|
HC STYLET TPR .017 70CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET TPR .017 70CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC SUBOXONE METABOLITE
|
Facility
OP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$127.74
|
| Rate for Payer: Aetna Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$23.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Centivo All Commercial |
$77.19
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Humana Medicare |
$77.19
|
| Rate for Payer: Lucent All Commercial |
$77.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: Managed Health Services Medicaid |
$23.71
|
| Rate for Payer: MDWise Medicaid |
$23.71
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.03
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.65
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
| Rate for Payer: United Healthcare Medicare |
$49.94
|
|
|
HC SUBOXONE METABOLITE
|
Facility
IP
|
$151.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
63001518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$130.76
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cigna All Commercial |
$130.61
|
| Rate for Payer: CORVEL All Commercial |
$140.75
|
| Rate for Payer: Coventry All Commercial |
$133.19
|
| Rate for Payer: Encore All Commercial |
$139.32
|
| Rate for Payer: Frontpath All Commercial |
$139.24
|
| Rate for Payer: Humana ChoiceCare |
$130.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.21
|
| Rate for Payer: PHCS All Commercial |
$113.51
|
| Rate for Payer: PHP All Commercial |
$114.78
|
| Rate for Payer: Sagamore Health Network All Products |
$116.84
|
| Rate for Payer: Signature Care EPO |
$125.62
|
| Rate for Payer: Signature Care PPO |
$133.19
|
| Rate for Payer: United Healthcare Commercial |
$119.26
|
|
|
HC SUBTELOMERE FISH CHROMO HYBRID
|
Facility
OP
|
$61.67
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
63002086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$57.35 |
| Rate for Payer: Aetna Commercial |
$52.05
|
| Rate for Payer: Aetna Medicare |
$20.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$36.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.39
|
| Rate for Payer: Cash Price |
$38.24
|
| Rate for Payer: Cash Price |
$38.24
|
| Rate for Payer: Centivo All Commercial |
$31.45
|
| Rate for Payer: Cigna All Commercial |
$53.22
|
| Rate for Payer: CORVEL All Commercial |
$57.35
|
| Rate for Payer: Coventry All Commercial |
$54.27
|
| Rate for Payer: Encore All Commercial |
$56.77
|
| Rate for Payer: Frontpath All Commercial |
$56.74
|
| Rate for Payer: Humana ChoiceCare |
$53.26
|
| Rate for Payer: Humana Medicare |
$31.45
|
| Rate for Payer: Lucent All Commercial |
$31.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.50
|
| Rate for Payer: Managed Health Services Medicaid |
$36.44
|
| Rate for Payer: MDWise Medicaid |
$36.44
|
| Rate for Payer: PHCS All Commercial |
$46.25
|
| Rate for Payer: PHP All Commercial |
$46.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.05
|
| Rate for Payer: Sagamore Health Network All Products |
$47.61
|
| Rate for Payer: Signature Care EPO |
$51.19
|
| Rate for Payer: Signature Care PPO |
$54.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.42
|
| Rate for Payer: United Healthcare Commercial |
$48.60
|
| Rate for Payer: United Healthcare Medicare |
$20.35
|
|
|
HC SUBTELOMERE FISH CHROMO HYBRID
|
Facility
IP
|
$61.67
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
63002086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$57.35 |
| Rate for Payer: Cigna All Commercial |
$53.22
|
| Rate for Payer: Aetna Commercial |
$53.28
|
| Rate for Payer: Cash Price |
$38.24
|
| Rate for Payer: CORVEL All Commercial |
$57.35
|
| Rate for Payer: Coventry All Commercial |
