|
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
|
|
|
HC TUBE SALEM SUMP NG 16FR
|
Facility
|
OP
|
$6.65
|
|
| Hospital Charge Code |
41601190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$5.61
|
| Rate for Payer: Aetna Medicare |
$2.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.41
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Centivo All Commercial |
$3.39
|
| Rate for Payer: Cigna All Commercial |
$5.74
|
| Rate for Payer: CORVEL All Commercial |
$6.18
|
| Rate for Payer: Coventry All Commercial |
$5.85
|
| Rate for Payer: Encore All Commercial |
$6.12
|
| Rate for Payer: Frontpath All Commercial |
$6.12
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare |
$3.39
|
| Rate for Payer: Lucent All Commercial |
$3.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$4.99
|
| Rate for Payer: PHP All Commercial |
$5.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.59
|
| Rate for Payer: Sagamore Health Network All Products |
$5.13
|
| Rate for Payer: Signature Care EPO |
$5.52
|
| Rate for Payer: Signature Care PPO |
$5.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.65
|
| Rate for Payer: United Healthcare Commercial |
$5.24
|
| Rate for Payer: United Healthcare Medicare |
$2.19
|
|
|
HC TUBE SALEM SUMP NG 16FR
|
Facility
|
IP
|
$6.65
|
|
| Hospital Charge Code |
41601190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cigna All Commercial |
$5.74
|
| Rate for Payer: CORVEL All Commercial |
$6.18
|
| Rate for Payer: Coventry All Commercial |
$5.85
|
| Rate for Payer: Encore All Commercial |
$6.12
|
| Rate for Payer: Frontpath All Commercial |
$6.12
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.98
|
| Rate for Payer: PHCS All Commercial |
$4.99
|
| Rate for Payer: PHP All Commercial |
$5.04
|
| Rate for Payer: Sagamore Health Network All Products |
$5.13
|
| Rate for Payer: Signature Care EPO |
$5.52
|
| Rate for Payer: Signature Care PPO |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$5.24
|
|
|
HC TUBE SALEM SUMP NG 18FR
|
Facility
|
OP
|
$6.65
|
|
| Hospital Charge Code |
41601191
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$5.61
|
| Rate for Payer: Aetna Medicare |
$2.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.41
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Centivo All Commercial |
$3.39
|
| Rate for Payer: Cigna All Commercial |
$5.74
|
| Rate for Payer: CORVEL All Commercial |
$6.18
|
| Rate for Payer: Coventry All Commercial |
$5.85
|
| Rate for Payer: Encore All Commercial |
$6.12
|
| Rate for Payer: Frontpath All Commercial |
$6.12
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare |
$3.39
|
| Rate for Payer: Lucent All Commercial |
$3.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.98
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$4.99
|
| Rate for Payer: PHP All Commercial |
$5.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.59
|
| Rate for Payer: Sagamore Health Network All Products |
$5.13
|
| Rate for Payer: Signature Care EPO |
$5.52
|
| Rate for Payer: Signature Care PPO |
$5.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.65
|
| Rate for Payer: United Healthcare Commercial |
$5.24
|
| Rate for Payer: United Healthcare Medicare |
$2.19
|
|
|
HC TUBE SALEM SUMP NG 18FR
|
Facility
|
IP
|
$6.65
|
|
| Hospital Charge Code |
41601191
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cigna All Commercial |
$5.74
|
| Rate for Payer: CORVEL All Commercial |
$6.18
|
| Rate for Payer: Coventry All Commercial |
$5.85
|
| Rate for Payer: Encore All Commercial |
$6.12
|
| Rate for Payer: Frontpath All Commercial |
$6.12
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.98
|
| Rate for Payer: PHCS All Commercial |
$4.99
|
| Rate for Payer: PHP All Commercial |
$5.04
|
| Rate for Payer: Sagamore Health Network All Products |
$5.13
|
| Rate for Payer: Signature Care EPO |
$5.52
