|
HC TUBING CAPNOLINE COLON
|
Facility
|
OP
|
$141.42
|
|
| Hospital Charge Code |
41601193
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.67 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$119.36
|
| Rate for Payer: Aetna Medicare |
$46.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$81.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.34
|
| Rate for Payer: Cash Price |
$87.68
|
| Rate for Payer: Cash Price |
$87.68
|
| Rate for Payer: Centivo All Commercial |
$72.12
|
| Rate for Payer: Cigna All Commercial |
$122.05
|
| Rate for Payer: CORVEL All Commercial |
$131.52
|
| Rate for Payer: Coventry All Commercial |
$124.45
|
| Rate for Payer: Encore All Commercial |
$130.18
|
| Rate for Payer: Frontpath All Commercial |
$130.11
|
| Rate for Payer: Humana ChoiceCare |
$122.14
|
| Rate for Payer: Humana Medicare |
$72.12
|
| Rate for Payer: Lucent All Commercial |
$72.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.28
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$106.06
|
| Rate for Payer: PHP All Commercial |
$107.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.15
|
| Rate for Payer: Sagamore Health Network All Products |
$109.18
|
| Rate for Payer: Signature Care EPO |
$117.38
|
| Rate for Payer: Signature Care PPO |
$124.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120.21
|
| Rate for Payer: United Healthcare Commercial |
$111.44
|
| Rate for Payer: United Healthcare Medicare |
$46.67
|
|
|
HC TUBING CAPNOLINE COLON
|
Facility
|
IP
|
$141.42
|
|
| Hospital Charge Code |
41601193
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$106.06 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$122.19
|
| Rate for Payer: Cash Price |
$87.68
|
| Rate for Payer: Cigna All Commercial |
$122.05
|
| Rate for Payer: CORVEL All Commercial |
$131.52
|
| Rate for Payer: Coventry All Commercial |
$124.45
|
| Rate for Payer: Encore All Commercial |
$130.18
|
| Rate for Payer: Frontpath All Commercial |
$130.11
|
| Rate for Payer: Humana ChoiceCare |
$122.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.28
|
| Rate for Payer: PHCS All Commercial |
$106.06
|
| Rate for Payer: PHP All Commercial |
$107.25
|
| Rate for Payer: Sagamore Health Network All Products |
$109.18
|
| Rate for Payer: Signature Care EPO |
$117.38
|
| Rate for Payer: Signature Care PPO |
$124.45
|
| Rate for Payer: United Healthcare Commercial |
$111.44
|
|
|
HC TUBING CAPNOLINE GASTRO 100/BX
|
Facility
|
IP
|
$132.89
|
|
| Hospital Charge Code |
41601798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$123.59 |
| Rate for Payer: Aetna Commercial |
$114.82
|
| Rate for Payer: Cash Price |
$82.39
|
| Rate for Payer: Cigna All Commercial |
$114.68
|
| Rate for Payer: CORVEL All Commercial |
$123.59
|
| Rate for Payer: Coventry All Commercial |
$116.94
|
| Rate for Payer: Encore All Commercial |
$122.33
|
| Rate for Payer: Frontpath All Commercial |
$122.26
|
| Rate for Payer: Humana ChoiceCare |
$114.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.60
|
| Rate for Payer: PHCS All Commercial |
$99.67
|
| Rate for Payer: PHP All Commercial |
$100.78
|
| Rate for Payer: Sagamore Health Network All Products |
$102.59
|
| Rate for Payer: Signature Care EPO |
$110.30
|
| Rate for Payer: Signature Care PPO |
$116.94
|
| Rate for Payer: United Healthcare Commercial |
$104.72
|
|
|
HC TUBING CAPNOLINE GASTRO 100/BX
|
Facility
|
OP
|
$132.89
|
|
| Hospital Charge Code |
41601798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$123.59 |
| Rate for Payer: Aetna Commercial |
$112.16
|
| Rate for Payer: Aetna Medicare |
$43.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.24
|
| Rate for Payer: Cash Price |
$82.39
|
| Rate for Payer: Cash Price |
$82.39
|
| Rate for Payer: Centivo All Commercial |
$67.77
|
| Rate for Payer: Cigna All Commercial |
$114.68
|
| Rate for Payer: CORVEL All Commercial |
$123.59
|
| Rate for Payer: Coventry All Commercial |
$116.94
|
| Rate for Payer: Encore All Commercial |