$54.27
|
| Rate for Payer: Encore All Commercial |
$56.77
|
| Rate for Payer: Frontpath All Commercial |
$56.74
|
| Rate for Payer: Humana ChoiceCare |
$53.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.50
|
| Rate for Payer: PHCS All Commercial |
$46.25
|
| Rate for Payer: PHP All Commercial |
$46.77
|
| Rate for Payer: Sagamore Health Network All Products |
$47.61
|
| Rate for Payer: Signature Care EPO |
$51.19
|
| Rate for Payer: Signature Care PPO |
$54.27
|
| Rate for Payer: United Healthcare Commercial |
$48.60
|
|
|
HC SUBTELOMERE FISH MOLEC DNA EA
|
Facility
OP
|
$366.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$340.70 |
| Rate for Payer: Aetna Commercial |
$309.19
|
| Rate for Payer: Aetna Medicare |
$120.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$210.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$229.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$132.98
|
| Rate for Payer: Cash Price |
$227.13
|
| Rate for Payer: Cash Price |
$227.13
|
| Rate for Payer: Centivo All Commercial |
$186.84
|
| Rate for Payer: Cigna All Commercial |
$316.15
|
| Rate for Payer: CORVEL All Commercial |
$340.70
|
| Rate for Payer: Coventry All Commercial |
$322.38
|
| Rate for Payer: Encore All Commercial |
$337.22
|
| Rate for Payer: Frontpath All Commercial |
$337.04
|
| Rate for Payer: Humana ChoiceCare |
$316.41
|
| Rate for Payer: Humana Medicare |
$186.84
|
| Rate for Payer: Lucent All Commercial |
$186.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$329.71
|
| Rate for Payer: Managed Health Services Medicaid |
$19.70
|
| Rate for Payer: MDWise Medicaid |
$19.70
|
| Rate for Payer: PHCS All Commercial |
$274.76
|
| Rate for Payer: PHP All Commercial |
$277.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.87
|
| Rate for Payer: Sagamore Health Network All Products |
$282.82
|
| Rate for Payer: Signature Care EPO |
$304.06
|
| Rate for Payer: Signature Care PPO |
$322.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$311.39
|
| Rate for Payer: United Healthcare Commercial |
$288.68
|
| Rate for Payer: United Healthcare Medicare |
$120.89
|
|
|
HC SUBTELOMERE FISH MOLEC DNA EA
|
Facility
IP
|
$366.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$274.76 |
| Max. Negotiated Rate |
$340.70 |
| Rate for Payer: Aetna Commercial |
$316.52
|
| Rate for Payer: Cash Price |
$227.13
|
| Rate for Payer: Cigna All Commercial |
$316.15
|
| Rate for Payer: CORVEL All Commercial |
$340.70
|
| Rate for Payer: Coventry All Commercial |
$322.38
|
| Rate for Payer: Encore All Commercial |
$337.22
|
| Rate for Payer: Frontpath All Commercial |
$337.04
|
| Rate for Payer: Humana ChoiceCare |
$316.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$329.71
|
| Rate for Payer: PHCS All Commercial |
$274.76
|
| Rate for Payer: PHP All Commercial |
$277.83
|
| Rate for Payer: Sagamore Health Network All Products |
$282.82
|
| Rate for Payer: Signature Care EPO |
$304.06
|
| Rate for Payer: Signature Care PPO |
$322.38
|
| Rate for Payer: United Healthcare Commercial |
$288.68
|
|
|
HC SUCTION COAGULATOR 10 FR 6 IN
|
Facility
IP
|
$63.24
|
|
| Hospital Charge Code |
41602435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.43 |
| Max. Negotiated Rate |
$58.81 |
| Rate for Payer: Aetna Commercial |
$54.64
|
| Rate for Payer: Cash Price |
$39.21
|
| Rate for Payer: Cigna All Commercial |
$54.58
|
| Rate for Payer: CORVEL All Commercial |
$58.81
|
| Rate for Payer: Coventry All Commercial |
$55.65
|
| Rate for Payer: Encore All Commercial |
$58.21
|
| Rate for Payer: Frontpath All Commercial |
$58.18
|
| Rate for Payer: Humana ChoiceCare |
$54.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.92
|
| Rate for Payer: PHCS All Commercial |
$47.43
|
| Rate for Payer: PHP All Commercial |
