|
HC TRANSTIBIAL ACL DISP. KIT
|
Facility
|
IP
|
$1,237.50
|
|
| Hospital Charge Code |
41602389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$928.12 |
| Max. Negotiated Rate |
$1,150.88 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cigna All Commercial |
$1,067.96
|
| Rate for Payer: CORVEL All Commercial |
$1,150.88
|
| Rate for Payer: Coventry All Commercial |
$1,089.00
|
| Rate for Payer: Encore All Commercial |
$1,139.12
|
| Rate for Payer: Frontpath All Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$1,068.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.75
|
| Rate for Payer: PHCS All Commercial |
$928.12
|
| Rate for Payer: PHP All Commercial |
$938.52
|
| Rate for Payer: Sagamore Health Network All Products |
$955.35
|
| Rate for Payer: Signature Care EPO |
$1,027.12
|
| Rate for Payer: Signature Care PPO |
$1,089.00
|
| Rate for Payer: United Healthcare Commercial |
$975.15
|
|
|
HC TRANSTIBIAL ACL DISP. KIT
|
Facility
|
OP
|
$1,237.50
|
|
| Hospital Charge Code |
41602389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,150.88 |
| Rate for Payer: Aetna Commercial |
$1,044.45
|
| Rate for Payer: Aetna Medicare |
$408.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$408.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$710.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$773.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$469.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$449.21
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Centivo All Commercial |
$631.12
|
| Rate for Payer: Cigna All Commercial |
$1,067.96
|
| Rate for Payer: CORVEL All Commercial |
$1,150.88
|
| Rate for Payer: Coventry All Commercial |
$1,089.00
|
| Rate for Payer: Encore All Commercial |
$1,139.12
|
| Rate for Payer: Frontpath All Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$1,068.83
|
| Rate for Payer: Humana Medicare |
$631.12
|
| Rate for Payer: Lucent All Commercial |
$631.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$928.12
|
| Rate for Payer: PHP All Commercial |
$938.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$482.62
|
| Rate for Payer: Sagamore Health Network All Products |
$955.35
|
| Rate for Payer: Signature Care EPO |
$1,027.12
|
| Rate for Payer: Signature Care PPO |
$1,089.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,051.88
|
| Rate for Payer: United Healthcare Commercial |
$975.15
|
| Rate for Payer: United Healthcare Medicare |
$408.38
|
|
|
HC TRAP POLYP
|
Facility
|
OP
|
$63.45
|
|
| Hospital Charge Code |
41602060
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna Medicare |
$20.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.03
|
| Rate for Payer: Cash Price |
$39.34
|
| Rate for Payer: Cash Price |
$39.34
|
| Rate for Payer: Centivo All Commercial |
$32.36
|
| Rate for Payer: Cigna All Commercial |
$54.76
|
| Rate for Payer: CORVEL All Commercial |
$59.01
|
| Rate for Payer: Coventry All Commercial |
$55.84
|
| Rate for Payer: Encore All Commercial |
$58.41
|
| Rate for Payer: Frontpath All Commercial |
$58.37
|
| Rate for Payer: Humana ChoiceCare |
$54.80
|
| Rate for Payer: Humana Medicare |
$32.36
|
| Rate for Payer: Lucent All Commercial |
$32.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.10
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$47.59
|
| Rate for Payer: PHP All Commercial |
$48.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.75
|
| Rate for Payer: Sagamore Health Network All Products |
$48.98
|
| Rate for Payer: Signature Care EPO |
$52.66
|
| Rate for Payer: Signature Care PPO |
$55.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.93