|
| Rate for Payer: Signature Care PPO |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$5.24
|
|
|
HC TUBESET ARTHROSCOPY PUMP
|
Facility
|
IP
|
$306.77
|
|
| Hospital Charge Code |
41601203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.08 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna All Commercial |
$264.74
|
| Rate for Payer: CORVEL All Commercial |
$285.30
|
| Rate for Payer: Coventry All Commercial |
$269.96
|
| Rate for Payer: Encore All Commercial |
$282.38
|
| Rate for Payer: Frontpath All Commercial |
$282.23
|
| Rate for Payer: Humana ChoiceCare |
$264.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.09
|
| Rate for Payer: PHCS All Commercial |
$230.08
|
| Rate for Payer: PHP All Commercial |
$232.65
|
| Rate for Payer: Sagamore Health Network All Products |
$236.83
|
| Rate for Payer: Signature Care EPO |
$254.62
|
| Rate for Payer: Signature Care PPO |
$269.96
|
| Rate for Payer: United Healthcare Commercial |
$241.73
|
|
|
HC TUBESET ARTHROSCOPY PUMP
|
Facility
|
OP
|
$306.77
|
|
| Hospital Charge Code |
41601203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna Commercial |
$258.91
|
| Rate for Payer: Aetna Medicare |
$101.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$176.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.36
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Centivo All Commercial |
$156.45
|
| Rate for Payer: Cigna All Commercial |
$264.74
|
| Rate for Payer: CORVEL All Commercial |
$285.30
|
| Rate for Payer: Coventry All Commercial |
$269.96
|
| Rate for Payer: Encore All Commercial |
$282.38
|
| Rate for Payer: Frontpath All Commercial |
$282.23
|
| Rate for Payer: Humana ChoiceCare |
$264.96
|
| Rate for Payer: Humana Medicare |
$156.45
|
| Rate for Payer: Lucent All Commercial |
$156.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$230.08
|
| Rate for Payer: PHP All Commercial |
$232.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.64
|
| Rate for Payer: Sagamore Health Network All Products |
$236.83
|
| Rate for Payer: Signature Care EPO |
$254.62
|
| Rate for Payer: Signature Care PPO |
$269.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.75
|
| Rate for Payer: United Healthcare Commercial |
$241.73
|
| Rate for Payer: United Healthcare Medicare |
$101.23
|
|
|
HC TUBE TRACH 3.0
|
Facility
|
OP
|
$421.75
|
|
| Hospital Charge Code |
41601851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$392.23 |
| Rate for Payer: Aetna Commercial |
$355.96
|
| Rate for Payer: Aetna Medicare |
$139.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$242.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.10
|
| Rate for Payer: Cash Price |
$261.49
|
| Rate for Payer: Cash Price |
$261.49
|
| Rate for Payer: Centivo All Commercial |
$215.09
|
| Rate for Payer: Cigna All Commercial |
$363.97
|
| Rate for Payer: CORVEL All Commercial |
$392.23
|
| Rate for Payer: Coventry All Commercial |
$371.14
|
| Rate for Payer: Encore All Commercial |
$388.22
|
| Rate for Payer: Frontpath All Commercial |
$388.01
|
| Rate for Payer: Humana ChoiceCare |
$364.27
|
| Rate for Payer: Humana Medicare |
$215.09
|
| Rate for Payer: Lucent All Commercial |
$215.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$316.31
|
| Rate for Payer: PHP All Commercial |
$319.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.48
|
| Rate for Payer: Sagamore Health Network All Products |
$325.59
|
| Rate for Payer: Signature Care EPO |
$350.05
|
| Rate for Payer: Signature Care PPO |
$371.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$358.49
|
| Rate for Payer: United Healthcare Commercial |
$332.34
|
| Rate for Payer: United Healthcare Medicare |
$139.18
|
|
|
HC TUBE TRACH 3.0
|
Facility
|
IP
|
$421.75
|
|
| Hospital Charge Code |
41601851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.31 |
| Max. Negotiated Rate |
$392.23 |
