|
HC BALLOON DILATION 12-15
|
Facility
IP
|
$964.80
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.60 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$833.59
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
|
|
HC BALLOON DILATION FIXED 15-18MM
|
Facility
OP
|
$964.80
|
|
| Hospital Charge Code |
41608247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$814.29
|
| Rate for Payer: Aetna Medicare |
$318.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$554.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.22
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Centivo All Commercial |
$492.05
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Humana Medicare |
$492.05
|
| Rate for Payer: Lucent All Commercial |
$492.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.27
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.08
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
| Rate for Payer: United Healthcare Medicare |
$318.38
|
|
|
HC BALLOON DILATION FIXED 15-18MM
|
Facility
IP
|
$964.80
|
|
| Hospital Charge Code |
41608247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.60 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$833.59
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
|
|
HC BALLOON DILATION GUIDE 10-12MM
|
Facility
IP
|
$1,099.35
|
|
| Hospital Charge Code |
41608249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$824.51 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$949.84
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.42
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
|
|
HC BALLOON DILATION GUIDE 10-12MM
|
Facility
OP
|
$1,099.35
|
|
| Hospital Charge Code |
41608249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Aetna Medicare |
$362.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$362.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$631.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$687.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$417.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$399.06
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Centivo All Commercial |
$560.67
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Humana Medicare |
$560.67
|
| Rate for Payer: Lucent All Commercial |
$560.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.42
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$428.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$934.45
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
| Rate for Payer: United Healthcare Medicare |
$362.79
|
|
|
HC BALLOON DILATION GUIDE 12-15MM
|
Facility
OP
|
$1,099.35
|
|
| Hospital Charge Code |
41608250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Aetna Medicare |
$362.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$362.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$631.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$687.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$417.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$399.06
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Centivo All Commercial |
$560.67
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Humana Medicare |
$560.67
|
| Rate for Payer: Lucent All Commercial |
$560.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.42
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$428.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$934.45
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
| Rate for Payer: United Healthcare Medicare |
$362.79
|
|
|
HC BALLOON DILATION GUIDE 12-15MM
|
Facility
IP
|
$1,099.35
|
|
| Hospital Charge Code |
41608250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$824.51 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$949.84
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.42
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
|
|
HC BALLOON DILATION GUIDE 8-10MM
|
Facility
OP
|
$1,099.35
|
|
| Hospital Charge Code |
41608248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Aetna Medicare |
$362.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$362.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$631.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$687.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$417.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$399.06
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Centivo All Commercial |
$560.67
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Humana Medicare |
$560.67
|
| Rate for Payer: Lucent All Commercial |
$560.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.42
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$428.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$934.45
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
| Rate for Payer: United Healthcare Medicare |
$362.79
|
|
|
HC BALLOON DILATION GUIDE 8-10MM
|
Facility
IP
|
$1,099.35
|
|
| Hospital Charge Code |
41608248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$824.51 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$949.84
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.42
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
|