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
| Rate for Payer: United Healthcare Medicare |
$20.94
|
|
|
HC TRAP POLYP
|
Facility
|
IP
|
$63.45
|
|
| Hospital Charge Code |
41602060
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$59.01 |
| Rate for Payer: Aetna Commercial |
$54.82
|
| Rate for Payer: Cash Price |
$39.34
|
| Rate for Payer: Cigna All Commercial |
$54.76
|
| Rate for Payer: CORVEL All Commercial |
$59.01
|
| Rate for Payer: Coventry All Commercial |
$55.84
|
| Rate for Payer: Encore All Commercial |
$58.41
|
| Rate for Payer: Frontpath All Commercial |
$58.37
|
| Rate for Payer: Humana ChoiceCare |
$54.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.10
|
| Rate for Payer: PHCS All Commercial |
$47.59
|
| Rate for Payer: PHP All Commercial |
$48.12
|
| Rate for Payer: Sagamore Health Network All Products |
$48.98
|
| Rate for Payer: Signature Care EPO |
$52.66
|
| Rate for Payer: Signature Care PPO |
$55.84
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
HC TRAXI RETRACTION
|
Facility
|
OP
|
$433.29
|
|
| Hospital Charge Code |
41606637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$402.96 |
| Rate for Payer: Aetna Commercial |
$365.70
|
| Rate for Payer: Aetna Medicare |
$142.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$248.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$270.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$164.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$157.28
|
| Rate for Payer: Cash Price |
$268.64
|
| Rate for Payer: Cash Price |
$268.64
|
| Rate for Payer: Centivo All Commercial |
$220.98
|
| Rate for Payer: Cigna All Commercial |
$373.93
|
| Rate for Payer: CORVEL All Commercial |
$402.96
|
| Rate for Payer: Coventry All Commercial |
$381.30
|
| Rate for Payer: Encore All Commercial |
$398.84
|
| Rate for Payer: Frontpath All Commercial |
$398.63
|
| Rate for Payer: Humana ChoiceCare |
$374.23
|
| Rate for Payer: Humana Medicare |
$220.98
|
| Rate for Payer: Lucent All Commercial |
$220.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$389.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$324.97
|
| Rate for Payer: PHP All Commercial |
$328.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$168.98
|
| Rate for Payer: Sagamore Health Network All Products |
$334.50
|
| Rate for Payer: Signature Care EPO |
$359.63
|
| Rate for Payer: Signature Care PPO |
$381.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$368.30
|
| Rate for Payer: United Healthcare Commercial |
$341.43
|
| Rate for Payer: United Healthcare Medicare |
$142.99
|
|
|
HC TRAXI RETRACTION
|
Facility
|
IP
|
$433.29
|
|
| Hospital Charge Code |
41606637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.97 |
| Max. Negotiated Rate |
$402.96 |
| Rate for Payer: Aetna Commercial |
$374.36
|
| Rate for Payer: Cash Price |
$268.64
|
| Rate for Payer: Cigna All Commercial |
$373.93
|
| Rate for Payer: CORVEL All Commercial |
$402.96
|
| Rate for Payer: Coventry All Commercial |
$381.30
|
| Rate for Payer: Encore All Commercial |
$398.84
|
| Rate for Payer: Frontpath All Commercial |
$398.63
|
| Rate for Payer: Humana ChoiceCare |
$374.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$389.96
|
| Rate for Payer: PHCS All Commercial |
$324.97
|
| Rate for Payer: PHP All Commercial |
$328.61
|
| Rate for Payer: Sagamore Health Network All Products |
$334.50
|
| Rate for Payer: Signature Care EPO |
$359.63
|
| Rate for Payer: Signature Care PPO |
$381.30
|
| Rate for Payer: United Healthcare Commercial |
$341.43
|
|
|
HC TRAY ADULT LUMBAR PUNCTURE
|
Facility
|
OP
|
$151.20
|
|
| Hospital Charge Code |
41607852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.90 |
