|
HC BIOPSY FCP RADIAL 4 HOT
|
Facility
IP
|
$187.46
|
|
| Hospital Charge Code |
41608212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$174.34 |
| Rate for Payer: Aetna Commercial |
$161.97
|
| Rate for Payer: Cash Price |
$116.23
|
| Rate for Payer: Cigna All Commercial |
$161.78
|
| Rate for Payer: CORVEL All Commercial |
$174.34
|
| Rate for Payer: Coventry All Commercial |
$164.96
|
| Rate for Payer: Encore All Commercial |
$172.56
|
| Rate for Payer: Frontpath All Commercial |
$172.46
|
| Rate for Payer: Humana ChoiceCare |
$161.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.71
|
| Rate for Payer: PHCS All Commercial |
$140.60
|
| Rate for Payer: PHP All Commercial |
$142.17
|
| Rate for Payer: Sagamore Health Network All Products |
$144.72
|
| Rate for Payer: Signature Care EPO |
$155.59
|
| Rate for Payer: Signature Care PPO |
$164.96
|
| Rate for Payer: United Healthcare Commercial |
$147.72
|
|
|
HC BIOPSY FCP RJ3 160CM
|
Facility
OP
|
$140.00
|
|
| Hospital Charge Code |
41602259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$118.16
|
| Rate for Payer: Aetna Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.82
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Centivo All Commercial |
$71.40
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.92
|
| Rate for Payer: Humana Medicare |
$71.40
|
| Rate for Payer: Lucent All Commercial |
$71.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.60
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
|
|
HC BIOPSY FCP RJ3 160CM
|
Facility
IP
|
$140.00
|
|
| Hospital Charge Code |
41602259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$120.96
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.18
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
|
|
HC BIOPSY FCP RJ3 240CM
|
Facility
OP
|
$70.00
|
|
| Hospital Charge Code |
41602260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$59.08
|
| Rate for Payer: Aetna Medicare |
$23.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.41
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Centivo All Commercial |
$35.70
|
| Rate for Payer: Cigna All Commercial |
$60.41
|
| Rate for Payer: CORVEL All Commercial |
$65.10
|
| Rate for Payer: Coventry All Commercial |
$61.60
|
| Rate for Payer: Encore All Commercial |
$64.44
|
| Rate for Payer: Frontpath All Commercial |
$64.40
|
| Rate for Payer: Humana ChoiceCare |
$60.46
|
| Rate for Payer: Humana Medicare |
$35.70
|
| Rate for Payer: Lucent All Commercial |
$35.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$52.50
|
| Rate for Payer: PHP All Commercial |
$53.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.30
|
| Rate for Payer: Sagamore Health Network All Products |
$54.04
|
| Rate for Payer: Signature Care EPO |
$58.10
|
| Rate for Payer: Signature Care PPO |
$61.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$55.16
|
| Rate for Payer: United Healthcare Medicare |
$23.10
|
|
|
HC BIOPSY FCP RJ3 240CM
|
Facility
IP
|
$70.00
|
|
| Hospital Charge Code |
41602260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$60.48
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cigna All Commercial |
$60.41
|
| Rate for Payer: CORVEL All Commercial |
$65.10
|
| Rate for Payer: Coventry All Commercial |
$61.60
|
| Rate for Payer: Encore All Commercial |
$64.44
|
| Rate for Payer: Frontpath All Commercial |
$64.40
|
| Rate for Payer: Humana ChoiceCare |
$60.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: PHCS All Commercial |
$52.50
|
| Rate for Payer: PHP All Commercial |
$53.09
|
| Rate for Payer: Sagamore Health Network All Products |
$54.04
|
| Rate for Payer: Signature Care EPO |
$58.10
|
