|
HC TUBE SUMP SALEM 8FR X 24IN
|
Facility
|
OP
|
$28.67
|
|
| Hospital Charge Code |
41608362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$24.20
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.09
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Centivo All Commercial |
$15.60
|
| Rate for Payer: Cigna All Commercial |
$24.74
|
| Rate for Payer: CORVEL All Commercial |
$26.66
|
| Rate for Payer: Coventry All Commercial |
$25.23
|
| Rate for Payer: Encore All Commercial |
$26.39
|
| Rate for Payer: Frontpath All Commercial |
$26.38
|
| Rate for Payer: Humana ChoiceCare |
$24.76
|
| Rate for Payer: Humana Medicare |
$9.17
|
| Rate for Payer: Lucent All Commercial |
$15.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$21.50
|
| Rate for Payer: PHP All Commercial |
$21.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.18
|
| Rate for Payer: Sagamore Health Network All Products |
$22.13
|
| Rate for Payer: Signature Care EPO |
$23.80
|
| Rate for Payer: Signature Care PPO |
$25.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.37
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
| Rate for Payer: United Healthcare Medicare |
$9.17
|
|
|
HC TUBE SUMP SALEM 8FR X 24IN
|
Facility
|
IP
|
$28.67
|
|
| Hospital Charge Code |
41608362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$26.66 |
| Rate for Payer: Aetna Commercial |
$24.77
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cigna All Commercial |
$24.74
|
| Rate for Payer: CORVEL All Commercial |
$26.66
|
| Rate for Payer: Coventry All Commercial |
$25.23
|
| Rate for Payer: Encore All Commercial |
$26.39
|
| Rate for Payer: Frontpath All Commercial |
$26.38
|
| Rate for Payer: Humana ChoiceCare |
$24.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.80
|
| Rate for Payer: PHCS All Commercial |
$21.50
|
| Rate for Payer: PHP All Commercial |
$21.74
|
| Rate for Payer: Sagamore Health Network All Products |
$22.13
|
| Rate for Payer: Signature Care EPO |
$23.80
|
| Rate for Payer: Signature Care PPO |
$25.23
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
|
|
HC TUBE TRACH 6.0
|
Facility
|
OP
|
$276.36
|
|
| Hospital Charge Code |
41601854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$257.01 |
| Rate for Payer: Aetna Commercial |
$233.25
|
| Rate for Payer: Aetna Medicare |
$88.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$158.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.28
|
| Rate for Payer: Cash Price |
$165.82
|
| Rate for Payer: Cash Price |
$165.82
|
| Rate for Payer: Centivo All Commercial |
$150.34
|
| Rate for Payer: Cigna All Commercial |
$238.50
|
| Rate for Payer: CORVEL All Commercial |
$257.01
|
| Rate for Payer: Coventry All Commercial |
$243.20
|
| Rate for Payer: Encore All Commercial |
$254.39
|
| Rate for Payer: Frontpath All Commercial |
$254.25
|
| Rate for Payer: Humana ChoiceCare |
$238.69
|
| Rate for Payer: Humana Medicare |
$88.44
|
| Rate for Payer: Lucent All Commercial |
$150.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$248.72
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$207.27
|
| Rate for Payer: PHP All Commercial |
$209.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.78
|
| Rate for Payer: Sagamore Health Network All Products |
$213.35
|
| Rate for Payer: Signature Care EPO |
$229.38
|
| Rate for Payer: Signature Care PPO |
$243.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$234.91
|
| Rate for Payer: United Healthcare Commercial |
$217.77
|
| Rate for Payer: United Healthcare Medicare |
$88.44
|
|
|
HC TUBE TRACH 6.0
|
Facility
|
IP
|
$276.36
|
|
| Hospital Charge Code |
41601854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.27 |
| Max. Negotiated Rate |
$257.01 |
| Rate for Payer: Aetna Commercial |
$238.78
|
| Rate for Payer: Cash Price |
$165.82
|
| Rate for Payer: Cigna All Commercial |
$238.50
|
| Rate for Payer: CORVEL All Commercial |
$257.01
|
