|
HC AIRWAY LMA UNIQUE #5 ADULT
|
Facility
OP
|
$38.50
|
|
| Hospital Charge Code |
41601209
|
|
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 #5 ADULT
|
Facility
IP
|
$38.50
|
|
| Hospital Charge Code |
41601209
|
|
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 NASOPHARYNGEAL 14FR
|
Facility
IP
|
$13.01
|
|
| Hospital Charge Code |
41603468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$11.24
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Cigna All Commercial |
$11.23
|
| Rate for Payer: CORVEL All Commercial |
$12.10
|
| Rate for Payer: Coventry All Commercial |
$11.45
|
| Rate for Payer: Encore All Commercial |
$11.98
|
| Rate for Payer: Frontpath All Commercial |
$11.97
|
| Rate for Payer: Humana ChoiceCare |
$11.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.71
|
| Rate for Payer: PHCS All Commercial |
$9.76
|
| Rate for Payer: PHP All Commercial |
$9.87
|
| Rate for Payer: Sagamore Health Network All Products |
$10.04
|
| Rate for Payer: Signature Care EPO |
$10.80
|
| Rate for Payer: Signature Care PPO |
$11.45
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
|
|
HC AIRWAY NASOPHARYNGEAL 14FR
|
Facility
OP
|
$13.01
|
|
| Hospital Charge Code |
41603468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.72
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Centivo All Commercial |
$6.64
|
| Rate for Payer: Cigna All Commercial |
$11.23
|
| Rate for Payer: CORVEL All Commercial |
$12.10
|
| Rate for Payer: Coventry All Commercial |
$11.45
|
| Rate for Payer: Encore All Commercial |
$11.98
|
| Rate for Payer: Frontpath All Commercial |
$11.97
|
| Rate for Payer: Humana ChoiceCare |
$11.24
|
| Rate for Payer: Humana Medicare |
$6.64
|
| Rate for Payer: Lucent All Commercial |
$6.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.76
|
| Rate for Payer: PHP All Commercial |
$9.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.07
|
| Rate for Payer: Sagamore Health Network All Products |
$10.04
|
| Rate for Payer: Signature Care EPO |
$10.80
|
| Rate for Payer: Signature Care PPO |
$11.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.06
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
| Rate for Payer: United Healthcare Medicare |
$4.29
|
|
|
HC AIRWAY NASOPHARYNGEAL 18FR
|
Facility
OP
|
$12.12
|
|
| Hospital Charge Code |
41603470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.23
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.40
|
| Rate for Payer: Cash Price |
$7.51
|
| Rate for Payer: Cash Price |
$7.51
|
| Rate for Payer: Centivo All Commercial |
$6.18
|
| Rate for Payer: Cigna All Commercial |
$10.46
|
| Rate for Payer: CORVEL All Commercial |
$11.27
|
| Rate for Payer: Coventry All Commercial |
$10.67
|
| Rate for Payer: Encore All Commercial |
$11.16
|
| Rate for Payer: Frontpath All Commercial |
$11.15
|
| Rate for Payer: Humana ChoiceCare |
$10.47
|
| Rate for Payer: Humana Medicare |
$6.18
|
| Rate for Payer: Lucent All Commercial |
$6.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.91
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.09
|
| Rate for Payer: PHP All Commercial |
$9.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.73
|
| Rate for Payer: Sagamore Health Network All Products |
$9.36
|
| Rate for Payer: Signature Care EPO |
$10.06
|
| Rate for Payer: Signature Care PPO |
$10.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.30
|
| Rate for Payer: United Healthcare Commercial |
$9.55
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
|
|
HC AIRWAY NASOPHARYNGEAL 18FR
|
Facility
IP
|
$12.12
|
|
| Hospital Charge Code |
41603470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna Commercial |
$10.47
|
| Rate for Payer: Cash Price |
$7.51
|
| Rate for Payer: Cigna All Commercial |
$10.46
|
| Rate for Payer: CORVEL All Commercial |
$11.27
|
| Rate for Payer: Coventry All Commercial |
$10.67
|
| Rate for Payer: Encore All Commercial |
$11.16
|
| Rate for Payer: Frontpath All Commercial |
$11.15
|
| Rate for Payer: Humana ChoiceCare |
$10.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.91
|
| Rate for Payer: PHCS All Commercial |
$9.09
|
| Rate for Payer: PHP All Commercial |
$9.19
|
| Rate for Payer: Sagamore Health Network All Products |
$9.36
|
| Rate for Payer: Signature Care EPO |
$10.06
|
| Rate for Payer: Signature Care PPO |
$10.67
|
| Rate for Payer: United Healthcare Commercial |
$9.55
|
|
|
HC AIRWAY NASOPHARYNGEAL 20FR
|
Facility
OP
|
$13.01
|
|
| Hospital Charge Code |
41603471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.72
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Centivo All Commercial |