$122.33
|
| Rate for Payer: Frontpath All Commercial |
$122.26
|
| Rate for Payer: Humana ChoiceCare |
$114.78
|
| Rate for Payer: Humana Medicare |
$67.77
|
| Rate for Payer: Lucent All Commercial |
$67.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.60
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$99.67
|
| Rate for Payer: PHP All Commercial |
$100.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.83
|
| Rate for Payer: Sagamore Health Network All Products |
$102.59
|
| Rate for Payer: Signature Care EPO |
$110.30
|
| Rate for Payer: Signature Care PPO |
$116.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.96
|
| Rate for Payer: United Healthcare Commercial |
$104.72
|
| Rate for Payer: United Healthcare Medicare |
$43.85
|
|
|
HC TUBING CYSTO
|
Facility
|
OP
|
$48.71
|
|
| Hospital Charge Code |
41601194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$41.11
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.68
|
| Rate for Payer: Cash Price |
$30.20
|
| Rate for Payer: Cash Price |
$30.20
|
| Rate for Payer: Centivo All Commercial |
$24.84
|
| Rate for Payer: Cigna All Commercial |
$42.04
|
| Rate for Payer: CORVEL All Commercial |
$45.30
|
| Rate for Payer: Coventry All Commercial |
$42.86
|
| Rate for Payer: Encore All Commercial |
$44.84
|
| Rate for Payer: Frontpath All Commercial |
$44.81
|
| Rate for Payer: Humana ChoiceCare |
$42.07
|
| Rate for Payer: Humana Medicare |
$24.84
|
| Rate for Payer: Lucent All Commercial |
$24.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$36.53
|
| Rate for Payer: PHP All Commercial |
$36.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.00
|
| Rate for Payer: Sagamore Health Network All Products |
$37.60
|
| Rate for Payer: Signature Care EPO |
$40.43
|
| Rate for Payer: Signature Care PPO |
$42.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.40
|
| Rate for Payer: United Healthcare Commercial |
$38.38
|
| Rate for Payer: United Healthcare Medicare |
$16.07
|
|
|
HC TUBING CYSTO
|
Facility
|
IP
|
$48.71
|
|
| Hospital Charge Code |
41601194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.53 |
| Max. Negotiated Rate |
$45.30 |
| Rate for Payer: Aetna Commercial |
$42.09
|
| Rate for Payer: Cash Price |
$30.20
|
| Rate for Payer: Cigna All Commercial |
$42.04
|
| Rate for Payer: CORVEL All Commercial |
$45.30
|
| Rate for Payer: Coventry All Commercial |
$42.86
|
| Rate for Payer: Encore All Commercial |
$44.84
|
| Rate for Payer: Frontpath All Commercial |
$44.81
|
| Rate for Payer: Humana ChoiceCare |
$42.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.84
|
| Rate for Payer: PHCS All Commercial |
$36.53
|
| Rate for Payer: PHP All Commercial |
$36.94
|
| Rate for Payer: Sagamore Health Network All Products |
$37.60
|
| Rate for Payer: Signature Care EPO |
$40.43
|
| Rate for Payer: Signature Care PPO |
$42.86
|
| Rate for Payer: United Healthcare Commercial |
$38.38
|
|
|
HC TUBING FILTERLINE ADULT/PED
|
Facility
|
IP
|
$69.33
|
|
| Hospital Charge Code |
41607729
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$64.48 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Cigna All Commercial |
$59.83
|
| Rate for Payer: CORVEL All Commercial |
$64.48
|
| Rate for Payer: Coventry All Commercial |
$61.01
|
| Rate for Payer: Encore All Commercial |
$63.82
|
| Rate for Payer: Frontpath All Commercial |
$63.78
|
| Rate for Payer: Humana ChoiceCare |
$59.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.40
|
| Rate for Payer: PHCS All Commercial |
$52.00
|
| Rate for Payer: PHP All Commercial |
$52.58
|
| Rate for Payer: Sagamore Health Network All Products |
$53.52
|
| Rate for Payer: Signature Care EPO |
$57.54
|
| Rate for Payer: Signature Care PPO |
$61.01
|
| Rate for Payer: United Healthcare Commercial |
$54.63
|
|
|
HC TUBING FILTERLINE ADULT/PED
|
Facility
|
OP
|
$69.33
|
|
| Hospital Charge Code |
41607729
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$58.51
|
