|
HC TSH REFLEX FREE T4
|
Facility
|
IP
|
$152.85
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.64 |
| Max. Negotiated Rate |
$142.15 |
| Rate for Payer: Aetna Commercial |
$132.06
|
| Rate for Payer: Cash Price |
$94.77
|
| Rate for Payer: Cigna All Commercial |
$131.91
|
| Rate for Payer: CORVEL All Commercial |
$142.15
|
| Rate for Payer: Coventry All Commercial |
$134.51
|
| Rate for Payer: Encore All Commercial |
$140.70
|
| Rate for Payer: Frontpath All Commercial |
$140.62
|
| Rate for Payer: Humana ChoiceCare |
$132.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.56
|
| Rate for Payer: PHCS All Commercial |
$114.64
|
| Rate for Payer: PHP All Commercial |
$115.92
|
| Rate for Payer: Sagamore Health Network All Products |
$118.00
|
| Rate for Payer: Signature Care EPO |
$126.86
|
| Rate for Payer: Signature Care PPO |
$134.51
|
| Rate for Payer: United Healthcare Commercial |
$120.44
|
|
|
HC TSH REFLEX FREE T4
|
Facility
|
OP
|
$152.85
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$142.15 |
| Rate for Payer: Aetna Commercial |
$129.00
|
| Rate for Payer: Aetna Medicare |
$50.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.48
|
| Rate for Payer: Cash Price |
$94.77
|
| Rate for Payer: Cash Price |
$94.77
|
| Rate for Payer: Centivo All Commercial |
$77.95
|
| Rate for Payer: Cigna All Commercial |
$131.91
|
| Rate for Payer: CORVEL All Commercial |
$142.15
|
| Rate for Payer: Coventry All Commercial |
$134.51
|
| Rate for Payer: Encore All Commercial |
$140.70
|
| Rate for Payer: Frontpath All Commercial |
$140.62
|
| Rate for Payer: Humana ChoiceCare |
$132.01
|
| Rate for Payer: Humana Medicare |
$77.95
|
| Rate for Payer: Lucent All Commercial |
$77.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.56
|
| Rate for Payer: Managed Health Services Medicaid |
$16.80
|
| Rate for Payer: MDWise Medicaid |
$16.80
|
| Rate for Payer: PHCS All Commercial |
$114.64
|
| Rate for Payer: PHP All Commercial |
$115.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.61
|
| Rate for Payer: Sagamore Health Network All Products |
$118.00
|
| Rate for Payer: Signature Care EPO |
$126.86
|
| Rate for Payer: Signature Care PPO |
$134.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.92
|
| Rate for Payer: United Healthcare Commercial |
$120.44
|
| Rate for Payer: United Healthcare Medicare |
$50.44
|
|
|
HC TT ECHO CONG ABN; COMPLETE
|
Facility
|
OP
|
$1,090.80
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
00863303
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$359.96 |
| Max. Negotiated Rate |
$1,014.44 |
| Rate for Payer: Aetna Commercial |
$920.63
|
| Rate for Payer: Aetna Medicare |
$359.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$359.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$626.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$681.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$413.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$395.96
|
| Rate for Payer: Cash Price |
$676.30
|
| Rate for Payer: Cash Price |
$676.30
|
| Rate for Payer: Centivo All Commercial |
$556.31
|
| Rate for Payer: Cigna All Commercial |
$941.36
|
| Rate for Payer: CORVEL All Commercial |
$1,014.44
|
| Rate for Payer: Coventry All Commercial |
$959.90
|
| Rate for Payer: Encore All Commercial |
$1,004.08
|
| Rate for Payer: Frontpath All Commercial |
$1,003.53
|
| Rate for Payer: Humana ChoiceCare |
$942.12
|
| Rate for Payer: Humana Medicare |
$556.31
|
| Rate for Payer: Lucent All Commercial |
$556.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.72
|
| Rate for Payer: Managed Health Services Medicaid |
$788.70
|
| Rate for Payer: MDWise Medicaid |
$788.70
|
| Rate for Payer: PHCS All Commercial |
$818.10
|
| Rate for Payer: PHP All Commercial |
$827.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$425.41
|
