hospital Charge Code |
41602243
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$4.81
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.07
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Centivo All Commercial |
$2.91
|
| Rate for Payer: Cigna All Commercial |
$4.92
|
| Rate for Payer: CORVEL All Commercial |
$5.30
|
| Rate for Payer: Coventry All Commercial |
$5.02
|
| Rate for Payer: Encore All Commercial |
$5.25
|
| Rate for Payer: Frontpath All Commercial |
$5.24
|
| Rate for Payer: Humana ChoiceCare |
$4.92
|
| Rate for Payer: Humana Medicare |
$2.91
|
| Rate for Payer: Lucent All Commercial |
$2.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.13
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$4.28
|
| Rate for Payer: PHP All Commercial |
$4.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.22
|
| Rate for Payer: Sagamore Health Network All Products |
$4.40
|
| Rate for Payer: Signature Care EPO |
$4.73
|
| Rate for Payer: Signature Care PPO |
$5.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.84
|
| Rate for Payer: United Healthcare Commercial |
$4.49
|
| Rate for Payer: United Healthcare Medicare |
$1.88
|
|
|
HC PREALBUMIN
|
Facility
OP
|
$169.71
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
63001003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$157.83 |
| Rate for Payer: Aetna Commercial |
$143.23
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.60
|
| Rate for Payer: Cash Price |
$105.22
|
| Rate for Payer: Cash Price |
$105.22
|
| Rate for Payer: Centivo All Commercial |
$86.55
|
| Rate for Payer: Cigna All Commercial |
$146.46
|
| Rate for Payer: CORVEL All Commercial |
$157.83
|
| Rate for Payer: Coventry All Commercial |
$149.34
|
| Rate for Payer: Encore All Commercial |
$156.22
|
| Rate for Payer: Frontpath All Commercial |
$156.13
|
| Rate for Payer: Humana ChoiceCare |
$146.58
|
| Rate for Payer: Humana Medicare |
$86.55
|
| Rate for Payer: Lucent All Commercial |
$86.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.74
|
| Rate for Payer: Managed Health Services Medicaid |
$7.82
|
| Rate for Payer: MDWise Medicaid |
$7.82
|
| Rate for Payer: PHCS All Commercial |
$127.28
|
| Rate for Payer: PHP All Commercial |
$128.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.19
|
| Rate for Payer: Sagamore Health Network All Products |
$131.01
|
| Rate for Payer: Signature Care EPO |
$140.86
|
| Rate for Payer: Signature Care PPO |
$149.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144.25
|
| Rate for Payer: United Healthcare Commercial |
$133.73
|
| Rate for Payer: United Healthcare Medicare |
$56.00
|
|
|
HC PREALBUMIN
|
Facility
IP
|
$169.71
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
63001003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.28 |
| Max. Negotiated Rate |
$157.83 |
| Rate for Payer: Aetna Commercial |
$146.63
|
| Rate for Payer: Cash Price |
$105.22
|
| Rate for Payer: Cigna All Commercial |
$146.46
|
| Rate for Payer: CORVEL All Commercial |
$157.83
|
| Rate for Payer: Coventry All Commercial |
$149.34
|
| Rate for Payer: Encore All Commercial |
$156.22
|
| Rate for Payer: Frontpath All Commercial |
$156.13
|
| Rate for Payer: Humana ChoiceCare |
$146.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.74
|
| Rate for Payer: PHCS All Commercial |
$127.28
|
| Rate for Payer: PHP All Commercial |
$128.71
|
| Rate for Payer: Sagamore Health Network All Products |
$131.01
|
| Rate for Payer: Signature Care EPO |
$140.86
|
| Rate for Payer: Signature Care PPO |
$149.34
|
| Rate for Payer: United Healthcare Commercial |
$133.73
|
|
|
HC PREGNENOLONE-SERUM
|
Facility
OP
|
$192.98