| Rate for Payer: Coventry All Commercial |
$243.20
|
| Rate for Payer: Encore All Commercial |
$254.39
|
| Rate for Payer: Frontpath All Commercial |
$254.25
|
| Rate for Payer: Humana ChoiceCare |
$238.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$248.72
|
| Rate for Payer: PHCS All Commercial |
$207.27
|
| Rate for Payer: PHP All Commercial |
$209.59
|
| Rate for Payer: Sagamore Health Network All Products |
$213.35
|
| Rate for Payer: Signature Care EPO |
$229.38
|
| Rate for Payer: Signature Care PPO |
$243.20
|
| Rate for Payer: United Healthcare Commercial |
$217.77
|
|
|
HC TUBING CAPNOLINE ADULT 02 LONG
|
Facility
|
IP
|
$115.56
|
|
| Hospital Charge Code |
41601192
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$86.67 |
| Max. Negotiated Rate |
$107.47 |
| Rate for Payer: Aetna Commercial |
$99.84
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Cigna All Commercial |
$99.73
|
| Rate for Payer: CORVEL All Commercial |
$107.47
|
| Rate for Payer: Coventry All Commercial |
$101.69
|
| Rate for Payer: Encore All Commercial |
$106.37
|
| Rate for Payer: Frontpath All Commercial |
$106.32
|
| Rate for Payer: Humana ChoiceCare |
$99.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.00
|
| Rate for Payer: PHCS All Commercial |
$86.67
|
| Rate for Payer: PHP All Commercial |
$87.64
|
| Rate for Payer: Sagamore Health Network All Products |
$89.21
|
| Rate for Payer: Signature Care EPO |
$95.91
|
| Rate for Payer: Signature Care PPO |
$101.69
|
| Rate for Payer: United Healthcare Commercial |
$91.06
|
|
|
HC TUBING CAPNOLINE ADULT 02 LONG
|
Facility
|
OP
|
$115.56
|
|
| Hospital Charge Code |
41601192
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$107.47 |
| Rate for Payer: Aetna Commercial |
$97.53
|
| Rate for Payer: Aetna Medicare |
$36.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.68
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Centivo All Commercial |
$62.86
|
| Rate for Payer: Cigna All Commercial |
$99.73
|
| Rate for Payer: CORVEL All Commercial |
$107.47
|
| Rate for Payer: Coventry All Commercial |
$101.69
|
| Rate for Payer: Encore All Commercial |
$106.37
|
| Rate for Payer: Frontpath All Commercial |
$106.32
|
| Rate for Payer: Humana ChoiceCare |
$99.81
|
| Rate for Payer: Humana Medicare |
$36.98
|
| Rate for Payer: Lucent All Commercial |
$62.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.00
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$86.67
|
| Rate for Payer: PHP All Commercial |
$87.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.07
|
| Rate for Payer: Sagamore Health Network All Products |
$89.21
|
| Rate for Payer: Signature Care EPO |
$95.91
|
| Rate for Payer: Signature Care PPO |
$101.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.23
|
| Rate for Payer: United Healthcare Commercial |
$91.06
|
| Rate for Payer: United Healthcare Medicare |
$36.98
|
|
|
HC TUBING CAPNOLINE COLON
|
Facility
|
IP
|
$141.42
|
|
| Hospital Charge Code |
41601193
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$106.06 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$122.19
|
| Rate for Payer: Cash Price |
$84.85
|
| Rate for Payer: Cigna All Commercial |
$122.05
|
| Rate for Payer: CORVEL All Commercial |
$131.52
|
| Rate for Payer: Coventry All Commercial |
$124.45
|
| Rate for Payer: Encore All Commercial |
$130.18
|
| Rate for Payer: Frontpath All Commercial |
$130.11
|
| Rate for Payer: Humana ChoiceCare |
$122.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.28
|
| Rate for Payer: PHCS All Commercial |
$106.06
|
| Rate for Payer: PHP All Commercial |
$107.25
|
| Rate for Payer: Sagamore Health Network All Products |
$109.18
|
| Rate for Payer: Signature Care EPO |
$117.38
|
| Rate for Payer: Signature Care PPO |
$124.45
|
| Rate for Payer: United Healthcare Commercial |
$111.44
|
|
|
HC TUBING CAPNOLINE COLON
|
Facility
|
OP
|
$141.42
|
|
| Hospital Charge Code |
41601193