| Max. Negotiated Rate |
$140.62 |
| Rate for Payer: Aetna Commercial |
$127.61
|
| Rate for Payer: Aetna Medicare |
$49.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.89
|
| Rate for Payer: Cash Price |
$93.74
|
| Rate for Payer: Cash Price |
$93.74
|
| Rate for Payer: Centivo All Commercial |
$77.11
|
| Rate for Payer: Cigna All Commercial |
$130.49
|
| Rate for Payer: CORVEL All Commercial |
$140.62
|
| Rate for Payer: Coventry All Commercial |
$133.06
|
| Rate for Payer: Encore All Commercial |
$139.18
|
| Rate for Payer: Frontpath All Commercial |
$139.10
|
| Rate for Payer: Humana ChoiceCare |
$130.59
|
| Rate for Payer: Humana Medicare |
$77.11
|
| Rate for Payer: Lucent All Commercial |
$77.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$113.40
|
| Rate for Payer: PHP All Commercial |
$114.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.97
|
| Rate for Payer: Sagamore Health Network All Products |
$116.73
|
| Rate for Payer: Signature Care EPO |
$125.50
|
| Rate for Payer: Signature Care PPO |
$133.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.52
|
| Rate for Payer: United Healthcare Commercial |
$119.15
|
| Rate for Payer: United Healthcare Medicare |
$49.90
|
|
|
HC TRAY ADULT LUMBAR PUNCTURE
|
Facility
|
IP
|
$151.20
|
|
| Hospital Charge Code |
41607852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$140.62 |
| Rate for Payer: Aetna Commercial |
$130.64
|
| Rate for Payer: Cash Price |
$93.74
|
| Rate for Payer: Cigna All Commercial |
$130.49
|
| Rate for Payer: CORVEL All Commercial |
$140.62
|
| Rate for Payer: Coventry All Commercial |
$133.06
|
| Rate for Payer: Encore All Commercial |
$139.18
|
| Rate for Payer: Frontpath All Commercial |
$139.10
|
| Rate for Payer: Humana ChoiceCare |
$130.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.08
|
| Rate for Payer: PHCS All Commercial |
$113.40
|
| Rate for Payer: PHP All Commercial |
$114.67
|
| Rate for Payer: Sagamore Health Network All Products |
$116.73
|
| Rate for Payer: Signature Care EPO |
$125.50
|
| Rate for Payer: Signature Care PPO |
$133.06
|
| Rate for Payer: United Healthcare Commercial |
$119.15
|
|
|
HC TRAY ARTHROGRAM
|
Facility
|
IP
|
$111.93
|
|
| Hospital Charge Code |
41607851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.95 |
| Max. Negotiated Rate |
$104.09 |
| Rate for Payer: Aetna Commercial |
$96.71
|
| Rate for Payer: Cash Price |
$69.40
|
| Rate for Payer: Cigna All Commercial |
$96.60
|
| Rate for Payer: CORVEL All Commercial |
$104.09
|
| Rate for Payer: Coventry All Commercial |
$98.50
|
| Rate for Payer: Encore All Commercial |
$103.03
|
| Rate for Payer: Frontpath All Commercial |
$102.98
|
| Rate for Payer: Humana ChoiceCare |
$96.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.74
|
| Rate for Payer: PHCS All Commercial |
$83.95
|
| Rate for Payer: PHP All Commercial |
$84.89
|
| Rate for Payer: Sagamore Health Network All Products |
$86.41
|
| Rate for Payer: Signature Care EPO |
$92.90
|
| Rate for Payer: Signature Care PPO |
$98.50
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
|
|
HC TRAY ARTHROGRAM
|
Facility
|
IP
|
$104.18
|
|
| Hospital Charge Code |
41601182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$96.89 |
| Rate for Payer: Aetna Commercial |
$90.01
|
| Rate for Payer: Cash Price |
$64.59
|
| Rate for Payer: Cigna All Commercial |
$89.91
|
| Rate for Payer: CORVEL All Commercial |
$96.89
|
| Rate for Payer: Coventry All Commercial |
$91.68
|
| Rate for Payer: Encore All Commercial |
$95.90
|
| Rate for Payer: Frontpath All Commercial |
$95.85
|
| Rate for Payer: Humana ChoiceCare |