$47.96
|
| Rate for Payer: Sagamore Health Network All Products |
$48.82
|
| Rate for Payer: Signature Care EPO |
$52.49
|
| Rate for Payer: Signature Care PPO |
$55.65
|
| Rate for Payer: United Healthcare Commercial |
$49.83
|
|
|
HC SUCTION COAGULATOR 10 FR 6 IN
|
Facility
OP
|
$63.24
|
|
| Hospital Charge Code |
41602435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna Medicare |
$20.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.96
|
| Rate for Payer: Cash Price |
$39.21
|
| Rate for Payer: Cash Price |
$39.21
|
| Rate for Payer: Centivo All Commercial |
$32.25
|
| Rate for Payer: Cigna All Commercial |
$54.58
|
| Rate for Payer: CORVEL All Commercial |
$58.81
|
| Rate for Payer: Coventry All Commercial |
$55.65
|
| Rate for Payer: Encore All Commercial |
$58.21
|
| Rate for Payer: Frontpath All Commercial |
$58.18
|
| Rate for Payer: Humana ChoiceCare |
$54.62
|
| Rate for Payer: Humana Medicare |
$32.25
|
| Rate for Payer: Lucent All Commercial |
$32.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$47.43
|
| Rate for Payer: PHP All Commercial |
$47.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.66
|
| Rate for Payer: Sagamore Health Network All Products |
$48.82
|
| Rate for Payer: Signature Care EPO |
$52.49
|
| Rate for Payer: Signature Care PPO |
$55.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.75
|
| Rate for Payer: United Healthcare Commercial |
$49.83
|
| Rate for Payer: United Healthcare Medicare |
$20.87
|
|
|
HC SUCTION COAGULATOR 8 FR 6 IN
|
Facility
OP
|
$95.69
|
|
| Hospital Charge Code |
41602436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.58 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$80.76
|
| Rate for Payer: Aetna Medicare |
$31.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.74
|
| Rate for Payer: Cash Price |
$59.33
|
| Rate for Payer: Cash Price |
$59.33
|
| Rate for Payer: Centivo All Commercial |
$48.80
|
| Rate for Payer: Cigna All Commercial |
$82.58
|
| Rate for Payer: CORVEL All Commercial |
$88.99
|
| Rate for Payer: Coventry All Commercial |
$84.21
|
| Rate for Payer: Encore All Commercial |
$88.08
|
| Rate for Payer: Frontpath All Commercial |
$88.03
|
| Rate for Payer: Humana ChoiceCare |
$82.65
|
| Rate for Payer: Humana Medicare |
$48.80
|
| Rate for Payer: Lucent All Commercial |
$48.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$71.77
|
| Rate for Payer: PHP All Commercial |
$72.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.32
|
| Rate for Payer: Sagamore Health Network All Products |
$73.87
|
| Rate for Payer: Signature Care EPO |
$79.42
|
| Rate for Payer: Signature Care PPO |
$84.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.34
|
| Rate for Payer: United Healthcare Commercial |
$75.40
|
| Rate for Payer: United Healthcare Medicare |
$31.58
|
|
|
HC SUCTION COAGULATOR 8 FR 6 IN
|
Facility
IP
|
$95.69
|
|
| Hospital Charge Code |
41602436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.77 |
| Max. Negotiated Rate |
$88.99 |
| Rate for Payer: Aetna Commercial |
$82.68
|
| Rate for Payer: Cash Price |
$59.33
|
| Rate for Payer: Cigna All Commercial |
$82.58
|
| Rate for Payer: CORVEL All Commercial |
$88.99
|
| Rate for Payer: Coventry All Commercial |
$84.21
|
| Rate for Payer: Encore All Commercial |
$88.08
|
| Rate for Payer: Frontpath All Commercial |
$88.03
|
| Rate for Payer: Humana ChoiceCare |
$82.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.12
|
| Rate for Payer: PHCS All Commercial |
$71.77
|
| Rate for Payer: PHP All Commercial |
$72.57
|
| Rate for Payer: Sagamore Health Network All Products |
$73.87
|
| Rate for Payer: Signature Care EPO |
$79.42
|
| Rate for Payer: Signature Care PPO |
$84.21
|
| Rate for Payer: United Healthcare Commercial |
$75.40
|
|
