|
HC STOCKING THIGH MEDIUM/REGULAR
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601117
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH MEDIUM/REGULAR
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601117
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH MEDIUM/SHORT
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601118
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH MEDIUM/SHORT
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601118
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH SMALL/REGULAR
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601119
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH SMALL/REGULAR
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601119
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH SMALL/SHORT
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601120
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH SMALL/SHORT
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601120
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH X LARGE LONG
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH X LARGE LONG
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH X LARGE REGULAR
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH X LARGE REGULAR
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH X LARGE/SHORT
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601123
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH X LARGE/SHORT
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601123
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH XX LARGE/LONG
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601124
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH XX LARGE/LONG
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601124
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH XX LARGE/REGULAR
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601125
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH XX LARGE/REGULAR
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601125
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH XX LARGE/SHORT
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601126
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH XX LARGE/SHORT
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601126
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STONE ANALYSIS
|
Facility
OP
|
$471.24
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
63001479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$438.25 |
| Rate for Payer: Aetna Commercial |
$397.73
|
| Rate for Payer: Aetna Medicare |
$155.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$155.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$270.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$178.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.06
|
| Rate for Payer: Cash Price |
$292.17
|
| Rate for Payer: Cash Price |
$292.17
|
| Rate for Payer: Centivo All Commercial |
$240.33
|
| Rate for Payer: Cigna All Commercial |
$406.68
|
| Rate for Payer: CORVEL All Commercial |
$438.25
|
| Rate for Payer: Coventry All Commercial |
$414.69
|
| Rate for Payer: Encore All Commercial |
$433.78
|
| Rate for Payer: Frontpath All Commercial |
$433.54
|
| Rate for Payer: Humana ChoiceCare |
$407.01
|
| Rate for Payer: Humana Medicare |
$240.33
|
| Rate for Payer: Lucent All Commercial |
$240.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.12
|
| Rate for Payer: Managed Health Services Medicaid |
$12.90
|
| Rate for Payer: MDWise Medicaid |
$12.90
|
| Rate for Payer: PHCS All Commercial |
$353.43
|
| Rate for Payer: PHP All Commercial |
$357.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$183.78
|
| Rate for Payer: Sagamore Health Network All Products |
$363.80
|
| Rate for Payer: Signature Care EPO |
$391.13
|
| Rate for Payer: Signature Care PPO |
$414.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.55
|
| Rate for Payer: United Healthcare Commercial |
$371.34
|
| Rate for Payer: United Healthcare Medicare |
$155.51
|
|
|
HC STONE ANALYSIS
|
Facility
IP
|
$471.24
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
63001479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$353.43 |
| Max. Negotiated Rate |
$438.25 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: Cash Price |
$292.17
|
| Rate for Payer: Cigna All Commercial |
$406.68
|
| Rate for Payer: CORVEL All Commercial |
$438.25
|
| Rate for Payer: Coventry All Commercial |
$414.69
|
| Rate for Payer: Encore All Commercial |
$433.78
|
| Rate for Payer: Frontpath All Commercial |
$433.54
|
| Rate for Payer: Humana ChoiceCare |