$89.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.76
|
| Rate for Payer: PHCS All Commercial |
$78.14
|
| Rate for Payer: PHP All Commercial |
$79.01
|
| Rate for Payer: Sagamore Health Network All Products |
$80.43
|
| Rate for Payer: Signature Care EPO |
$86.47
|
| Rate for Payer: Signature Care PPO |
$91.68
|
| Rate for Payer: United Healthcare Commercial |
$82.09
|
|
|
HC TRAY ARTHROGRAM
|
Facility
|
OP
|
$104.18
|
|
| Hospital Charge Code |
41601182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.38 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Aetna Medicare |
$34.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.82
|
| Rate for Payer: Cash Price |
$64.59
|
| Rate for Payer: Cash Price |
$64.59
|
| Rate for Payer: Centivo All Commercial |
$53.13
|
| Rate for Payer: Cigna All Commercial |
$89.91
|
| Rate for Payer: CORVEL All Commercial |
$96.89
|
| Rate for Payer: Coventry All Commercial |
$91.68
|
| Rate for Payer: Encore All Commercial |
$95.90
|
| Rate for Payer: Frontpath All Commercial |
$95.85
|
| Rate for Payer: Humana ChoiceCare |
$89.98
|
| Rate for Payer: Humana Medicare |
$53.13
|
| Rate for Payer: Lucent All Commercial |
$53.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$78.14
|
| Rate for Payer: PHP All Commercial |
$79.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.63
|
| Rate for Payer: Sagamore Health Network All Products |
$80.43
|
| Rate for Payer: Signature Care EPO |
$86.47
|
| Rate for Payer: Signature Care PPO |
$91.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88.55
|
| Rate for Payer: United Healthcare Commercial |
$82.09
|
| Rate for Payer: United Healthcare Medicare |
$34.38
|
|
|
HC TRAY ARTHROGRAM
|
Facility
|
OP
|
$111.93
|
|
| Hospital Charge Code |
41607851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.94 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$94.47
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.63
|
| Rate for Payer: Cash Price |
$69.40
|
| Rate for Payer: Cash Price |
$69.40
|
| Rate for Payer: Centivo All Commercial |
$57.08
|
| Rate for Payer: Cigna All Commercial |
$96.60
|
| Rate for Payer: CORVEL All Commercial |
$104.09
|
| Rate for Payer: Coventry All Commercial |
$98.50
|
| Rate for Payer: Encore All Commercial |
$103.03
|
| Rate for Payer: Frontpath All Commercial |
$102.98
|
| Rate for Payer: Humana ChoiceCare |
$96.67
|
| Rate for Payer: Humana Medicare |
$57.08
|
| Rate for Payer: Lucent All Commercial |
$57.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.74
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$83.95
|
| Rate for Payer: PHP All Commercial |
$84.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.65
|
| Rate for Payer: Sagamore Health Network All Products |
$86.41
|
| Rate for Payer: Signature Care EPO |
$92.90
|
| Rate for Payer: Signature Care PPO |
$98.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.14
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
| Rate for Payer: United Healthcare Medicare |
$36.94
|
|
|
HC TRAY ARTHROGRAM STANDARD
|
Facility
|
OP
|
$204.33
|
|
| Hospital Charge Code |
41603541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.43 |
| Max. Negotiated Rate |
$190.03 |
| Rate for Payer: Aetna Commercial |
$172.45
|
| Rate for Payer: Aetna Medicare |
$67.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.17
|
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: Centivo All Commercial |
$104.21
|
| Rate for Payer: Cigna All Commercial |
$176.34
|
| Rate for Payer: CORVEL All Commercial |
$190.03
|
| Rate for Payer: Coventry All Commercial |
$179.81
|
| Rate for Payer: Encore All Commercial |
$188.09
|
| Rate for Payer: Frontpath All Commercial |