| Rate for Payer: Aetna Commercial |
$364.39
|
| Rate for Payer: Cash Price |
$261.49
|
| Rate for Payer: Cigna All Commercial |
$363.97
|
| Rate for Payer: CORVEL All Commercial |
$392.23
|
| Rate for Payer: Coventry All Commercial |
$371.14
|
| Rate for Payer: Encore All Commercial |
$388.22
|
| Rate for Payer: Frontpath All Commercial |
$388.01
|
| Rate for Payer: Humana ChoiceCare |
$364.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.58
|
| Rate for Payer: PHCS All Commercial |
$316.31
|
| Rate for Payer: PHP All Commercial |
$319.86
|
| Rate for Payer: Sagamore Health Network All Products |
$325.59
|
| Rate for Payer: Signature Care EPO |
$350.05
|
| Rate for Payer: Signature Care PPO |
$371.14
|
| Rate for Payer: United Healthcare Commercial |
$332.34
|
|
|
HC TUBE TRACH 4.0
|
Facility
|
OP
|
$409.43
|
|
| Hospital Charge Code |
41601852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$380.77 |
| Rate for Payer: Aetna Commercial |
$345.56
|
| Rate for Payer: Aetna Medicare |
$135.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$235.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.62
|
| Rate for Payer: Cash Price |
$253.85
|
| Rate for Payer: Cash Price |
$253.85
|
| Rate for Payer: Centivo All Commercial |
$208.81
|
| Rate for Payer: Cigna All Commercial |
$353.34
|
| Rate for Payer: CORVEL All Commercial |
$380.77
|
| Rate for Payer: Coventry All Commercial |
$360.30
|
| Rate for Payer: Encore All Commercial |
$376.88
|
| Rate for Payer: Frontpath All Commercial |
$376.68
|
| Rate for Payer: Humana ChoiceCare |
$353.62
|
| Rate for Payer: Humana Medicare |
$208.81
|
| Rate for Payer: Lucent All Commercial |
$208.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.49
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$307.07
|
| Rate for Payer: PHP All Commercial |
$310.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.68
|
| Rate for Payer: Sagamore Health Network All Products |
$316.08
|
| Rate for Payer: Signature Care EPO |
$339.83
|
| Rate for Payer: Signature Care PPO |
$360.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$348.02
|
| Rate for Payer: United Healthcare Commercial |
$322.63
|
| Rate for Payer: United Healthcare Medicare |
$135.11
|
|
|
HC TUBE TRACH 4.0
|
Facility
|
IP
|
$409.43
|
|
| Hospital Charge Code |
41601852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.07 |
| Max. Negotiated Rate |
$380.77 |
| Rate for Payer: Aetna Commercial |
$353.75
|
| Rate for Payer: Cash Price |
$253.85
|
| Rate for Payer: Cigna All Commercial |
$353.34
|
| Rate for Payer: CORVEL All Commercial |
$380.77
|
| Rate for Payer: Coventry All Commercial |
$360.30
|
| Rate for Payer: Encore All Commercial |
$376.88
|
| Rate for Payer: Frontpath All Commercial |
$376.68
|
| Rate for Payer: Humana ChoiceCare |
$353.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.49
|
| Rate for Payer: PHCS All Commercial |
$307.07
|
| Rate for Payer: PHP All Commercial |
$310.51
|
| Rate for Payer: Sagamore Health Network All Products |
$316.08
|
| Rate for Payer: Signature Care EPO |
$339.83
|
| Rate for Payer: Signature Care PPO |
$360.30
|
| Rate for Payer: United Healthcare Commercial |
$322.63
|
|
|
HC TUBE TRACH 5.0
|
Facility
|
OP
|
$409.43
|
|
| Hospital Charge Code |
41601853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$380.77 |
| Rate for Payer: Aetna Commercial |
$345.56
|
| Rate for Payer: Aetna Medicare |
$135.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$235.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.62
|
| Rate for Payer: Cash Price |
$253.85
|
| Rate for Payer: Cash Price |
$253.85
|
| Rate for Payer: Centivo All Commercial |
$208.81
|
| Rate for Payer: Cigna All Commercial |
$353.34
|
| Rate for Payer: CORVEL All Commercial |
$380.77
|
| Rate for Payer: Coventry All Commercial |
$360.30
|
| Rate for Payer: Encore All Commercial |