$6.64
|
| Rate for Payer: Cigna All Commercial |
$11.23
|
| Rate for Payer: CORVEL All Commercial |
$12.10
|
| Rate for Payer: Coventry All Commercial |
$11.45
|
| Rate for Payer: Encore All Commercial |
$11.98
|
| Rate for Payer: Frontpath All Commercial |
$11.97
|
| Rate for Payer: Humana ChoiceCare |
$11.24
|
| Rate for Payer: Humana Medicare |
$6.64
|
| Rate for Payer: Lucent All Commercial |
$6.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.76
|
| Rate for Payer: PHP All Commercial |
$9.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.07
|
| Rate for Payer: Sagamore Health Network All Products |
$10.04
|
| Rate for Payer: Signature Care EPO |
$10.80
|
| Rate for Payer: Signature Care PPO |
$11.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.06
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
| Rate for Payer: United Healthcare Medicare |
$4.29
|
|
|
HC AIRWAY NASOPHARYNGEAL 20FR
|
Facility
IP
|
$13.01
|
|
| Hospital Charge Code |
41603471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$11.24
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Cigna All Commercial |
$11.23
|
| Rate for Payer: CORVEL All Commercial |
$12.10
|
| Rate for Payer: Coventry All Commercial |
$11.45
|
| Rate for Payer: Encore All Commercial |
$11.98
|
| Rate for Payer: Frontpath All Commercial |
$11.97
|
| Rate for Payer: Humana ChoiceCare |
$11.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.71
|
| Rate for Payer: PHCS All Commercial |
$9.76
|
| Rate for Payer: PHP All Commercial |
$9.87
|
| Rate for Payer: Sagamore Health Network All Products |
$10.04
|
| Rate for Payer: Signature Care EPO |
$10.80
|
| Rate for Payer: Signature Care PPO |
$11.45
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
|
|
HC AIRWAY NASOPHARYNGEAL 22FR
|
Facility
IP
|
$13.01
|
|
| Hospital Charge Code |
41603472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$11.24
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Cigna All Commercial |
$11.23
|
| Rate for Payer: CORVEL All Commercial |
$12.10
|
| Rate for Payer: Coventry All Commercial |
$11.45
|
| Rate for Payer: Encore All Commercial |
$11.98
|
| Rate for Payer: Frontpath All Commercial |
$11.97
|
| Rate for Payer: Humana ChoiceCare |
$11.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.71
|
| Rate for Payer: PHCS All Commercial |
$9.76
|
| Rate for Payer: PHP All Commercial |
$9.87
|
| Rate for Payer: Sagamore Health Network All Products |
$10.04
|
| Rate for Payer: Signature Care EPO |
$10.80
|
| Rate for Payer: Signature Care PPO |
$11.45
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
|
|
HC AIRWAY NASOPHARYNGEAL 22FR
|
Facility
OP
|
$13.01
|
|
| Hospital Charge Code |
41603472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.72
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Centivo All Commercial |
$6.64
|
| Rate for Payer: Cigna All Commercial |
$11.23
|
| Rate for Payer: CORVEL All Commercial |
$12.10
|
| Rate for Payer: Coventry All Commercial |
$11.45
|
| Rate for Payer: Encore All Commercial |
$11.98
|
| Rate for Payer: Frontpath All Commercial |
$11.97
|
| Rate for Payer: Humana ChoiceCare |
$11.24
|
| Rate for Payer: Humana Medicare |
$6.64
|
| Rate for Payer: Lucent All Commercial |
$6.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.76
|
| Rate for Payer: PHP All Commercial |
$9.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.07
|
| Rate for Payer: Sagamore Health Network All Products |
$10.04
|
| Rate for Payer: Signature Care EPO |
$10.80
|
| Rate for Payer: Signature Care PPO |
$11.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.06
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
| Rate for Payer: United Healthcare Medicare |
$4.29
|
|
|
HC AIRWAY NASOPHARYNGEAL 24FR
|
Facility
IP
|
$13.01
|
|
| Hospital Charge Code |
41603473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$11.24
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Cigna All Commercial |
$11.23
|
| Rate for Payer: CORVEL All Commercial |
$12.10
|
| Rate for Payer: Coventry All Commercial |
$11.45
|
| Rate for Payer: Encore All Commercial |
$11.98
|
| Rate for Payer: Frontpath All Commercial |
$11.97
|
| Rate for Payer: Humana ChoiceCare |
$11.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.71
|
| Rate for Payer: PHCS All Commercial |
$9.76
|
| Rate for Payer: PHP All Commercial |
$9.87
|
| Rate for Payer: Sagamore Health Network All Products |
$10.04
|
| Rate for Payer: Signature Care EPO |
$10.80
|
| Rate for Payer: Signature Care PPO |
$11.45
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