| Rate for Payer: Aetna Medicare |
$22.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.17
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Centivo All Commercial |
$35.36
|
| Rate for Payer: Cigna All Commercial |
$59.83
|
| Rate for Payer: CORVEL All Commercial |
$64.48
|
| Rate for Payer: Coventry All Commercial |
$61.01
|
| Rate for Payer: Encore All Commercial |
$63.82
|
| Rate for Payer: Frontpath All Commercial |
$63.78
|
| Rate for Payer: Humana ChoiceCare |
$59.88
|
| Rate for Payer: Humana Medicare |
$35.36
|
| Rate for Payer: Lucent All Commercial |
$35.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.40
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$52.00
|
| Rate for Payer: PHP All Commercial |
$52.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.04
|
| Rate for Payer: Sagamore Health Network All Products |
$53.52
|
| Rate for Payer: Signature Care EPO |
$57.54
|
| Rate for Payer: Signature Care PPO |
$61.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.93
|
| Rate for Payer: United Healthcare Commercial |
$54.63
|
| Rate for Payer: United Healthcare Medicare |
$22.88
|
|
|
HC TUBING FLOSTEADY ARTHROSCOPY
|
Facility
|
OP
|
$378.44
|
|
| Hospital Charge Code |
41603419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$351.95 |
| Rate for Payer: Aetna Commercial |
$319.40
|
| Rate for Payer: Aetna Medicare |
$124.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$217.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$236.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.37
|
| Rate for Payer: Cash Price |
$234.63
|
| Rate for Payer: Cash Price |
$234.63
|
| Rate for Payer: Centivo All Commercial |
$193.00
|
| Rate for Payer: Cigna All Commercial |
$326.59
|
| Rate for Payer: CORVEL All Commercial |
$351.95
|
| Rate for Payer: Coventry All Commercial |
$333.03
|
| Rate for Payer: Encore All Commercial |
$348.35
|
| Rate for Payer: Frontpath All Commercial |
$348.16
|
| Rate for Payer: Humana ChoiceCare |
$326.86
|
| Rate for Payer: Humana Medicare |
$193.00
|
| Rate for Payer: Lucent All Commercial |
$193.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$340.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$283.83
|
| Rate for Payer: PHP All Commercial |
$287.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.59
|
| Rate for Payer: Sagamore Health Network All Products |
$292.16
|
| Rate for Payer: Signature Care EPO |
$314.11
|
| Rate for Payer: Signature Care PPO |
$333.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$321.67
|
| Rate for Payer: United Healthcare Commercial |
$298.21
|
| Rate for Payer: United Healthcare Medicare |
$124.89
|
|
|
HC TUBING FLOSTEADY ARTHROSCOPY
|
Facility
|
IP
|
$378.44
|
|
| Hospital Charge Code |
41603419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.83 |
| Max. Negotiated Rate |
$351.95 |
| Rate for Payer: Aetna Commercial |
$326.97
|
| Rate for Payer: Cash Price |
$234.63
|
| Rate for Payer: Cigna All Commercial |
$326.59
|
| Rate for Payer: CORVEL All Commercial |
$351.95
|
| Rate for Payer: Coventry All Commercial |
$333.03
|
| Rate for Payer: Encore All Commercial |
$348.35
|
| Rate for Payer: Frontpath All Commercial |
$348.16
|
| Rate for Payer: Humana ChoiceCare |
$326.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$340.60
|
| Rate for Payer: PHCS All Commercial |
$283.83
|
| Rate for Payer: PHP All Commercial |
$287.01
|
| Rate for Payer: Sagamore Health Network All Products |
$292.16
|
| Rate for Payer: Signature Care EPO |
$314.11
|
| Rate for Payer: Signature Care PPO |
$333.03
|
| Rate for Payer: United Healthcare Commercial |
$298.21
|
|
|
HC TUBING MICROSTRAEM ADULT O2
|
Facility
|
OP
|
$48.15
|
|
| Hospital Charge Code |
41607797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$40.64
|
| Rate for Payer: Aetna Medicare |
$15.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.48
|
| Rate for Payer: Cash Price |
$29.85
|
| Rate for Payer: Cash Price |
$29.85
|