| Rate for Payer: Signature Care PPO |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$55.16
|
|
|
HC BIOPSY FCP RJ4 240CM
|
Facility
OP
|
$192.75
|
|
| Hospital Charge Code |
41601788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.61 |
| Max. Negotiated Rate |
$179.26 |
| Rate for Payer: Aetna Commercial |
$162.68
|
| Rate for Payer: Aetna Medicare |
$63.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$110.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.97
|
| Rate for Payer: Cash Price |
$119.51
|
| Rate for Payer: Cash Price |
$119.51
|
| Rate for Payer: Centivo All Commercial |
$98.30
|
| Rate for Payer: Cigna All Commercial |
$166.34
|
| Rate for Payer: CORVEL All Commercial |
$179.26
|
| Rate for Payer: Coventry All Commercial |
$169.62
|
| Rate for Payer: Encore All Commercial |
$177.43
|
| Rate for Payer: Frontpath All Commercial |
$177.33
|
| Rate for Payer: Humana ChoiceCare |
$166.48
|
| Rate for Payer: Humana Medicare |
$98.30
|
| Rate for Payer: Lucent All Commercial |
$98.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$144.56
|
| Rate for Payer: PHP All Commercial |
$146.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.17
|
| Rate for Payer: Sagamore Health Network All Products |
$148.80
|
| Rate for Payer: Signature Care EPO |
$159.98
|
| Rate for Payer: Signature Care PPO |
$169.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$163.84
|
| Rate for Payer: United Healthcare Commercial |
$151.89
|
| Rate for Payer: United Healthcare Medicare |
$63.61
|
|
|
HC BIOPSY FCP RJ4 240CM
|
Facility
IP
|
$192.75
|
|
| Hospital Charge Code |
41601788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.56 |
| Max. Negotiated Rate |
$179.26 |
| Rate for Payer: Aetna Commercial |
$166.54
|
| Rate for Payer: Cash Price |
$119.51
|
| Rate for Payer: Cigna All Commercial |
$166.34
|
| Rate for Payer: CORVEL All Commercial |
$179.26
|
| Rate for Payer: Coventry All Commercial |
$169.62
|
| Rate for Payer: Encore All Commercial |
$177.43
|
| Rate for Payer: Frontpath All Commercial |
$177.33
|
| Rate for Payer: Humana ChoiceCare |
$166.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.48
|
| Rate for Payer: PHCS All Commercial |
$144.56
|
| Rate for Payer: PHP All Commercial |
$146.18
|
| Rate for Payer: Sagamore Health Network All Products |
$148.80
|
| Rate for Payer: Signature Care EPO |
$159.98
|
| Rate for Payer: Signature Care PPO |
$169.62
|
| Rate for Payer: United Healthcare Commercial |
$151.89
|
|
|
HC BIOPSY SITE IDENTIFIER 14G TRIBELL SHAPE
|
Facility
IP
|
$640.07
|
|
| Hospital Charge Code |
41602084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.05 |
| Max. Negotiated Rate |
$595.27 |
| Rate for Payer: Aetna Commercial |
$553.02
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Cigna All Commercial |
$552.38
|
| Rate for Payer: CORVEL All Commercial |
$595.27
|
| Rate for Payer: Coventry All Commercial |
$563.26
|
| Rate for Payer: Encore All Commercial |
$589.18
|
| Rate for Payer: Frontpath All Commercial |
$588.86
|
| Rate for Payer: Humana ChoiceCare |
$552.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.06
|
| Rate for Payer: PHCS All Commercial |
$480.05
|
| Rate for Payer: PHP All Commercial |
$485.43
|
| Rate for Payer: Sagamore Health Network All Products |
$494.13
|
| Rate for Payer: Signature Care EPO |
$531.26
|
| Rate for Payer: Signature Care PPO |
$563.26
|
| Rate for Payer: United Healthcare Commercial |
$504.38
|
|
|
HC BIOPSY SITE IDENTIFIER 14G TRIBELL SHAPE
|
Facility
OP
|
$640.07
|
|
| Hospital Charge Code |
41602084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$595.27 |
| Rate for Payer: Aetna Commercial |
$540.22
|
| Rate for Payer: Aetna Medicare |