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
63001356
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$179.48 |
| Rate for Payer: Aetna Commercial |
$162.88
|
| Rate for Payer: Aetna Medicare |
$63.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$88.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.05
|
| Rate for Payer: Cash Price |
$119.65
|
| Rate for Payer: Cash Price |
$119.65
|
| Rate for Payer: Centivo All Commercial |
$98.42
|
| Rate for Payer: Cigna All Commercial |
$166.55
|
| Rate for Payer: CORVEL All Commercial |
$179.48
|
| Rate for Payer: Coventry All Commercial |
$169.83
|
| Rate for Payer: Encore All Commercial |
$177.64
|
| Rate for Payer: Frontpath All Commercial |
$177.55
|
| Rate for Payer: Humana ChoiceCare |
$166.68
|
| Rate for Payer: Humana Medicare |
$98.42
|
| Rate for Payer: Lucent All Commercial |
$98.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.69
|
| Rate for Payer: Managed Health Services Medicaid |
$20.67
|
| Rate for Payer: MDWise Medicaid |
$20.67
|
| Rate for Payer: PHCS All Commercial |
$144.74
|
| Rate for Payer: PHP All Commercial |
$146.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.26
|
| Rate for Payer: Sagamore Health Network All Products |
$148.98
|
| Rate for Payer: Signature Care EPO |
$160.18
|
| Rate for Payer: Signature Care PPO |
$169.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$164.04
|
| Rate for Payer: United Healthcare Commercial |
$152.07
|
| Rate for Payer: United Healthcare Medicare |
$63.68
|
|
|
HC PREGNENOLONE-SERUM
|
Facility
IP
|
$192.98
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
63001356
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$179.48 |
| Rate for Payer: Aetna Commercial |
$166.74
|
| Rate for Payer: Cash Price |
$119.65
|
| Rate for Payer: Cigna All Commercial |
$166.55
|
| Rate for Payer: CORVEL All Commercial |
$179.48
|
| Rate for Payer: Coventry All Commercial |
$169.83
|
| Rate for Payer: Encore All Commercial |
$177.64
|
| Rate for Payer: Frontpath All Commercial |
$177.55
|
| Rate for Payer: Humana ChoiceCare |
$166.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.69
|
| Rate for Payer: PHCS All Commercial |
$144.74
|
| Rate for Payer: PHP All Commercial |
$146.36
|
| Rate for Payer: Sagamore Health Network All Products |
$148.98
|
| Rate for Payer: Signature Care EPO |
$160.18
|
| Rate for Payer: Signature Care PPO |
$169.83
|
| Rate for Payer: United Healthcare Commercial |
$152.07
|
|
|
HC PREMIUM POWDER
|
Facility
OP
|
$8.19
|
|
| Hospital Charge Code |
41601088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.97
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Centivo All Commercial |
$4.18
|
| Rate for Payer: Cigna All Commercial |
$7.07
|
| Rate for Payer: CORVEL All Commercial |
$7.62
|
| Rate for Payer: Coventry All Commercial |
$7.21
|
| Rate for Payer: Encore All Commercial |
$7.54
|
| Rate for Payer: Frontpath All Commercial |
$7.53
|
| Rate for Payer: Humana ChoiceCare |
$7.07
|
| Rate for Payer: Humana Medicare |
$4.18
|
| Rate for Payer: Lucent All Commercial |
$4.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.37
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.14
|
| Rate for Payer: PHP All Commercial |
$6.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.19
|
| Rate for Payer: Sagamore Health Network All Products |
$6.32
|
| Rate for Payer: Signature Care EPO |
$6.80
|
| Rate for Payer: Signature Care PPO |
$7.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.96
|
| Rate for Payer: United Healthcare Commercial |
$6.45
|
| Rate for Payer: United Healthcare Medicare |
$2.70
|
|
|
HC PREMIUM POWDER