|
HC SUCTION IRRIGATOR
|
Facility
IP
|
$427.90
|
|
| Hospital Charge Code |
41601130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.92 |
| Max. Negotiated Rate |
$397.95 |
| Rate for Payer: Aetna Commercial |
$369.71
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cigna All Commercial |
$369.28
|
| Rate for Payer: CORVEL All Commercial |
$397.95
|
| Rate for Payer: Coventry All Commercial |
$376.55
|
| Rate for Payer: Encore All Commercial |
$393.88
|
| Rate for Payer: Frontpath All Commercial |
$393.67
|
| Rate for Payer: Humana ChoiceCare |
$369.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$385.11
|
| Rate for Payer: PHCS All Commercial |
$320.92
|
| Rate for Payer: PHP All Commercial |
$324.52
|
| Rate for Payer: Sagamore Health Network All Products |
$330.34
|
| Rate for Payer: Signature Care EPO |
$355.16
|
| Rate for Payer: Signature Care PPO |
$376.55
|
| Rate for Payer: United Healthcare Commercial |
$337.19
|
|
|
HC SUCTION IRRIGATOR
|
Facility
OP
|
$427.90
|
|
| Hospital Charge Code |
41601130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$397.95 |
| Rate for Payer: Aetna Commercial |
$361.15
|
| Rate for Payer: Aetna Medicare |
$141.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$245.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$267.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.33
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Centivo All Commercial |
$218.23
|
| Rate for Payer: Cigna All Commercial |
$369.28
|
| Rate for Payer: CORVEL All Commercial |
$397.95
|
| Rate for Payer: Coventry All Commercial |
$376.55
|
| Rate for Payer: Encore All Commercial |
$393.88
|
| Rate for Payer: Frontpath All Commercial |
$393.67
|
| Rate for Payer: Humana ChoiceCare |
$369.58
|
| Rate for Payer: Humana Medicare |
$218.23
|
| Rate for Payer: Lucent All Commercial |
$218.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$385.11
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$320.92
|
| Rate for Payer: PHP All Commercial |
$324.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.88
|
| Rate for Payer: Sagamore Health Network All Products |
$330.34
|
| Rate for Payer: Signature Care EPO |
$355.16
|
| Rate for Payer: Signature Care PPO |
$376.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$363.72
|
| Rate for Payer: United Healthcare Commercial |
$337.19
|
| Rate for Payer: United Healthcare Medicare |
$141.21
|
|
|
HC SUCTION TIP ORTHO
|
Facility
IP
|
$1,078.51
|
|
| Hospital Charge Code |
41602394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$808.88 |
| Max. Negotiated Rate |
$1,003.01 |
| Rate for Payer: Aetna Commercial |
$931.83
|
| Rate for Payer: Cash Price |
$668.68
|
| Rate for Payer: Cigna All Commercial |
$930.75
|
| Rate for Payer: CORVEL All Commercial |
$1,003.01
|
| Rate for Payer: Coventry All Commercial |
$949.09
|
| Rate for Payer: Encore All Commercial |
$992.77
|
| Rate for Payer: Frontpath All Commercial |
$992.23
|
| Rate for Payer: Humana ChoiceCare |
$931.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$970.66
|
| Rate for Payer: PHCS All Commercial |
$808.88
|
| Rate for Payer: PHP All Commercial |
$817.94
|
| Rate for Payer: Sagamore Health Network All Products |
$832.61
|
| Rate for Payer: Signature Care EPO |
$895.16
|
| Rate for Payer: Signature Care PPO |
$949.09
|
| Rate for Payer: United Healthcare Commercial |
$849.87
|
|
|
HC SUCTION TIP ORTHO
|
Facility
OP
|
$1,078.51
|
|
| Hospital Charge Code |
41602394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,003.01 |
| Rate for Payer: Aetna Commercial |
$910.26
|
| Rate for Payer: Aetna Medicare |
$355.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$355.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$619.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$674.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$409.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$391.50