$211.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$211.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$367.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$400.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$242.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$232.35
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Centivo All Commercial |
$326.44
|
| Rate for Payer: Cigna All Commercial |
$552.38
|
| Rate for Payer: CORVEL All Commercial |
$595.27
|
| Rate for Payer: Coventry All Commercial |
$563.26
|
| Rate for Payer: Encore All Commercial |
$589.18
|
| Rate for Payer: Frontpath All Commercial |
$588.86
|
| Rate for Payer: Humana ChoiceCare |
$552.83
|
| Rate for Payer: Humana Medicare |
$326.44
|
| Rate for Payer: Lucent All Commercial |
$326.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.06
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$480.05
|
| Rate for Payer: PHP All Commercial |
$485.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.63
|
| Rate for Payer: Sagamore Health Network All Products |
$494.13
|
| Rate for Payer: Signature Care EPO |
$531.26
|
| Rate for Payer: Signature Care PPO |
$563.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$544.06
|
| Rate for Payer: United Healthcare Commercial |
$504.38
|
| Rate for Payer: United Healthcare Medicare |
$211.22
|
|
|
HC BIOPSY VALVE IRRIG LINE
|
Facility
OP
|
$78.75
|
|
| Hospital Charge Code |
41601897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: Aetna Medicare |
$25.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.59
|
| Rate for Payer: Cash Price |
$48.83
|
| Rate for Payer: Cash Price |
$48.83
|
| Rate for Payer: Centivo All Commercial |
$40.16
|
| Rate for Payer: Cigna All Commercial |
$67.96
|
| Rate for Payer: CORVEL All Commercial |
$73.24
|
| Rate for Payer: Coventry All Commercial |
$69.30
|
| Rate for Payer: Encore All Commercial |
$72.49
|
| Rate for Payer: Frontpath All Commercial |
$72.45
|
| Rate for Payer: Humana ChoiceCare |
$68.02
|
| Rate for Payer: Humana Medicare |
$40.16
|
| Rate for Payer: Lucent All Commercial |
$40.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$59.06
|
| Rate for Payer: PHP All Commercial |
$59.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.71
|
| Rate for Payer: Sagamore Health Network All Products |
$60.80
|
| Rate for Payer: Signature Care EPO |
$65.36
|
| Rate for Payer: Signature Care PPO |
$69.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.94
|
| Rate for Payer: United Healthcare Commercial |
$62.06
|
| Rate for Payer: United Healthcare Medicare |
$25.99
|
|
|
HC BIOPSY VALVE IRRIG LINE
|
Facility
IP
|
$78.75
|
|
| Hospital Charge Code |
41601897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.06 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$68.04
|
| Rate for Payer: Cash Price |
$48.83
|
| Rate for Payer: Cigna All Commercial |
$67.96
|
| Rate for Payer: CORVEL All Commercial |
$73.24
|
| Rate for Payer: Coventry All Commercial |
$69.30
|
| Rate for Payer: Encore All Commercial |
$72.49
|
| Rate for Payer: Frontpath All Commercial |
$72.45
|
| Rate for Payer: Humana ChoiceCare |
$68.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.88
|
| Rate for Payer: PHCS All Commercial |
$59.06
|
| Rate for Payer: PHP All Commercial |
$59.72
|
| Rate for Payer: Sagamore Health Network All Products |
$60.80
|
| Rate for Payer: Signature Care EPO |
$65.36
|
| Rate for Payer: Signature Care PPO |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$62.06
|
|
|
HC BIOVAC DIRECT SUCTION DEVICE
|
Facility
OP
|
$885.50
|
|
| Hospital Charge Code |
41601218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$823.52 |
| Rate for Payer: Aetna Commercial |
$747.36
|