| Rate for Payer: Sagamore Health Network All Products |
$842.10
|
| Rate for Payer: Signature Care EPO |
$905.36
|
| Rate for Payer: Signature Care PPO |
$959.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$927.18
|
| Rate for Payer: United Healthcare Commercial |
$859.55
|
| Rate for Payer: United Healthcare Medicare |
$359.96
|
|
|
HC TT ECHO CONG ABN; COMPLETE
|
Facility
|
IP
|
$1,090.80
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
00863303
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$818.10 |
| Max. Negotiated Rate |
$1,014.44 |
| Rate for Payer: Aetna Commercial |
$942.45
|
| Rate for Payer: Cash Price |
$676.30
|
| Rate for Payer: Cigna All Commercial |
$941.36
|
| Rate for Payer: CORVEL All Commercial |
$1,014.44
|
| Rate for Payer: Coventry All Commercial |
$959.90
|
| Rate for Payer: Encore All Commercial |
$1,004.08
|
| Rate for Payer: Frontpath All Commercial |
$1,003.53
|
| Rate for Payer: Humana ChoiceCare |
$942.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.72
|
| Rate for Payer: PHCS All Commercial |
$818.10
|
| Rate for Payer: PHP All Commercial |
$827.26
|
| Rate for Payer: Sagamore Health Network All Products |
$842.10
|
| Rate for Payer: Signature Care EPO |
$905.36
|
| Rate for Payer: Signature Care PPO |
$959.90
|
| Rate for Payer: United Healthcare Commercial |
$859.55
|
|
|
HC TTE CONG ABN; LIMITED/F-UP
|
Facility
|
IP
|
$963.90
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
00863304
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$722.92 |
| Max. Negotiated Rate |
$896.43 |
| Rate for Payer: Aetna Commercial |
$832.81
|
| Rate for Payer: Cash Price |
$597.62
|
| Rate for Payer: Cigna All Commercial |
$831.85
|
| Rate for Payer: CORVEL All Commercial |
$896.43
|
| Rate for Payer: Coventry All Commercial |
$848.23
|
| Rate for Payer: Encore All Commercial |
$887.27
|
| Rate for Payer: Frontpath All Commercial |
$886.79
|
| Rate for Payer: Humana ChoiceCare |
$832.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$867.51
|
| Rate for Payer: PHCS All Commercial |
$722.92
|
| Rate for Payer: PHP All Commercial |
$731.02
|
| Rate for Payer: Sagamore Health Network All Products |
$744.13
|
| Rate for Payer: Signature Care EPO |
$800.04
|
| Rate for Payer: Signature Care PPO |
$848.23
|
| Rate for Payer: United Healthcare Commercial |
$759.55
|
|
|
HC TTE CONG ABN; LIMITED/F-UP
|
Facility
|
OP
|
$963.90
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
00863304
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$318.09 |
| Max. Negotiated Rate |
$896.43 |
| Rate for Payer: Aetna Commercial |
$813.53
|
| Rate for Payer: Aetna Medicare |
$318.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$553.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$602.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$788.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.90
|
| Rate for Payer: Cash Price |
$597.62
|
| Rate for Payer: Cash Price |
$597.62
|
| Rate for Payer: Centivo All Commercial |
$491.59
|
| Rate for Payer: Cigna All Commercial |
$831.85
|
| Rate for Payer: CORVEL All Commercial |
$896.43
|
| Rate for Payer: Coventry All Commercial |
$848.23
|
| Rate for Payer: Encore All Commercial |
$887.27
|
| Rate for Payer: Frontpath All Commercial |
$886.79
|
| Rate for Payer: Humana ChoiceCare |
$832.52
|
| Rate for Payer: Humana Medicare |
$491.59
|
| Rate for Payer: Lucent All Commercial |
$491.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$867.51
|
| Rate for Payer: Managed Health Services Medicaid |
$788.70
|
| Rate for Payer: MDWise Medicaid |
$788.70
|
| Rate for Payer: PHCS All Commercial |
$722.92
|
| Rate for Payer: PHP All Commercial |
$731.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.92
|
| Rate for Payer: Sagamore Health Network All Products |
$744.13
|
| Rate for Payer: Signature Care EPO |
$800.04
|