|
Facility
IP
|
$8.19
|
|
| Hospital Charge Code |
41601088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$7.62 |
| Rate for Payer: Aetna Commercial |
$7.08
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna All Commercial |
$7.07
|
| Rate for Payer: CORVEL All Commercial |
$7.62
|
| Rate for Payer: Coventry All Commercial |
$7.21
|
| Rate for Payer: Encore All Commercial |
$7.54
|
| Rate for Payer: Frontpath All Commercial |
$7.53
|
| Rate for Payer: Humana ChoiceCare |
$7.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.37
|
| Rate for Payer: PHCS All Commercial |
$6.14
|
| Rate for Payer: PHP All Commercial |
$6.21
|
| Rate for Payer: Sagamore Health Network All Products |
$6.32
|
| Rate for Payer: Signature Care EPO |
$6.80
|
| Rate for Payer: Signature Care PPO |
$7.21
|
| Rate for Payer: United Healthcare Commercial |
$6.45
|
|
|
HC PREMIUM SURGICLIP MEDIUM
|
Facility
OP
|
$426.99
|
|
| Hospital Charge Code |
41601089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$397.10 |
| Rate for Payer: Aetna Commercial |
$360.38
|
| Rate for Payer: Aetna Medicare |
$140.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$245.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$266.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.00
|
| Rate for Payer: Cash Price |
$264.73
|
| Rate for Payer: Cash Price |
$264.73
|
| Rate for Payer: Centivo All Commercial |
$217.76
|
| Rate for Payer: Cigna All Commercial |
$368.49
|
| Rate for Payer: CORVEL All Commercial |
$397.10
|
| Rate for Payer: Coventry All Commercial |
$375.75
|
| Rate for Payer: Encore All Commercial |
$393.04
|
| Rate for Payer: Frontpath All Commercial |
$392.83
|
| Rate for Payer: Humana ChoiceCare |
$368.79
|
| Rate for Payer: Humana Medicare |
$217.76
|
| Rate for Payer: Lucent All Commercial |
$217.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$384.29
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$320.24
|
| Rate for Payer: PHP All Commercial |
$323.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.53
|
| Rate for Payer: Sagamore Health Network All Products |
$329.64
|
| Rate for Payer: Signature Care EPO |
$354.40
|
| Rate for Payer: Signature Care PPO |
$375.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$362.94
|
| Rate for Payer: United Healthcare Commercial |
$336.47
|
| Rate for Payer: United Healthcare Medicare |
$140.91
|
|
|
HC PREMIUM SURGICLIP MEDIUM
|
Facility
IP
|
$426.99
|
|
| Hospital Charge Code |
41601089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.24 |
| Max. Negotiated Rate |
$397.10 |
| Rate for Payer: Aetna Commercial |
$368.92
|
| Rate for Payer: Cash Price |
$264.73
|
| Rate for Payer: Cigna All Commercial |
$368.49
|
| Rate for Payer: CORVEL All Commercial |
$397.10
|
| Rate for Payer: Coventry All Commercial |
$375.75
|
| Rate for Payer: Encore All Commercial |
$393.04
|
| Rate for Payer: Frontpath All Commercial |
$392.83
|
| Rate for Payer: Humana ChoiceCare |
$368.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$384.29
|
| Rate for Payer: PHCS All Commercial |
$320.24
|
| Rate for Payer: PHP All Commercial |
$323.83
|
| Rate for Payer: Sagamore Health Network All Products |
$329.64
|
| Rate for Payer: Signature Care EPO |
$354.40
|
| Rate for Payer: Signature Care PPO |
$375.75
|
| Rate for Payer: United Healthcare Commercial |
$336.47
|
|
|
HC PRESSURE TRANSDUCER KIT
|
Facility
IP
|
$113.33
|
|
| Hospital Charge Code |
41601224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Aetna Commercial |
$97.92
|
| Rate for Payer: Cash Price |
$70.27
|
| Rate for Payer: Cigna All Commercial |
$97.80
|
| Rate for Payer: CORVEL All Commercial |