$407.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.12
|
| Rate for Payer: PHCS All Commercial |
$353.43
|
| Rate for Payer: PHP All Commercial |
$357.39
|
| Rate for Payer: Sagamore Health Network All Products |
$363.80
|
| Rate for Payer: Signature Care EPO |
$391.13
|
| Rate for Payer: Signature Care PPO |
$414.69
|
| Rate for Payer: United Healthcare Commercial |
$371.34
|
|
|
HC STONE BASKET NITINOL 1.5
|
Facility
IP
|
$1,151.90
|
|
| Hospital Charge Code |
41602178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$863.92 |
| Max. Negotiated Rate |
$1,071.27 |
| Rate for Payer: Aetna Commercial |
$995.24
|
| Rate for Payer: Cash Price |
$714.18
|
| Rate for Payer: Cigna All Commercial |
$994.09
|
| Rate for Payer: CORVEL All Commercial |
$1,071.27
|
| Rate for Payer: Coventry All Commercial |
$1,013.67
|
| Rate for Payer: Encore All Commercial |
$1,060.32
|
| Rate for Payer: Frontpath All Commercial |
$1,059.75
|
| Rate for Payer: Humana ChoiceCare |
$994.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,036.71
|
| Rate for Payer: PHCS All Commercial |
$863.92
|
| Rate for Payer: PHP All Commercial |
$873.60
|
| Rate for Payer: Sagamore Health Network All Products |
$889.27
|
| Rate for Payer: Signature Care EPO |
$956.08
|
| Rate for Payer: Signature Care PPO |
$1,013.67
|
| Rate for Payer: United Healthcare Commercial |
$907.70
|
|
|
HC STONE BASKET NITINOL 1.5
|
Facility
OP
|
$1,151.90
|
|
| Hospital Charge Code |
41602178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,071.27 |
| Rate for Payer: Aetna Commercial |
$972.20
|
| Rate for Payer: Aetna Medicare |
$380.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$380.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$661.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$720.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$437.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$418.14
|
| Rate for Payer: Cash Price |
$714.18
|
| Rate for Payer: Cash Price |
$714.18
|
| Rate for Payer: Centivo All Commercial |
$587.47
|
| Rate for Payer: Cigna All Commercial |
$994.09
|
| Rate for Payer: CORVEL All Commercial |
$1,071.27
|
| Rate for Payer: Coventry All Commercial |
$1,013.67
|
| Rate for Payer: Encore All Commercial |
$1,060.32
|
| Rate for Payer: Frontpath All Commercial |
$1,059.75
|
| Rate for Payer: Humana ChoiceCare |
$994.90
|
| Rate for Payer: Humana Medicare |
$587.47
|
| Rate for Payer: Lucent All Commercial |
$587.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,036.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$863.92
|
| Rate for Payer: PHP All Commercial |
$873.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$449.24
|
| Rate for Payer: Sagamore Health Network All Products |
$889.27
|
| Rate for Payer: Signature Care EPO |
$956.08
|
| Rate for Payer: Signature Care PPO |
$1,013.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$979.12
|
| Rate for Payer: United Healthcare Commercial |
$907.70
|
| Rate for Payer: United Healthcare Medicare |
$380.13
|
|
|
HC STONE BASKET NITINOL 2.8-5
|
Facility
OP
|
$1,054.85
|
|
| Hospital Charge Code |
41601364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$981.01 |
| Rate for Payer: Aetna Commercial |
$890.29
|
| Rate for Payer: Aetna Medicare |
$348.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$348.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$605.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$659.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$400.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$382.91
|
| Rate for Payer: Cash Price |
$654.01
|
| Rate for Payer: Cash Price |
$654.01
|
| Rate for Payer: Centivo All Commercial |
$537.97
|
| Rate for Payer: Cigna All Commercial |
$910.34
|
| Rate for Payer: CORVEL All Commercial |
$981.01
|
| Rate for Payer: Coventry All Commercial |
$928.27
|
| Rate for Payer: Encore All Commercial |
$970.99
|
| Rate for Payer: Frontpath All Commercial |
$970.46
|
| Rate for Payer: Humana ChoiceCare |
$911.07
|
| Rate for Payer: Humana Medicare |
$537.97
|
| Rate for Payer: Lucent All Commercial |
$537.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$949.36
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$791.14
|
| Rate for Payer: PHP All Commercial |
$800.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$411.39
|
| Rate for Payer: Sagamore Health Network All Products |
$814.34
|
| Rate for Payer: Signature Care EPO |
$875.53
|
| Rate for Payer: Signature Care PPO |
$928.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$896.62
|
| Rate for Payer: United Healthcare Commercial |
$831.22
|
| Rate for Payer: United Healthcare Medicare |
$348.10
|
|