|
|
HC AIRWAY NASOPHARYNGEAL 24FR
|
Facility
OP
|
$13.01
|
|
| Hospital Charge Code |
41603473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.72
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Centivo All Commercial |
$6.64
|
| Rate for Payer: Cigna All Commercial |
$11.23
|
| Rate for Payer: CORVEL All Commercial |
$12.10
|
| Rate for Payer: Coventry All Commercial |
$11.45
|
| Rate for Payer: Encore All Commercial |
$11.98
|
| Rate for Payer: Frontpath All Commercial |
$11.97
|
| Rate for Payer: Humana ChoiceCare |
$11.24
|
| Rate for Payer: Humana Medicare |
$6.64
|
| Rate for Payer: Lucent All Commercial |
$6.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.76
|
| Rate for Payer: PHP All Commercial |
$9.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.07
|
| Rate for Payer: Sagamore Health Network All Products |
$10.04
|
| Rate for Payer: Signature Care EPO |
$10.80
|
| Rate for Payer: Signature Care PPO |
$11.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.06
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
| Rate for Payer: United Healthcare Medicare |
$4.29
|
|
|
HC AIRWAY NASOPHARYNGEAL 26FR
|
Facility
OP
|
$18.28
|
|
| Hospital Charge Code |
41601004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.43
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.64
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Centivo All Commercial |
$9.32
|
| Rate for Payer: Cigna All Commercial |
$15.78
|
| Rate for Payer: CORVEL All Commercial |
$17.00
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Encore All Commercial |
$16.83
|
| Rate for Payer: Frontpath All Commercial |
$16.82
|
| Rate for Payer: Humana ChoiceCare |
$15.79
|
| Rate for Payer: Humana Medicare |
$9.32
|
| Rate for Payer: Lucent All Commercial |
$9.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.71
|
| Rate for Payer: PHP All Commercial |
$13.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.13
|
| Rate for Payer: Sagamore Health Network All Products |
$14.11
|
| Rate for Payer: Signature Care EPO |
$15.17
|
| Rate for Payer: Signature Care PPO |
$16.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.54
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Medicare |
$6.03
|
|
|
HC AIRWAY NASOPHARYNGEAL 26FR
|
Facility
IP
|
$18.28
|
|
| Hospital Charge Code |
41601004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cigna All Commercial |
$15.78
|
| Rate for Payer: CORVEL All Commercial |
$17.00
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Encore All Commercial |
$16.83
|
| Rate for Payer: Frontpath All Commercial |
$16.82
|
| Rate for Payer: Humana ChoiceCare |
$15.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.45
|
| Rate for Payer: PHCS All Commercial |
$13.71
|
| Rate for Payer: PHP All Commercial |
$13.86
|
| Rate for Payer: Sagamore Health Network All Products |
$14.11
|
| Rate for Payer: Signature Care EPO |
$15.17
|
| Rate for Payer: Signature Care PPO |
$16.09
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
HC AIRWAY NASOPHARYNGEAL 28FR
|
Facility
OP
|
$18.28
|
|
| Hospital Charge Code |
41601005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.43
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.64
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Centivo All Commercial |
$9.32
|
| Rate for Payer: Cigna All Commercial |
$15.78
|
| Rate for Payer: CORVEL All Commercial |
$17.00
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Encore All Commercial |
$16.83
|
| Rate for Payer: Frontpath All Commercial |
$16.82
|
| Rate for Payer: Humana ChoiceCare |
$15.79
|
| Rate for Payer: Humana Medicare |
$9.32
|
| Rate for Payer: Lucent All Commercial |
$9.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.71
|
| Rate for Payer: PHP All Commercial |
$13.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.13
|
| Rate for Payer: Sagamore Health Network All Products |
$14.11
|
| Rate for Payer: Signature Care EPO |
$15.17
|
| Rate for Payer: Signature Care PPO |
$16.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.54
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Medicare |
$6.03
|
|
|
HC AIRWAY NASOPHARYNGEAL 28FR
|
Facility
IP
|
$18.28
|
|
| Hospital Charge Code |
41601005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cigna All Commercial |
$15.78
|
| Rate for Payer: CORVEL All Commercial |
$17.00
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Encore All Commercial |
$16.83
|
| Rate for Payer: Frontpath All Commercial |
$16.82
|
| Rate for Payer: Humana ChoiceCare |
$15.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.45