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$119.36
|
| Rate for Payer: Aetna Medicare |
$45.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$81.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.78
|
| Rate for Payer: Cash Price |
$84.85
|
| Rate for Payer: Cash Price |
$84.85
|
| Rate for Payer: Centivo All Commercial |
$76.93
|
| Rate for Payer: Cigna All Commercial |
$122.05
|
| Rate for Payer: CORVEL All Commercial |
$131.52
|
| Rate for Payer: Coventry All Commercial |
$124.45
|
| Rate for Payer: Encore All Commercial |
$130.18
|
| Rate for Payer: Frontpath All Commercial |
$130.11
|
| Rate for Payer: Humana ChoiceCare |
$122.14
|
| Rate for Payer: Humana Medicare |
$45.25
|
| Rate for Payer: Lucent All Commercial |
$76.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.28
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$106.06
|
| Rate for Payer: PHP All Commercial |
$107.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.15
|
| Rate for Payer: Sagamore Health Network All Products |
$109.18
|
| Rate for Payer: Signature Care EPO |
$117.38
|
| Rate for Payer: Signature Care PPO |
$124.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120.21
|
| Rate for Payer: United Healthcare Commercial |
$111.44
|
| Rate for Payer: United Healthcare Medicare |
$45.25
|
|
|
HC TUBING CAPNOLINE GASTRO 100/BX
|
Facility
|
IP
|
$132.34
|
|
| Hospital Charge Code |
41601798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.25 |
| Max. Negotiated Rate |
$123.08 |
| Rate for Payer: Aetna Commercial |
$114.34
|
| Rate for Payer: Cash Price |
$79.40
|
| Rate for Payer: Cigna All Commercial |
$114.21
|
| Rate for Payer: CORVEL All Commercial |
$123.08
|
| Rate for Payer: Coventry All Commercial |
$116.46
|
| Rate for Payer: Encore All Commercial |
$121.82
|
| Rate for Payer: Frontpath All Commercial |
$121.75
|
| Rate for Payer: Humana ChoiceCare |
$114.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.11
|
| Rate for Payer: PHCS All Commercial |
$99.25
|
| Rate for Payer: PHP All Commercial |
$100.37
|
| Rate for Payer: Sagamore Health Network All Products |
$102.17
|
| Rate for Payer: Signature Care EPO |
$109.84
|
| Rate for Payer: Signature Care PPO |
$116.46
|
| Rate for Payer: United Healthcare Commercial |
$104.28
|
|
|
HC TUBING CAPNOLINE GASTRO 100/BX
|
Facility
|
OP
|
$132.34
|
|
| Hospital Charge Code |
41601798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$123.08 |
| Rate for Payer: Aetna Commercial |
$111.69
|
| Rate for Payer: Aetna Medicare |
$42.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$76.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.58
|
| Rate for Payer: Cash Price |
$79.40
|
| Rate for Payer: Cash Price |
$79.40
|
| Rate for Payer: Centivo All Commercial |
$71.99
|
| Rate for Payer: Cigna All Commercial |
$114.21
|
| Rate for Payer: CORVEL All Commercial |
$123.08
|
| Rate for Payer: Coventry All Commercial |
$116.46
|
| Rate for Payer: Encore All Commercial |
$121.82
|
| Rate for Payer: Frontpath All Commercial |
$121.75
|
| Rate for Payer: Humana ChoiceCare |
$114.30
|
| Rate for Payer: Humana Medicare |
$42.35
|
| Rate for Payer: Lucent All Commercial |
$71.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.11
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$99.25
|
| Rate for Payer: PHP All Commercial |
$100.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.61
|
| Rate for Payer: Sagamore Health Network All Products |
$102.17
|
| Rate for Payer: Signature Care EPO |
$109.84
|
| Rate for Payer: Signature Care PPO |
$116.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.49
|
| Rate for Payer: United Healthcare Commercial |
$104.28
|
| Rate for Payer: United Healthcare Medicare |
$42.35
|
|
|
HC TUBING CYSTO
|
Facility
|
OP
|
$34.51
|
|
| Hospital Charge Code |
41601194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$32.09 |
| Rate for Payer: Aetna Commercial |
$29.13