|
| Rate for Payer: Cash Price |
$668.68
|
| Rate for Payer: Cash Price |
$668.68
|
| Rate for Payer: Centivo All Commercial |
$550.04
|
| Rate for Payer: Cigna All Commercial |
$930.75
|
| Rate for Payer: CORVEL All Commercial |
$1,003.01
|
| Rate for Payer: Coventry All Commercial |
$949.09
|
| Rate for Payer: Encore All Commercial |
$992.77
|
| Rate for Payer: Frontpath All Commercial |
$992.23
|
| Rate for Payer: Humana ChoiceCare |
$931.51
|
| Rate for Payer: Humana Medicare |
$550.04
|
| Rate for Payer: Lucent All Commercial |
$550.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$970.66
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$808.88
|
| Rate for Payer: PHP All Commercial |
$817.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$420.62
|
| Rate for Payer: Sagamore Health Network All Products |
$832.61
|
| Rate for Payer: Signature Care EPO |
$895.16
|
| Rate for Payer: Signature Care PPO |
$949.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$916.73
|
| Rate for Payer: United Healthcare Commercial |
$849.87
|
| Rate for Payer: United Healthcare Medicare |
$355.91
|
|
|
HC SUPPORT ABD 30-45
|
Facility
OP
|
$42.91
|
|
|
Service Code
|
CPT A4461
|
| Hospital Charge Code |
41601233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$36.22
|
| Rate for Payer: Aetna Medicare |
$14.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.58
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Centivo All Commercial |
$21.88
|
| Rate for Payer: Cigna All Commercial |
$37.03
|
| Rate for Payer: CORVEL All Commercial |
$39.91
|
| Rate for Payer: Coventry All Commercial |
$37.76
|
| Rate for Payer: Encore All Commercial |
$39.50
|
| Rate for Payer: Frontpath All Commercial |
$39.48
|
| Rate for Payer: Humana ChoiceCare |
$37.06
|
| Rate for Payer: Humana Medicare |
$21.88
|
| Rate for Payer: Lucent All Commercial |
$21.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$32.18
|
| Rate for Payer: PHP All Commercial |
$32.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.73
|
| Rate for Payer: Sagamore Health Network All Products |
$33.13
|
| Rate for Payer: Signature Care EPO |
$35.62
|
| Rate for Payer: Signature Care PPO |
$37.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.47
|
| Rate for Payer: United Healthcare Commercial |
$33.81
|
| Rate for Payer: United Healthcare Medicare |
$14.16
|
|
|
HC SUPPORT ABD 30-45
|
Facility
IP
|
$42.91
|
|
|
Service Code
|
CPT A4461
|
| Hospital Charge Code |
41601233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.18 |
| Max. Negotiated Rate |
$39.91 |
| Rate for Payer: Aetna Commercial |
$37.07
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cigna All Commercial |
$37.03
|
| Rate for Payer: CORVEL All Commercial |
$39.91
|
| Rate for Payer: Coventry All Commercial |
$37.76
|
| Rate for Payer: Encore All Commercial |
$39.50
|
| Rate for Payer: Frontpath All Commercial |
$39.48
|
| Rate for Payer: Humana ChoiceCare |
$37.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.62
|
| Rate for Payer: PHCS All Commercial |
$32.18
|
| Rate for Payer: PHP All Commercial |
$32.54
|
| Rate for Payer: Sagamore Health Network All Products |
$33.13
|
| Rate for Payer: Signature Care EPO |
$35.62
|
| Rate for Payer: Signature Care PPO |
$37.76
|
| Rate for Payer: United Healthcare Commercial |
$33.81
|
|
|
HC SUPPORT ABD 46-62
|
Facility
IP
|
$43.61
|
|
|
Service Code
|
CPT A4461
|
| Hospital Charge Code |
41601234
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.71 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Aetna Commercial |
$37.68
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: Cigna All Commercial |
