|
HC Z WASHER 3.5 4.0
|
Facility
OP
|
$261.03
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.14 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$220.31
|
| Rate for Payer: Aetna Medicare |
$86.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$86.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$163.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.75
|
| Rate for Payer: Cash Price |
$161.84
|
| Rate for Payer: Cash Price |
$161.84
|
| Rate for Payer: Centivo All Commercial |
$133.13
|
| Rate for Payer: Cigna All Commercial |
$225.27
|
| Rate for Payer: CORVEL All Commercial |
$242.76
|
| Rate for Payer: Coventry All Commercial |
$229.71
|
| Rate for Payer: Encore All Commercial |
$240.28
|
| Rate for Payer: Frontpath All Commercial |
$240.15
|
| Rate for Payer: Humana ChoiceCare |
$225.45
|
| Rate for Payer: Humana Medicare |
$133.13
|
| Rate for Payer: Lucent All Commercial |
$133.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$195.77
|
| Rate for Payer: PHP All Commercial |
$197.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.80
|
| Rate for Payer: Sagamore Health Network All Products |
$201.52
|
| Rate for Payer: Signature Care EPO |
$216.65
|
| Rate for Payer: Signature Care PPO |
$229.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.88
|
| Rate for Payer: United Healthcare Commercial |
$205.69
|
| Rate for Payer: United Healthcare Medicare |
$86.14
|
|
|
HC Z WASHER 3.5 LOW PRO CORT
|
Facility
IP
|
$466.62
|
|
| Hospital Charge Code |
41606741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.96 |
| Max. Negotiated Rate |
$433.96 |
| Rate for Payer: Aetna Commercial |
$403.16
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cigna All Commercial |
$402.69
|
| Rate for Payer: CORVEL All Commercial |
$433.96
|
| Rate for Payer: Coventry All Commercial |
$410.63
|
| Rate for Payer: Encore All Commercial |
$429.52
|
| Rate for Payer: Frontpath All Commercial |
$429.29
|
| Rate for Payer: Humana ChoiceCare |
$403.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.96
|
| Rate for Payer: PHCS All Commercial |
$349.96
|
| Rate for Payer: PHP All Commercial |
$353.88
|
| Rate for Payer: Sagamore Health Network All Products |
$360.23
|
| Rate for Payer: Signature Care EPO |
$387.29
|
| Rate for Payer: Signature Care PPO |
$410.63
|
| Rate for Payer: United Healthcare Commercial |
$367.70
|
|
|
HC Z WASHER 3.5 LOW PRO CORT
|
Facility
OP
|
$466.62
|
|
| Hospital Charge Code |
41606741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$433.96 |
| Rate for Payer: Aetna Commercial |
$393.83
|
| Rate for Payer: Aetna Medicare |
$153.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$153.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$267.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$291.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$177.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$169.38
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Centivo All Commercial |
$237.98
|
| Rate for Payer: Cigna All Commercial |
$402.69
|
| Rate for Payer: CORVEL All Commercial |
$433.96
|
| Rate for Payer: Coventry All Commercial |
$410.63
|
| Rate for Payer: Encore All Commercial |
$429.52
|
| Rate for Payer: Frontpath All Commercial |
$429.29
|
| Rate for Payer: Humana ChoiceCare |
$403.02
|
| Rate for Payer: Humana Medicare |
$237.98
|
| Rate for Payer: Lucent All Commercial |
$237.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$349.96
|
| Rate for Payer: PHP All Commercial |
$353.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.98
|
| Rate for Payer: Sagamore Health Network All Products |
$360.23
|
| Rate for Payer: Signature Care EPO |
$387.29
|
| Rate for Payer: Signature Care PPO |
$410.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$396.63
|
| Rate for Payer: United Healthcare Commercial |
$367.70
|
| Rate for Payer: United Healthcare Medicare |
$153.98
|
|
|
HC Z WASHER 5.0 FLAT
|
Facility
OP
|
$377.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.46 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$318.32
|
| Rate for Payer: Aetna Medicare |
$124.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$216.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$235.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.91
|
| Rate for Payer: Cash Price |
$233.84
|
| Rate for Payer: Cash Price |
$233.84
|
| Rate for Payer: Centivo All Commercial |
$192.35
|
| Rate for Payer: Cigna All Commercial |
$325.49
|
| Rate for Payer: CORVEL All Commercial |
$350.76
|
| Rate for Payer: Coventry All Commercial |
$331.90
|
| Rate for Payer: Encore All Commercial |
$347.18
|
| Rate for Payer: Frontpath All Commercial |
$346.99
|
| Rate for Payer: Humana ChoiceCare |
$325.75
|
| Rate for Payer: Humana Medicare |
$192.35
|
| Rate for Payer: Lucent All Commercial |
$192.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$339.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$282.87
|
| Rate for Payer: PHP All Commercial |
$286.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.09
|
| Rate for Payer: Sagamore Health Network All Products |
$291.17
|
| Rate for Payer: Signature Care EPO |
$313.04
|
| Rate for Payer: Signature Care PPO |
$331.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$320.59