| Rate for Payer: Centivo All Commercial |
$24.56
|
| Rate for Payer: Cigna All Commercial |
$41.55
|
| Rate for Payer: CORVEL All Commercial |
$44.78
|
| Rate for Payer: Coventry All Commercial |
$42.37
|
| Rate for Payer: Encore All Commercial |
$44.32
|
| Rate for Payer: Frontpath All Commercial |
$44.30
|
| Rate for Payer: Humana ChoiceCare |
$41.59
|
| Rate for Payer: Humana Medicare |
$24.56
|
| Rate for Payer: Lucent All Commercial |
$24.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.34
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$36.11
|
| Rate for Payer: PHP All Commercial |
$36.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.78
|
| Rate for Payer: Sagamore Health Network All Products |
$37.17
|
| Rate for Payer: Signature Care EPO |
$39.96
|
| Rate for Payer: Signature Care PPO |
$42.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.93
|
| Rate for Payer: United Healthcare Commercial |
$37.94
|
| Rate for Payer: United Healthcare Medicare |
$15.89
|
|
|
HC TUBING MICROSTRAEM ADULT O2
|
Facility
|
IP
|
$48.15
|
|
| Hospital Charge Code |
41607797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$44.78 |
| Rate for Payer: Aetna Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$29.85
|
| Rate for Payer: Cigna All Commercial |
$41.55
|
| Rate for Payer: CORVEL All Commercial |
$44.78
|
| Rate for Payer: Coventry All Commercial |
$42.37
|
| Rate for Payer: Encore All Commercial |
$44.32
|
| Rate for Payer: Frontpath All Commercial |
$44.30
|
| Rate for Payer: Humana ChoiceCare |
$41.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.34
|
| Rate for Payer: PHCS All Commercial |
$36.11
|
| Rate for Payer: PHP All Commercial |
$36.52
|
| Rate for Payer: Sagamore Health Network All Products |
$37.17
|
| Rate for Payer: Signature Care EPO |
$39.96
|
| Rate for Payer: Signature Care PPO |
$42.37
|
| Rate for Payer: United Healthcare Commercial |
$37.94
|
|
|
HC TUBING MICROSTREAM FILTERLINE
|
Facility
|
IP
|
$69.33
|
|
| Hospital Charge Code |
41601195
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$64.48 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Cigna All Commercial |
$59.83
|
| Rate for Payer: CORVEL All Commercial |
$64.48
|
| Rate for Payer: Coventry All Commercial |
$61.01
|
| Rate for Payer: Encore All Commercial |
$63.82
|
| Rate for Payer: Frontpath All Commercial |
$63.78
|
| Rate for Payer: Humana ChoiceCare |
$59.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.40
|
| Rate for Payer: PHCS All Commercial |
$52.00
|
| Rate for Payer: PHP All Commercial |
$52.58
|
| Rate for Payer: Sagamore Health Network All Products |
$53.52
|
| Rate for Payer: Signature Care EPO |
$57.54
|
| Rate for Payer: Signature Care PPO |
$61.01
|
| Rate for Payer: United Healthcare Commercial |
$54.63
|
|
|
HC TUBING MICROSTREAM FILTERLINE
|
Facility
|
OP
|
$69.33
|
|
| Hospital Charge Code |
41601195
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$58.51
|
| Rate for Payer: Aetna Medicare |
$22.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.17
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Centivo All Commercial |
$35.36
|
| Rate for Payer: Cigna All Commercial |
$59.83
|
| Rate for Payer: CORVEL All Commercial |
$64.48
|
| Rate for Payer: Coventry All Commercial |
$61.01
|
| Rate for Payer: Encore All Commercial |
$63.82
|
| Rate for Payer: Frontpath All Commercial |
$63.78
|
| Rate for Payer: Humana ChoiceCare |
$59.88
|
| Rate for Payer: Humana Medicare |
$35.36
|
| Rate for Payer: Lucent All Commercial |
$35.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.40
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$52.00
|
| Rate for Payer: PHP All Commercial |
$52.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.04
|
| Rate for Payer: Sagamore Health Network All Products |
$53.52
|
| Rate for Payer: Signature Care EPO |
$57.54
|
| Rate for Payer: Signature Care PPO |
$61.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.93
|
| Rate for Payer: United Healthcare Commercial |