| Rate for Payer: Signature Care PPO |
$848.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$819.32
|
| Rate for Payer: United Healthcare Commercial |
$759.55
|
| Rate for Payer: United Healthcare Medicare |
$318.09
|
|
|
HC TUBE CONNECTING 14FR X 30CM
|
Facility
|
OP
|
$123.97
|
|
| Hospital Charge Code |
41607839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$104.63
|
| Rate for Payer: Aetna Medicare |
$40.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.00
|
| Rate for Payer: Cash Price |
$76.86
|
| Rate for Payer: Cash Price |
$76.86
|
| Rate for Payer: Centivo All Commercial |
$63.22
|
| Rate for Payer: Cigna All Commercial |
$106.99
|
| Rate for Payer: CORVEL All Commercial |
$115.29
|
| Rate for Payer: Coventry All Commercial |
$109.09
|
| Rate for Payer: Encore All Commercial |
$114.11
|
| Rate for Payer: Frontpath All Commercial |
$114.05
|
| Rate for Payer: Humana ChoiceCare |
$107.07
|
| Rate for Payer: Humana Medicare |
$63.22
|
| Rate for Payer: Lucent All Commercial |
$63.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$92.98
|
| Rate for Payer: PHP All Commercial |
$94.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.35
|
| Rate for Payer: Sagamore Health Network All Products |
$95.70
|
| Rate for Payer: Signature Care EPO |
$102.90
|
| Rate for Payer: Signature Care PPO |
$109.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.37
|
| Rate for Payer: United Healthcare Commercial |
$97.69
|
| Rate for Payer: United Healthcare Medicare |
$40.91
|
|
|
HC TUBE CONNECTING 14FR X 30CM
|
Facility
|
IP
|
$123.97
|
|
| Hospital Charge Code |
41607839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.98 |
| Max. Negotiated Rate |
$115.29 |
| Rate for Payer: Aetna Commercial |
$107.11
|
| Rate for Payer: Cash Price |
$76.86
|
| Rate for Payer: Cigna All Commercial |
$106.99
|
| Rate for Payer: CORVEL All Commercial |
$115.29
|
| Rate for Payer: Coventry All Commercial |
$109.09
|
| Rate for Payer: Encore All Commercial |
$114.11
|
| Rate for Payer: Frontpath All Commercial |
$114.05
|
| Rate for Payer: Humana ChoiceCare |
$107.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.57
|
| Rate for Payer: PHCS All Commercial |
$92.98
|
| Rate for Payer: PHP All Commercial |
$94.02
|
| Rate for Payer: Sagamore Health Network All Products |
$95.70
|
| Rate for Payer: Signature Care EPO |
$102.90
|
| Rate for Payer: Signature Care PPO |
$109.09
|
| Rate for Payer: United Healthcare Commercial |
$97.69
|
|
|
HC TUBE ENDO CUFF 3.5
|
Facility
|
OP
|
$10.09
|
|
| Hospital Charge Code |
41603474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.52
|
| Rate for Payer: Aetna Medicare |
$3.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.66
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Centivo All Commercial |
$5.15
|
| Rate for Payer: Cigna All Commercial |
$8.71
|
| Rate for Payer: CORVEL All Commercial |
$9.38
|
| Rate for Payer: Coventry All Commercial |
$8.88
|
| Rate for Payer: Encore All Commercial |
$9.29
|
| Rate for Payer: Frontpath All Commercial |
$9.28
|
| Rate for Payer: Humana ChoiceCare |
$8.71
|
| Rate for Payer: Humana Medicare |
$5.15
|
| Rate for Payer: Lucent All Commercial |
$5.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.57
|
| Rate for Payer: PHP All Commercial |
$7.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.94
|
| Rate for Payer: Sagamore Health Network All Products |
$7.79
|
| Rate for Payer: Signature Care EPO |
$8.37
|
| Rate for Payer: Signature Care PPO |
$8.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.58
|
| Rate for Payer: United Healthcare Commercial |
$7.95
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
|
|
HC TUBE ENDO CUFF 3.5
|
Facility
|
IP
|
$10.09
|
|
| Hospital Charge Code |
41603474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$9.38 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cigna All Commercial |