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.15
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Centivo All Commercial |
$18.77
|
| Rate for Payer: Cigna All Commercial |
$29.78
|
| Rate for Payer: CORVEL All Commercial |
$32.09
|
| Rate for Payer: Coventry All Commercial |
$30.37
|
| Rate for Payer: Encore All Commercial |
$31.77
|
| Rate for Payer: Frontpath All Commercial |
$31.75
|
| Rate for Payer: Humana ChoiceCare |
$29.81
|
| Rate for Payer: Humana Medicare |
$11.04
|
| Rate for Payer: Lucent All Commercial |
$18.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.06
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$25.88
|
| Rate for Payer: PHP All Commercial |
$26.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.46
|
| Rate for Payer: Sagamore Health Network All Products |
$26.64
|
| Rate for Payer: Signature Care EPO |
$28.64
|
| Rate for Payer: Signature Care PPO |
$30.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.33
|
| Rate for Payer: United Healthcare Commercial |
$27.19
|
| Rate for Payer: United Healthcare Medicare |
$11.04
|
|
|
HC TUBING CYSTO
|
Facility
|
IP
|
$34.51
|
|
| Hospital Charge Code |
41601194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$32.09 |
| Rate for Payer: Aetna Commercial |
$29.82
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cigna All Commercial |
$29.78
|
| Rate for Payer: CORVEL All Commercial |
$32.09
|
| Rate for Payer: Coventry All Commercial |
$30.37
|
| Rate for Payer: Encore All Commercial |
$31.77
|
| Rate for Payer: Frontpath All Commercial |
$31.75
|
| Rate for Payer: Humana ChoiceCare |
$29.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.06
|
| Rate for Payer: PHCS All Commercial |
$25.88
|
| Rate for Payer: PHP All Commercial |
$26.17
|
| Rate for Payer: Sagamore Health Network All Products |
$26.64
|
| Rate for Payer: Signature Care EPO |
$28.64
|
| Rate for Payer: Signature Care PPO |
$30.37
|
| Rate for Payer: United Healthcare Commercial |
$27.19
|
|
|
HC TUBING FILTERLINE ADULT/PED
|
Facility
|
IP
|
$82.53
|
|
| Hospital Charge Code |
41607729
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$76.75 |
| Rate for Payer: Aetna Commercial |
$71.31
|
| Rate for Payer: Cash Price |
$49.52
|
| Rate for Payer: Cigna All Commercial |
$71.22
|
| Rate for Payer: CORVEL All Commercial |
$76.75
|
| Rate for Payer: Coventry All Commercial |
$72.63
|
| Rate for Payer: Encore All Commercial |
$75.97
|
| Rate for Payer: Frontpath All Commercial |
$75.93
|
| Rate for Payer: Humana ChoiceCare |
$71.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.28
|
| Rate for Payer: PHCS All Commercial |
$61.90
|
| Rate for Payer: PHP All Commercial |
$62.59
|
| Rate for Payer: Sagamore Health Network All Products |
$63.71
|
| Rate for Payer: Signature Care EPO |
$68.50
|
| Rate for Payer: Signature Care PPO |
$72.63
|
| Rate for Payer: United Healthcare Commercial |
$65.03
|
|
|
HC TUBING FILTERLINE ADULT/PED
|
Facility
|
OP
|
$82.53
|
|
| Hospital Charge Code |
41607729
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$76.75 |
| Rate for Payer: Aetna Commercial |
$69.66
|
| Rate for Payer: Aetna Medicare |
$26.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.05
|
| Rate for Payer: Cash Price |
$49.52
|
| Rate for Payer: Cash Price |
$49.52
|
| Rate for Payer: Centivo All Commercial |
$44.90
|
| Rate for Payer: Cigna All Commercial |
$71.22
|
| Rate for Payer: CORVEL All Commercial |
$76.75
|
| Rate for Payer: Coventry All Commercial |
$72.63
|
| Rate for Payer: Encore All Commercial |
$75.97
|
| Rate for Payer: Frontpath All Commercial |
$75.93
|
| Rate for Payer: Humana ChoiceCare |
$71.28
|
| Rate for Payer: Humana Medicare |
$26.41
|
| Rate for Payer: Lucent All Commercial |
$44.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.28
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$61.90
|
| Rate for Payer: PHP All Commercial |
$62.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.19