| Rate for Payer: Aetna Medicare |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$508.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$553.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$336.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.44
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Centivo All Commercial |
$451.60
|
| Rate for Payer: Cigna All Commercial |
$764.19
|
| Rate for Payer: CORVEL All Commercial |
$823.52
|
| Rate for Payer: Coventry All Commercial |
$779.24
|
| Rate for Payer: Encore All Commercial |
$815.10
|
| Rate for Payer: Frontpath All Commercial |
$814.66
|
| Rate for Payer: Humana ChoiceCare |
$764.81
|
| Rate for Payer: Humana Medicare |
$451.60
|
| Rate for Payer: Lucent All Commercial |
$451.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$664.12
|
| Rate for Payer: PHP All Commercial |
$671.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.34
|
| Rate for Payer: Sagamore Health Network All Products |
$683.61
|
| Rate for Payer: Signature Care EPO |
$734.96
|
| Rate for Payer: Signature Care PPO |
$779.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$752.68
|
| Rate for Payer: United Healthcare Commercial |
$697.77
|
| Rate for Payer: United Healthcare Medicare |
$292.22
|
|
|
HC BIOVAC DIRECT SUCTION DEVICE
|
Facility
IP
|
$885.50
|
|
| Hospital Charge Code |
41601218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$664.12 |
| Max. Negotiated Rate |
$823.52 |
| Rate for Payer: Aetna Commercial |
$765.07
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Cigna All Commercial |
$764.19
|
| Rate for Payer: CORVEL All Commercial |
$823.52
|
| Rate for Payer: Coventry All Commercial |
$779.24
|
| Rate for Payer: Encore All Commercial |
$815.10
|
| Rate for Payer: Frontpath All Commercial |
$814.66
|
| Rate for Payer: Humana ChoiceCare |
$764.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.95
|
| Rate for Payer: PHCS All Commercial |
$664.12
|
| Rate for Payer: PHP All Commercial |
$671.56
|
| Rate for Payer: Sagamore Health Network All Products |
$683.61
|
| Rate for Payer: Signature Care EPO |
$734.96
|
| Rate for Payer: Signature Care PPO |
$779.24
|
| Rate for Payer: United Healthcare Commercial |
$697.77
|
|
|
HC BIV ICD CLARIA MRI CRT-D1
|
Facility
OP
|
$72,341.54
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$67,277.63 |
| Rate for Payer: Aetna Commercial |
$61,056.26
|
| Rate for Payer: Aetna Medicare |
$23,872.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23,872.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41,545.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45,220.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27,453.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26,259.98
|
| Rate for Payer: Cash Price |
$44,851.76
|
| Rate for Payer: Cash Price |
$44,851.76
|
| Rate for Payer: Centivo All Commercial |
$36,894.19
|
| Rate for Payer: Cigna All Commercial |
$62,430.75
|
| Rate for Payer: CORVEL All Commercial |
$67,277.63
|
| Rate for Payer: Coventry All Commercial |
$63,660.56
|
| Rate for Payer: Encore All Commercial |
$66,590.39
|
| Rate for Payer: Frontpath All Commercial |
$66,554.22
|
| Rate for Payer: Humana ChoiceCare |
$62,481.39
|
| Rate for Payer: Humana Medicare |
$36,894.19
|
| Rate for Payer: Lucent All Commercial |
$36,894.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65,107.39
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$54,256.16
|
| Rate for Payer: PHP All Commercial |
$54,863.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28,213.20
|
| Rate for Payer: Sagamore Health Network All Products |
$55,847.67
|
| Rate for Payer: Signature Care EPO |
$60,043.48
|
| Rate for Payer: Signature Care PPO |