$187.98
|
| Rate for Payer: Humana ChoiceCare |
$176.48
|
| Rate for Payer: Humana Medicare |
$104.21
|
| Rate for Payer: Lucent All Commercial |
$104.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$153.25
|
| Rate for Payer: PHP All Commercial |
$154.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.69
|
| Rate for Payer: Sagamore Health Network All Products |
$157.74
|
| Rate for Payer: Signature Care EPO |
$169.59
|
| Rate for Payer: Signature Care PPO |
$179.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.68
|
| Rate for Payer: United Healthcare Commercial |
$161.01
|
| Rate for Payer: United Healthcare Medicare |
$67.43
|
|
|
HC TRAY ARTHROGRAM STANDARD
|
Facility
|
IP
|
$204.33
|
|
| Hospital Charge Code |
41603541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.25 |
| Max. Negotiated Rate |
$190.03 |
| Rate for Payer: Aetna Commercial |
$176.54
|
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: Cigna All Commercial |
$176.34
|
| Rate for Payer: CORVEL All Commercial |
$190.03
|
| Rate for Payer: Coventry All Commercial |
$179.81
|
| Rate for Payer: Encore All Commercial |
$188.09
|
| Rate for Payer: Frontpath All Commercial |
$187.98
|
| Rate for Payer: Humana ChoiceCare |
$176.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.90
|
| Rate for Payer: PHCS All Commercial |
$153.25
|
| Rate for Payer: PHP All Commercial |
$154.96
|
| Rate for Payer: Sagamore Health Network All Products |
$157.74
|
| Rate for Payer: Signature Care EPO |
$169.59
|
| Rate for Payer: Signature Care PPO |
$179.81
|
| Rate for Payer: United Healthcare Commercial |
$161.01
|
|
|
HC TRAY DRESSING CHANGE CENTRAL L
|
Facility
|
OP
|
$117.72
|
|
| Hospital Charge Code |
41607590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: Aetna Medicare |
$38.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$67.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.73
|
| Rate for Payer: Cash Price |
$72.99
|
| Rate for Payer: Cash Price |
$72.99
|
| Rate for Payer: Centivo All Commercial |
$60.04
|
| Rate for Payer: Cigna All Commercial |
$101.59
|
| Rate for Payer: CORVEL All Commercial |
$109.48
|
| Rate for Payer: Coventry All Commercial |
$103.59
|
| Rate for Payer: Encore All Commercial |
$108.36
|
| Rate for Payer: Frontpath All Commercial |
$108.30
|
| Rate for Payer: Humana ChoiceCare |
$101.67
|
| Rate for Payer: Humana Medicare |
$60.04
|
| Rate for Payer: Lucent All Commercial |
$60.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$88.29
|
| Rate for Payer: PHP All Commercial |
$89.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.91
|
| Rate for Payer: Sagamore Health Network All Products |
$90.88
|
| Rate for Payer: Signature Care EPO |
$97.71
|
| Rate for Payer: Signature Care PPO |
$103.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$100.06
|
| Rate for Payer: United Healthcare Commercial |
$92.76
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
|
|
HC TRAY DRESSING CHANGE CENTRAL L
|
Facility
|
IP
|
$117.72
|
|
| Hospital Charge Code |
41607590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.29 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$101.71
|
| Rate for Payer: Cash Price |
$72.99
|
| Rate for Payer: Cigna All Commercial |
$101.59
|
| Rate for Payer: CORVEL All Commercial |
$109.48
|
| Rate for Payer: Coventry All Commercial |
$103.59
|
| Rate for Payer: Encore All Commercial |
$108.36
|
| Rate for Payer: Frontpath All Commercial |
$108.30
|
| Rate for Payer: Humana ChoiceCare |
$101.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.95
|
| Rate for Payer: PHCS All Commercial |
$88.29
|
| Rate for Payer: PHP All Commercial |
$89.28
|