|
| Rate for Payer: Sagamore Health Network All Products |
$63.71
|
| Rate for Payer: Signature Care EPO |
$68.50
|
| Rate for Payer: Signature Care PPO |
$72.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.15
|
| Rate for Payer: United Healthcare Commercial |
$65.03
|
| Rate for Payer: United Healthcare Medicare |
$26.41
|
|
|
HC TUBING O2 ADULT ORAL/NASAL 13F
|
Facility
|
OP
|
$95.13
|
|
| Hospital Charge Code |
41607938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$88.47 |
| Rate for Payer: Aetna Commercial |
$80.29
|
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$57.08
|
| Rate for Payer: Cash Price |
$57.08
|
| Rate for Payer: Centivo All Commercial |
$51.75
|
| Rate for Payer: Cigna All Commercial |
$82.10
|
| Rate for Payer: CORVEL All Commercial |
$88.47
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.57
|
| Rate for Payer: Frontpath All Commercial |
$87.52
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Humana Medicare |
$30.44
|
| Rate for Payer: Lucent All Commercial |
$51.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.62
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$71.35
|
| Rate for Payer: PHP All Commercial |
$72.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.10
|
| Rate for Payer: Sagamore Health Network All Products |
$73.44
|
| Rate for Payer: Signature Care EPO |
$78.96
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.86
|
| Rate for Payer: United Healthcare Commercial |
$74.96
|
| Rate for Payer: United Healthcare Medicare |
$30.44
|
|
|
HC TUBING O2 ADULT ORAL/NASAL 13F
|
Facility
|
IP
|
$95.13
|
|
| Hospital Charge Code |
41607938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$88.47 |
| Rate for Payer: Aetna Commercial |
$82.19
|
| Rate for Payer: Cash Price |
$57.08
|
| Rate for Payer: Cigna All Commercial |
$82.10
|
| Rate for Payer: CORVEL All Commercial |
$88.47
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.57
|
| Rate for Payer: Frontpath All Commercial |
$87.52
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.62
|
| Rate for Payer: PHCS All Commercial |
$71.35
|
| Rate for Payer: PHP All Commercial |
$72.15
|
| Rate for Payer: Sagamore Health Network All Products |
$73.44
|
| Rate for Payer: Signature Care EPO |
$78.96
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: United Healthcare Commercial |
$74.96
|
|
|
HC TUBING SMART OMNILINE PLUS O2
|
Facility
|
IP
|
$69.35
|
|
| Hospital Charge Code |
41601196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.01 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Cigna All Commercial |
$59.85
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.03
|
| Rate for Payer: Encore All Commercial |
$63.84
|
| Rate for Payer: Frontpath All Commercial |
$63.80
|
| Rate for Payer: Humana ChoiceCare |
$59.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.41
|
| Rate for Payer: PHCS All Commercial |
$52.01
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Sagamore Health Network All Products |
$53.54
|
| Rate for Payer: Signature Care EPO |
$57.56
|
| Rate for Payer: Signature Care PPO |
$61.03
|
| Rate for Payer: United Healthcare Commercial |
$54.65
|
|
|
HC TUBING SMART OMNILINE PLUS O2
|
Facility
|
OP
|
$69.35
|
|
| Hospital Charge Code |
41601196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.53
|
| Rate for Payer: Aetna Medicare |
$22.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$39.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.41
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Centivo All Commercial |
$37.73
|
| Rate for Payer: Cigna All Commercial |
$59.85
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.03
|
| Rate for Payer: Encore All Commercial |
$63.84
|
| Rate for Payer: Frontpath All Commercial |
$63.80
|
| Rate for Payer: Humana ChoiceCare |
$59.90
|
| Rate for Payer: Humana Medicare |
$22.19
|
| Rate for Payer: Lucent All Commercial |