$37.64
|
| Rate for Payer: CORVEL All Commercial |
$40.56
|
| Rate for Payer: Coventry All Commercial |
$38.38
|
| Rate for Payer: Encore All Commercial |
$40.14
|
| Rate for Payer: Frontpath All Commercial |
$40.12
|
| Rate for Payer: Humana ChoiceCare |
$37.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.25
|
| Rate for Payer: PHCS All Commercial |
$32.71
|
| Rate for Payer: PHP All Commercial |
$33.07
|
| Rate for Payer: Sagamore Health Network All Products |
$33.67
|
| Rate for Payer: Signature Care EPO |
$36.20
|
| Rate for Payer: Signature Care PPO |
$38.38
|
| Rate for Payer: United Healthcare Commercial |
$34.36
|
|
|
HC SUPPORT ABD 46-62
|
Facility
OP
|
$43.61
|
|
|
Service Code
|
CPT A4461
|
| Hospital Charge Code |
41601234
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$36.81
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.83
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: Centivo All Commercial |
$22.24
|
| Rate for Payer: Cigna All Commercial |
$37.64
|
| Rate for Payer: CORVEL All Commercial |
$40.56
|
| Rate for Payer: Coventry All Commercial |
$38.38
|
| Rate for Payer: Encore All Commercial |
$40.14
|
| Rate for Payer: Frontpath All Commercial |
$40.12
|
| Rate for Payer: Humana ChoiceCare |
$37.67
|
| Rate for Payer: Humana Medicare |
$22.24
|
| Rate for Payer: Lucent All Commercial |
$22.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.25
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$32.71
|
| Rate for Payer: PHP All Commercial |
$33.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.01
|
| Rate for Payer: Sagamore Health Network All Products |
$33.67
|
| Rate for Payer: Signature Care EPO |
$36.20
|
| Rate for Payer: Signature Care PPO |
$38.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.07
|
| Rate for Payer: United Healthcare Commercial |
$34.36
|
| Rate for Payer: United Healthcare Medicare |
$14.39
|
|
|
HC SUPPORT SCROTAL
|
Facility
IP
|
$80.57
|
|
| Hospital Charge Code |
41601131
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.43 |
| Max. Negotiated Rate |
$74.93 |
| Rate for Payer: Aetna Commercial |
$69.61
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cigna All Commercial |
$69.53
|
| Rate for Payer: CORVEL All Commercial |
$74.93
|
| Rate for Payer: Coventry All Commercial |
$70.90
|
| Rate for Payer: Encore All Commercial |
$74.16
|
| Rate for Payer: Frontpath All Commercial |
$74.12
|
| Rate for Payer: Humana ChoiceCare |
$69.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.51
|
| Rate for Payer: PHCS All Commercial |
$60.43
|
| Rate for Payer: PHP All Commercial |
$61.10
|
| Rate for Payer: Sagamore Health Network All Products |
$62.20
|
| Rate for Payer: Signature Care EPO |
$66.87
|
| Rate for Payer: Signature Care PPO |
$70.90
|
| Rate for Payer: United Healthcare Commercial |
$63.49
|
|
|
HC SUPPORT SCROTAL
|
Facility
OP
|
$80.57
|
|
| Hospital Charge Code |
41601131
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.59 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna Medicare |
$26.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.25
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Centivo All Commercial |
$41.09
|
| Rate for Payer: Cigna All Commercial |
$69.53
|
| Rate for Payer: CORVEL All Commercial |
$74.93
|
| Rate for Payer: Coventry All Commercial |
$70.90
|
| Rate for Payer: Encore All Commercial |
$74.16
|
| Rate for Payer: Frontpath All Commercial |
$74.12
|
| Rate for Payer: Humana ChoiceCare |
$69.59
|
| Rate for Payer: Humana Medicare |
$41.09
|
| Rate for Payer: Lucent All Commercial |
$41.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.51
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$60.43
|
| Rate for Payer: PHP All Commercial |