$376.88
|
| Rate for Payer: Frontpath All Commercial |
$376.68
|
| Rate for Payer: Humana ChoiceCare |
$353.62
|
| Rate for Payer: Humana Medicare |
$208.81
|
| Rate for Payer: Lucent All Commercial |
$208.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.49
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$307.07
|
| Rate for Payer: PHP All Commercial |
$310.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.68
|
| Rate for Payer: Sagamore Health Network All Products |
$316.08
|
| Rate for Payer: Signature Care EPO |
$339.83
|
| Rate for Payer: Signature Care PPO |
$360.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$348.02
|
| Rate for Payer: United Healthcare Commercial |
$322.63
|
| Rate for Payer: United Healthcare Medicare |
$135.11
|
|
|
HC TUBE TRACH 5.0
|
Facility
|
IP
|
$409.43
|
|
| Hospital Charge Code |
41601853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.07 |
| Max. Negotiated Rate |
$380.77 |
| Rate for Payer: Aetna Commercial |
$353.75
|
| Rate for Payer: Cash Price |
$253.85
|
| Rate for Payer: Cigna All Commercial |
$353.34
|
| Rate for Payer: CORVEL All Commercial |
$380.77
|
| Rate for Payer: Coventry All Commercial |
$360.30
|
| Rate for Payer: Encore All Commercial |
$376.88
|
| Rate for Payer: Frontpath All Commercial |
$376.68
|
| Rate for Payer: Humana ChoiceCare |
$353.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.49
|
| Rate for Payer: PHCS All Commercial |
$307.07
|
| Rate for Payer: PHP All Commercial |
$310.51
|
| Rate for Payer: Sagamore Health Network All Products |
$316.08
|
| Rate for Payer: Signature Care EPO |
$339.83
|
| Rate for Payer: Signature Care PPO |
$360.30
|
| Rate for Payer: United Healthcare Commercial |
$322.63
|
|
|
HC TUBE TRACH 6.0
|
Facility
|
OP
|
$239.40
|
|
| Hospital Charge Code |
41601854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$222.64 |
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$137.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.90
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Centivo All Commercial |
$122.09
|
| Rate for Payer: Cigna All Commercial |
$206.60
|
| Rate for Payer: CORVEL All Commercial |
$222.64
|
| Rate for Payer: Coventry All Commercial |
$210.67
|
| Rate for Payer: Encore All Commercial |
$220.37
|
| Rate for Payer: Frontpath All Commercial |
$220.25
|
| Rate for Payer: Humana ChoiceCare |
$206.77
|
| Rate for Payer: Humana Medicare |
$122.09
|
| Rate for Payer: Lucent All Commercial |
$122.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$179.55
|
| Rate for Payer: PHP All Commercial |
$181.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.37
|
| Rate for Payer: Sagamore Health Network All Products |
$184.82
|
| Rate for Payer: Signature Care EPO |
$198.70
|
| Rate for Payer: Signature Care PPO |
$210.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$203.49
|
| Rate for Payer: United Healthcare Commercial |
$188.65
|
| Rate for Payer: United Healthcare Medicare |
$79.00
|
|
|
HC TUBE TRACH 6.0
|
Facility
|
IP
|
$239.40
|
|
| Hospital Charge Code |
41601854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.55 |
| Max. Negotiated Rate |
$222.64 |
| Rate for Payer: Aetna Commercial |
$206.84
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Cigna All Commercial |
$206.60
|
| Rate for Payer: CORVEL All Commercial |
$222.64
|
| Rate for Payer: Coventry All Commercial |
$210.67
|
| Rate for Payer: Encore All Commercial |
$220.37
|
| Rate for Payer: Frontpath All Commercial |
$220.25
|
| Rate for Payer: Humana ChoiceCare |
$206.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.46
|
| Rate for Payer: PHCS All Commercial |
$179.55
|
| Rate for Payer: PHP All Commercial |
$181.56
|
| Rate for Payer: Sagamore Health Network All Products |
$184.82
|
| Rate for Payer: Signature Care EPO |
$198.70
|
| Rate for Payer: Signature Care PPO |
$210.67
|