|
| Rate for Payer: PHCS All Commercial |
$13.71
|
| Rate for Payer: PHP All Commercial |
$13.86
|
| Rate for Payer: Sagamore Health Network All Products |
$14.11
|
| Rate for Payer: Signature Care EPO |
$15.17
|
| Rate for Payer: Signature Care PPO |
$16.09
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
HC AIRWAY NASOPHARYNGEAL 30FR
|
Facility
OP
|
$18.28
|
|
| Hospital Charge Code |
41601446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.43
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.64
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Centivo All Commercial |
$9.32
|
| Rate for Payer: Cigna All Commercial |
$15.78
|
| Rate for Payer: CORVEL All Commercial |
$17.00
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Encore All Commercial |
$16.83
|
| Rate for Payer: Frontpath All Commercial |
$16.82
|
| Rate for Payer: Humana ChoiceCare |
$15.79
|
| Rate for Payer: Humana Medicare |
$9.32
|
| Rate for Payer: Lucent All Commercial |
$9.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.71
|
| Rate for Payer: PHP All Commercial |
$13.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.13
|
| Rate for Payer: Sagamore Health Network All Products |
$14.11
|
| Rate for Payer: Signature Care EPO |
$15.17
|
| Rate for Payer: Signature Care PPO |
$16.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.54
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Medicare |
$6.03
|
|
|
HC AIRWAY NASOPHARYNGEAL 30FR
|
Facility
IP
|
$18.28
|
|
| Hospital Charge Code |
41601446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cigna All Commercial |
$15.78
|
| Rate for Payer: CORVEL All Commercial |
$17.00
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Encore All Commercial |
$16.83
|
| Rate for Payer: Frontpath All Commercial |
$16.82
|
| Rate for Payer: Humana ChoiceCare |
$15.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.45
|
| Rate for Payer: PHCS All Commercial |
$13.71
|
| Rate for Payer: PHP All Commercial |
$13.86
|
| Rate for Payer: Sagamore Health Network All Products |
$14.11
|
| Rate for Payer: Signature Care EPO |
$15.17
|
| Rate for Payer: Signature Care PPO |
$16.09
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
HC AIRWAY NASOPHARYNGEAL 32FR
|
Facility
OP
|
$18.28
|
|
| Hospital Charge Code |
41601447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.43
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.64
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Centivo All Commercial |
$9.32
|
| Rate for Payer: Cigna All Commercial |
$15.78
|
| Rate for Payer: CORVEL All Commercial |
$17.00
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Encore All Commercial |
$16.83
|
| Rate for Payer: Frontpath All Commercial |
$16.82
|
| Rate for Payer: Humana ChoiceCare |
$15.79
|
| Rate for Payer: Humana Medicare |
$9.32
|
| Rate for Payer: Lucent All Commercial |
$9.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.71
|
| Rate for Payer: PHP All Commercial |
$13.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.13
|
| Rate for Payer: Sagamore Health Network All Products |
$14.11
|
| Rate for Payer: Signature Care EPO |
$15.17
|
| Rate for Payer: Signature Care PPO |
$16.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.54
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Medicare |
$6.03
|
|
|
HC AIRWAY NASOPHARYNGEAL 32FR
|
Facility
IP
|
$18.28
|
|
| Hospital Charge Code |
41601447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cigna All Commercial |
$15.78
|
| Rate for Payer: CORVEL All Commercial |
$17.00
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Encore All Commercial |
$16.83
|
| Rate for Payer: Frontpath All Commercial |
$16.82
|
| Rate for Payer: Humana ChoiceCare |
$15.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.45
|
| Rate for Payer: PHCS All Commercial |
$13.71
|
| Rate for Payer: PHP All Commercial |
$13.86
|
| Rate for Payer: Sagamore Health Network All Products |
$14.11
|
| Rate for Payer: Signature Care EPO |
$15.17
|
| Rate for Payer: Signature Care PPO |
$16.09
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
HC AIRWAY NASOPHARYNGEAL 34FR
|
Facility
OP
|
$18.28
|
|
| Hospital Charge Code |
41601448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.43
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.64
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Centivo All Commercial |
$9.32
|
| Rate for Payer: Cigna All Commercial |
$15.78
|
| Rate for Payer: CORVEL All Commercial |
$17.00
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Encore All Commercial |
