|
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
|
|
|
HC SURGICEL 2X14
|
Facility
|
OP
|
$471.14
|
|
| Hospital Charge Code |
41602085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$438.16 |
| Rate for Payer: Aetna Commercial |
$397.64
|
| Rate for Payer: Aetna Medicare |
$155.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$155.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$270.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$178.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.02
|
| Rate for Payer: Cash Price |
$292.11
|
| Rate for Payer: Cash Price |
$292.11
|
| Rate for Payer: Centivo All Commercial |
$240.28
|
| Rate for Payer: Cigna All Commercial |
$406.59
|
| Rate for Payer: CORVEL All Commercial |
$438.16
|
| Rate for Payer: Coventry All Commercial |
$414.60
|
| Rate for Payer: Encore All Commercial |
$433.68
|
| Rate for Payer: Frontpath All Commercial |
$433.45
|
| Rate for Payer: Humana ChoiceCare |
$406.92
|
| Rate for Payer: Humana Medicare |
$240.28
|
| Rate for Payer: Lucent All Commercial |
$240.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$353.36
|
| Rate for Payer: PHP All Commercial |
$357.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$183.74
|
| Rate for Payer: Sagamore Health Network All Products |
$363.72
|
| Rate for Payer: Signature Care EPO |
$391.05
|
| Rate for Payer: Signature Care PPO |
$414.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.47
|
| Rate for Payer: United Healthcare Commercial |
$371.26
|
| Rate for Payer: United Healthcare Medicare |
$155.48
|
|
|
HC SURGICEL 2X14
|
Facility
|
IP
|
$471.14
|
|
| Hospital Charge Code |
41602085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.36 |
| Max. Negotiated Rate |
$438.16 |
| Rate for Payer: Aetna Commercial |
$407.06
|
| Rate for Payer: Cash Price |
$292.11
|
| Rate for Payer: Cigna All Commercial |
$406.59
|
| Rate for Payer: CORVEL All Commercial |
$438.16
|
| Rate for Payer: Coventry All Commercial |
$414.60
|
| Rate for Payer: Encore All Commercial |
$433.68
|
| Rate for Payer: Frontpath All Commercial |
$433.45
|
| Rate for Payer: Humana ChoiceCare |
$406.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.03
|
| Rate for Payer: PHCS All Commercial |
$353.36
|
| Rate for Payer: PHP All Commercial |
$357.31
|
| Rate for Payer: Sagamore Health Network All Products |
$363.72
|
| Rate for Payer: Signature Care EPO |
$391.05
|
| Rate for Payer: Signature Care PPO |
$414.60
|
| Rate for Payer: United Healthcare Commercial |
$371.26
|
|
|
HC SURGICEL POWDER 3.0
|
Facility
|
OP
|
$808.85
|
|
| Hospital Charge Code |
41607789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$752.23 |
| Rate for Payer: Aetna Commercial |
$682.67
|
| Rate for Payer: Aetna Medicare |
$266.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$266.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$464.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$505.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$306.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$293.61
|
| Rate for Payer: Cash Price |
$501.49
|
| Rate for Payer: Cash Price |
$501.49
|
| Rate for Payer: Centivo All Commercial |
$412.51
|
| Rate for Payer: Cigna All Commercial |
$698.04
|
| Rate for Payer: CORVEL All Commercial |
$752.23
|
| Rate for Payer: Coventry All Commercial |
$711.79
|
| Rate for Payer: Encore All Commercial |
$744.55
|
| Rate for Payer: Frontpath All Commercial |
$744.14
|
| Rate for Payer: Humana ChoiceCare |
$698.60
|
| Rate for Payer: Humana Medicare |
$412.51
|
| Rate for Payer: Lucent All Commercial |
$412.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$727.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$606.64
|
| Rate for Payer: PHP All Commercial |
$613.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$315.45
|
| Rate for Payer: Sagamore Health Network All Products |