| Rate for Payer: United Healthcare Commercial |
$188.65
|
|
|
HC TUBE TRACH 7.0
|
Facility
|
OP
|
$239.40
|
|
| Hospital Charge Code |
41601855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$222.64 |
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$137.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.90
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Centivo All Commercial |
$122.09
|
| Rate for Payer: Cigna All Commercial |
$206.60
|
| Rate for Payer: CORVEL All Commercial |
$222.64
|
| Rate for Payer: Coventry All Commercial |
$210.67
|
| Rate for Payer: Encore All Commercial |
$220.37
|
| Rate for Payer: Frontpath All Commercial |
$220.25
|
| Rate for Payer: Humana ChoiceCare |
$206.77
|
| Rate for Payer: Humana Medicare |
$122.09
|
| Rate for Payer: Lucent All Commercial |
$122.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$179.55
|
| Rate for Payer: PHP All Commercial |
$181.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.37
|
| Rate for Payer: Sagamore Health Network All Products |
$184.82
|
| Rate for Payer: Signature Care EPO |
$198.70
|
| Rate for Payer: Signature Care PPO |
$210.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$203.49
|
| Rate for Payer: United Healthcare Commercial |
$188.65
|
| Rate for Payer: United Healthcare Medicare |
$79.00
|
|
|
HC TUBE TRACH 7.0
|
Facility
|
IP
|
$239.40
|
|
| Hospital Charge Code |
41601855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.55 |
| Max. Negotiated Rate |
$222.64 |
| Rate for Payer: Aetna Commercial |
$206.84
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Cigna All Commercial |
$206.60
|
| Rate for Payer: CORVEL All Commercial |
$222.64
|
| Rate for Payer: Coventry All Commercial |
$210.67
|
| Rate for Payer: Encore All Commercial |
$220.37
|
| Rate for Payer: Frontpath All Commercial |
$220.25
|
| Rate for Payer: Humana ChoiceCare |
$206.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.46
|
| Rate for Payer: PHCS All Commercial |
$179.55
|
| Rate for Payer: PHP All Commercial |
$181.56
|
| Rate for Payer: Sagamore Health Network All Products |
$184.82
|
| Rate for Payer: Signature Care EPO |
$198.70
|
| Rate for Payer: Signature Care PPO |
$210.67
|
| Rate for Payer: United Healthcare Commercial |
$188.65
|
|
|
HC TUBE TRACH 8.0
|
Facility
|
OP
|
$230.72
|
|
| Hospital Charge Code |
41601856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$214.57 |
| Rate for Payer: Aetna Commercial |
$194.73
|
| Rate for Payer: Aetna Medicare |
$76.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.75
|
| Rate for Payer: Cash Price |
$143.05
|
| Rate for Payer: Cash Price |
$143.05
|
| Rate for Payer: Centivo All Commercial |
$117.67
|
| Rate for Payer: Cigna All Commercial |
$199.11
|
| Rate for Payer: CORVEL All Commercial |
$214.57
|
| Rate for Payer: Coventry All Commercial |
$203.03
|
| Rate for Payer: Encore All Commercial |
$212.38
|
| Rate for Payer: Frontpath All Commercial |
$212.26
|
| Rate for Payer: Humana ChoiceCare |
$199.27
|
| Rate for Payer: Humana Medicare |
$117.67
|
| Rate for Payer: Lucent All Commercial |
$117.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.65
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$173.04
|
| Rate for Payer: PHP All Commercial |
$174.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.98
|
| Rate for Payer: Sagamore Health Network All Products |
$178.12
|
| Rate for Payer: Signature Care EPO |
$191.50
|
| Rate for Payer: Signature Care PPO |
$203.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$196.11
|
| Rate for Payer: United Healthcare Commercial |
$181.81
|
| Rate for Payer: United Healthcare Medicare |
$76.14
|
|
|
HC TUBE TRACH 8.0
|
Facility
|
IP
|
$230.72
|
|
| Hospital Charge Code |
41601856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.04 |
| Max. Negotiated Rate |
$214.57 |
| Rate for Payer: Aetna Commercial |