$54.63
|
| Rate for Payer: United Healthcare Medicare |
$22.88
|
|
|
HC TUBING O2 ADULT ORAL/NASAL 13F
|
Facility
|
OP
|
$98.22
|
|
| Hospital Charge Code |
41607938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$82.90
|
| Rate for Payer: Aetna Medicare |
$32.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.65
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Centivo All Commercial |
$50.09
|
| Rate for Payer: Cigna All Commercial |
$84.76
|
| Rate for Payer: CORVEL All Commercial |
$91.34
|
| Rate for Payer: Coventry All Commercial |
$86.43
|
| Rate for Payer: Encore All Commercial |
$90.41
|
| Rate for Payer: Frontpath All Commercial |
$90.36
|
| Rate for Payer: Humana ChoiceCare |
$84.83
|
| Rate for Payer: Humana Medicare |
$50.09
|
| Rate for Payer: Lucent All Commercial |
$50.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$73.66
|
| Rate for Payer: PHP All Commercial |
$74.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.31
|
| Rate for Payer: Sagamore Health Network All Products |
$75.83
|
| Rate for Payer: Signature Care EPO |
$81.52
|
| Rate for Payer: Signature Care PPO |
$86.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.49
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Medicare |
$32.41
|
|
|
HC TUBING O2 ADULT ORAL/NASAL 13F
|
Facility
|
IP
|
$98.22
|
|
| Hospital Charge Code |
41607938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.66 |
| Max. Negotiated Rate |
$91.34 |
| Rate for Payer: Aetna Commercial |
$84.86
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cigna All Commercial |
$84.76
|
| Rate for Payer: CORVEL All Commercial |
$91.34
|
| Rate for Payer: Coventry All Commercial |
$86.43
|
| Rate for Payer: Encore All Commercial |
$90.41
|
| Rate for Payer: Frontpath All Commercial |
$90.36
|
| Rate for Payer: Humana ChoiceCare |
$84.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.40
|
| Rate for Payer: PHCS All Commercial |
$73.66
|
| Rate for Payer: PHP All Commercial |
$74.49
|
| Rate for Payer: Sagamore Health Network All Products |
$75.83
|
| Rate for Payer: Signature Care EPO |
$81.52
|
| Rate for Payer: Signature Care PPO |
$86.43
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
HC TUBING SMART OMNILINE PLUS O2
|
Facility
|
OP
|
$69.35
|
|
| Hospital Charge Code |
41601196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$58.53
|
| Rate for Payer: Aetna Medicare |
$22.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.17
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Centivo All Commercial |
$35.37
|
| Rate for Payer: Cigna All Commercial |
$59.85
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.03
|
| Rate for Payer: Encore All Commercial |
$63.84
|
| Rate for Payer: Frontpath All Commercial |
$63.80
|
| Rate for Payer: Humana ChoiceCare |
$59.90
|
| Rate for Payer: Humana Medicare |
$35.37
|
| Rate for Payer: Lucent All Commercial |
$35.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.42
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$52.01
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.05
|
| Rate for Payer: Sagamore Health Network All Products |
$53.54
|
| Rate for Payer: Signature Care EPO |
$57.56
|
| Rate for Payer: Signature Care PPO |
$61.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.95
|
| Rate for Payer: United Healthcare Commercial |
$54.65
|
| Rate for Payer: United Healthcare Medicare |
$22.89
|
|
|
HC TUBING SMART OMNILINE PLUS O2
|
Facility
|
IP
|
$69.35
|
|
| Hospital Charge Code |
41601196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.01 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna All Commercial |
$59.85
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.03
|
| Rate for Payer: Encore All Commercial |
$63.84
|
| Rate for Payer: Frontpath All Commercial |
$63.80
|
| Rate for Payer: Humana ChoiceCare |
$59.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.42
|
| Rate for Payer: PHCS All Commercial |
$52.01