$624.43
|
| Rate for Payer: Signature Care EPO |
$671.35
|
| Rate for Payer: Signature Care PPO |
$711.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$687.52
|
| Rate for Payer: United Healthcare Commercial |
$637.37
|
| Rate for Payer: United Healthcare Medicare |
$266.92
|
|
|
HC SURGICEL POWDER 3.0
|
Facility
|
IP
|
$808.85
|
|
| Hospital Charge Code |
41607789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.64 |
| Max. Negotiated Rate |
$752.23 |
| Rate for Payer: Aetna Commercial |
$698.85
|
| Rate for Payer: Cash Price |
$501.49
|
| Rate for Payer: Cigna All Commercial |
$698.04
|
| Rate for Payer: CORVEL All Commercial |
$752.23
|
| Rate for Payer: Coventry All Commercial |
$711.79
|
| Rate for Payer: Encore All Commercial |
$744.55
|
| Rate for Payer: Frontpath All Commercial |
$744.14
|
| Rate for Payer: Humana ChoiceCare |
$698.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$727.96
|
| Rate for Payer: PHCS All Commercial |
$606.64
|
| Rate for Payer: PHP All Commercial |
$613.43
|
| Rate for Payer: Sagamore Health Network All Products |
$624.43
|
| Rate for Payer: Signature Care EPO |
$671.35
|
| Rate for Payer: Signature Care PPO |
$711.79
|
| Rate for Payer: United Healthcare Commercial |
$637.37
|
|
|
HC SURGICLIP PREMIUM LARGE
|
Facility
|
OP
|
$360.65
|
|
| Hospital Charge Code |
41602493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.01 |
| Max. Negotiated Rate |
$335.40 |
| Rate for Payer: Aetna Commercial |
$304.39
|
| Rate for Payer: Aetna Medicare |
$119.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$207.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$136.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$130.92
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Centivo All Commercial |
$183.93
|
| Rate for Payer: Cigna All Commercial |
$311.24
|
| Rate for Payer: CORVEL All Commercial |
$335.40
|
| Rate for Payer: Coventry All Commercial |
$317.37
|
| Rate for Payer: Encore All Commercial |
$331.98
|
| Rate for Payer: Frontpath All Commercial |
$331.80
|
| Rate for Payer: Humana ChoiceCare |
$311.49
|
| Rate for Payer: Humana Medicare |
$183.93
|
| Rate for Payer: Lucent All Commercial |
$183.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$324.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$270.49
|
| Rate for Payer: PHP All Commercial |
$273.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.65
|
| Rate for Payer: Sagamore Health Network All Products |
$278.42
|
| Rate for Payer: Signature Care EPO |
$299.34
|
| Rate for Payer: Signature Care PPO |
$317.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$306.55
|
| Rate for Payer: United Healthcare Commercial |
$284.19
|
| Rate for Payer: United Healthcare Medicare |
$119.01
|
|
|
HC SURGICLIP PREMIUM LARGE
|
Facility
|
IP
|
$360.65
|
|
| Hospital Charge Code |
41602493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.49 |
| Max. Negotiated Rate |
$335.40 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cigna All Commercial |
$311.24
|
| Rate for Payer: CORVEL All Commercial |
$335.40
|
| Rate for Payer: Coventry All Commercial |
$317.37
|
| Rate for Payer: Encore All Commercial |
$331.98
|
| Rate for Payer: Frontpath All Commercial |
$331.80
|
| Rate for Payer: Humana ChoiceCare |
$311.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$324.58
|
| Rate for Payer: PHCS All Commercial |
$270.49
|
| Rate for Payer: PHP All Commercial |
$273.52
|
| Rate for Payer: Sagamore Health Network All Products |
$278.42
|
| Rate for Payer: Signature Care EPO |
$299.34
|
| Rate for Payer: Signature Care PPO |
$317.37
|
| Rate for Payer: United Healthcare Commercial |
$284.19
|
|
|
HC SURGINEEDLE 150MM
|
Facility
|
IP
|
$293.43
|
|
| Hospital Charge Code |
41602487
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.07 |
| Max. Negotiated Rate |
$272.89 |
| Rate for Payer: Aetna Commercial |
