|
HC AEROCHAMBER ADULT
|
Facility
OP
|
$21.41
|
|
| Hospital Charge Code |
41601210
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$18.07
|
| Rate for Payer: Aetna Medicare |
$7.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.77
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Centivo All Commercial |
$10.92
|
| Rate for Payer: Cigna All Commercial |
$18.48
|
| Rate for Payer: CORVEL All Commercial |
$19.91
|
| Rate for Payer: Coventry All Commercial |
$18.84
|
| Rate for Payer: Encore All Commercial |
$19.71
|
| Rate for Payer: Frontpath All Commercial |
$19.70
|
| Rate for Payer: Humana ChoiceCare |
$18.49
|
| Rate for Payer: Humana Medicare |
$10.92
|
| Rate for Payer: Lucent All Commercial |
$10.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.27
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$16.06
|
| Rate for Payer: PHP All Commercial |
$16.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.35
|
| Rate for Payer: Sagamore Health Network All Products |
$16.53
|
| Rate for Payer: Signature Care EPO |
$17.77
|
| Rate for Payer: Signature Care PPO |
$18.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.20
|
| Rate for Payer: United Healthcare Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare |
$7.07
|
|
|
HC AEROCHAMBER ADULT
|
Facility
IP
|
$21.41
|
|
| Hospital Charge Code |
41601210
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$19.91 |
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cigna All Commercial |
$18.48
|
| Rate for Payer: CORVEL All Commercial |
$19.91
|
| Rate for Payer: Coventry All Commercial |
$18.84
|
| Rate for Payer: Encore All Commercial |
$19.71
|
| Rate for Payer: Frontpath All Commercial |
$19.70
|
| Rate for Payer: Humana ChoiceCare |
$18.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.27
|
| Rate for Payer: PHCS All Commercial |
$16.06
|
| Rate for Payer: PHP All Commercial |
$16.24
|
| Rate for Payer: Sagamore Health Network All Products |
$16.53
|
| Rate for Payer: Signature Care EPO |
$17.77
|
| Rate for Payer: Signature Care PPO |
$18.84
|
| Rate for Payer: United Healthcare Commercial |
$16.87
|
|
|
HC AEROCHAMBER PEDIATRIC
|
Facility
OP
|
$91.52
|
|
| Hospital Charge Code |
41601211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$77.24
|
| Rate for Payer: Aetna Medicare |
$30.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.22
|
| Rate for Payer: Cash Price |
$56.74
|
| Rate for Payer: Cash Price |
$56.74
|
| Rate for Payer: Centivo All Commercial |
$46.68
|
| Rate for Payer: Cigna All Commercial |
$78.98
|
| Rate for Payer: CORVEL All Commercial |
$85.11
|
| Rate for Payer: Coventry All Commercial |
$80.54
|
| Rate for Payer: Encore All Commercial |
$84.24
|
| Rate for Payer: Frontpath All Commercial |
$84.20
|
| Rate for Payer: Humana ChoiceCare |
$79.05
|
| Rate for Payer: Humana Medicare |
$46.68
|
| Rate for Payer: Lucent All Commercial |
$46.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.37
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$68.64
|
| Rate for Payer: PHP All Commercial |
$69.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.69
|
| Rate for Payer: Sagamore Health Network All Products |
$70.65
|
| Rate for Payer: Signature Care EPO |
$75.96
|
| Rate for Payer: Signature Care PPO |
$80.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.79
|
| Rate for Payer: United Healthcare Commercial |
$72.12
|
| Rate for Payer: United Healthcare Medicare |
$30.20
|
|
|
HC AEROCHAMBER PEDIATRIC
|
Facility
IP
|
$91.52
|
|
| Hospital Charge Code |
41601211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$85.11 |
| Rate for Payer: Aetna Commercial |
$79.07
|
| Rate for Payer: Cash Price |
$56.74
|
| Rate for Payer: Cigna All Commercial |
$78.98
|
| Rate for Payer: CORVEL All Commercial |
$85.11
|