|
HC BALLOON DILATION W/WIRE 8-10
|
Facility
IP
|
$964.80
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.60 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$833.59
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
|
|
HC BALLOON DILATION W/WIRE 8-10
|
Facility
OP
|
$964.80
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$814.29
|
| Rate for Payer: Aetna Medicare |
$318.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$554.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.22
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Cash Price |
$598.18
|
| Rate for Payer: Centivo All Commercial |
$492.05
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Humana Medicare |
$492.05
|
| Rate for Payer: Lucent All Commercial |
$492.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.27
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.08
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
| Rate for Payer: United Healthcare Medicare |
$318.38
|
|
|
HC BALLOON POSTPARTUM 500ML
|
Facility
OP
|
$1,673.75
|
|
| Hospital Charge Code |
41603544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,556.59 |
| Rate for Payer: Aetna Commercial |
$1,412.64
|
| Rate for Payer: Aetna Medicare |
$552.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$552.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$961.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,046.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$635.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$607.57
|
| Rate for Payer: Cash Price |
$1,037.73
|
| Rate for Payer: Cash Price |
$1,037.73
|
| Rate for Payer: Centivo All Commercial |
$853.61
|
| Rate for Payer: Cigna All Commercial |
$1,444.45
|
| Rate for Payer: CORVEL All Commercial |
$1,556.59
|
| Rate for Payer: Coventry All Commercial |
$1,472.90
|
| Rate for Payer: Encore All Commercial |
$1,540.69
|
| Rate for Payer: Frontpath All Commercial |
$1,539.85
|
| Rate for Payer: Humana ChoiceCare |
$1,445.62
|
| Rate for Payer: Humana Medicare |
$853.61
|
| Rate for Payer: Lucent All Commercial |
$853.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,506.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,255.31
|
| Rate for Payer: PHP All Commercial |
$1,269.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$652.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,292.14
|
| Rate for Payer: Signature Care EPO |
$1,389.21
|
| Rate for Payer: Signature Care PPO |
$1,472.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,422.69
|
| Rate for Payer: United Healthcare Commercial |
$1,318.92
|
| Rate for Payer: United Healthcare Medicare |
$552.34
|
|
|
HC BALLOON POSTPARTUM 500ML
|
Facility
IP
|
$1,673.75
|
|
| Hospital Charge Code |
41603544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,255.31 |
| Max. Negotiated Rate |
$1,556.59 |
| Rate for Payer: Aetna Commercial |
$1,446.12
|
| Rate for Payer: Cash Price |
$1,037.73
|
| Rate for Payer: Cigna All Commercial |
$1,444.45
|
| Rate for Payer: CORVEL All Commercial |
$1,556.59
|
| Rate for Payer: Coventry All Commercial |
$1,472.90
|
| Rate for Payer: Encore All Commercial |
$1,540.69
|
| Rate for Payer: Frontpath All Commercial |
$1,539.85
|
| Rate for Payer: Humana ChoiceCare |
$1,445.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,506.38
|
| Rate for Payer: PHCS All Commercial |
$1,255.31
|
| Rate for Payer: PHP All Commercial |
$1,269.37
|
| Rate for Payer: Sagamore Health Network All Products |
$1,292.14
|
| Rate for Payer: Signature Care EPO |
$1,389.21
|
| Rate for Payer: Signature Care PPO |
$1,472.90
|
| Rate for Payer: United Healthcare Commercial |
$1,318.92
|
|
|
HC BALLOON ULTRAXX
|
Facility
OP
|
$1,377.50
|
|
| Hospital Charge Code |
41603420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,281.08 |
| Rate for Payer: Aetna Commercial |
$1,162.61
|
| Rate for Payer: Aetna Medicare |
$454.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$454.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$791.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$861.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$522.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$500.03
|
| Rate for Payer: Cash Price |
$854.05
|
| Rate for Payer: Cash Price |
$854.05
|
| Rate for Payer: Centivo All Commercial |
$702.52
|
| Rate for Payer: Cigna All Commercial |
$1,188.78
|
| Rate for Payer: CORVEL All Commercial |
$1,281.08
|
| Rate for Payer: Coventry All Commercial |
$1,212.20
|
| Rate for Payer: Encore All Commercial |
$1,267.99
|
| Rate for Payer: Frontpath All Commercial |
$1,267.30
|
| Rate for Payer: Humana ChoiceCare |
$1,189.75
|
| Rate for Payer: Humana Medicare |
$702.52
|
| Rate for Payer: Lucent All Commercial |
$702.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,239.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,033.12
|
| Rate for Payer: PHP All Commercial |
$1,044.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$537.22
|
| Rate for Payer: Sagamore Health Network All Products |
$1,063.43
|
| Rate for Payer: Signature Care EPO |
$1,143.32
|
| Rate for Payer: Signature Care PPO |