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Sagamore Health Network All Products |
$53.54
|
| Rate for Payer: Signature Care EPO |
$57.56
|
| Rate for Payer: Signature Care PPO |
$61.03
|
| Rate for Payer: United Healthcare Commercial |
$54.65
|
|
|
HC TUBING TUR BLADDER 2 LEAD
|
Facility
|
OP
|
$82.89
|
|
| Hospital Charge Code |
41602081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.35 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$69.96
|
| Rate for Payer: Aetna Medicare |
$27.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.09
|
| Rate for Payer: Cash Price |
$51.39
|
| Rate for Payer: Cash Price |
$51.39
|
| Rate for Payer: Centivo All Commercial |
$42.27
|
| Rate for Payer: Cigna All Commercial |
$71.53
|
| Rate for Payer: CORVEL All Commercial |
$77.09
|
| Rate for Payer: Coventry All Commercial |
$72.94
|
| Rate for Payer: Encore All Commercial |
$76.30
|
| Rate for Payer: Frontpath All Commercial |
$76.26
|
| Rate for Payer: Humana ChoiceCare |
$71.59
|
| Rate for Payer: Humana Medicare |
$42.27
|
| Rate for Payer: Lucent All Commercial |
$42.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$62.17
|
| Rate for Payer: PHP All Commercial |
$62.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.33
|
| Rate for Payer: Sagamore Health Network All Products |
$63.99
|
| Rate for Payer: Signature Care EPO |
$68.80
|
| Rate for Payer: Signature Care PPO |
$72.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.46
|
| Rate for Payer: United Healthcare Commercial |
$65.32
|
| Rate for Payer: United Healthcare Medicare |
$27.35
|
|
|
HC TUBING TUR BLADDER 2 LEAD
|
Facility
|
IP
|
$82.89
|
|
| Hospital Charge Code |
41602081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$77.09 |
| Rate for Payer: Aetna Commercial |
$71.62
|
| Rate for Payer: Cash Price |
$51.39
|
| Rate for Payer: Cigna All Commercial |
$71.53
|
| Rate for Payer: CORVEL All Commercial |
$77.09
|
| Rate for Payer: Coventry All Commercial |
$72.94
|
| Rate for Payer: Encore All Commercial |
$76.30
|
| Rate for Payer: Frontpath All Commercial |
$76.26
|
| Rate for Payer: Humana ChoiceCare |
$71.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.60
|
| Rate for Payer: PHCS All Commercial |
$62.17
|
| Rate for Payer: PHP All Commercial |
$62.86
|
| Rate for Payer: Sagamore Health Network All Products |
$63.99
|
| Rate for Payer: Signature Care EPO |
$68.80
|
| Rate for Payer: Signature Care PPO |
$72.94
|
| Rate for Payer: United Healthcare Commercial |
$65.32
|
|
|
HC TUBING TUR BLADDER 4 LEAD
|
Facility
|
OP
|
$102.59
|
|
| Hospital Charge Code |
41601452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$86.59
|
| Rate for Payer: Aetna Medicare |
$33.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.24
|
| Rate for Payer: Cash Price |
$63.61
|
| Rate for Payer: Cash Price |
$63.61
|
| Rate for Payer: Centivo All Commercial |
$52.32
|
| Rate for Payer: Cigna All Commercial |
$88.54
|
| Rate for Payer: CORVEL All Commercial |
$95.41
|
| Rate for Payer: Coventry All Commercial |
$90.28
|
| Rate for Payer: Encore All Commercial |
$94.43
|
| Rate for Payer: Frontpath All Commercial |
$94.38
|
| Rate for Payer: Humana ChoiceCare |
$88.61
|
| Rate for Payer: Humana Medicare |
$52.32
|
| Rate for Payer: Lucent All Commercial |
$52.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.33
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$76.94
|
| Rate for Payer: PHP All Commercial |
$77.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.01
|
| Rate for Payer: Sagamore Health Network All Products |
$79.20
|
| Rate for Payer: Signature Care EPO |
$85.15
|
| Rate for Payer: Signature Care PPO |
$90.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.20
|
| Rate for Payer: United Healthcare Commercial |
$80.84
|
| Rate for Payer: United Healthcare Medicare |
$33.85
|
|
|
HC TUBING TUR BLADDER 4 LEAD
|
Facility
|
IP
|
$102.59
|
|
| Hospital Charge Code |
41601452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.94 |