$199.34
|
| Rate for Payer: Cash Price |
$143.05
|
| Rate for Payer: Cigna All Commercial |
$199.11
|
| Rate for Payer: CORVEL All Commercial |
$214.57
|
| Rate for Payer: Coventry All Commercial |
$203.03
|
| Rate for Payer: Encore All Commercial |
$212.38
|
| Rate for Payer: Frontpath All Commercial |
$212.26
|
| Rate for Payer: Humana ChoiceCare |
$199.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.65
|
| Rate for Payer: PHCS All Commercial |
$173.04
|
| Rate for Payer: PHP All Commercial |
$174.98
|
| Rate for Payer: Sagamore Health Network All Products |
$178.12
|
| Rate for Payer: Signature Care EPO |
$191.50
|
| Rate for Payer: Signature Care PPO |
$203.03
|
| Rate for Payer: United Healthcare Commercial |
$181.81
|
|
|
HC TUBE VENT ARMSTRNG 1.14
|
Facility
|
IP
|
$239.40
|
|
| Hospital Charge Code |
41602629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.55 |
| Max. Negotiated Rate |
$222.64 |
| Rate for Payer: Aetna Commercial |
$206.84
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Cigna All Commercial |
$206.60
|
| Rate for Payer: CORVEL All Commercial |
$222.64
|
| Rate for Payer: Coventry All Commercial |
$210.67
|
| Rate for Payer: Encore All Commercial |
$220.37
|
| Rate for Payer: Frontpath All Commercial |
$220.25
|
| Rate for Payer: Humana ChoiceCare |
$206.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.46
|
| Rate for Payer: PHCS All Commercial |
$179.55
|
| Rate for Payer: PHP All Commercial |
$181.56
|
| Rate for Payer: Sagamore Health Network All Products |
$184.82
|
| Rate for Payer: Signature Care EPO |
$198.70
|
| Rate for Payer: Signature Care PPO |
$210.67
|
| Rate for Payer: United Healthcare Commercial |
$188.65
|
|
|
HC TUBE VENT ARMSTRNG 1.14
|
Facility
|
OP
|
$239.40
|
|
| Hospital Charge Code |
41602629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$137.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.90
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Centivo All Commercial |
$122.09
|
| Rate for Payer: Cigna All Commercial |
$206.60
|
| Rate for Payer: CORVEL All Commercial |
$222.64
|
| Rate for Payer: Coventry All Commercial |
$210.67
|
| Rate for Payer: Encore All Commercial |
$220.37
|
| Rate for Payer: Frontpath All Commercial |
$220.25
|
| Rate for Payer: Humana ChoiceCare |
$206.77
|
| Rate for Payer: Humana Medicare |
$122.09
|
| Rate for Payer: Lucent All Commercial |
$122.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.46
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$179.55
|
| Rate for Payer: PHP All Commercial |
$181.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.37
|
| Rate for Payer: Sagamore Health Network All Products |
$184.82
|
| Rate for Payer: Signature Care EPO |
$198.70
|
| Rate for Payer: Signature Care PPO |
$210.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$203.49
|
| Rate for Payer: United Healthcare Commercial |
$188.65
|
| Rate for Payer: United Healthcare Medicare |
$79.00
|
|
|
HC TUBE VENT T 1.14
|
Facility
|
IP
|
$219.80
|
|
| Hospital Charge Code |
41602630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.85 |
| Max. Negotiated Rate |
$204.41 |
| Rate for Payer: Aetna Commercial |
$189.91
|
| Rate for Payer: Cash Price |
$136.28
|
| Rate for Payer: Cigna All Commercial |
$189.69
|
| Rate for Payer: CORVEL All Commercial |
$204.41
|
| Rate for Payer: Coventry All Commercial |
$193.42
|
| Rate for Payer: Encore All Commercial |
$202.33
|
| Rate for Payer: Frontpath All Commercial |
$202.22
|
| Rate for Payer: Humana ChoiceCare |
$189.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.82
|
| Rate for Payer: PHCS All Commercial |
$164.85
|
| Rate for Payer: PHP All Commercial |
$166.70
|
| Rate for Payer: Sagamore Health Network All Products |
$169.69
|
| Rate for Payer: Signature Care EPO |
$182.43
|
| Rate for Payer: Signature Care PPO |
$193.42
|