| Rate for Payer: Coventry All Commercial |
$80.54
|
| Rate for Payer: Encore All Commercial |
$84.24
|
| Rate for Payer: Frontpath All Commercial |
$84.20
|
| Rate for Payer: Humana ChoiceCare |
$79.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.37
|
| Rate for Payer: PHCS All Commercial |
$68.64
|
| Rate for Payer: PHP All Commercial |
$69.41
|
| Rate for Payer: Sagamore Health Network All Products |
$70.65
|
| Rate for Payer: Signature Care EPO |
$75.96
|
| Rate for Payer: Signature Care PPO |
$80.54
|
| Rate for Payer: United Healthcare Commercial |
$72.12
|
|
|
HC AEROSOL/MDI INSTRUCTION
|
Facility
OP
|
$91.76
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
01604664
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Aetna Commercial |
$77.44
|
| Rate for Payer: Aetna Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.31
|
| Rate for Payer: Cash Price |
$56.89
|
| Rate for Payer: Cash Price |
$56.89
|
| Rate for Payer: Centivo All Commercial |
$46.80
|
| Rate for Payer: Cigna All Commercial |
$79.19
|
| Rate for Payer: CORVEL All Commercial |
$85.34
|
| Rate for Payer: Coventry All Commercial |
$80.75
|
| Rate for Payer: Encore All Commercial |
$84.46
|
| Rate for Payer: Frontpath All Commercial |
$84.42
|
| Rate for Payer: Humana ChoiceCare |
$79.25
|
| Rate for Payer: Humana Medicare |
$46.80
|
| Rate for Payer: Lucent All Commercial |
$46.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.58
|
| Rate for Payer: Managed Health Services Medicaid |
$24.84
|
| Rate for Payer: MDWise Medicaid |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$68.82
|
| Rate for Payer: PHP All Commercial |
$69.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.79
|
| Rate for Payer: Sagamore Health Network All Products |
$70.84
|
| Rate for Payer: Signature Care EPO |
$76.16
|
| Rate for Payer: Signature Care PPO |
$80.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$72.31
|
| Rate for Payer: United Healthcare Medicare |
$30.28
|
|
|
HC AEROSOL/MDI INSTRUCTION
|
Facility
IP
|
$91.76
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
01604664
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Aetna Commercial |
$79.28
|
| Rate for Payer: Cash Price |
$56.89
|
| Rate for Payer: Cigna All Commercial |
$79.19
|
| Rate for Payer: CORVEL All Commercial |
$85.34
|
| Rate for Payer: Coventry All Commercial |
$80.75
|
| Rate for Payer: Encore All Commercial |
$84.46
|
| Rate for Payer: Frontpath All Commercial |
$84.42
|
| Rate for Payer: Humana ChoiceCare |
$79.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.58
|
| Rate for Payer: PHCS All Commercial |
$68.82
|
| Rate for Payer: PHP All Commercial |
$69.59
|
| Rate for Payer: Sagamore Health Network All Products |
$70.84
|
| Rate for Payer: Signature Care EPO |
$76.16
|
| Rate for Payer: Signature Care PPO |
$80.75
|
| Rate for Payer: United Healthcare Commercial |
$72.31
|
|
|
HC AEROSOL TX SUBSEQUENT
|
Facility
IP
|
$169.33
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
01706002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
|
|
HC AEROSOL TX SUBSEQUENT
|
Facility
OP
|
$169.33
|
|
|
Service Code
|
CPT 94640 76
|
| Hospital Charge Code |
01706002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$55.88 |
| Max. Negotiated Rate |
$157.48 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Aetna Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.47
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Centivo All Commercial |
$86.36
|
| Rate for Payer: Cigna All Commercial |
$146.13
|
| Rate for Payer: CORVEL All Commercial |
$157.48
|
| Rate for Payer: Coventry All Commercial |
$149.01
|
| Rate for Payer: Encore All Commercial |
$155.87
|
| Rate for Payer: Frontpath All Commercial |
$155.78
|
| Rate for Payer: Humana ChoiceCare |
$146.25
|
| Rate for Payer: Humana Medicare |