$105.40
|
| Rate for Payer: Coventry All Commercial |
$99.73
|
| Rate for Payer: Encore All Commercial |
$104.32
|
| Rate for Payer: Frontpath All Commercial |
$104.26
|
| Rate for Payer: Humana ChoiceCare |
$97.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.00
|
| Rate for Payer: PHCS All Commercial |
$85.00
|
| Rate for Payer: PHP All Commercial |
$85.95
|
| Rate for Payer: Sagamore Health Network All Products |
$87.49
|
| Rate for Payer: Signature Care EPO |
$94.06
|
| Rate for Payer: Signature Care PPO |
$99.73
|
| Rate for Payer: United Healthcare Commercial |
$89.30
|
|
|
HC PRESSURE TRANSDUCER KIT
|
Facility
OP
|
$113.33
|
|
| Hospital Charge Code |
41601224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$95.65
|
| Rate for Payer: Aetna Medicare |
$37.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.14
|
| Rate for Payer: Cash Price |
$70.27
|
| Rate for Payer: Cash Price |
$70.27
|
| Rate for Payer: Centivo All Commercial |
$57.80
|
| Rate for Payer: Cigna All Commercial |
$97.80
|
| Rate for Payer: CORVEL All Commercial |
$105.40
|
| Rate for Payer: Coventry All Commercial |
$99.73
|
| Rate for Payer: Encore All Commercial |
$104.32
|
| Rate for Payer: Frontpath All Commercial |
$104.26
|
| Rate for Payer: Humana ChoiceCare |
$97.88
|
| Rate for Payer: Humana Medicare |
$57.80
|
| Rate for Payer: Lucent All Commercial |
$57.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$85.00
|
| Rate for Payer: PHP All Commercial |
$85.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.20
|
| Rate for Payer: Sagamore Health Network All Products |
$87.49
|
| Rate for Payer: Signature Care EPO |
$94.06
|
| Rate for Payer: Signature Care PPO |
$99.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.33
|
| Rate for Payer: United Healthcare Commercial |
$89.30
|
| Rate for Payer: United Healthcare Medicare |
$37.40
|
|
|
HC PRESUMPTIVE BACT ID
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
63001076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$115.32 |
| Rate for Payer: Aetna Commercial |
$104.66
|
| Rate for Payer: Aetna Medicare |
$40.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.01
|
| Rate for Payer: Cash Price |
$76.88
|
| Rate for Payer: Cash Price |
$76.88
|
| Rate for Payer: Centivo All Commercial |
$63.24
|
| Rate for Payer: Cigna All Commercial |
$107.01
|
| Rate for Payer: CORVEL All Commercial |
$115.32
|
| Rate for Payer: Coventry All Commercial |
$109.12
|
| Rate for Payer: Encore All Commercial |
$114.14
|
| Rate for Payer: Frontpath All Commercial |
$114.08
|
| Rate for Payer: Humana ChoiceCare |
$107.10
|
| Rate for Payer: Humana Medicare |
$63.24
|
| Rate for Payer: Lucent All Commercial |
$63.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.60
|
| Rate for Payer: Managed Health Services Medicaid |
$8.09
|
| Rate for Payer: MDWise Medicaid |
$8.09
|
| Rate for Payer: PHCS All Commercial |
$93.00
|
| Rate for Payer: PHP All Commercial |
$94.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.36
|
| Rate for Payer: Sagamore Health Network All Products |
$95.73
|
| Rate for Payer: Signature Care EPO |
$102.92
|
| Rate for Payer: Signature Care PPO |
$109.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.40
|
| Rate for Payer: United Healthcare Commercial |
$97.71
|
| Rate for Payer: United Healthcare Medicare |
$40.92
|
|
|
HC PRESUMPTIVE BACT ID
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
63001076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$115.32 |
| Rate for Payer: Aetna Commercial |
$107.14
|
| Rate for Payer: Cash Price |
$76.88
|
| Rate for Payer: Cigna All Commercial |
$107.01
|