| Rate for Payer: Sagamore Health Network All Products |
$90.88
|
| Rate for Payer: Signature Care EPO |
$97.71
|
| Rate for Payer: Signature Care PPO |
$103.59
|
| Rate for Payer: United Healthcare Commercial |
$92.76
|
|
|
HC TRAY PERIPHERAL NERVE BLOCK BRAUN
|
Facility
|
OP
|
$271.64
|
|
| Hospital Charge Code |
41601352
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.64 |
| Max. Negotiated Rate |
$252.63 |
| Rate for Payer: Aetna Commercial |
$229.26
|
| Rate for Payer: Aetna Medicare |
$89.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$89.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$169.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.61
|
| Rate for Payer: Cash Price |
$168.42
|
| Rate for Payer: Cash Price |
$168.42
|
| Rate for Payer: Centivo All Commercial |
$138.54
|
| Rate for Payer: Cigna All Commercial |
$234.43
|
| Rate for Payer: CORVEL All Commercial |
$252.63
|
| Rate for Payer: Coventry All Commercial |
$239.04
|
| Rate for Payer: Encore All Commercial |
$250.04
|
| Rate for Payer: Frontpath All Commercial |
$249.91
|
| Rate for Payer: Humana ChoiceCare |
$234.62
|
| Rate for Payer: Humana Medicare |
$138.54
|
| Rate for Payer: Lucent All Commercial |
$138.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$244.48
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$203.73
|
| Rate for Payer: PHP All Commercial |
$206.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.94
|
| Rate for Payer: Sagamore Health Network All Products |
$209.71
|
| Rate for Payer: Signature Care EPO |
$225.46
|
| Rate for Payer: Signature Care PPO |
$239.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$230.89
|
| Rate for Payer: United Healthcare Commercial |
$214.05
|
| Rate for Payer: United Healthcare Medicare |
$89.64
|
|
|
HC TRAY PERIPHERAL NERVE BLOCK BRAUN
|
Facility
|
IP
|
$271.64
|
|
| Hospital Charge Code |
41601352
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$203.73 |
| Max. Negotiated Rate |
$252.63 |
| Rate for Payer: Aetna Commercial |
$234.70
|
| Rate for Payer: Cash Price |
$168.42
|
| Rate for Payer: Cigna All Commercial |
$234.43
|
| Rate for Payer: CORVEL All Commercial |
$252.63
|
| Rate for Payer: Coventry All Commercial |
$239.04
|
| Rate for Payer: Encore All Commercial |
$250.04
|
| Rate for Payer: Frontpath All Commercial |
$249.91
|
| Rate for Payer: Humana ChoiceCare |
$234.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$244.48
|
| Rate for Payer: PHCS All Commercial |
$203.73
|
| Rate for Payer: PHP All Commercial |
$206.01
|
| Rate for Payer: Sagamore Health Network All Products |
$209.71
|
| Rate for Payer: Signature Care EPO |
$225.46
|
| Rate for Payer: Signature Care PPO |
$239.04
|
| Rate for Payer: United Healthcare Commercial |
$214.05
|
|
|
HC TRAY PORT ACCESSING
|
Facility
|
OP
|
$198.59
|
|
| Hospital Charge Code |
41607683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$184.69 |
| Rate for Payer: Aetna Commercial |
$167.61
|
| Rate for Payer: Aetna Medicare |
$65.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$114.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.09
|
| Rate for Payer: Cash Price |
$123.13
|
| Rate for Payer: Cash Price |
$123.13
|
| Rate for Payer: Centivo All Commercial |
$101.28
|
| Rate for Payer: Cigna All Commercial |
$171.38
|
| Rate for Payer: CORVEL All Commercial |
$184.69
|
| Rate for Payer: Coventry All Commercial |
$174.76
|
| Rate for Payer: Encore All Commercial |
$182.80
|
| Rate for Payer: Frontpath All Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$171.52
|
| Rate for Payer: Humana Medicare |
$101.28
|
| Rate for Payer: Lucent All Commercial |