$16.83
|
| Rate for Payer: Frontpath All Commercial |
$16.82
|
| Rate for Payer: Humana ChoiceCare |
$15.79
|
| Rate for Payer: Humana Medicare |
$9.32
|
| Rate for Payer: Lucent All Commercial |
$9.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.71
|
| Rate for Payer: PHP All Commercial |
$13.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.13
|
| Rate for Payer: Sagamore Health Network All Products |
$14.11
|
| Rate for Payer: Signature Care EPO |
$15.17
|
| Rate for Payer: Signature Care PPO |
$16.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.54
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Medicare |
$6.03
|
|
|
HC AIRWAY NASOPHARYNGEAL 34FR
|
Facility
IP
|
$18.28
|
|
| Hospital Charge Code |
41601448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cigna All Commercial |
$15.78
|
| Rate for Payer: CORVEL All Commercial |
$17.00
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Encore All Commercial |
$16.83
|
| Rate for Payer: Frontpath All Commercial |
$16.82
|
| Rate for Payer: Humana ChoiceCare |
$15.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.45
|
| Rate for Payer: PHCS All Commercial |
$13.71
|
| Rate for Payer: PHP All Commercial |
$13.86
|
| Rate for Payer: Sagamore Health Network All Products |
$14.11
|
| Rate for Payer: Signature Care EPO |
$15.17
|
| Rate for Payer: Signature Care PPO |
$16.09
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
|
|
HC ALBUMIN
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
63001216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$39.75
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Cigna All Commercial |
$39.70
|
| Rate for Payer: CORVEL All Commercial |
$42.78
|
| Rate for Payer: Coventry All Commercial |
$40.48
|
| Rate for Payer: Encore All Commercial |
$42.34
|
| Rate for Payer: Frontpath All Commercial |
$42.32
|
| Rate for Payer: Humana ChoiceCare |
$39.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.40
|
| Rate for Payer: PHCS All Commercial |
$34.50
|
| Rate for Payer: PHP All Commercial |
$34.89
|
| Rate for Payer: Sagamore Health Network All Products |
$35.51
|
| Rate for Payer: Signature Care EPO |
$38.18
|
| Rate for Payer: Signature Care PPO |
$40.48
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
|
|
HC ALBUMIN
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
63001216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$38.83
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.70
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Centivo All Commercial |
$23.46
|
| Rate for Payer: Cigna All Commercial |
$39.70
|
| Rate for Payer: CORVEL All Commercial |
$42.78
|
| Rate for Payer: Coventry All Commercial |
$40.48
|
| Rate for Payer: Encore All Commercial |
$42.34
|
| Rate for Payer: Frontpath All Commercial |
$42.32
|
| Rate for Payer: Humana ChoiceCare |
$39.73
|
| Rate for Payer: Humana Medicare |
$23.46
|
| Rate for Payer: Lucent All Commercial |
$23.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.40
|
| Rate for Payer: Managed Health Services Medicaid |
$4.95
|
| Rate for Payer: MDWise Medicaid |
$4.95
|
| Rate for Payer: PHCS All Commercial |
$34.50
|
| Rate for Payer: PHP All Commercial |
$34.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.94
|
| Rate for Payer: Sagamore Health Network All Products |
$35.51
|
| Rate for Payer: Signature Care EPO |
$38.18
|
| Rate for Payer: Signature Care PPO |
$40.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.10
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
| Rate for Payer: United Healthcare Medicare |
$15.18
|
|
|
HC ALCOHOL ETHYL-SERUM/PLASMA
|
Facility
IP
|
$206.04
|
|
|
Service Code
|
CPT 82077
|
| Hospital Charge Code |
63001387
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.53 |
| Max. Negotiated Rate |
$191.62 |
| Rate for Payer: Aetna Commercial |
$178.02
|
| Rate for Payer: Cash Price |
$127.75
|
| Rate for Payer: Cigna All Commercial |
$177.81
|
| Rate for Payer: CORVEL All Commercial |
$191.62
|
| Rate for Payer: Coventry All Commercial |
$181.32
|
| Rate for Payer: Encore All Commercial |
$189.66
|
| Rate for Payer: Frontpath All Commercial |
$189.56
|
| Rate for Payer: Humana ChoiceCare |
$177.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.44
|
| Rate for Payer: PHCS All Commercial |
$154.53
|
| Rate for Payer: PHP All Commercial |
$156.26
|
| Rate for Payer: Sagamore Health Network All Products |
$159.06
|
| Rate for Payer: Signature Care EPO |
$171.01
|
| Rate for Payer: Signature Care PPO |
$181.32
|
| Rate for Payer: United Healthcare Commercial |
$162.36
|
|