$8.71
|
| Rate for Payer: CORVEL All Commercial |
$9.38
|
| Rate for Payer: Coventry All Commercial |
$8.88
|
| Rate for Payer: Encore All Commercial |
$9.29
|
| Rate for Payer: Frontpath All Commercial |
$9.28
|
| Rate for Payer: Humana ChoiceCare |
$8.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.08
|
| Rate for Payer: PHCS All Commercial |
$7.57
|
| Rate for Payer: PHP All Commercial |
$7.65
|
| Rate for Payer: Sagamore Health Network All Products |
$7.79
|
| Rate for Payer: Signature Care EPO |
$8.37
|
| Rate for Payer: Signature Care PPO |
$8.88
|
| Rate for Payer: United Healthcare Commercial |
$7.95
|
|
|
HC TUBE ENDO MALL CUFF 3.0
|
Facility
|
OP
|
$11.17
|
|
| Hospital Charge Code |
41602465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.43
|
| Rate for Payer: Aetna Medicare |
$3.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Centivo All Commercial |
$5.70
|
| Rate for Payer: Cigna All Commercial |
$9.64
|
| Rate for Payer: CORVEL All Commercial |
$10.39
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Encore All Commercial |
$10.28
|
| Rate for Payer: Frontpath All Commercial |
$10.28
|
| Rate for Payer: Humana ChoiceCare |
$9.65
|
| Rate for Payer: Humana Medicare |
$5.70
|
| Rate for Payer: Lucent All Commercial |
$5.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.38
|
| Rate for Payer: PHP All Commercial |
$8.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.36
|
| Rate for Payer: Sagamore Health Network All Products |
$8.62
|
| Rate for Payer: Signature Care EPO |
$9.27
|
| Rate for Payer: Signature Care PPO |
$9.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
| Rate for Payer: United Healthcare Medicare |
$3.69
|
|
|
HC TUBE ENDO MALL CUFF 3.0
|
Facility
|
IP
|
$11.17
|
|
| Hospital Charge Code |
41602465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna Commercial |
$9.65
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna All Commercial |
$9.64
|
| Rate for Payer: CORVEL All Commercial |
$10.39
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Encore All Commercial |
$10.28
|
| Rate for Payer: Frontpath All Commercial |
$10.28
|
| Rate for Payer: Humana ChoiceCare |
$9.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.05
|
| Rate for Payer: PHCS All Commercial |
$8.38
|
| Rate for Payer: PHP All Commercial |
$8.47
|
| Rate for Payer: Sagamore Health Network All Products |
$8.62
|
| Rate for Payer: Signature Care EPO |
$9.27
|
| Rate for Payer: Signature Care PPO |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
|
|
HC TUBE ENDO MALL CUFF 4.0
|
Facility
|
OP
|
$10.32
|
|
| Hospital Charge Code |
41602466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.71
|
| Rate for Payer: Aetna Medicare |
$3.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.75
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Centivo All Commercial |
$5.26
|
| Rate for Payer: Cigna All Commercial |
$8.91
|
| Rate for Payer: CORVEL All Commercial |
$9.60
|
| Rate for Payer: Coventry All Commercial |
$9.08
|
| Rate for Payer: Encore All Commercial |
$9.50
|
| Rate for Payer: Frontpath All Commercial |
$9.49
|
| Rate for Payer: Humana ChoiceCare |
$8.91
|
| Rate for Payer: Humana Medicare |
$5.26
|
| Rate for Payer: Lucent All Commercial |
$5.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.29
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.74
|
| Rate for Payer: PHP All Commercial |
$7.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.02
|
| Rate for Payer: Sagamore Health Network All Products |
$7.97
|
| Rate for Payer: Signature Care EPO |
$8.57
|
| Rate for Payer: Signature Care PPO |
$9.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.77
|
| Rate for Payer: United Healthcare Commercial |
$8.13
|
| Rate for Payer: United Healthcare Medicare |
$3.41
|
|
|
HC TUBE ENDO MALL CUFF 4.0