$37.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.41
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$52.01
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.05
|
| Rate for Payer: Sagamore Health Network All Products |
$53.54
|
| Rate for Payer: Signature Care EPO |
$57.56
|
| Rate for Payer: Signature Care PPO |
$61.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.95
|
| Rate for Payer: United Healthcare Commercial |
$54.65
|
| Rate for Payer: United Healthcare Medicare |
$22.19
|
|
|
HC TUBING TUR BLADDER 2 LEAD
|
Facility
|
OP
|
$42.63
|
|
| Hospital Charge Code |
41602081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Commercial |
$35.98
|
| Rate for Payer: Aetna Medicare |
$13.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.01
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Centivo All Commercial |
$23.19
|
| Rate for Payer: Cigna All Commercial |
$36.79
|
| Rate for Payer: CORVEL All Commercial |
$39.65
|
| Rate for Payer: Coventry All Commercial |
$37.51
|
| Rate for Payer: Encore All Commercial |
$39.24
|
| Rate for Payer: Frontpath All Commercial |
$39.22
|
| Rate for Payer: Humana ChoiceCare |
$36.82
|
| Rate for Payer: Humana Medicare |
$13.64
|
| Rate for Payer: Lucent All Commercial |
$23.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.37
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$31.97
|
| Rate for Payer: PHP All Commercial |
$32.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.63
|
| Rate for Payer: Sagamore Health Network All Products |
$32.91
|
| Rate for Payer: Signature Care EPO |
$35.38
|
| Rate for Payer: Signature Care PPO |
$37.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.24
|
| Rate for Payer: United Healthcare Commercial |
$33.59
|
| Rate for Payer: United Healthcare Medicare |
$13.64
|
|
|
HC TUBING TUR BLADDER 2 LEAD
|
Facility
|
IP
|
$42.63
|
|
| Hospital Charge Code |
41602081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.97 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Commercial |
$36.83
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cigna All Commercial |
$36.79
|
| Rate for Payer: CORVEL All Commercial |
$39.65
|
| Rate for Payer: Coventry All Commercial |
$37.51
|
| Rate for Payer: Encore All Commercial |
$39.24
|
| Rate for Payer: Frontpath All Commercial |
$39.22
|
| Rate for Payer: Humana ChoiceCare |
$36.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.37
|
| Rate for Payer: PHCS All Commercial |
$31.97
|
| Rate for Payer: PHP All Commercial |
$32.33
|
| Rate for Payer: Sagamore Health Network All Products |
$32.91
|
| Rate for Payer: Signature Care EPO |
$35.38
|
| Rate for Payer: Signature Care PPO |
$37.51
|
| Rate for Payer: United Healthcare Commercial |
$33.59
|
|
|
HC ULTRASOUND/15 MIN-OT
|
Facility
|
IP
|
$122.40
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
1738089
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$105.75
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
|
|
HC ULTRASOUND/15 MIN-OT
|
Facility
|
OP
|
$122.40
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
1738089
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.94 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$103.31
|
| Rate for Payer: Aetna Medicare |
$39.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$70.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.08
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Centivo All Commercial |
$66.59
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Humana Medicare |
$39.17
|
| Rate for Payer: Lucent All Commercial |
$66.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.74
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.04
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
| Rate for Payer: United Healthcare Medicare |
$39.17
|
|
|
HC ULTRASOUND/15 MIN-PT
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
1728087