$253.52
|
| Rate for Payer: Cash Price |
$181.93
|
| Rate for Payer: Cigna All Commercial |
$253.23
|
| Rate for Payer: CORVEL All Commercial |
$272.89
|
| Rate for Payer: Coventry All Commercial |
$258.22
|
| Rate for Payer: Encore All Commercial |
$270.10
|
| Rate for Payer: Frontpath All Commercial |
$269.96
|
| Rate for Payer: Humana ChoiceCare |
$253.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.09
|
| Rate for Payer: PHCS All Commercial |
$220.07
|
| Rate for Payer: PHP All Commercial |
$222.54
|
| Rate for Payer: Sagamore Health Network All Products |
$226.53
|
| Rate for Payer: Signature Care EPO |
$243.55
|
| Rate for Payer: Signature Care PPO |
$258.22
|
| Rate for Payer: United Healthcare Commercial |
$231.22
|
|
|
HC SURGINEEDLE 150MM
|
Facility
|
OP
|
$293.43
|
|
| Hospital Charge Code |
41602487
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.83 |
| Max. Negotiated Rate |
$272.89 |
| Rate for Payer: Aetna Commercial |
$247.65
|
| Rate for Payer: Aetna Medicare |
$96.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$168.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.52
|
| Rate for Payer: Cash Price |
$181.93
|
| Rate for Payer: Cash Price |
$181.93
|
| Rate for Payer: Centivo All Commercial |
$149.65
|
| Rate for Payer: Cigna All Commercial |
$253.23
|
| Rate for Payer: CORVEL All Commercial |
$272.89
|
| Rate for Payer: Coventry All Commercial |
$258.22
|
| Rate for Payer: Encore All Commercial |
$270.10
|
| Rate for Payer: Frontpath All Commercial |
$269.96
|
| Rate for Payer: Humana ChoiceCare |
$253.44
|
| Rate for Payer: Humana Medicare |
$149.65
|
| Rate for Payer: Lucent All Commercial |
$149.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.09
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$220.07
|
| Rate for Payer: PHP All Commercial |
$222.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.44
|
| Rate for Payer: Sagamore Health Network All Products |
$226.53
|
| Rate for Payer: Signature Care EPO |
$243.55
|
| Rate for Payer: Signature Care PPO |
$258.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$249.42
|
| Rate for Payer: United Healthcare Commercial |
$231.22
|
| Rate for Payer: United Healthcare Medicare |
$96.83
|
|
|
HC SUT MCRYL+ 0 CT 36" MCP358H
|
Facility
|
IP
|
$17.39
|
|
| Hospital Charge Code |
41607964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Aetna Commercial |
$15.02
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cigna All Commercial |
$15.01
|
| Rate for Payer: CORVEL All Commercial |
$16.17
|
| Rate for Payer: Coventry All Commercial |
$15.30
|
| Rate for Payer: Encore All Commercial |
$16.01
|
| Rate for Payer: Frontpath All Commercial |
$16.00
|
| Rate for Payer: Humana ChoiceCare |
$15.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.65
|
| Rate for Payer: PHCS All Commercial |
$13.04
|
| Rate for Payer: PHP All Commercial |
$13.19
|
| Rate for Payer: Sagamore Health Network All Products |
$13.43
|
| Rate for Payer: Signature Care EPO |
$14.43
|
| Rate for Payer: Signature Care PPO |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$13.70
|
|
|
HC SUT MCRYL+ 0 CT 36" MCP358H
|
Facility
|
OP
|
$17.39
|
|
| Hospital Charge Code |
41607964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.68
|
| Rate for Payer: Aetna Medicare |
$5.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.31
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Centivo All Commercial |
$8.87
|
| Rate for Payer: Cigna All Commercial |
$15.01
|
| Rate for Payer: CORVEL All Commercial |
$16.17
|
| Rate for Payer: Coventry All Commercial |
$15.30
|
| Rate for Payer: Encore All Commercial |
$16.01
|
| Rate for Payer: Frontpath All Commercial |
$16.00
|
| Rate for Payer: Humana ChoiceCare |
$15.02
|
| Rate for Payer: Humana Medicare |
$8.87
|
| Rate for Payer: Lucent All Commercial |
$8.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.65