$101.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.73
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$148.94
|
| Rate for Payer: PHP All Commercial |
$150.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.45
|
| Rate for Payer: Sagamore Health Network All Products |
$153.31
|
| Rate for Payer: Signature Care EPO |
$164.83
|
| Rate for Payer: Signature Care PPO |
$174.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$168.80
|
| Rate for Payer: United Healthcare Commercial |
$156.49
|
| Rate for Payer: United Healthcare Medicare |
$65.53
|
|
|
HC TRAY PORT ACCESSING
|
Facility
|
IP
|
$198.59
|
|
| Hospital Charge Code |
41607683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.94 |
| Max. Negotiated Rate |
$184.69 |
| Rate for Payer: Aetna Commercial |
$171.58
|
| Rate for Payer: Cash Price |
$123.13
|
| Rate for Payer: Cigna All Commercial |
$171.38
|
| Rate for Payer: CORVEL All Commercial |
$184.69
|
| Rate for Payer: Coventry All Commercial |
$174.76
|
| Rate for Payer: Encore All Commercial |
$182.80
|
| Rate for Payer: Frontpath All Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$171.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.73
|
| Rate for Payer: PHCS All Commercial |
$148.94
|
| Rate for Payer: PHP All Commercial |
$150.61
|
| Rate for Payer: Sagamore Health Network All Products |
$153.31
|
| Rate for Payer: Signature Care EPO |
$164.83
|
| Rate for Payer: Signature Care PPO |
$174.76
|
| Rate for Payer: United Healthcare Commercial |
$156.49
|
|
|
HC TRAY PUDENDAL DISPOSABLE
|
Facility
|
OP
|
$95.03
|
|
| Hospital Charge Code |
41607955
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$80.21
|
| Rate for Payer: Aetna Medicare |
$31.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.50
|
| Rate for Payer: Cash Price |
$58.92
|
| Rate for Payer: Cash Price |
$58.92
|
| Rate for Payer: Centivo All Commercial |
$48.47
|
| Rate for Payer: Cigna All Commercial |
$82.01
|
| Rate for Payer: CORVEL All Commercial |
$88.38
|
| Rate for Payer: Coventry All Commercial |
$83.63
|
| Rate for Payer: Encore All Commercial |
$87.48
|
| Rate for Payer: Frontpath All Commercial |
$87.43
|
| Rate for Payer: Humana ChoiceCare |
$82.08
|
| Rate for Payer: Humana Medicare |
$48.47
|
| Rate for Payer: Lucent All Commercial |
$48.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$71.27
|
| Rate for Payer: PHP All Commercial |
$72.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.06
|
| Rate for Payer: Sagamore Health Network All Products |
$73.36
|
| Rate for Payer: Signature Care EPO |
$78.87
|
| Rate for Payer: Signature Care PPO |
$83.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.78
|
| Rate for Payer: United Healthcare Commercial |
$74.88
|
| Rate for Payer: United Healthcare Medicare |
$31.36
|
|
|
HC TRAY PUDENDAL DISPOSABLE
|
Facility
|
IP
|
$95.03
|
|
| Hospital Charge Code |
41607955
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.27 |
| Max. Negotiated Rate |
$88.38 |
| Rate for Payer: Aetna Commercial |
$82.11
|
| Rate for Payer: Cash Price |
$58.92
|
| Rate for Payer: Cigna All Commercial |
$82.01
|
| Rate for Payer: CORVEL All Commercial |
$88.38
|
| Rate for Payer: Coventry All Commercial |
$83.63
|
| Rate for Payer: Encore All Commercial |
$87.48
|
| Rate for Payer: Frontpath All Commercial |
$87.43
|
| Rate for Payer: Humana ChoiceCare |
$82.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.53
|
| Rate for Payer: PHCS All Commercial |
$71.27
|
| Rate for Payer: PHP All Commercial |
$72.07
|
| Rate for Payer: Sagamore Health Network All Products |
$73.36
|
| Rate for Payer: Signature Care EPO |
$78.87
|
| Rate for Payer: Signature Care PPO |
