|
HC AIRWAY HUDSON #4
|
Facility
IP
|
$4.61
|
|
| Hospital Charge Code |
41601003
|
|
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 LMA MERCURY MED SIZE 1
|
Facility
IP
|
$57.82
|
|
| Hospital Charge Code |
41601918
|
|
Hospital Revenue Code
|
270
|
| 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 LMA MERCURY MED SIZE 1
|
Facility
OP
|
$57.82
|
|
| Hospital Charge Code |
41601918
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$96.84 |
| 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 |
$96.84
|
| 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 |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| 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 LMA MERCURY MED SIZE 1.5
|
Facility
OP
|
$57.82
|
|
| Hospital Charge Code |
41601924
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$96.84 |
| 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 |
$96.84
|
| 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 |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| 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 LMA MERCURY MED SIZE 1.5
|
Facility
IP
|
$57.82
|
|
| Hospital Charge Code |
41601924
|
|
Hospital Revenue Code
|
270
|
| 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 LMA MERCURY MED SIZE 2.0
|
Facility
OP
|
$57.82
|
|
| Hospital Charge Code |
41601906
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$96.84 |
| 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 |
$96.84
|
| 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 |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| 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 LMA MERCURY MED SIZE 2.0
|
Facility
IP
|
$57.82
|
|
| Hospital Charge Code |
41601906
|
|
Hospital Revenue Code
|
270
|
| 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 LMA SUPREME #1
|
Facility
OP
|
$83.65
|
|
| Hospital Charge Code |
41607793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: Aetna Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.36
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Centivo All Commercial |
$42.66
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Humana Medicare |
$42.66
|
| Rate for Payer: Lucent All Commercial |
$42.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.10
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
|
|
HC AIRWAY LMA SUPREME #1
|
Facility
IP
|
$83.65
|
|
| Hospital Charge Code |
41607793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
|
|
HC AIRWAY LMA SUPREME #1.5
|
Facility
OP
|
$83.65
|
|
| Hospital Charge Code |
41607794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: Aetna Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.36
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Centivo All Commercial |
$42.66
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Humana Medicare |
$42.66
|
| Rate for Payer: Lucent All Commercial |
$42.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.10
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
|
|
HC AIRWAY LMA SUPREME #1.5
|
Facility
IP
|
$83.65
|
|
| Hospital Charge Code |
41607794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
|
|
HC AIRWAY LMA SUPREME #2
|
Facility
IP
|
$83.65
|
|
| Hospital Charge Code |
41607795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
|
|
HC AIRWAY LMA SUPREME #2
|
Facility
OP
|
$83.65
|
|
| Hospital Charge Code |
41607795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: Aetna Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.36
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Centivo All Commercial |
$42.66
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Humana Medicare |
$42.66
|
| Rate for Payer: Lucent All Commercial |
$42.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.10
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
|
|
HC AIRWAY LMA SUPREME #2.5
|
Facility
OP
|
$83.65
|
|
| Hospital Charge Code |
41607796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: Aetna Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.36
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Centivo All Commercial |
$42.66
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Humana Medicare |
$42.66
|
| Rate for Payer: Lucent All Commercial |
$42.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.10
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
|
|
HC AIRWAY LMA SUPREME #2.5
|
Facility
IP
|
$83.65
|
|
| Hospital Charge Code |
41607796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
|
|
HC AIRWAY LMA SUPREME #3
|
Facility
OP
|
$83.65
|
|
| Hospital Charge Code |
41601204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: Aetna Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.36
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Centivo All Commercial |
$42.66
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Humana Medicare |
$42.66
|
| Rate for Payer: Lucent All Commercial |
$42.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.10
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
|
|
HC AIRWAY LMA SUPREME #3
|
Facility
IP
|
$83.65
|
|
| Hospital Charge Code |
41601204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
|
|
HC AIRWAY LMA SUPREME #4
|
Facility
OP
|
$83.65
|
|
| Hospital Charge Code |
41601205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: Aetna Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.36
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Centivo All Commercial |
$42.66
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Humana Medicare |
$42.66
|
| Rate for Payer: Lucent All Commercial |
$42.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.10
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
|
|
HC AIRWAY LMA SUPREME #4
|
Facility
IP
|
$83.65
|
|
| Hospital Charge Code |
41601205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
|
|
HC AIRWAY LMA SUPREME #5
|
Facility
OP
|
$83.65
|
|
| Hospital Charge Code |
41601206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: Aetna Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.36
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Centivo All Commercial |
$42.66
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Humana Medicare |
$42.66
|
| Rate for Payer: Lucent All Commercial |
$42.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.62
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.10
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
| Rate for Payer: United Healthcare Medicare |
$27.60
|
|
|
HC AIRWAY LMA SUPREME #5
|
Facility
IP
|
$83.65
|
|
| Hospital Charge Code |
41601206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Cash Price |
$51.86
|
| Rate for Payer: Cigna All Commercial |
$72.19
|
| Rate for Payer: CORVEL All Commercial |
$77.79
|
| Rate for Payer: Coventry All Commercial |
$73.61
|
| Rate for Payer: Encore All Commercial |
$77.00
|
| Rate for Payer: Frontpath All Commercial |
$76.96
|
| Rate for Payer: Humana ChoiceCare |
$72.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.28
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: PHP All Commercial |
$63.44
|
| Rate for Payer: Sagamore Health Network All Products |
$64.58
|
| Rate for Payer: Signature Care EPO |
$69.43
|
| Rate for Payer: Signature Care PPO |
$73.61
|
| Rate for Payer: United Healthcare Commercial |
$65.92
|
|
|
HC AIRWAY LMA UNIQUE #3 CHILD
|
Facility
OP
|
$38.50
|
|
| Hospital Charge Code |
41601207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: Aetna Medicare |
$12.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.98
|
| Rate for Payer: Cash Price |
$23.87
|
| Rate for Payer: Cash Price |
$23.87
|
| Rate for Payer: Centivo All Commercial |
$19.64
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Humana Medicare |
$19.64
|
| Rate for Payer: Lucent All Commercial |
$19.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.02
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.96
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.72
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
| Rate for Payer: United Healthcare Medicare |
$12.70
|
|
|
HC AIRWAY LMA UNIQUE #3 CHILD
|
Facility
IP
|
$38.50
|
|
| Hospital Charge Code |
41601207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Cash Price |
$23.87
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.96
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
|
|
HC AIRWAY LMA UNIQUE #4 ADULT
|
Facility
OP
|
$38.50
|
|
| Hospital Charge Code |
41601208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: Aetna Medicare |
$12.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.98
|
| Rate for Payer: Cash Price |
$23.87
|
| Rate for Payer: Cash Price |
$23.87
|
| Rate for Payer: Centivo All Commercial |
$19.64
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Humana Medicare |
$19.64
|
| Rate for Payer: Lucent All Commercial |
$19.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.02
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.96
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.72
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
| Rate for Payer: United Healthcare Medicare |
$12.70
|
|
|
HC AIRWAY LMA UNIQUE #4 ADULT
|
Facility
IP
|
$38.50
|
|
| Hospital Charge Code |
41601208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Cash Price |
$23.87
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.96
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
|