$86.36
|
| Rate for Payer: Lucent All Commercial |
$86.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.40
|
| Rate for Payer: PHCS All Commercial |
$127.00
|
| Rate for Payer: PHP All Commercial |
$128.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.04
|
| Rate for Payer: Sagamore Health Network All Products |
$130.72
|
| Rate for Payer: Signature Care EPO |
$140.54
|
| Rate for Payer: Signature Care PPO |
$149.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.93
|
| Rate for Payer: United Healthcare Commercial |
$133.43
|
| Rate for Payer: United Healthcare Medicare |
$55.88
|
|
|
HC AFP-TM
|
Facility
IP
|
$214.72
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
63001155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.04 |
| Max. Negotiated Rate |
$199.69 |
| Rate for Payer: Aetna Commercial |
$185.52
|
| Rate for Payer: Cash Price |
$133.13
|
| Rate for Payer: Cigna All Commercial |
$185.30
|
| Rate for Payer: CORVEL All Commercial |
$199.69
|
| Rate for Payer: Coventry All Commercial |
$188.95
|
| Rate for Payer: Encore All Commercial |
$197.65
|
| Rate for Payer: Frontpath All Commercial |
$197.54
|
| Rate for Payer: Humana ChoiceCare |
$185.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.25
|
| Rate for Payer: PHCS All Commercial |
$161.04
|
| Rate for Payer: PHP All Commercial |
$162.84
|
| Rate for Payer: Sagamore Health Network All Products |
$165.76
|
| Rate for Payer: Signature Care EPO |
$178.22
|
| Rate for Payer: Signature Care PPO |
$188.95
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
|
|
HC AFP-TM
|
Facility
OP
|
$214.72
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
63001155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$199.69 |
| Rate for Payer: Aetna Commercial |
$181.22
|
| Rate for Payer: Aetna Medicare |
$70.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.94
|
| Rate for Payer: Cash Price |
$133.13
|
| Rate for Payer: Cash Price |
$133.13
|
| Rate for Payer: Centivo All Commercial |
$109.51
|
| Rate for Payer: Cigna All Commercial |
$185.30
|
| Rate for Payer: CORVEL All Commercial |
$199.69
|
| Rate for Payer: Coventry All Commercial |
$188.95
|
| Rate for Payer: Encore All Commercial |
$197.65
|
| Rate for Payer: Frontpath All Commercial |
$197.54
|
| Rate for Payer: Humana ChoiceCare |
$185.45
|
| Rate for Payer: Humana Medicare |
$109.51
|
| Rate for Payer: Lucent All Commercial |
$109.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.25
|
| Rate for Payer: Managed Health Services Medicaid |
$16.77
|
| Rate for Payer: MDWise Medicaid |
$16.77
|
| Rate for Payer: PHCS All Commercial |
$161.04
|
| Rate for Payer: PHP All Commercial |
$162.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.74
|
| Rate for Payer: Sagamore Health Network All Products |
$165.76
|
| Rate for Payer: Signature Care EPO |
$178.22
|
| Rate for Payer: Signature Care PPO |
$188.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.51
|
| Rate for Payer: United Healthcare Commercial |
$169.20
|
| Rate for Payer: United Healthcare Medicare |
$70.86
|
|
|
HC AINTREE INTUBATION CATHETER MELKER
|
Facility
OP
|
$377.37
|
|
| Hospital Charge Code |
41601354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$350.95 |
| Rate for Payer: Aetna Commercial |
$318.50
|
| Rate for Payer: Aetna Medicare |
$124.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$216.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$235.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.99
|
| Rate for Payer: Cash Price |
$233.97
|
| Rate for Payer: Cash Price |
$233.97
|
| Rate for Payer: Centivo All Commercial |
$192.46
|
| Rate for Payer: Cigna All Commercial |
$325.67
|
| Rate for Payer: CORVEL All Commercial |
$350.95
|
| Rate for Payer: Coventry All Commercial |
$332.09
|
| Rate for Payer: Encore All Commercial |