$83.63
|
| Rate for Payer: United Healthcare Commercial |
$74.88
|
|
|
HC TRAY SAFETY PARACENTESIS 5FR 10CM
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
41601795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$247.38 |
| Rate for Payer: Aetna Commercial |
$224.50
|
| Rate for Payer: Aetna Medicare |
$87.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$152.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.56
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Centivo All Commercial |
$135.66
|
| Rate for Payer: Cigna All Commercial |
$229.56
|
| Rate for Payer: CORVEL All Commercial |
$247.38
|
| Rate for Payer: Coventry All Commercial |
$234.08
|
| Rate for Payer: Encore All Commercial |
$244.85
|
| Rate for Payer: Frontpath All Commercial |
$244.72
|
| Rate for Payer: Humana ChoiceCare |
$229.74
|
| Rate for Payer: Humana Medicare |
$135.66
|
| Rate for Payer: Lucent All Commercial |
$135.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$199.50
|
| Rate for Payer: PHP All Commercial |
$201.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.74
|
| Rate for Payer: Sagamore Health Network All Products |
$205.35
|
| Rate for Payer: Signature Care EPO |
$220.78
|
| Rate for Payer: Signature Care PPO |
$234.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$226.10
|
| Rate for Payer: United Healthcare Commercial |
$209.61
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
|
|
HC TRAY SAFETY PARACENTESIS 5FR 10CM
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
41601795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$247.38 |
| Rate for Payer: Aetna Commercial |
$229.82
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cigna All Commercial |
$229.56
|
| Rate for Payer: CORVEL All Commercial |
$247.38
|
| Rate for Payer: Coventry All Commercial |
$234.08
|
| Rate for Payer: Encore All Commercial |
$244.85
|
| Rate for Payer: Frontpath All Commercial |
$244.72
|
| Rate for Payer: Humana ChoiceCare |
$229.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.40
|
| Rate for Payer: PHCS All Commercial |
$199.50
|
| Rate for Payer: PHP All Commercial |
$201.73
|
| Rate for Payer: Sagamore Health Network All Products |
$205.35
|
| Rate for Payer: Signature Care EPO |
$220.78
|
| Rate for Payer: Signature Care PPO |
$234.08
|
| Rate for Payer: United Healthcare Commercial |
$209.61
|
|
|
HC TRAY SPINAL PENCAN
|
Facility
|
OP
|
$121.74
|
|
| Hospital Charge Code |
41601184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Medicare |
$40.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.19
|
| Rate for Payer: Cash Price |
$75.48
|
| Rate for Payer: Cash Price |
$75.48
|
| Rate for Payer: Centivo All Commercial |
$62.09
|
| Rate for Payer: Cigna All Commercial |
$105.06
|
| Rate for Payer: CORVEL All Commercial |
$113.22
|
| Rate for Payer: Coventry All Commercial |
$107.13
|
| Rate for Payer: Encore All Commercial |
$112.06
|
| Rate for Payer: Frontpath All Commercial |
$112.00
|
| Rate for Payer: Humana ChoiceCare |
$105.15
|
| Rate for Payer: Humana Medicare |
$62.09
|
| Rate for Payer: Lucent All Commercial |
$62.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.57
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$91.30
|
| Rate for Payer: PHP All Commercial |
$92.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.48
|
| Rate for Payer: Sagamore Health Network All Products |
$93.98
|
| Rate for Payer: Signature Care EPO |
$101.04
|
| Rate for Payer: Signature Care PPO |
$107.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.48
|
| Rate for Payer: United Healthcare Commercial |
$95.93
|
| Rate for Payer: United Healthcare Medicare |
$40.17
|
|