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.04
|
| Rate for Payer: PHP All Commercial |
$13.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.78
|
| Rate for Payer: Sagamore Health Network All Products |
$13.43
|
| Rate for Payer: Signature Care EPO |
$14.43
|
| Rate for Payer: Signature Care PPO |
$15.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$13.70
|
| Rate for Payer: United Healthcare Medicare |
$5.74
|
|
|
HC SUT MCRYL+ 2-0 SH 27" MCP417H
|
Facility
|
OP
|
$16.86
|
|
| Hospital Charge Code |
41607965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.12
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Centivo All Commercial |
$8.60
|
| Rate for Payer: Cigna All Commercial |
$14.55
|
| Rate for Payer: CORVEL All Commercial |
$15.68
|
| Rate for Payer: Coventry All Commercial |
$14.84
|
| Rate for Payer: Encore All Commercial |
$15.52
|
| Rate for Payer: Frontpath All Commercial |
$15.51
|
| Rate for Payer: Humana ChoiceCare |
$14.56
|
| Rate for Payer: Humana Medicare |
$8.60
|
| Rate for Payer: Lucent All Commercial |
$8.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.17
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.64
|
| Rate for Payer: PHP All Commercial |
$12.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.58
|
| Rate for Payer: Sagamore Health Network All Products |
$13.02
|
| Rate for Payer: Signature Care EPO |
$13.99
|
| Rate for Payer: Signature Care PPO |
$14.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.33
|
| Rate for Payer: United Healthcare Commercial |
$13.29
|
| Rate for Payer: United Healthcare Medicare |
$5.56
|
|
|
HC SUT MCRYL+ 2-0 SH 27" MCP417H
|
Facility
|
IP
|
$16.86
|
|
| Hospital Charge Code |
41607965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna Commercial |
$14.57
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cigna All Commercial |
$14.55
|
| Rate for Payer: CORVEL All Commercial |
$15.68
|
| Rate for Payer: Coventry All Commercial |
$14.84
|
| Rate for Payer: Encore All Commercial |
$15.52
|
| Rate for Payer: Frontpath All Commercial |
$15.51
|
| Rate for Payer: Humana ChoiceCare |
$14.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.17
|
| Rate for Payer: PHCS All Commercial |
$12.64
|
| Rate for Payer: PHP All Commercial |
$12.79
|
| Rate for Payer: Sagamore Health Network All Products |
$13.02
|
| Rate for Payer: Signature Care EPO |
$13.99
|
| Rate for Payer: Signature Care PPO |
$14.84
|
| Rate for Payer: United Healthcare Commercial |
$13.29
|
|
|
HC SUT MCRYL+ 3-0 KS 27" MCP523H
|
Facility
|
IP
|
$25.68
|
|
| Hospital Charge Code |
41607966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.19
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cigna All Commercial |
$22.16
|
| Rate for Payer: CORVEL All Commercial |
$23.88
|
| Rate for Payer: Coventry All Commercial |
$22.60
|
| Rate for Payer: Encore All Commercial |
$23.64
|
| Rate for Payer: Frontpath All Commercial |
$23.63
|
| Rate for Payer: Humana ChoiceCare |
$22.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.11
|
| Rate for Payer: PHCS All Commercial |
$19.26
|
| Rate for Payer: PHP All Commercial |
$19.48
|
| Rate for Payer: Sagamore Health Network All Products |
$19.82
|
| Rate for Payer: Signature Care EPO |
$21.31
|
| Rate for Payer: Signature Care PPO |
$22.60
|
| Rate for Payer: United Healthcare Commercial |
$20.24
|
|
|
HC SUT MCRYL+ 3-0 KS 27" MCP523H
|
Facility
|
OP
|
$25.68
|
|
| Hospital Charge Code |
41607966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$21.67
|
| Rate for Payer: Aetna Medicare |
$8.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.32
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Centivo All Commercial |
$13.10
|
| Rate for Payer: Cigna All Commercial |
$22.16
|
| Rate for Payer: CORVEL All Commercial |
$23.88
|
| Rate for Payer: Coventry All Commercial |