$347.37
|
| Rate for Payer: Frontpath All Commercial |
$347.18
|
| Rate for Payer: Humana ChoiceCare |
$325.93
|
| Rate for Payer: Humana Medicare |
$192.46
|
| Rate for Payer: Lucent All Commercial |
$192.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$339.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$283.03
|
| Rate for Payer: PHP All Commercial |
$286.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.17
|
| Rate for Payer: Sagamore Health Network All Products |
$291.33
|
| Rate for Payer: Signature Care EPO |
$313.22
|
| Rate for Payer: Signature Care PPO |
$332.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$320.76
|
| Rate for Payer: United Healthcare Commercial |
$297.37
|
| Rate for Payer: United Healthcare Medicare |
$124.53
|
|
|
HC AINTREE INTUBATION CATHETER MELKER
|
Facility
IP
|
$377.37
|
|
| Hospital Charge Code |
41601354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.03 |
| Max. Negotiated Rate |
$350.95 |
| Rate for Payer: Aetna Commercial |
$326.05
|
| Rate for Payer: Cash Price |
$233.97
|
| Rate for Payer: Cigna All Commercial |
$325.67
|
| Rate for Payer: CORVEL All Commercial |
$350.95
|
| Rate for Payer: Coventry All Commercial |
$332.09
|
| Rate for Payer: Encore All Commercial |
$347.37
|
| Rate for Payer: Frontpath All Commercial |
$347.18
|
| Rate for Payer: Humana ChoiceCare |
$325.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$339.63
|
| Rate for Payer: PHCS All Commercial |
$283.03
|
| Rate for Payer: PHP All Commercial |
$286.20
|
| Rate for Payer: Sagamore Health Network All Products |
$291.33
|
| Rate for Payer: Signature Care EPO |
$313.22
|
| Rate for Payer: Signature Care PPO |
$332.09
|
| Rate for Payer: United Healthcare Commercial |
$297.37
|
|
|
HC AIRWAY AIR-Q 2.5
|
Facility
OP
|
$57.82
|
|
| Hospital Charge Code |
41601001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$48.80
|
| Rate for Payer: Aetna Medicare |
$19.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.99
|
| Rate for Payer: Cash Price |
$35.85
|
| Rate for Payer: Cash Price |
$35.85
|
| Rate for Payer: Centivo All Commercial |
$29.49
|
| Rate for Payer: Cigna All Commercial |
$49.90
|
| Rate for Payer: CORVEL All Commercial |
$53.77
|
| Rate for Payer: Coventry All Commercial |
$50.88
|
| Rate for Payer: Encore All Commercial |
$53.22
|
| Rate for Payer: Frontpath All Commercial |
$53.19
|
| Rate for Payer: Humana ChoiceCare |
$49.94
|
| Rate for Payer: Humana Medicare |
$29.49
|
| Rate for Payer: Lucent All Commercial |
$29.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.04
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$43.36
|
| Rate for Payer: PHP All Commercial |
$43.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.55
|
| Rate for Payer: Sagamore Health Network All Products |
$44.64
|
| Rate for Payer: Signature Care EPO |
$47.99
|
| Rate for Payer: Signature Care PPO |
$50.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.15
|
| Rate for Payer: United Healthcare Commercial |
$45.56
|
| Rate for Payer: United Healthcare Medicare |
$19.08
|
|
|
HC AIRWAY AIR-Q 2.5
|
Facility
IP
|
$57.82
|
|
| Hospital Charge Code |
41601001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.36 |
| Max. Negotiated Rate |
$53.77 |
| Rate for Payer: Aetna Commercial |
$49.96
|
| Rate for Payer: Cash Price |
$35.85
|
| Rate for Payer: Cigna All Commercial |
$49.90
|
| Rate for Payer: CORVEL All Commercial |
$53.77
|
| Rate for Payer: Coventry All Commercial |
$50.88
|
| Rate for Payer: Encore All Commercial |
$53.22
|
| Rate for Payer: Frontpath All Commercial |
$53.19
|
| Rate for Payer: Humana ChoiceCare |
$49.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.04
|
| Rate for Payer: PHCS All Commercial |
$43.36
|
| Rate for Payer: PHP All Commercial |
$43.85
|