$1,212.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,170.88
|
| Rate for Payer: United Healthcare Commercial |
$1,085.47
|
| Rate for Payer: United Healthcare Medicare |
$454.58
|
|
|
HC BALLOON ULTRAXX
|
Facility
IP
|
$1,377.50
|
|
| Hospital Charge Code |
41603420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.12 |
| Max. Negotiated Rate |
$1,281.08 |
| Rate for Payer: Aetna Commercial |
$1,190.16
|
| Rate for Payer: Cash Price |
$854.05
|
| Rate for Payer: Cigna All Commercial |
$1,188.78
|
| Rate for Payer: CORVEL All Commercial |
$1,281.08
|
| Rate for Payer: Coventry All Commercial |
$1,212.20
|
| Rate for Payer: Encore All Commercial |
$1,267.99
|
| Rate for Payer: Frontpath All Commercial |
$1,267.30
|
| Rate for Payer: Humana ChoiceCare |
$1,189.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,239.75
|
| Rate for Payer: PHCS All Commercial |
$1,033.12
|
| Rate for Payer: PHP All Commercial |
$1,044.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,063.43
|
| Rate for Payer: Signature Care EPO |
$1,143.32
|
| Rate for Payer: Signature Care PPO |
$1,212.20
|
| Rate for Payer: United Healthcare Commercial |
$1,085.47
|
|
|
HC BANDAGE ACE DOUBLE 6 IN
|
Facility
IP
|
$43.05
|
|
| Hospital Charge Code |
41601811
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.29 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Cigna All Commercial |
$37.15
|
| Rate for Payer: CORVEL All Commercial |
$40.04
|
| Rate for Payer: Coventry All Commercial |
$37.88
|
| Rate for Payer: Encore All Commercial |
$39.63
|
| Rate for Payer: Frontpath All Commercial |
$39.61
|
| Rate for Payer: Humana ChoiceCare |
$37.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.74
|
| Rate for Payer: PHCS All Commercial |
$32.29
|
| Rate for Payer: PHP All Commercial |
$32.65
|
| Rate for Payer: Sagamore Health Network All Products |
$33.23
|
| Rate for Payer: Signature Care EPO |
$35.73
|
| Rate for Payer: Signature Care PPO |
$37.88
|
| Rate for Payer: United Healthcare Commercial |
$33.92
|
|
|
HC BANDAGE ACE DOUBLE 6 IN
|
Facility
OP
|
$43.05
|
|
| Hospital Charge Code |
41601811
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$36.33
|
| Rate for Payer: Aetna Medicare |
$14.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.63
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Centivo All Commercial |
$21.96
|
| Rate for Payer: Cigna All Commercial |
$37.15
|
| Rate for Payer: CORVEL All Commercial |
$40.04
|
| Rate for Payer: Coventry All Commercial |
$37.88
|
| Rate for Payer: Encore All Commercial |
$39.63
|
| Rate for Payer: Frontpath All Commercial |
$39.61
|
| Rate for Payer: Humana ChoiceCare |
$37.18
|
| Rate for Payer: Humana Medicare |
$21.96
|
| Rate for Payer: Lucent All Commercial |
$21.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.74
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$32.29
|
| Rate for Payer: PHP All Commercial |
$32.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.79
|
| Rate for Payer: Sagamore Health Network All Products |
$33.23
|
| Rate for Payer: Signature Care EPO |
$35.73
|
| Rate for Payer: Signature Care PPO |
$37.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.59
|
| Rate for Payer: United Healthcare Commercial |
$33.92
|
| Rate for Payer: United Healthcare Medicare |
$14.21
|
|
|
HC BARBITUATE GC/MS CONFIRM
|
Facility
IP
|
$179.11
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.33 |
| Max. Negotiated Rate |
$166.57 |
| Rate for Payer: Aetna Commercial |
$154.75
|
| Rate for Payer: Cash Price |
$111.05
|
| Rate for Payer: Cigna All Commercial |
$154.57
|
| Rate for Payer: CORVEL All Commercial |
$166.57
|
| Rate for Payer: Coventry All Commercial |
$157.62
|
| Rate for Payer: Encore All Commercial |
$164.87
|
| Rate for Payer: Frontpath All Commercial |
$164.78
|
| Rate for Payer: Humana ChoiceCare |
$154.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.20
|
| Rate for Payer: PHCS All Commercial |
$134.33
|
| Rate for Payer: PHP All Commercial |
$135.84
|
| Rate for Payer: Sagamore Health Network All Products |
$138.27
|
| Rate for Payer: Signature Care EPO |
$148.66
|
| Rate for Payer: Signature Care PPO |
$157.62
|
| Rate for Payer: United Healthcare Commercial |
$141.14
|
|
|
HC BARBITUATE GC/MS CONFIRM
|
Facility
OP
|
$179.11
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$166.57 |
| Rate for Payer: Aetna Commercial |
$151.17
|
| Rate for Payer: Aetna Medicare |
$59.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.02
|
| Rate for Payer: Cash Price |
$111.05
|
| Rate for Payer: Cash Price |
$111.05
|
| Rate for Payer: Centivo All Commercial |
$91.35
|
| Rate for Payer: Cigna All Commercial |
$154.57
|
| Rate for Payer: CORVEL All Commercial |
$166.57
|
| Rate for Payer: Coventry All Commercial |
$157.62
|
| Rate for Payer: Encore All Commercial |
$164.87
|
| Rate for Payer: Frontpath All Commercial |
$164.78
|
| Rate for Payer: Humana ChoiceCare |
$154.70
|
| Rate for Payer: Humana Medicare |
$91.35
|
| Rate for Payer: Lucent All Commercial |
$91.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.20
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$134.33
|
| Rate for Payer: PHP All Commercial |