|
| Rate for Payer: United Healthcare Commercial |
$297.20
|
| Rate for Payer: United Healthcare Medicare |
$124.46
|
|
|
HC Z WASHER 5.0 FLAT
|
Facility
IP
|
$377.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.87 |
| Max. Negotiated Rate |
$350.76 |
| Rate for Payer: Aetna Commercial |
$325.87
|
| Rate for Payer: Cash Price |
$233.84
|
| Rate for Payer: Cigna All Commercial |
$325.49
|
| Rate for Payer: CORVEL All Commercial |
$350.76
|
| Rate for Payer: Coventry All Commercial |
$331.90
|
| Rate for Payer: Encore All Commercial |
$347.18
|
| Rate for Payer: Frontpath All Commercial |
$346.99
|
| Rate for Payer: Humana ChoiceCare |
$325.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$339.44
|
| Rate for Payer: PHCS All Commercial |
$282.87
|
| Rate for Payer: PHP All Commercial |
$286.04
|
| Rate for Payer: Sagamore Health Network All Products |
$291.17
|
| Rate for Payer: Signature Care EPO |
$313.04
|
| Rate for Payer: Signature Care PPO |
$331.90
|
| Rate for Payer: United Healthcare Commercial |
$297.20
|
|
|
HC Z WASHER 5.5 6.0 6.5 7
|
Facility
IP
|
$261.03
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.77 |
| Max. Negotiated Rate |
$242.76 |
| Rate for Payer: Aetna Commercial |
$225.53
|
| Rate for Payer: Cash Price |
$161.84
|
| Rate for Payer: Cigna All Commercial |
$225.27
|
| Rate for Payer: CORVEL All Commercial |
$242.76
|
| Rate for Payer: Coventry All Commercial |
$229.71
|
| Rate for Payer: Encore All Commercial |
$240.28
|
| Rate for Payer: Frontpath All Commercial |
$240.15
|
| Rate for Payer: Humana ChoiceCare |
$225.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.93
|
| Rate for Payer: PHCS All Commercial |
$195.77
|
| Rate for Payer: PHP All Commercial |
$197.97
|
| Rate for Payer: Sagamore Health Network All Products |
$201.52
|
| Rate for Payer: Signature Care EPO |
$216.65
|
| Rate for Payer: Signature Care PPO |
$229.71
|
| Rate for Payer: United Healthcare Commercial |
$205.69
|
|
|
HC Z WASHER 5.5 6.0 6.5 7
|
Facility
OP
|
$261.03
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.14 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$220.31
|
| Rate for Payer: Aetna Medicare |
$86.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$86.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$163.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.75
|
| Rate for Payer: Cash Price |
$161.84
|
| Rate for Payer: Cash Price |
$161.84
|
| Rate for Payer: Centivo All Commercial |
$133.13
|
| Rate for Payer: Cigna All Commercial |
$225.27
|
| Rate for Payer: CORVEL All Commercial |
$242.76
|
| Rate for Payer: Coventry All Commercial |
$229.71
|
| Rate for Payer: Encore All Commercial |
$240.28
|
| Rate for Payer: Frontpath All Commercial |
$240.15
|
| Rate for Payer: Humana ChoiceCare |
$225.45
|
| Rate for Payer: Humana Medicare |
$133.13
|
| Rate for Payer: Lucent All Commercial |
$133.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$195.77
|
| Rate for Payer: PHP All Commercial |
$197.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.80
|
| Rate for Payer: Sagamore Health Network All Products |
$201.52
|
| Rate for Payer: Signature Care EPO |
$216.65
|
| Rate for Payer: Signature Care PPO |
$229.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.88
|
| Rate for Payer: United Healthcare Commercial |
$205.69
|
| Rate for Payer: United Healthcare Medicare |
$86.14
|
|
|
HC Z WASHER 6.5 3PK
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z WASHER 6.5 3PK
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z WASHER CUP3.5/4.0
|
Facility
OP
|
$855.47
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.31 |
| Max. Negotiated Rate |
$795.59 |
| Rate for Payer: Aetna Commercial |
$722.02
|
| Rate for Payer: Aetna Medicare |
$282.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$282.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$491.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$534.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$324.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$310.54
|
| Rate for Payer: Cash Price |
$530.39
|
| Rate for Payer: Cash Price |
$530.39
|
| Rate for Payer: Centivo All Commercial |
$436.29
|
| Rate for Payer: Cigna All Commercial |
$738.27
|
| Rate for Payer: CORVEL All Commercial |
$795.59
|
| Rate for Payer: Coventry All Commercial |
$752.81
|
| Rate for Payer: Encore All Commercial |
$787.46
|
| Rate for Payer: Frontpath All Commercial |
$787.03
|
| Rate for Payer: Humana ChoiceCare |
$738.87
|
| Rate for Payer: Humana Medicare |
$436.29
|
| Rate for Payer: Lucent All Commercial |
$436.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$769.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$641.60
|
| Rate for Payer: PHP All Commercial |
$648.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$333.63
|
| Rate for Payer: Sagamore Health Network All Products |
$660.42
|
| Rate for Payer: Signature Care EPO |
$710.04
|
| Rate for Payer: Signature Care PPO |
$752.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$727.15
|
| Rate for Payer: United Healthcare Commercial |
$674.11
|
| Rate for Payer: United Healthcare Medicare |
$282.31
|
|
|
HC Z WASHER CUP3.5/4.0
|
Facility
IP
|
$855.47
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.60 |