| Rate for Payer: Sagamore Health Network All Products |
$44.64
|
| Rate for Payer: Signature Care EPO |
$47.99
|
| Rate for Payer: Signature Care PPO |
$50.88
|
| Rate for Payer: United Healthcare Commercial |
$45.56
|
|
|
HC AIRWAY BERMAN INFANT 50MM
|
Facility
IP
|
$2.45
|
|
| Hospital Charge Code |
41601879
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna All Commercial |
$2.11
|
| Rate for Payer: CORVEL All Commercial |
$2.28
|
| Rate for Payer: Coventry All Commercial |
$2.16
|
| Rate for Payer: Encore All Commercial |
$2.26
|
| Rate for Payer: Frontpath All Commercial |
$2.25
|
| Rate for Payer: Humana ChoiceCare |
$2.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.20
|
| Rate for Payer: PHCS All Commercial |
$1.84
|
| Rate for Payer: PHP All Commercial |
$1.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1.89
|
| Rate for Payer: Signature Care EPO |
$2.03
|
| Rate for Payer: Signature Care PPO |
$2.16
|
| Rate for Payer: United Healthcare Commercial |
$1.93
|
|
|
HC AIRWAY BERMAN INFANT 50MM
|
Facility
OP
|
$2.45
|
|
| Hospital Charge Code |
41601879
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.89
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Centivo All Commercial |
$1.25
|
| Rate for Payer: Cigna All Commercial |
$2.11
|
| Rate for Payer: CORVEL All Commercial |
$2.28
|
| Rate for Payer: Coventry All Commercial |
$2.16
|
| Rate for Payer: Encore All Commercial |
$2.26
|
| Rate for Payer: Frontpath All Commercial |
$2.25
|
| Rate for Payer: Humana ChoiceCare |
$2.12
|
| Rate for Payer: Humana Medicare |
$1.25
|
| Rate for Payer: Lucent All Commercial |
$1.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.20
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$1.84
|
| Rate for Payer: PHP All Commercial |
$1.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.96
|
| Rate for Payer: Sagamore Health Network All Products |
$1.89
|
| Rate for Payer: Signature Care EPO |
$2.03
|
| Rate for Payer: Signature Care PPO |
$2.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.08
|
| Rate for Payer: United Healthcare Commercial |
$1.93
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
|
|
HC AIRWAY BERMAN NEO-NATAL 40MM
|
Facility
OP
|
$2.03
|
|
| Hospital Charge Code |
41601878
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$1.71
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.74
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Centivo All Commercial |
$1.04
|
| Rate for Payer: Cigna All Commercial |
$1.75
|
| Rate for Payer: CORVEL All Commercial |
$1.89
|
| Rate for Payer: Coventry All Commercial |
$1.79
|
| Rate for Payer: Encore All Commercial |
$1.87
|
| Rate for Payer: Frontpath All Commercial |
$1.87
|
| Rate for Payer: Humana ChoiceCare |
$1.75
|
| Rate for Payer: Humana Medicare |
$1.04
|
| Rate for Payer: Lucent All Commercial |
$1.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.83
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$1.52
|
| Rate for Payer: PHP All Commercial |
$1.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1.57
|
| Rate for Payer: Signature Care EPO |
$1.68
|
| Rate for Payer: Signature Care PPO |
$1.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.73
|
| Rate for Payer: United Healthcare Commercial |
$1.60
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
|
|
HC AIRWAY BERMAN NEO-NATAL 40MM
|
Facility
IP
|
$2.03
|
|
| Hospital Charge Code |
41601878
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna All Commercial |
$1.75
|
| Rate for Payer: CORVEL All Commercial |
$1.89
|
| Rate for Payer: Coventry All Commercial |
$1.79
|
| Rate for Payer: Encore All Commercial |
$1.87
|
| Rate for Payer: Frontpath All Commercial |
$1.87
|
| Rate for Payer: Humana ChoiceCare |
$1.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.83
|