$22.60
|
| Rate for Payer: Encore All Commercial |
$23.64
|
| Rate for Payer: Frontpath All Commercial |
$23.63
|
| Rate for Payer: Humana ChoiceCare |
$22.18
|
| Rate for Payer: Humana Medicare |
$13.10
|
| Rate for Payer: Lucent All Commercial |
$13.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.11
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$19.26
|
| Rate for Payer: PHP All Commercial |
$19.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.02
|
| Rate for Payer: Sagamore Health Network All Products |
$19.82
|
| Rate for Payer: Signature Care EPO |
$21.31
|
| Rate for Payer: Signature Care PPO |
$22.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.83
|
| Rate for Payer: United Healthcare Commercial |
$20.24
|
| Rate for Payer: United Healthcare Medicare |
$8.47
|
|
|
HC SUT MCRYL+ 3-0 PS-2 MCP427H
|
Facility
|
OP
|
$45.84
|
|
| Hospital Charge Code |
41607967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$38.69
|
| Rate for Payer: Aetna Medicare |
$15.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.64
|
| Rate for Payer: Cash Price |
$28.42
|
| Rate for Payer: Cash Price |
$28.42
|
| Rate for Payer: Centivo All Commercial |
$23.38
|
| Rate for Payer: Cigna All Commercial |
$39.56
|
| Rate for Payer: CORVEL All Commercial |
$42.63
|
| Rate for Payer: Coventry All Commercial |
$40.34
|
| Rate for Payer: Encore All Commercial |
$42.20
|
| Rate for Payer: Frontpath All Commercial |
$42.17
|
| Rate for Payer: Humana ChoiceCare |
$39.59
|
| Rate for Payer: Humana Medicare |
$23.38
|
| Rate for Payer: Lucent All Commercial |
$23.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$34.38
|
| Rate for Payer: PHP All Commercial |
$34.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.88
|
| Rate for Payer: Sagamore Health Network All Products |
$35.39
|
| Rate for Payer: Signature Care EPO |
$38.05
|
| Rate for Payer: Signature Care PPO |
$40.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.96
|
| Rate for Payer: United Healthcare Commercial |
$36.12
|
| Rate for Payer: United Healthcare Medicare |
$15.13
|
|
|
HC SUT MCRYL+ 3-0 PS-2 MCP427H
|
Facility
|
IP
|
$45.84
|
|
| Hospital Charge Code |
41607967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.38 |
| Max. Negotiated Rate |
$42.63 |
| Rate for Payer: Aetna Commercial |
$39.61
|
| Rate for Payer: Cash Price |
$28.42
|
| Rate for Payer: Cigna All Commercial |
$39.56
|
| Rate for Payer: CORVEL All Commercial |
$42.63
|
| Rate for Payer: Coventry All Commercial |
$40.34
|
| Rate for Payer: Encore All Commercial |
$42.20
|
| Rate for Payer: Frontpath All Commercial |
$42.17
|
| Rate for Payer: Humana ChoiceCare |
$39.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.26
|
| Rate for Payer: PHCS All Commercial |
$34.38
|
| Rate for Payer: PHP All Commercial |
$34.77
|
| Rate for Payer: Sagamore Health Network All Products |
$35.39
|
| Rate for Payer: Signature Care EPO |
$38.05
|
| Rate for Payer: Signature Care PPO |
$40.34
|
| Rate for Payer: United Healthcare Commercial |
$36.12
|
|
|
HC SUT MCRYL+ 4-0 P-3 18" MCP494G
|
Facility
|
IP
|
$45.35
|
|
| Hospital Charge Code |
41607968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$42.18 |
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Cash Price |
$28.12
|
| Rate for Payer: Cigna All Commercial |
$39.14
|
| Rate for Payer: CORVEL All Commercial |
$42.18
|
| Rate for Payer: Coventry All Commercial |
$39.91
|
| Rate for Payer: Encore All Commercial |
$41.74
|
| Rate for Payer: Frontpath All Commercial |
$41.72
|
| Rate for Payer: Humana ChoiceCare |
$39.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.82
|
| Rate for Payer: PHCS All Commercial |
$34.01
|
| Rate for Payer: PHP All Commercial |
$34.39
|
| Rate for Payer: Sagamore Health Network All Products |
$35.01
|
| Rate for Payer: Signature Care EPO |
$37.64
|
| Rate for Payer: Signature Care PPO |