| Rate for Payer: CORVEL All Commercial |
$115.32
|
| Rate for Payer: Coventry All Commercial |
$109.12
|
| Rate for Payer: Encore All Commercial |
$114.14
|
| Rate for Payer: Frontpath All Commercial |
$114.08
|
| Rate for Payer: Humana ChoiceCare |
$107.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.60
|
| Rate for Payer: PHCS All Commercial |
$93.00
|
| Rate for Payer: PHP All Commercial |
$94.04
|
| Rate for Payer: Sagamore Health Network All Products |
$95.73
|
| Rate for Payer: Signature Care EPO |
$102.92
|
| Rate for Payer: Signature Care PPO |
$109.12
|
| Rate for Payer: United Healthcare Commercial |
$97.71
|
|
|
HC PRIMIDONE/PHENO
|
Facility
IP
|
$126.70
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
63001196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$117.84 |
| Rate for Payer: Aetna Commercial |
$109.47
|
| Rate for Payer: Cash Price |
$78.56
|
| Rate for Payer: Cigna All Commercial |
$109.35
|
| Rate for Payer: CORVEL All Commercial |
$117.84
|
| Rate for Payer: Coventry All Commercial |
$111.50
|
| Rate for Payer: Encore All Commercial |
$116.63
|
| Rate for Payer: Frontpath All Commercial |
$116.57
|
| Rate for Payer: Humana ChoiceCare |
$109.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.03
|
| Rate for Payer: PHCS All Commercial |
$95.03
|
| Rate for Payer: PHP All Commercial |
$96.09
|
| Rate for Payer: Sagamore Health Network All Products |
$97.82
|
| Rate for Payer: Signature Care EPO |
$105.16
|
| Rate for Payer: Signature Care PPO |
$111.50
|
| Rate for Payer: United Healthcare Commercial |
$99.84
|
|
|
HC PRIMIDONE/PHENO
|
Facility
OP
|
$126.70
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
63001196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.59 |
| Max. Negotiated Rate |
$117.84 |
| Rate for Payer: Aetna Commercial |
$106.94
|
| Rate for Payer: Aetna Medicare |
$41.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$72.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.99
|
| Rate for Payer: Cash Price |
$78.56
|
| Rate for Payer: Cash Price |
$78.56
|
| Rate for Payer: Centivo All Commercial |
$64.62
|
| Rate for Payer: Cigna All Commercial |
$109.35
|
| Rate for Payer: CORVEL All Commercial |
$117.84
|
| Rate for Payer: Coventry All Commercial |
$111.50
|
| Rate for Payer: Encore All Commercial |
$116.63
|
| Rate for Payer: Frontpath All Commercial |
$116.57
|
| Rate for Payer: Humana ChoiceCare |
$109.43
|
| Rate for Payer: Humana Medicare |
$64.62
|
| Rate for Payer: Lucent All Commercial |
$64.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.03
|
| Rate for Payer: Managed Health Services Medicaid |
$16.59
|
| Rate for Payer: MDWise Medicaid |
$16.59
|
| Rate for Payer: PHCS All Commercial |
$95.03
|
| Rate for Payer: PHP All Commercial |
$96.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.41
|
| Rate for Payer: Sagamore Health Network All Products |
$97.82
|
| Rate for Payer: Signature Care EPO |
$105.16
|
| Rate for Payer: Signature Care PPO |
$111.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$107.70
|
| Rate for Payer: United Healthcare Commercial |
$99.84
|
| Rate for Payer: United Healthcare Medicare |
$41.81
|
|
|
HC PROBE BLANKET HYPOTHERM DISP
|
Facility
IP
|
$43.40
|
|
| Hospital Charge Code |
41601011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$40.36 |
| Rate for Payer: Aetna Commercial |
$37.50
|
| Rate for Payer: Cash Price |
$26.91
|
| Rate for Payer: Cigna All Commercial |
$37.45
|
| Rate for Payer: CORVEL All Commercial |
$40.36
|
| Rate for Payer: Coventry All Commercial |
$38.19
|
| Rate for Payer: Encore All Commercial |
$39.95
|
| Rate for Payer: Frontpath All Commercial |