$63,660.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61,490.31
|
| Rate for Payer: United Healthcare Commercial |
$57,005.13
|
| Rate for Payer: United Healthcare Medicare |
$23,872.71
|
|
|
HC BIV ICD CLARIA MRI CRT-D1
|
Facility
IP
|
$72,341.54
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$54,256.16 |
| Max. Negotiated Rate |
$67,277.63 |
| Rate for Payer: Aetna Commercial |
$62,503.09
|
| Rate for Payer: Cash Price |
$44,851.76
|
| Rate for Payer: Cigna All Commercial |
$62,430.75
|
| Rate for Payer: CORVEL All Commercial |
$67,277.63
|
| Rate for Payer: Coventry All Commercial |
$63,660.56
|
| Rate for Payer: Encore All Commercial |
$66,590.39
|
| Rate for Payer: Frontpath All Commercial |
$66,554.22
|
| Rate for Payer: Humana ChoiceCare |
$62,481.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65,107.39
|
| Rate for Payer: PHCS All Commercial |
$54,256.16
|
| Rate for Payer: PHP All Commercial |
$54,863.82
|
| Rate for Payer: Sagamore Health Network All Products |
$55,847.67
|
| Rate for Payer: Signature Care EPO |
$60,043.48
|
| Rate for Payer: Signature Care PPO |
$63,660.56
|
| Rate for Payer: United Healthcare Commercial |
$57,005.13
|
|
|
HC BIV ICD CLARIA MRI CRT-D4
|
Facility
IP
|
$72,341.54
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$54,256.16 |
| Max. Negotiated Rate |
$67,277.63 |
| Rate for Payer: Aetna Commercial |
$62,503.09
|
| Rate for Payer: Cash Price |
$44,851.76
|
| Rate for Payer: Cigna All Commercial |
$62,430.75
|
| Rate for Payer: CORVEL All Commercial |
$67,277.63
|
| Rate for Payer: Coventry All Commercial |
$63,660.56
|
| Rate for Payer: Encore All Commercial |
$66,590.39
|
| Rate for Payer: Frontpath All Commercial |
$66,554.22
|
| Rate for Payer: Humana ChoiceCare |
$62,481.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65,107.39
|
| Rate for Payer: PHCS All Commercial |
$54,256.16
|
| Rate for Payer: PHP All Commercial |
$54,863.82
|
| Rate for Payer: Sagamore Health Network All Products |
$55,847.67
|
| Rate for Payer: Signature Care EPO |
$60,043.48
|
| Rate for Payer: Signature Care PPO |
$63,660.56
|
| Rate for Payer: United Healthcare Commercial |
$57,005.13
|
|
|
HC BIV ICD CLARIA MRI CRT-D4
|
Facility
OP
|
$72,341.54
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$67,277.63 |
| Rate for Payer: Aetna Commercial |
$61,056.26
|
| Rate for Payer: Aetna Medicare |
$23,872.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23,872.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41,545.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45,220.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27,453.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26,259.98
|
| Rate for Payer: Cash Price |
$44,851.76
|
| Rate for Payer: Cash Price |
$44,851.76
|
| Rate for Payer: Centivo All Commercial |
$36,894.19
|
| Rate for Payer: Cigna All Commercial |
$62,430.75
|
| Rate for Payer: CORVEL All Commercial |
$67,277.63
|
| Rate for Payer: Coventry All Commercial |
$63,660.56
|
| Rate for Payer: Encore All Commercial |
$66,590.39
|
| Rate for Payer: Frontpath All Commercial |
$66,554.22
|
| Rate for Payer: Humana ChoiceCare |
$62,481.39
|
| Rate for Payer: Humana Medicare |
$36,894.19
|
| Rate for Payer: Lucent All Commercial |
$36,894.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65,107.39
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$54,256.16
|
| Rate for Payer: PHP All Commercial |
$54,863.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28,213.20
|
| Rate for Payer: Sagamore Health Network All Products |
$55,847.67
|
| Rate for Payer: Signature Care EPO |
$60,043.48
|
| Rate for Payer: Signature Care PPO |