$39.91
|
| Rate for Payer: United Healthcare Commercial |
$35.74
|
|
|
HC SUT MCRYL+ 4-0 P-3 18" MCP494G
|
Facility
|
OP
|
$45.35
|
|
| Hospital Charge Code |
41607968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$38.28
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.46
|
| Rate for Payer: Cash Price |
$28.12
|
| Rate for Payer: Cash Price |
$28.12
|
| Rate for Payer: Centivo All Commercial |
$23.13
|
| Rate for Payer: Cigna All Commercial |
$39.14
|
| Rate for Payer: CORVEL All Commercial |
$42.18
|
| Rate for Payer: Coventry All Commercial |
$39.91
|
| Rate for Payer: Encore All Commercial |
$41.74
|
| Rate for Payer: Frontpath All Commercial |
$41.72
|
| Rate for Payer: Humana ChoiceCare |
$39.17
|
| Rate for Payer: Humana Medicare |
$23.13
|
| Rate for Payer: Lucent All Commercial |
$23.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$34.01
|
| Rate for Payer: PHP All Commercial |
$34.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.69
|
| Rate for Payer: Sagamore Health Network All Products |
$35.01
|
| Rate for Payer: Signature Care EPO |
$37.64
|
| Rate for Payer: Signature Care PPO |
$39.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.55
|
| Rate for Payer: United Healthcare Commercial |
$35.74
|
| Rate for Payer: United Healthcare Medicare |
$14.97
|
|
|
HC SUT MCRYL+ 4-0 PS-2 MCP496G
|
Facility
|
IP
|
$45.09
|
|
| Hospital Charge Code |
41607969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$41.93 |
| Rate for Payer: Aetna Commercial |
$38.96
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Cigna All Commercial |
$38.91
|
| Rate for Payer: CORVEL All Commercial |
$41.93
|
| Rate for Payer: Coventry All Commercial |
$39.68
|
| Rate for Payer: Encore All Commercial |
$41.51
|
| Rate for Payer: Frontpath All Commercial |
$41.48
|
| Rate for Payer: Humana ChoiceCare |
$38.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.58
|
| Rate for Payer: PHCS All Commercial |
$33.82
|
| Rate for Payer: PHP All Commercial |
$34.20
|
| Rate for Payer: Sagamore Health Network All Products |
$34.81
|
| Rate for Payer: Signature Care EPO |
$37.42
|
| Rate for Payer: Signature Care PPO |
$39.68
|
| Rate for Payer: United Healthcare Commercial |
$35.53
|
|
|
HC SUT MCRYL+ 4-0 PS-2 MCP496G
|
Facility
|
OP
|
$45.09
|
|
| Hospital Charge Code |
41607969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna Medicare |
$14.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.37
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Centivo All Commercial |
$23.00
|
| Rate for Payer: Cigna All Commercial |
$38.91
|
| Rate for Payer: CORVEL All Commercial |
$41.93
|
| Rate for Payer: Coventry All Commercial |
$39.68
|
| Rate for Payer: Encore All Commercial |
$41.51
|
| Rate for Payer: Frontpath All Commercial |
$41.48
|
| Rate for Payer: Humana ChoiceCare |
$38.94
|
| Rate for Payer: Humana Medicare |
$23.00
|
| Rate for Payer: Lucent All Commercial |
$23.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$33.82
|
| Rate for Payer: PHP All Commercial |
$34.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.59
|
| Rate for Payer: Sagamore Health Network All Products |
$34.81
|
| Rate for Payer: Signature Care EPO |
$37.42
|
| Rate for Payer: Signature Care PPO |
$39.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.33
|
| Rate for Payer: United Healthcare Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare |
$14.88
|
|
|
HC SUT MCRYL+ 5-0 P-3 18" MCP493G
|
Facility
|
OP
|
$48.88
|
|
| Hospital Charge Code |
41607970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$41.25
|
| Rate for Payer: Aetna Medicare |
$16.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.74
|
| Rate for Payer: Cash Price |
$30.31
|
| Rate for Payer: Cash Price |
$30.31
|
| Rate for Payer: Centivo All Commercial |
$24.93
|
| Rate for Payer: Cigna All Commercial |
$42.18
|