$39.93
|
| Rate for Payer: Humana ChoiceCare |
$37.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.06
|
| Rate for Payer: PHCS All Commercial |
$32.55
|
| Rate for Payer: PHP All Commercial |
$32.91
|
| Rate for Payer: Sagamore Health Network All Products |
$33.50
|
| Rate for Payer: Signature Care EPO |
$36.02
|
| Rate for Payer: Signature Care PPO |
$38.19
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
|
HC PROBE BLANKET HYPOTHERM DISP
|
Facility
OP
|
$43.40
|
|
| Hospital Charge Code |
41601011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$36.63
|
| Rate for Payer: Aetna Medicare |
$14.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.75
|
| Rate for Payer: Cash Price |
$26.91
|
| Rate for Payer: Cash Price |
$26.91
|
| Rate for Payer: Centivo All Commercial |
$22.13
|
| Rate for Payer: Cigna All Commercial |
$37.45
|
| Rate for Payer: CORVEL All Commercial |
$40.36
|
| Rate for Payer: Coventry All Commercial |
$38.19
|
| Rate for Payer: Encore All Commercial |
$39.95
|
| Rate for Payer: Frontpath All Commercial |
$39.93
|
| Rate for Payer: Humana ChoiceCare |
$37.48
|
| Rate for Payer: Humana Medicare |
$22.13
|
| Rate for Payer: Lucent All Commercial |
$22.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.06
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$32.55
|
| Rate for Payer: PHP All Commercial |
$32.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.93
|
| Rate for Payer: Sagamore Health Network All Products |
$33.50
|
| Rate for Payer: Signature Care EPO |
$36.02
|
| Rate for Payer: Signature Care PPO |
$38.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.89
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Medicare |
$14.32
|
|
|
HC PROBE TEMP 9F
|
Facility
IP
|
$10.36
|
|
| Hospital Charge Code |
41607463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Cigna All Commercial |
$8.94
|
| Rate for Payer: CORVEL All Commercial |
$9.63
|
| Rate for Payer: Coventry All Commercial |
$9.12
|
| Rate for Payer: Encore All Commercial |
$9.54
|
| Rate for Payer: Frontpath All Commercial |
$9.53
|
| Rate for Payer: Humana ChoiceCare |
$8.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.32
|
| Rate for Payer: PHCS All Commercial |
$7.77
|
| Rate for Payer: PHP All Commercial |
$7.86
|
| Rate for Payer: Sagamore Health Network All Products |
$8.00
|
| Rate for Payer: Signature Care EPO |
$8.60
|
| Rate for Payer: Signature Care PPO |
$9.12
|
| Rate for Payer: United Healthcare Commercial |
$8.16
|
|
|
HC PROBE TEMP 9F
|
Facility
OP
|
$10.36
|
|
| Hospital Charge Code |
41607463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Medicare |
$3.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.76
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Centivo All Commercial |
$5.28
|
| Rate for Payer: Cigna All Commercial |
$8.94
|
| Rate for Payer: CORVEL All Commercial |
$9.63
|
| Rate for Payer: Coventry All Commercial |
$9.12
|
| Rate for Payer: Encore All Commercial |
$9.54
|
| Rate for Payer: Frontpath All Commercial |
$9.53
|
| Rate for Payer: Humana ChoiceCare |
$8.95
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Lucent All Commercial |
$5.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.77
|
| Rate for Payer: PHP All Commercial |
$7.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.04
|
| Rate for Payer: Sagamore Health Network All Products |
$8.00
|
| Rate for Payer: Signature Care EPO |
$8.60
|
| Rate for Payer: Signature Care PPO |
$9.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.81
|
| Rate for Payer: United Healthcare Commercial |
$8.16
|
| Rate for Payer: United Healthcare Medicare |
$3.42
|
|