$63,660.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61,490.31
|
| Rate for Payer: United Healthcare Commercial |
$57,005.13
|
| Rate for Payer: United Healthcare Medicare |
$23,872.71
|
|
|
HC BIV ICD CLARIA QUAD MRI CRTDQ1
|
Facility
IP
|
$72,446.54
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$54,334.90 |
| Max. Negotiated Rate |
$67,375.28 |
| Rate for Payer: Aetna Commercial |
$62,593.81
|
| Rate for Payer: Cash Price |
$44,916.86
|
| Rate for Payer: Cigna All Commercial |
$62,521.36
|
| Rate for Payer: CORVEL All Commercial |
$67,375.28
|
| Rate for Payer: Coventry All Commercial |
$63,752.96
|
| Rate for Payer: Encore All Commercial |
$66,687.04
|
| Rate for Payer: Frontpath All Commercial |
$66,650.82
|
| Rate for Payer: Humana ChoiceCare |
$62,572.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65,201.89
|
| Rate for Payer: PHCS All Commercial |
$54,334.90
|
| Rate for Payer: PHP All Commercial |
$54,943.46
|
| Rate for Payer: Sagamore Health Network All Products |
$55,928.73
|
| Rate for Payer: Signature Care EPO |
$60,130.63
|
| Rate for Payer: Signature Care PPO |
$63,752.96
|
| Rate for Payer: United Healthcare Commercial |
$57,087.87
|
|
|
HC BIV ICD CLARIA QUAD MRI CRTDQ1
|
Facility
OP
|
$72,446.54
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$67,375.28 |
| Rate for Payer: Aetna Commercial |
$61,144.88
|
| Rate for Payer: Aetna Medicare |
$23,907.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23,907.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41,606.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45,286.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27,493.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26,298.09
|
| Rate for Payer: Cash Price |
$44,916.86
|
| Rate for Payer: Cash Price |
$44,916.86
|
| Rate for Payer: Centivo All Commercial |
$36,947.74
|
| Rate for Payer: Cigna All Commercial |
$62,521.36
|
| Rate for Payer: CORVEL All Commercial |
$67,375.28
|
| Rate for Payer: Coventry All Commercial |
$63,752.96
|
| Rate for Payer: Encore All Commercial |
$66,687.04
|
| Rate for Payer: Frontpath All Commercial |
$66,650.82
|
| Rate for Payer: Humana ChoiceCare |
$62,572.08
|
| Rate for Payer: Humana Medicare |
$36,947.74
|
| Rate for Payer: Lucent All Commercial |
$36,947.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65,201.89
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$54,334.90
|
| Rate for Payer: PHP All Commercial |
$54,943.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28,254.15
|
| Rate for Payer: Sagamore Health Network All Products |
$55,928.73
|
| Rate for Payer: Signature Care EPO |
$60,130.63
|
| Rate for Payer: Signature Care PPO |
$63,752.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61,579.56
|
| Rate for Payer: United Healthcare Commercial |
$57,087.87
|
| Rate for Payer: United Healthcare Medicare |
$23,907.36
|
|
|
HC BIV ICD CLARIA QUAD MRI CRTDQQ
|
Facility
IP
|
$72,446.54
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$54,334.90 |
| Max. Negotiated Rate |
$67,375.28 |
| Rate for Payer: Aetna Commercial |
$62,593.81
|
| Rate for Payer: Cash Price |
$44,916.86
|
| Rate for Payer: Cigna All Commercial |
$62,521.36
|
| Rate for Payer: CORVEL All Commercial |
$67,375.28
|
| Rate for Payer: Coventry All Commercial |
$63,752.96
|
| Rate for Payer: Encore All Commercial |
$66,687.04
|
| Rate for Payer: Frontpath All Commercial |
$66,650.82
|
| Rate for Payer: Humana ChoiceCare |
$62,572.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65,201.89
|
| Rate for Payer: PHCS All Commercial |
$54,334.90
|
| Rate for Payer: PHP All Commercial |
$54,943.46
|
| Rate for Payer: Sagamore Health Network All Products |
$55,928.73
|
| Rate for Payer: Signature Care EPO |