$135.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.85
|
| Rate for Payer: Sagamore Health Network All Products |
$138.27
|
| Rate for Payer: Signature Care EPO |
$148.66
|
| Rate for Payer: Signature Care PPO |
$157.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$152.25
|
| Rate for Payer: United Healthcare Commercial |
$141.14
|
| Rate for Payer: United Healthcare Medicare |
$59.11
|
|
|
HC BARBITURATES GCMS
|
Facility
IP
|
$127.31
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$109.99
|
| Rate for Payer: Cash Price |
$78.93
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.39
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.12
|
| Rate for Payer: Humana ChoiceCare |
$109.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.66
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
|
|
HC BARBITURATES GCMS
|
Facility
OP
|
$127.31
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$107.45
|
| Rate for Payer: Aetna Medicare |
$42.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.21
|
| Rate for Payer: Cash Price |
$78.93
|
| Rate for Payer: Cash Price |
$78.93
|
| Rate for Payer: Centivo All Commercial |
$64.93
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.39
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.12
|
| Rate for Payer: Humana ChoiceCare |
$109.95
|
| Rate for Payer: Humana Medicare |
$64.93
|
| Rate for Payer: Lucent All Commercial |
$64.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.65
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.66
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.21
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
| Rate for Payer: United Healthcare Medicare |
$42.01
|
|
|
HC BARI ACCESSORY PACKAGE PER DAY
|
Facility
OP
|
$306.41
|
|
| Hospital Charge Code |
02337560
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Aetna Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.23
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Centivo All Commercial |
$156.27
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Humana Medicare |
$156.27
|
| Rate for Payer: Lucent All Commercial |
$156.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.50
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.45
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
| Rate for Payer: United Healthcare Medicare |
$101.11
|
|
|
HC BARI ACCESSORY PACKAGE PER DAY
|
Facility
IP
|
$306.41
|
|
| Hospital Charge Code |
02337560
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$229.81 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$264.74
|
| Rate for Payer: Cash Price |
$189.97
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
|
|
HC BARIATRIC (ALL) BED /DAY
|
Facility
IP
|
$356.43
|
|
| Hospital Charge Code |
02337557
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$267.32 |
| Max. Negotiated Rate |
$331.48 |
| Rate for Payer: Aetna Commercial |
$307.95
|
| Rate for Payer: Cash Price |
$220.99
|
| Rate for Payer: Cigna All Commercial |
$307.60
|
| Rate for Payer: CORVEL All Commercial |
$331.48
|
| Rate for Payer: Coventry All Commercial |
$313.66
|
| Rate for Payer: Encore All Commercial |
$328.09
|
| Rate for Payer: Frontpath All Commercial |
$327.91
|
| Rate for Payer: Humana ChoiceCare |
$307.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.79
|
| Rate for Payer: PHCS All Commercial |
$267.32
|
| Rate for Payer: PHP All Commercial |
$270.32
|
| Rate for Payer: Sagamore Health Network All Products |
$275.16
|
| Rate for Payer: Signature Care EPO |
$295.84
|
| Rate for Payer: Signature Care PPO |
$313.66
|
| Rate for Payer: United Healthcare Commercial |
$280.87
|
|
|
HC BARIATRIC (ALL) BED /DAY
|
Facility
OP
|
$356.43
|
|
| Hospital Charge Code |
02337557
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$331.48 |
| Rate for Payer: Aetna Commercial |
$300.83
|
| Rate for Payer: Aetna Medicare |
$117.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$204.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$222.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.38
|
| Rate for Payer: Cash Price |
$220.99
|
| Rate for Payer: Cash Price |
$220.99
|
| Rate for Payer: Centivo All Commercial |
$181.78
|
| Rate for Payer: Cigna All Commercial |
$307.60
|
| Rate for Payer: CORVEL All Commercial |
$331.48
|
| Rate for Payer: Coventry All Commercial |
$313.66
|
| Rate for Payer: Encore All Commercial |
$328.09
|
| Rate for Payer: Frontpath All Commercial |
$327.91
|
| Rate for Payer: Humana ChoiceCare |
$307.85
|
| Rate for Payer: Humana Medicare |
$181.78
|
| Rate for Payer: Lucent All Commercial |
$181.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.79
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$267.32
|
| Rate for Payer: PHP All Commercial |
$270.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.01
|
| Rate for Payer: Sagamore Health Network All Products |
$275.16
|
| Rate for Payer: Signature Care EPO |
$295.84
|
| Rate for Payer: Signature Care PPO |
$313.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$302.96
|
| Rate for Payer: United Healthcare Commercial |
$280.87
|
| Rate for Payer: United Healthcare Medicare |
$117.62
|
|