|
Facility
|
IP
|
$10.32
|
|
| Hospital Charge Code |
41602466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cigna All Commercial |
$8.91
|
| Rate for Payer: CORVEL All Commercial |
$9.60
|
| Rate for Payer: Coventry All Commercial |
$9.08
|
| Rate for Payer: Encore All Commercial |
$9.50
|
| Rate for Payer: Frontpath All Commercial |
$9.49
|
| Rate for Payer: Humana ChoiceCare |
$8.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.29
|
| Rate for Payer: PHCS All Commercial |
$7.74
|
| Rate for Payer: PHP All Commercial |
$7.83
|
| Rate for Payer: Sagamore Health Network All Products |
$7.97
|
| Rate for Payer: Signature Care EPO |
$8.57
|
| Rate for Payer: Signature Care PPO |
$9.08
|
| Rate for Payer: United Healthcare Commercial |
$8.13
|
|
|
HC TUBE ENDO MALL CUFF 4.5
|
Facility
|
OP
|
$10.32
|
|
| Hospital Charge Code |
41602467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.71
|
| Rate for Payer: Aetna Medicare |
$3.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.75
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Centivo All Commercial |
$5.26
|
| Rate for Payer: Cigna All Commercial |
$8.91
|
| Rate for Payer: CORVEL All Commercial |
$9.60
|
| Rate for Payer: Coventry All Commercial |
$9.08
|
| Rate for Payer: Encore All Commercial |
$9.50
|
| Rate for Payer: Frontpath All Commercial |
$9.49
|
| Rate for Payer: Humana ChoiceCare |
$8.91
|
| Rate for Payer: Humana Medicare |
$5.26
|
| Rate for Payer: Lucent All Commercial |
$5.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.29
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.74
|
| Rate for Payer: PHP All Commercial |
$7.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.02
|
| Rate for Payer: Sagamore Health Network All Products |
$7.97
|
| Rate for Payer: Signature Care EPO |
$8.57
|
| Rate for Payer: Signature Care PPO |
$9.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.77
|
| Rate for Payer: United Healthcare Commercial |
$8.13
|
| Rate for Payer: United Healthcare Medicare |
$3.41
|
|
|
HC TUBE ENDO MALL CUFF 4.5
|
Facility
|
IP
|
$10.32
|
|
| Hospital Charge Code |
41602467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cigna All Commercial |
$8.91
|
| Rate for Payer: CORVEL All Commercial |
$9.60
|
| Rate for Payer: Coventry All Commercial |
$9.08
|
| Rate for Payer: Encore All Commercial |
$9.50
|
| Rate for Payer: Frontpath All Commercial |
$9.49
|
| Rate for Payer: Humana ChoiceCare |
$8.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.29
|
| Rate for Payer: PHCS All Commercial |
$7.74
|
| Rate for Payer: PHP All Commercial |
$7.83
|
| Rate for Payer: Sagamore Health Network All Products |
$7.97
|
| Rate for Payer: Signature Care EPO |
$8.57
|
| Rate for Payer: Signature Care PPO |
$9.08
|
| Rate for Payer: United Healthcare Commercial |
$8.13
|
|
|
HC TUBE ESOPHAGEAL 20FR ADULT BLAKEMORE
|
Facility
|
OP
|
$1,565.85
|
|
| Hospital Charge Code |
41601807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$1,456.24 |
| Rate for Payer: Aetna Commercial |
$1,321.58
|
| Rate for Payer: Aetna Medicare |
$516.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$516.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$899.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$978.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$594.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$568.40
|
| Rate for Payer: Cash Price |
$970.83
|
| Rate for Payer: Cash Price |
$970.83
|
| Rate for Payer: Centivo All Commercial |
$798.58
|
| Rate for Payer: Cigna All Commercial |
$1,351.33
|
| Rate for Payer: CORVEL All Commercial |
$1,456.24
|
| Rate for Payer: Coventry All Commercial |
$1,377.95
|
| Rate for Payer: Encore All Commercial |
$1,441.36
|
| Rate for Payer: Frontpath All Commercial |
$1,440.58
|
| Rate for Payer: Humana ChoiceCare |
$1,352.42
|