$60,130.63
|
| Rate for Payer: Signature Care PPO |
$63,752.96
|
| Rate for Payer: United Healthcare Commercial |
$57,087.87
|
|
|
HC BIV ICD CLARIA QUAD MRI CRTDQQ
|
Facility
OP
|
$72,446.54
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$67,375.28 |
| Rate for Payer: Aetna Commercial |
$61,144.88
|
| Rate for Payer: Aetna Medicare |
$23,907.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23,907.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41,606.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45,286.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27,493.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26,298.09
|
| Rate for Payer: Cash Price |
$44,916.86
|
| Rate for Payer: Cash Price |
$44,916.86
|
| Rate for Payer: Centivo All Commercial |
$36,947.74
|
| Rate for Payer: Cigna All Commercial |
$62,521.36
|
| Rate for Payer: CORVEL All Commercial |
$67,375.28
|
| Rate for Payer: Coventry All Commercial |
$63,752.96
|
| Rate for Payer: Encore All Commercial |
$66,687.04
|
| Rate for Payer: Frontpath All Commercial |
$66,650.82
|
| Rate for Payer: Humana ChoiceCare |
$62,572.08
|
| Rate for Payer: Humana Medicare |
$36,947.74
|
| Rate for Payer: Lucent All Commercial |
$36,947.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65,201.89
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$54,334.90
|
| Rate for Payer: PHP All Commercial |
$54,943.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28,254.15
|
| Rate for Payer: Sagamore Health Network All Products |
$55,928.73
|
| Rate for Payer: Signature Care EPO |
$60,130.63
|
| Rate for Payer: Signature Care PPO |
$63,752.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61,579.56
|
| Rate for Payer: United Healthcare Commercial |
$57,087.87
|
| Rate for Payer: United Healthcare Medicare |
$23,907.36
|
|
|
HC BIV ICD DYNAGEN
|
Facility
OP
|
$60,637.50
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607255
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$56,392.88 |
| Rate for Payer: Aetna Commercial |
$51,178.05
|
| Rate for Payer: Aetna Medicare |
$20,010.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20,010.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34,824.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37,904.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23,011.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22,011.41
|
| Rate for Payer: Cash Price |
$37,595.25
|
| Rate for Payer: Cash Price |
$37,595.25
|
| Rate for Payer: Centivo All Commercial |
$30,925.12
|
| Rate for Payer: Cigna All Commercial |
$52,330.16
|
| Rate for Payer: CORVEL All Commercial |
$56,392.88
|
| Rate for Payer: Coventry All Commercial |
$53,361.00
|
| Rate for Payer: Encore All Commercial |
$55,816.82
|
| Rate for Payer: Frontpath All Commercial |
$55,786.50
|
| Rate for Payer: Humana ChoiceCare |
$52,372.61
|
| Rate for Payer: Humana Medicare |
$30,925.12
|
| Rate for Payer: Lucent All Commercial |
$30,925.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54,573.75
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$45,478.12
|
| Rate for Payer: PHP All Commercial |
$45,987.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23,648.62
|
| Rate for Payer: Sagamore Health Network All Products |
$46,812.15
|
| Rate for Payer: Signature Care EPO |
$50,329.12
|
| Rate for Payer: Signature Care PPO |
$53,361.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51,541.88
|
| Rate for Payer: United Healthcare Commercial |
$47,782.35
|
| Rate for Payer: United Healthcare Medicare |
$20,010.38
|
|
|
HC BIV ICD DYNAGEN
|
Facility
IP
|
$60,637.50
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607255