$61.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.42
|
| Rate for Payer: Sagamore Health Network All Products |
$62.20
|
| Rate for Payer: Signature Care EPO |
$66.87
|
| Rate for Payer: Signature Care PPO |
$70.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.48
|
| Rate for Payer: United Healthcare Commercial |
$63.49
|
| Rate for Payer: United Healthcare Medicare |
$26.59
|
|
|
HC SUREPATH HPV 36392
|
Facility
IP
|
$76.70
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
63044016
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.53 |
| Max. Negotiated Rate |
$71.33 |
| Rate for Payer: Aetna Commercial |
$66.27
|
| Rate for Payer: Cash Price |
$47.56
|
| Rate for Payer: Cigna All Commercial |
$66.20
|
| Rate for Payer: CORVEL All Commercial |
$71.33
|
| Rate for Payer: Coventry All Commercial |
$67.50
|
| Rate for Payer: Encore All Commercial |
$70.61
|
| Rate for Payer: Frontpath All Commercial |
$70.57
|
| Rate for Payer: Humana ChoiceCare |
$66.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.03
|
| Rate for Payer: PHCS All Commercial |
$57.53
|
| Rate for Payer: PHP All Commercial |
$58.17
|
| Rate for Payer: Sagamore Health Network All Products |
$59.22
|
| Rate for Payer: Signature Care EPO |
$63.66
|
| Rate for Payer: Signature Care PPO |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$60.44
|
|
|
HC SUREPATH HPV 36392
|
Facility
OP
|
$76.70
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
63044016
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.31 |
| Max. Negotiated Rate |
$71.33 |
| Rate for Payer: Aetna Commercial |
$64.74
|
| Rate for Payer: Aetna Medicare |
$25.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.84
|
| Rate for Payer: Cash Price |
$47.56
|
| Rate for Payer: Cash Price |
$47.56
|
| Rate for Payer: Centivo All Commercial |
$39.12
|
| Rate for Payer: Cigna All Commercial |
$66.20
|
| Rate for Payer: CORVEL All Commercial |
$71.33
|
| Rate for Payer: Coventry All Commercial |
$67.50
|
| Rate for Payer: Encore All Commercial |
$70.61
|
| Rate for Payer: Frontpath All Commercial |
$70.57
|
| Rate for Payer: Humana ChoiceCare |
$66.25
|
| Rate for Payer: Humana Medicare |
$39.12
|
| Rate for Payer: Lucent All Commercial |
$39.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.03
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$57.53
|
| Rate for Payer: PHP All Commercial |
$58.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.91
|
| Rate for Payer: Sagamore Health Network All Products |
$59.22
|
| Rate for Payer: Signature Care EPO |
$63.66
|
| Rate for Payer: Signature Care PPO |
$67.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.20
|
| Rate for Payer: United Healthcare Commercial |
$60.44
|
| Rate for Payer: United Healthcare Medicare |
$25.31
|
|
|
HC SURGICAL CULTURE
|
Facility
IP
|
$372.29
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
63001999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$279.22 |
| Max. Negotiated Rate |
$346.23 |
| Rate for Payer: Aetna Commercial |
$321.66
|
| Rate for Payer: Cash Price |
$230.82
|
| Rate for Payer: Cigna All Commercial |
$321.29
|
| Rate for Payer: CORVEL All Commercial |
$346.23
|
| Rate for Payer: Coventry All Commercial |
$327.62
|
| Rate for Payer: Encore All Commercial |
$342.69
|
| Rate for Payer: Frontpath All Commercial |
$342.51
|
| Rate for Payer: Humana ChoiceCare |
$321.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$335.06
|
| Rate for Payer: PHCS All Commercial |
$279.22
|
| Rate for Payer: PHP All Commercial |
$282.34
|
| Rate for Payer: Sagamore Health Network All Products |
$287.41
|
| Rate for Payer: Signature Care EPO |
$309.00
|
| Rate for Payer: Signature Care PPO |
$327.62
|
| Rate for Payer: United Healthcare Commercial |
$293.36
|
|