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.03 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cigna All Commercial |
$89.79
|
| Rate for Payer: CORVEL All Commercial |
$96.76
|
| Rate for Payer: Coventry All Commercial |
$91.56
|
| Rate for Payer: Encore All Commercial |
$95.77
|
| Rate for Payer: Frontpath All Commercial |
$95.72
|
| Rate for Payer: Humana ChoiceCare |
$89.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.64
|
| Rate for Payer: PHCS All Commercial |
$78.03
|
| Rate for Payer: PHP All Commercial |
$78.90
|
| Rate for Payer: Sagamore Health Network All Products |
$80.32
|
| Rate for Payer: Signature Care EPO |
$86.35
|
| Rate for Payer: Signature Care PPO |
$91.56
|
| Rate for Payer: United Healthcare Commercial |
$81.98
|
|
|
HC ULTRASOUND/15 MIN-PT
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
1728087
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$87.81
|
| Rate for Payer: Aetna Medicare |
$33.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$59.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.62
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Centivo All Commercial |
$56.60
|
| Rate for Payer: Cigna All Commercial |
$89.79
|
| Rate for Payer: CORVEL All Commercial |
$96.76
|
| Rate for Payer: Coventry All Commercial |
$91.56
|
| Rate for Payer: Encore All Commercial |
$95.77
|
| Rate for Payer: Frontpath All Commercial |
$95.72
|
| Rate for Payer: Humana ChoiceCare |
$89.86
|
| Rate for Payer: Humana Medicare |
$33.29
|
| Rate for Payer: Lucent All Commercial |
$56.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.64
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$78.03
|
| Rate for Payer: PHP All Commercial |
$78.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.58
|
| Rate for Payer: Sagamore Health Network All Products |
$80.32
|
| Rate for Payer: Signature Care EPO |
$86.35
|
| Rate for Payer: Signature Care PPO |
$91.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88.43
|
| Rate for Payer: United Healthcare Commercial |
$81.98
|
| Rate for Payer: United Healthcare Medicare |
$33.29
|
|
|
HC ULTRASOUND BREAST COMPLETE BILATERAL
|
Facility
|
OP
|
$1,299.52
|
|
|
Service Code
|
CPT 76641 50
|
| Hospital Charge Code |
21649641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$1,208.55 |
| Rate for Payer: Aetna Commercial |
$1,096.79
|
| Rate for Payer: Aetna Medicare |
$415.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$402.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$746.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$812.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$51.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$478.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$457.43
|
| Rate for Payer: Cash Price |
$779.71
|
| Rate for Payer: Cash Price |
$779.71
|
| Rate for Payer: Centivo All Commercial |
$706.94
|
| Rate for Payer: Cigna All Commercial |
$1,121.49
|
| Rate for Payer: CORVEL All Commercial |
$1,208.55
|
| Rate for Payer: Coventry All Commercial |
$1,143.58
|
| Rate for Payer: Encore All Commercial |
$1,196.21
|
| Rate for Payer: Frontpath All Commercial |
$1,195.56
|
| Rate for Payer: Humana ChoiceCare |
$1,122.40
|
| Rate for Payer: Humana Medicare |
$415.85
|
| Rate for Payer: Lucent All Commercial |
$706.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,169.57
|
| Rate for Payer: Managed Health Services Medicaid |
$51.67
|
| Rate for Payer: MDWise Medicaid |
$51.67
|
| Rate for Payer: PHCS All Commercial |
$974.64
|
| Rate for Payer: PHP All Commercial |
$985.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$506.81
|
| Rate for Payer: Sagamore Health Network All Products |
$1,003.23
|
| Rate for Payer: Signature Care EPO |
$1,078.60
|
| Rate for Payer: Signature Care PPO |
$1,143.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,104.59
|
| Rate for Payer: United Healthcare Commercial |
$1,024.02
|
| Rate for Payer: United Healthcare Medicare |
$415.85
|
|