| Rate for Payer: Humana Medicare |
$798.58
|
| Rate for Payer: Lucent All Commercial |
$798.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,409.26
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$1,174.39
|
| Rate for Payer: PHP All Commercial |
$1,187.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$610.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,208.84
|
| Rate for Payer: Signature Care EPO |
$1,299.66
|
| Rate for Payer: Signature Care PPO |
$1,377.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,330.97
|
| Rate for Payer: United Healthcare Commercial |
$1,233.89
|
| Rate for Payer: United Healthcare Medicare |
$516.73
|
|
|
HC TUBE ESOPHAGEAL 20FR ADULT BLAKEMORE
|
Facility
|
IP
|
$1,565.85
|
|
| Hospital Charge Code |
41601807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,174.39 |
| Max. Negotiated Rate |
$1,456.24 |
| Rate for Payer: Aetna Commercial |
$1,352.89
|
| Rate for Payer: Cash Price |
$970.83
|
| Rate for Payer: Cigna All Commercial |
$1,351.33
|
| Rate for Payer: CORVEL All Commercial |
$1,456.24
|
| Rate for Payer: Coventry All Commercial |
$1,377.95
|
| Rate for Payer: Encore All Commercial |
$1,441.36
|
| Rate for Payer: Frontpath All Commercial |
$1,440.58
|
| Rate for Payer: Humana ChoiceCare |
$1,352.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,409.26
|
| Rate for Payer: PHCS All Commercial |
$1,174.39
|
| Rate for Payer: PHP All Commercial |
$1,187.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,208.84
|
| Rate for Payer: Signature Care EPO |
$1,299.66
|
| Rate for Payer: Signature Care PPO |
$1,377.95
|
| Rate for Payer: United Healthcare Commercial |
$1,233.89
|
|
|
HC TUBE FEEDING 6.5FR X 16IN
|
Facility
|
IP
|
$7.37
|
|
| Hospital Charge Code |
41607013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Aetna Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Cigna All Commercial |
$6.36
|
| Rate for Payer: CORVEL All Commercial |
$6.85
|
| Rate for Payer: Coventry All Commercial |
$6.49
|
| Rate for Payer: Encore All Commercial |
$6.78
|
| Rate for Payer: Frontpath All Commercial |
$6.78
|
| Rate for Payer: Humana ChoiceCare |
$6.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.63
|
| Rate for Payer: PHCS All Commercial |
$5.53
|
| Rate for Payer: PHP All Commercial |
$5.59
|
| Rate for Payer: Sagamore Health Network All Products |
$5.69
|
| Rate for Payer: Signature Care EPO |
$6.12
|
| Rate for Payer: Signature Care PPO |
$6.49
|
| Rate for Payer: United Healthcare Commercial |
$5.81
|
|
|
HC TUBE FEEDING 6.5FR X 16IN
|
Facility
|
OP
|
$7.37
|
|
| Hospital Charge Code |
41607013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$6.22
|
| Rate for Payer: Aetna Medicare |
$2.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.68
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Centivo All Commercial |
$3.76
|
| Rate for Payer: Cigna All Commercial |
$6.36
|
| Rate for Payer: CORVEL All Commercial |
$6.85
|
| Rate for Payer: Coventry All Commercial |
$6.49
|
| Rate for Payer: Encore All Commercial |
$6.78
|
| Rate for Payer: Frontpath All Commercial |
$6.78
|
| Rate for Payer: Humana ChoiceCare |
$6.37
|
| Rate for Payer: Humana Medicare |
$3.76
|
| Rate for Payer: Lucent All Commercial |
$3.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$5.53
|
| Rate for Payer: PHP All Commercial |
$5.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.87
|
| Rate for Payer: Sagamore Health Network All Products |
$5.69
|
| Rate for Payer: Signature Care EPO |
$6.12
|
| Rate for Payer: Signature Care PPO |
$6.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.26
|
| Rate for Payer: United Healthcare Commercial |
$5.81
|
| Rate for Payer: United Healthcare Medicare |
$2.43
|
|
|
HC TUBE FEEDING JEJUNAL 12FR
|
Facility
|
IP
|
$962.50
|
|
| Hospital Charge Code |
41602288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC TUBE FEEDING JEJUNAL 12FR