| Max. Negotiated Rate |
$795.59 |
| Rate for Payer: Aetna Commercial |
$739.13
|
| Rate for Payer: Cash Price |
$530.39
|
| Rate for Payer: Cigna All Commercial |
$738.27
|
| Rate for Payer: CORVEL All Commercial |
$795.59
|
| Rate for Payer: Coventry All Commercial |
$752.81
|
| Rate for Payer: Encore All Commercial |
$787.46
|
| Rate for Payer: Frontpath All Commercial |
$787.03
|
| Rate for Payer: Humana ChoiceCare |
$738.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$769.92
|
| Rate for Payer: PHCS All Commercial |
$641.60
|
| Rate for Payer: PHP All Commercial |
$648.79
|
| Rate for Payer: Sagamore Health Network All Products |
$660.42
|
| Rate for Payer: Signature Care EPO |
$710.04
|
| Rate for Payer: Signature Care PPO |
$752.81
|
| Rate for Payer: United Healthcare Commercial |
$674.11
|
|
|
HC Z WASHER PLAIN 3PK
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z WASHER PLAIN 3PK
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z WASHLER FLAT 4.8/5.0
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z WASHLER FLAT 4.8/5.0
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z WIRE OLIVE 1.25
|
Facility
IP
|
$377.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.13 |
| Max. Negotiated Rate |
$351.08 |
| Rate for Payer: Aetna Commercial |
$326.17
|
| Rate for Payer: Cash Price |
$234.06
|
| Rate for Payer: Cigna All Commercial |
$325.79
|
| Rate for Payer: CORVEL All Commercial |
$351.08
|
| Rate for Payer: Coventry All Commercial |
$332.21
|
| Rate for Payer: Encore All Commercial |
$347.50
|
| Rate for Payer: Frontpath All Commercial |
$347.31
|
| Rate for Payer: Humana ChoiceCare |
$326.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$339.76
|
| Rate for Payer: PHCS All Commercial |
$283.13
|
| Rate for Payer: PHP All Commercial |
$286.30
|
| Rate for Payer: Sagamore Health Network All Products |
$291.44
|
| Rate for Payer: Signature Care EPO |
$313.33
|
| Rate for Payer: Signature Care PPO |
$332.21
|
| Rate for Payer: United Healthcare Commercial |
$297.48
|
|
|
HC Z WIRE OLIVE 1.25
|
Facility
OP
|
$377.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.58 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$318.62
|
| Rate for Payer: Aetna Medicare |
$124.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$216.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$235.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.04
|
| Rate for Payer: Cash Price |
$234.06
|
| Rate for Payer: Cash Price |
$234.06
|
| Rate for Payer: Centivo All Commercial |
$192.53
|
| Rate for Payer: Cigna All Commercial |
$325.79
|
| Rate for Payer: CORVEL All Commercial |
$351.08
|
| Rate for Payer: Coventry All Commercial |
$332.21
|
| Rate for Payer: Encore All Commercial |
$347.50
|
| Rate for Payer: Frontpath All Commercial |
$347.31
|
| Rate for Payer: Humana ChoiceCare |
$326.06
|
| Rate for Payer: Humana Medicare |
$192.53
|
| Rate for Payer: Lucent All Commercial |
$192.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$339.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$283.13
|
| Rate for Payer: PHP All Commercial |
$286.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.23
|
| Rate for Payer: Sagamore Health Network All Products |
$291.44
|
| Rate for Payer: Signature Care EPO |
$313.33
|
| Rate for Payer: Signature Care PPO |
$332.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$320.88
|
| Rate for Payer: United Healthcare Commercial |
$297.48
|
| Rate for Payer: United Healthcare Medicare |
$124.58
|
|
|
Hemorrhoidectomy, internal, by rubber band ligation(s)
|
Facility
OP
|
$648.18
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
CPT-46221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$648.18 |
| Max. Negotiated Rate |
$648.18 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$648.18
|
| Rate for Payer: Managed Health Services Medicaid |
$648.18
|
| Rate for Payer: MDWise Medicaid |
$648.18
|
|
|
HEPARIN (PORCINE) 1000 UNITS/ML INJ SOLN
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
HEPARIN (PORCINE) 1000 UNITS/ML INJ SOLN
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
HEPARIN (PORCINE) 25000 UNIT/500 ML IV SOLP
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
15845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.12
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Centivo All Commercial |
$53.55
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Humana Medicare |
$53.55
|
| Rate for Payer: Lucent All Commercial |
$53.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.95
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
|
|
HEPARIN (PORCINE) 25000 UNIT/500 ML IV SOLP
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
15845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$90.72
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML (1 ML) INJ CRTG
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
120987
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML (1 ML) INJ CRTG
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
120987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
HEPARIN, PORCINE (PF) 100 UNITS/ML IV SYRG
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
117963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