| Rate for Payer: PHCS All Commercial |
$1.52
|
| Rate for Payer: PHP All Commercial |
$1.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1.57
|
| Rate for Payer: Signature Care EPO |
$1.68
|
| Rate for Payer: Signature Care PPO |
$1.79
|
| Rate for Payer: United Healthcare Commercial |
$1.60
|
|
|
HC AIRWAY BERMAN SM CHILD 60MM
|
Facility
IP
|
$2.45
|
|
| Hospital Charge Code |
41601880
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna All Commercial |
$2.11
|
| Rate for Payer: CORVEL All Commercial |
$2.28
|
| Rate for Payer: Coventry All Commercial |
$2.16
|
| Rate for Payer: Encore All Commercial |
$2.26
|
| Rate for Payer: Frontpath All Commercial |
$2.25
|
| Rate for Payer: Humana ChoiceCare |
$2.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.20
|
| Rate for Payer: PHCS All Commercial |
$1.84
|
| Rate for Payer: PHP All Commercial |
$1.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1.89
|
| Rate for Payer: Signature Care EPO |
$2.03
|
| Rate for Payer: Signature Care PPO |
$2.16
|
| Rate for Payer: United Healthcare Commercial |
$1.93
|
|
|
HC AIRWAY BERMAN SM CHILD 60MM
|
Facility
OP
|
$2.45
|
|
| Hospital Charge Code |
41601880
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.89
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Centivo All Commercial |
$1.25
|
| Rate for Payer: Cigna All Commercial |
$2.11
|
| Rate for Payer: CORVEL All Commercial |
$2.28
|
| Rate for Payer: Coventry All Commercial |
$2.16
|
| Rate for Payer: Encore All Commercial |
$2.26
|
| Rate for Payer: Frontpath All Commercial |
$2.25
|
| Rate for Payer: Humana ChoiceCare |
$2.12
|
| Rate for Payer: Humana Medicare |
$1.25
|
| Rate for Payer: Lucent All Commercial |
$1.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.20
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$1.84
|
| Rate for Payer: PHP All Commercial |
$1.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.96
|
| Rate for Payer: Sagamore Health Network All Products |
$1.89
|
| Rate for Payer: Signature Care EPO |
$2.03
|
| Rate for Payer: Signature Care PPO |
$2.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.08
|
| Rate for Payer: United Healthcare Commercial |
$1.93
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
|
|
HC AIRWAY EXCHANGE CATHETER MELKER
|
Facility
OP
|
$421.26
|
|
| Hospital Charge Code |
41601353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$391.77 |
| Rate for Payer: Aetna Commercial |
$355.54
|
| Rate for Payer: Aetna Medicare |
$139.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.92
|
| Rate for Payer: Cash Price |
$261.18
|
| Rate for Payer: Cash Price |
$261.18
|
| Rate for Payer: Centivo All Commercial |
$214.84
|
| Rate for Payer: Cigna All Commercial |
$363.55
|
| Rate for Payer: CORVEL All Commercial |
$391.77
|
| Rate for Payer: Coventry All Commercial |
$370.71
|
| Rate for Payer: Encore All Commercial |
$387.77
|
| Rate for Payer: Frontpath All Commercial |
$387.56
|
| Rate for Payer: Humana ChoiceCare |
$363.84
|
| Rate for Payer: Humana Medicare |
$214.84
|
| Rate for Payer: Lucent All Commercial |
$214.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.13
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$315.94
|
| Rate for Payer: PHP All Commercial |
$319.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.29
|
| Rate for Payer: Sagamore Health Network All Products |
$325.21
|
| Rate for Payer: Signature Care EPO |
$349.65
|
| Rate for Payer: Signature Care PPO |
$370.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$358.07
|
| Rate for Payer: United Healthcare Commercial |
$331.95
|
| Rate for Payer: United Healthcare Medicare |
$139.02
|
|
|
HC AIRWAY EXCHANGE CATHETER MELKER
|
Facility
IP
|
$421.26
|
|
| Hospital Charge Code |
41601353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.94 |