| Rate for Payer: CORVEL All Commercial |
$45.46
|
| Rate for Payer: Coventry All Commercial |
$43.01
|
| Rate for Payer: Encore All Commercial |
$44.99
|
| Rate for Payer: Frontpath All Commercial |
$44.97
|
| Rate for Payer: Humana ChoiceCare |
$42.22
|
| Rate for Payer: Humana Medicare |
$24.93
|
| Rate for Payer: Lucent All Commercial |
$24.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.99
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$36.66
|
| Rate for Payer: PHP All Commercial |
$37.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.06
|
| Rate for Payer: Sagamore Health Network All Products |
$37.74
|
| Rate for Payer: Signature Care EPO |
$40.57
|
| Rate for Payer: Signature Care PPO |
$43.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.55
|
| Rate for Payer: United Healthcare Commercial |
$38.52
|
| Rate for Payer: United Healthcare Medicare |
$16.13
|
|
|
HC SUT MCRYL+ 5-0 P-3 18" MCP493G
|
Facility
|
IP
|
$48.88
|
|
| Hospital Charge Code |
41607970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$45.46 |
| Rate for Payer: Aetna Commercial |
$42.23
|
| Rate for Payer: Cash Price |
$30.31
|
| Rate for Payer: Cigna All Commercial |
$42.18
|
| Rate for Payer: CORVEL All Commercial |
$45.46
|
| Rate for Payer: Coventry All Commercial |
$43.01
|
| Rate for Payer: Encore All Commercial |
$44.99
|
| Rate for Payer: Frontpath All Commercial |
$44.97
|
| Rate for Payer: Humana ChoiceCare |
$42.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.99
|
| Rate for Payer: PHCS All Commercial |
$36.66
|
| Rate for Payer: PHP All Commercial |
$37.07
|
| Rate for Payer: Sagamore Health Network All Products |
$37.74
|
| Rate for Payer: Signature Care EPO |
$40.57
|
| Rate for Payer: Signature Care PPO |
$43.01
|
| Rate for Payer: United Healthcare Commercial |
$38.52
|
|
|
HC SUT PDS+ 0 CT-1 27" PDP340H
|
Facility
|
OP
|
$19.06
|
|
| Hospital Charge Code |
41607971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Aetna Medicare |
$6.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.92
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: Centivo All Commercial |
$9.72
|
| Rate for Payer: Cigna All Commercial |
$16.45
|
| Rate for Payer: CORVEL All Commercial |
$17.73
|
| Rate for Payer: Coventry All Commercial |
$16.77
|
| Rate for Payer: Encore All Commercial |
$17.54
|
| Rate for Payer: Frontpath All Commercial |
$17.54
|
| Rate for Payer: Humana ChoiceCare |
$16.46
|
| Rate for Payer: Humana Medicare |
$9.72
|
| Rate for Payer: Lucent All Commercial |
$9.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.15
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.30
|
| Rate for Payer: PHP All Commercial |
$14.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.43
|
| Rate for Payer: Sagamore Health Network All Products |
$14.71
|
| Rate for Payer: Signature Care EPO |
$15.82
|
| Rate for Payer: Signature Care PPO |
$16.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$15.02
|
| Rate for Payer: United Healthcare Medicare |
$6.29
|
|
|
HC SUT PDS+ 0 CT-1 27" PDP340H
|
Facility
|
IP
|
$19.06
|
|
| Hospital Charge Code |
41607971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$17.73 |
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: Cigna All Commercial |
$16.45
|
| Rate for Payer: CORVEL All Commercial |
$17.73
|
| Rate for Payer: Coventry All Commercial |
$16.77
|
| Rate for Payer: Encore All Commercial |
$17.54
|
| Rate for Payer: Frontpath All Commercial |
$17.54
|
| Rate for Payer: Humana ChoiceCare |
$16.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.15
|
| Rate for Payer: PHCS All Commercial |
$14.30
|
| Rate for Payer: PHP All Commercial |
$14.46
|
| Rate for Payer: Sagamore Health Network All Products |
$14.71
|
| Rate for Payer: Signature Care EPO |
$15.82
|
| Rate for Payer: Signature Care PPO |
$16.77
|
| Rate for Payer: United Healthcare Commercial |
$15.02
|
|