|
Facility
|
OP
|
$962.50
|
|
| Hospital Charge Code |
41602288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.39
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Centivo All Commercial |
$490.88
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$490.88
|
| Rate for Payer: Lucent All Commercial |
$490.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$317.62
|
|
|
HC TUBE FEEDING NASO CORFLO 10FR
|
Facility
|
OP
|
$152.55
|
|
| Hospital Charge Code |
41606958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$141.87 |
| Rate for Payer: Aetna Commercial |
$128.75
|
| Rate for Payer: Aetna Medicare |
$50.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$87.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.38
|
| Rate for Payer: Cash Price |
$94.58
|
| Rate for Payer: Cash Price |
$94.58
|
| Rate for Payer: Centivo All Commercial |
$77.80
|
| Rate for Payer: Cigna All Commercial |
$131.65
|
| Rate for Payer: CORVEL All Commercial |
$141.87
|
| Rate for Payer: Coventry All Commercial |
$134.24
|
| Rate for Payer: Encore All Commercial |
$140.42
|
| Rate for Payer: Frontpath All Commercial |
$140.35
|
| Rate for Payer: Humana ChoiceCare |
$131.76
|
| Rate for Payer: Humana Medicare |
$77.80
|
| Rate for Payer: Lucent All Commercial |
$77.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$114.41
|
| Rate for Payer: PHP All Commercial |
$115.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.49
|
| Rate for Payer: Sagamore Health Network All Products |
$117.77
|
| Rate for Payer: Signature Care EPO |
$126.62
|
| Rate for Payer: Signature Care PPO |
$134.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.67
|
| Rate for Payer: United Healthcare Commercial |
$120.21
|
| Rate for Payer: United Healthcare Medicare |
$50.34
|
|
|
HC TUBE FEEDING NASO CORFLO 10FR
|
Facility
|
IP
|
$152.55
|
|
| Hospital Charge Code |
41606958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.41 |
| Max. Negotiated Rate |
$141.87 |
| Rate for Payer: Aetna Commercial |
$131.80
|
| Rate for Payer: Cash Price |
$94.58
|
| Rate for Payer: Cigna All Commercial |
$131.65
|
| Rate for Payer: CORVEL All Commercial |
$141.87
|
| Rate for Payer: Coventry All Commercial |
$134.24
|
| Rate for Payer: Encore All Commercial |
$140.42
|
| Rate for Payer: Frontpath All Commercial |
$140.35
|
| Rate for Payer: Humana ChoiceCare |
$131.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.30
|
| Rate for Payer: PHCS All Commercial |
$114.41
|
| Rate for Payer: PHP All Commercial |
$115.69
|
| Rate for Payer: Sagamore Health Network All Products |
$117.77
|
| Rate for Payer: Signature Care EPO |
$126.62
|
| Rate for Payer: Signature Care PPO |
$134.24
|
| Rate for Payer: United Healthcare Commercial |
$120.21
|
|
|
HC TUBE FEEDING PED 6.5 ENFIT
|
Facility
|
OP
|
$41.78
|
|
| Hospital Charge Code |
41607868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Centivo All Commercial |
$21.31
|
| Rate for Payer: Cigna All Commercial |
$36.06
|
| Rate for Payer: CORVEL All Commercial |
$38.86
|
| Rate for Payer: Coventry All Commercial |
$36.77
|
| Rate for Payer: Encore All Commercial |
$38.46
|
| Rate for Payer: Frontpath All Commercial |
$38.44
|
| Rate for Payer: Humana ChoiceCare |
$36.09
|
| Rate for Payer: Humana Medicare |
$21.31
|
| Rate for Payer: Lucent All Commercial |
$21.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$31.34
|
| Rate for Payer: PHP All Commercial |
$31.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.29
|
| Rate for Payer: Sagamore Health Network All Products |
$32.25
|
| Rate for Payer: Signature Care EPO |
$34.68
|
| Rate for Payer: Signature Care PPO |
$36.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.51
|
| Rate for Payer: United Healthcare Commercial |
$32.92
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