| Max. Negotiated Rate |
$391.77 |
| Rate for Payer: Aetna Commercial |
$363.97
|
| Rate for Payer: Cash Price |
$261.18
|
| Rate for Payer: Cigna All Commercial |
$363.55
|
| Rate for Payer: CORVEL All Commercial |
$391.77
|
| Rate for Payer: Coventry All Commercial |
$370.71
|
| Rate for Payer: Encore All Commercial |
$387.77
|
| Rate for Payer: Frontpath All Commercial |
$387.56
|
| Rate for Payer: Humana ChoiceCare |
$363.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.13
|
| Rate for Payer: PHCS All Commercial |
$315.94
|
| Rate for Payer: PHP All Commercial |
$319.48
|
| Rate for Payer: Sagamore Health Network All Products |
$325.21
|
| Rate for Payer: Signature Care EPO |
$349.65
|
| Rate for Payer: Signature Care PPO |
$370.71
|
| Rate for Payer: United Healthcare Commercial |
$331.95
|
|
|
HC AIRWAY HUDSON #3
|
Facility
OP
|
$4.61
|
|
| Hospital Charge Code |
41601002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.67
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Centivo All Commercial |
$2.35
|
| Rate for Payer: Cigna All Commercial |
$3.98
|
| Rate for Payer: CORVEL All Commercial |
$4.29
|
| Rate for Payer: Coventry All Commercial |
$4.06
|
| Rate for Payer: Encore All Commercial |
$4.24
|
| Rate for Payer: Frontpath All Commercial |
$4.24
|
| Rate for Payer: Humana ChoiceCare |
$3.98
|
| Rate for Payer: Humana Medicare |
$2.35
|
| Rate for Payer: Lucent All Commercial |
$2.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.15
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3.46
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.80
|
| Rate for Payer: Sagamore Health Network All Products |
$3.56
|
| Rate for Payer: Signature Care EPO |
$3.83
|
| Rate for Payer: Signature Care PPO |
$4.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.92
|
| Rate for Payer: United Healthcare Commercial |
$3.63
|
| Rate for Payer: United Healthcare Medicare |
$1.52
|
|
|
HC AIRWAY HUDSON #3
|
Facility
IP
|
$4.61
|
|
| Hospital Charge Code |
41601002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cigna All Commercial |
$3.98
|
| Rate for Payer: CORVEL All Commercial |
$4.29
|
| Rate for Payer: Coventry All Commercial |
$4.06
|
| Rate for Payer: Encore All Commercial |
$4.24
|
| Rate for Payer: Frontpath All Commercial |
$4.24
|
| Rate for Payer: Humana ChoiceCare |
$3.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.15
|
| Rate for Payer: PHCS All Commercial |
$3.46
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: Sagamore Health Network All Products |
$3.56
|
| Rate for Payer: Signature Care EPO |
$3.83
|
| Rate for Payer: Signature Care PPO |
$4.06
|
| Rate for Payer: United Healthcare Commercial |
$3.63
|
|
|
HC AIRWAY HUDSON #4
|
Facility
OP
|
$4.61
|
|
| Hospital Charge Code |
41601003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.67
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Centivo All Commercial |
$2.35
|
| Rate for Payer: Cigna All Commercial |
$3.98
|
| Rate for Payer: CORVEL All Commercial |
$4.29
|
| Rate for Payer: Coventry All Commercial |
$4.06
|
| Rate for Payer: Encore All Commercial |
$4.24
|
| Rate for Payer: Frontpath All Commercial |
$4.24
|
| Rate for Payer: Humana ChoiceCare |
$3.98
|
| Rate for Payer: Humana Medicare |
$2.35
|
| Rate for Payer: Lucent All Commercial |
$2.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.15
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3.46
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.80
|
| Rate for Payer: Sagamore Health Network All Products |
$3.56
|
| Rate for Payer: Signature Care EPO |
$3.83
|
| Rate for Payer: Signature Care PPO |
$4.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.92
|
| Rate for Payer: United Healthcare Commercial |
$3.63
|
| Rate for Payer: United Healthcare Medicare |
$1.52
|
|