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$45,478.12 |
| Max. Negotiated Rate |
$56,392.88 |
| Rate for Payer: Aetna Commercial |
$52,390.80
|
| Rate for Payer: Cash Price |
$37,595.25
|
| Rate for Payer: Cigna All Commercial |
$52,330.16
|
| Rate for Payer: CORVEL All Commercial |
$56,392.88
|
| Rate for Payer: Coventry All Commercial |
$53,361.00
|
| Rate for Payer: Encore All Commercial |
$55,816.82
|
| Rate for Payer: Frontpath All Commercial |
$55,786.50
|
| Rate for Payer: Humana ChoiceCare |
$52,372.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54,573.75
|
| Rate for Payer: PHCS All Commercial |
$45,478.12
|
| Rate for Payer: PHP All Commercial |
$45,987.48
|
| Rate for Payer: Sagamore Health Network All Products |
$46,812.15
|
| Rate for Payer: Signature Care EPO |
$50,329.12
|
| Rate for Payer: Signature Care PPO |
$53,361.00
|
| Rate for Payer: United Healthcare Commercial |
$47,782.35
|
|
|
HC BIV ICD DYNAGEN DF4
|
Facility
OP
|
$60,637.50
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607254
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$56,392.88 |
| Rate for Payer: Aetna Commercial |
$51,178.05
|
| Rate for Payer: Aetna Medicare |
$20,010.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20,010.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34,824.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37,904.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23,011.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22,011.41
|
| Rate for Payer: Cash Price |
$37,595.25
|
| Rate for Payer: Cash Price |
$37,595.25
|
| Rate for Payer: Centivo All Commercial |
$30,925.12
|
| Rate for Payer: Cigna All Commercial |
$52,330.16
|
| Rate for Payer: CORVEL All Commercial |
$56,392.88
|
| Rate for Payer: Coventry All Commercial |
$53,361.00
|
| Rate for Payer: Encore All Commercial |
$55,816.82
|
| Rate for Payer: Frontpath All Commercial |
$55,786.50
|
| Rate for Payer: Humana ChoiceCare |
$52,372.61
|
| Rate for Payer: Humana Medicare |
$30,925.12
|
| Rate for Payer: Lucent All Commercial |
$30,925.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54,573.75
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$45,478.12
|
| Rate for Payer: PHP All Commercial |
$45,987.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23,648.62
|
| Rate for Payer: Sagamore Health Network All Products |
$46,812.15
|
| Rate for Payer: Signature Care EPO |
$50,329.12
|
| Rate for Payer: Signature Care PPO |
$53,361.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51,541.88
|
| Rate for Payer: United Healthcare Commercial |
$47,782.35
|
| Rate for Payer: United Healthcare Medicare |
$20,010.38
|
|
|
HC BIV ICD DYNAGEN DF4
|
Facility
IP
|
$60,637.50
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607254
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$45,478.12 |
| Max. Negotiated Rate |
$56,392.88 |
| Rate for Payer: Aetna Commercial |
$52,390.80
|
| Rate for Payer: Cash Price |
$37,595.25
|
| Rate for Payer: Cigna All Commercial |
$52,330.16
|
| Rate for Payer: CORVEL All Commercial |
$56,392.88
|
| Rate for Payer: Coventry All Commercial |
$53,361.00
|
| Rate for Payer: Encore All Commercial |
$55,816.82
|
| Rate for Payer: Frontpath All Commercial |
$55,786.50
|
| Rate for Payer: Humana ChoiceCare |
$52,372.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54,573.75
|
| Rate for Payer: PHCS All Commercial |
$45,478.12
|
| Rate for Payer: PHP All Commercial |
$45,987.48
|
| Rate for Payer: Sagamore Health Network All Products |
$46,812.15
|
| Rate for Payer: Signature Care EPO |
$50,329.12
|
| Rate for Payer: Signature Care PPO |
$53,361.00
|
| Rate for Payer: United Healthcare Commercial |
$47,782.35
|
|