| Rate for Payer: United Healthcare Commercial |
$173.20
|
|
|
HC TUBE VENT T 1.14
|
Facility
|
OP
|
$219.80
|
|
| Hospital Charge Code |
41602630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$185.51
|
| Rate for Payer: Aetna Medicare |
$72.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$126.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$137.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.79
|
| Rate for Payer: Cash Price |
$136.28
|
| Rate for Payer: Cash Price |
$136.28
|
| Rate for Payer: Centivo All Commercial |
$112.10
|
| Rate for Payer: Cigna All Commercial |
$189.69
|
| Rate for Payer: CORVEL All Commercial |
$204.41
|
| Rate for Payer: Coventry All Commercial |
$193.42
|
| Rate for Payer: Encore All Commercial |
$202.33
|
| Rate for Payer: Frontpath All Commercial |
$202.22
|
| Rate for Payer: Humana ChoiceCare |
$189.84
|
| Rate for Payer: Humana Medicare |
$112.10
|
| Rate for Payer: Lucent All Commercial |
$112.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.82
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$164.85
|
| Rate for Payer: PHP All Commercial |
$166.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.72
|
| Rate for Payer: Sagamore Health Network All Products |
$169.69
|
| Rate for Payer: Signature Care EPO |
$182.43
|
| Rate for Payer: Signature Care PPO |
$193.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$186.83
|
| Rate for Payer: United Healthcare Commercial |
$173.20
|
| Rate for Payer: United Healthcare Medicare |
$72.53
|
|
|
HC TUBING CAPNOLINE ADULT 02 LONG
|
Facility
|
OP
|
$115.56
|
|
| Hospital Charge Code |
41601192
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$107.47 |
| Rate for Payer: Aetna Commercial |
$97.53
|
| Rate for Payer: Aetna Medicare |
$38.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.95
|
| Rate for Payer: Cash Price |
$71.65
|
| Rate for Payer: Cash Price |
$71.65
|
| Rate for Payer: Centivo All Commercial |
$58.94
|
| Rate for Payer: Cigna All Commercial |
$99.73
|
| Rate for Payer: CORVEL All Commercial |
$107.47
|
| Rate for Payer: Coventry All Commercial |
$101.69
|
| Rate for Payer: Encore All Commercial |
$106.37
|
| Rate for Payer: Frontpath All Commercial |
$106.32
|
| Rate for Payer: Humana ChoiceCare |
$99.81
|
| Rate for Payer: Humana Medicare |
$58.94
|
| Rate for Payer: Lucent All Commercial |
$58.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.00
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$86.67
|
| Rate for Payer: PHP All Commercial |
$87.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.07
|
| Rate for Payer: Sagamore Health Network All Products |
$89.21
|
| Rate for Payer: Signature Care EPO |
$95.91
|
| Rate for Payer: Signature Care PPO |
$101.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.23
|
| Rate for Payer: United Healthcare Commercial |
$91.06
|
| Rate for Payer: United Healthcare Medicare |
$38.13
|
|
|
HC TUBING CAPNOLINE ADULT 02 LONG
|
Facility
|
IP
|
$115.56
|
|
| Hospital Charge Code |
41601192
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$86.67 |
| Max. Negotiated Rate |
$107.47 |
| Rate for Payer: Aetna Commercial |
$99.84
|
| Rate for Payer: Cash Price |
$71.65
|
| Rate for Payer: Cigna All Commercial |
$99.73
|
| Rate for Payer: CORVEL All Commercial |
$107.47
|
| Rate for Payer: Coventry All Commercial |
$101.69
|
| Rate for Payer: Encore All Commercial |
$106.37
|
| Rate for Payer: Frontpath All Commercial |
$106.32
|
| Rate for Payer: Humana ChoiceCare |
$99.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.00
|
| Rate for Payer: PHCS All Commercial |
$86.67
|
| Rate for Payer: PHP All Commercial |
$87.64
|
| Rate for Payer: Sagamore Health Network All Products |
$89.21
|
| Rate for Payer: Signature Care EPO |
$95.91
|
| Rate for Payer: Signature Care PPO |
$101.69
|
| Rate for Payer: United Healthcare Commercial |
$91.06
|
|