| Max. Negotiated Rate |
$95.41 |
| Rate for Payer: Aetna Commercial |
$88.64
|
| Rate for Payer: Cash Price |
$63.61
|
| Rate for Payer: Cigna All Commercial |
$88.54
|
| Rate for Payer: CORVEL All Commercial |
$95.41
|
| Rate for Payer: Coventry All Commercial |
$90.28
|
| Rate for Payer: Encore All Commercial |
$94.43
|
| Rate for Payer: Frontpath All Commercial |
$94.38
|
| Rate for Payer: Humana ChoiceCare |
$88.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.33
|
| Rate for Payer: PHCS All Commercial |
$76.94
|
| Rate for Payer: PHP All Commercial |
$77.80
|
| Rate for Payer: Sagamore Health Network All Products |
$79.20
|
| Rate for Payer: Signature Care EPO |
$85.15
|
| Rate for Payer: Signature Care PPO |
$90.28
|
| Rate for Payer: United Healthcare Commercial |
$80.84
|
|
|
HC TUBING XPS IRRIG STRAIGHT SHOT
|
Facility
|
OP
|
$259.00
|
|
| Hospital Charge Code |
41602434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$240.87 |
| Rate for Payer: Aetna Commercial |
$218.60
|
| Rate for Payer: Aetna Medicare |
$85.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$148.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.02
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Centivo All Commercial |
$132.09
|
| Rate for Payer: Cigna All Commercial |
$223.52
|
| Rate for Payer: CORVEL All Commercial |
$240.87
|
| Rate for Payer: Coventry All Commercial |
$227.92
|
| Rate for Payer: Encore All Commercial |
$238.41
|
| Rate for Payer: Frontpath All Commercial |
$238.28
|
| Rate for Payer: Humana ChoiceCare |
$223.70
|
| Rate for Payer: Humana Medicare |
$132.09
|
| Rate for Payer: Lucent All Commercial |
$132.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$194.25
|
| Rate for Payer: PHP All Commercial |
$196.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.01
|
| Rate for Payer: Sagamore Health Network All Products |
$199.95
|
| Rate for Payer: Signature Care EPO |
$214.97
|
| Rate for Payer: Signature Care PPO |
$227.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$204.09
|
| Rate for Payer: United Healthcare Medicare |
$85.47
|
|
|
HC TUBING XPS IRRIG STRAIGHT SHOT
|
Facility
|
IP
|
$259.00
|
|
| Hospital Charge Code |
41602434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$240.87 |
| Rate for Payer: Aetna Commercial |
$223.78
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cigna All Commercial |
$223.52
|
| Rate for Payer: CORVEL All Commercial |
$240.87
|
| Rate for Payer: Coventry All Commercial |
$227.92
|
| Rate for Payer: Encore All Commercial |
$238.41
|
| Rate for Payer: Frontpath All Commercial |
$238.28
|
| Rate for Payer: Humana ChoiceCare |
$223.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.10
|
| Rate for Payer: PHCS All Commercial |
$194.25
|
| Rate for Payer: PHP All Commercial |
$196.43
|
| Rate for Payer: Sagamore Health Network All Products |
$199.95
|
| Rate for Payer: Signature Care EPO |
$214.97
|
| Rate for Payer: Signature Care PPO |
$227.92
|
| Rate for Payer: United Healthcare Commercial |
$204.09
|
|
|
HC TWISTER POLYP RETRIEVAL 13
|
Facility
|
IP
|
$110.88
|
|
| Hospital Charge Code |
41602821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$103.12 |
| Rate for Payer: Aetna Commercial |
$95.80
|
| Rate for Payer: Cash Price |
$68.75
|
| Rate for Payer: Cigna All Commercial |
$95.69
|
| Rate for Payer: CORVEL All Commercial |
$103.12
|
| Rate for Payer: Coventry All Commercial |
$97.57
|
| Rate for Payer: Encore All Commercial |
$102.07
|
| Rate for Payer: Frontpath All Commercial |
$102.01
|
| Rate for Payer: Humana ChoiceCare |
$95.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.79
|
| Rate for Payer: PHCS All Commercial |
$83.16
|
| Rate for Payer: PHP All Commercial |
$84.09
|
| Rate for Payer: Sagamore Health Network All Products |
$85.60
|
| Rate for Payer: Signature Care EPO |
$92.03
|
| Rate for Payer: Signature Care PPO |
$97.57
|
| Rate for Payer: United Healthcare Commercial |
$87.37
|
|
