|
HC CAT BLADE 2.75 ANG VANTAGE
|
Facility
IP
|
$133.88
|
|
| Hospital Charge Code |
41602297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.41 |
| Max. Negotiated Rate |
$124.51 |
| Rate for Payer: Aetna Commercial |
$115.67
|
| Rate for Payer: Cash Price |
$83.01
|
| Rate for Payer: Cigna All Commercial |
$115.54
|
| Rate for Payer: CORVEL All Commercial |
$124.51
|
| Rate for Payer: Coventry All Commercial |
$117.81
|
| Rate for Payer: Encore All Commercial |
$123.24
|
| Rate for Payer: Frontpath All Commercial |
$123.17
|
| Rate for Payer: Humana ChoiceCare |
$115.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$120.49
|
| Rate for Payer: PHCS All Commercial |
$100.41
|
| Rate for Payer: PHP All Commercial |
$101.53
|
| Rate for Payer: Sagamore Health Network All Products |
$103.36
|
| Rate for Payer: Signature Care EPO |
$111.12
|
| Rate for Payer: Signature Care PPO |
$117.81
|
| Rate for Payer: United Healthcare Commercial |
$105.50
|
|
|
HC CAT BLADE MANI 2.8
|
Facility
OP
|
$118.16
|
|
| Hospital Charge Code |
41603266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.99 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$99.73
|
| Rate for Payer: Aetna Medicare |
$38.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$67.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.89
|
| Rate for Payer: Cash Price |
$73.26
|
| Rate for Payer: Cash Price |
$73.26
|
| Rate for Payer: Centivo All Commercial |
$60.26
|
| Rate for Payer: Cigna All Commercial |
$101.97
|
| Rate for Payer: CORVEL All Commercial |
$109.89
|
| Rate for Payer: Coventry All Commercial |
$103.98
|
| Rate for Payer: Encore All Commercial |
$108.77
|
| Rate for Payer: Frontpath All Commercial |
$108.71
|
| Rate for Payer: Humana ChoiceCare |
$102.05
|
| Rate for Payer: Humana Medicare |
$60.26
|
| Rate for Payer: Lucent All Commercial |
$60.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.34
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$88.62
|
| Rate for Payer: PHP All Commercial |
$89.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.08
|
| Rate for Payer: Sagamore Health Network All Products |
$91.22
|
| Rate for Payer: Signature Care EPO |
$98.07
|
| Rate for Payer: Signature Care PPO |
$103.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$100.44
|
| Rate for Payer: United Healthcare Commercial |
$93.11
|
| Rate for Payer: United Healthcare Medicare |
$38.99
|
|
|
HC CAT BLADE MANI 2.8
|
Facility
IP
|
$118.16
|
|
| Hospital Charge Code |
41603266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$109.89 |
| Rate for Payer: Aetna Commercial |
$102.09
|
| Rate for Payer: Cash Price |
$73.26
|
| Rate for Payer: Cigna All Commercial |
$101.97
|
| Rate for Payer: CORVEL All Commercial |
$109.89
|
| Rate for Payer: Coventry All Commercial |
$103.98
|
| Rate for Payer: Encore All Commercial |
$108.77
|
| Rate for Payer: Frontpath All Commercial |
$108.71
|
| Rate for Payer: Humana ChoiceCare |
$102.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.34
|
| Rate for Payer: PHCS All Commercial |
$88.62
|
| Rate for Payer: PHP All Commercial |
$89.61
|
| Rate for Payer: Sagamore Health Network All Products |
$91.22
|
| Rate for Payer: Signature Care EPO |
$98.07
|
| Rate for Payer: Signature Care PPO |
$103.98
|
| Rate for Payer: United Healthcare Commercial |
$93.11
|
|
|
HC CAT COLLAGEN SHIELD ALCON
|
Facility
IP
|
$243.95
|
|
| Hospital Charge Code |
41602300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.96 |
| Max. Negotiated Rate |
$226.87 |
| Rate for Payer: Aetna Commercial |
$210.77
|
| Rate for Payer: Cash Price |
$151.25
|
| Rate for Payer: Cigna All Commercial |
$210.53
|
| Rate for Payer: CORVEL All Commercial |
$226.87
|
| Rate for Payer: Coventry All Commercial |
$214.68
|
| Rate for Payer: Encore All Commercial |
$224.56
|
| Rate for Payer: Frontpath All Commercial |
$224.43
|
| Rate for Payer: Humana ChoiceCare |
$210.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.56
|
| Rate for Payer: PHCS All Commercial |
$182.96
|
| Rate for Payer: PHP All Commercial |
$185.01
|
| Rate for Payer: Sagamore Health Network All Products |
$188.33
|
| Rate for Payer: Signature Care EPO |
$202.48
|
| Rate for Payer: Signature Care PPO |
$214.68
|
| Rate for Payer: United Healthcare Commercial |
$192.23
|
|
|
HC CAT COLLAGEN SHIELD ALCON
|
Facility
OP
|
$243.95
|
|
| Hospital Charge Code |
41602300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$226.87 |
| Rate for Payer: Aetna Commercial |
$205.89
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$140.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$152.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.55
|
| Rate for Payer: Cash Price |
$151.25
|
| Rate for Payer: Cash Price |
$151.25
|
| Rate for Payer: Centivo All Commercial |
$124.41
|
| Rate for Payer: Cigna All Commercial |
$210.53
|
| Rate for Payer: CORVEL All Commercial |
$226.87
|
| Rate for Payer: Coventry All Commercial |
$214.68
|
| Rate for Payer: Encore All Commercial |
$224.56
|
| Rate for Payer: Frontpath All Commercial |
$224.43
|
| Rate for Payer: Humana ChoiceCare |
$210.70
|
| Rate for Payer: Humana Medicare |
$124.41
|
| Rate for Payer: Lucent All Commercial |
$124.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$182.96
|
| Rate for Payer: PHP All Commercial |
$185.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.14
|
| Rate for Payer: Sagamore Health Network All Products |
$188.33
|
| Rate for Payer: Signature Care EPO |
$202.48
|
| Rate for Payer: Signature Care PPO |
$214.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$207.36
|
| Rate for Payer: United Healthcare Commercial |
$192.23
|
| Rate for Payer: United Healthcare Medicare |
$80.50
|
|
|
HC CAT CYSTOTOME 25G ALCON
|
Facility
IP
|
$37.10
|
|
| Hospital Charge Code |
41602298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Aetna Commercial |
$32.05
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna All Commercial |
$32.02
|
| Rate for Payer: CORVEL All Commercial |
$34.50
|
| Rate for Payer: Coventry All Commercial |
$32.65
|
| Rate for Payer: Encore All Commercial |
$34.15
|
| Rate for Payer: Frontpath All Commercial |
$34.13
|
| Rate for Payer: Humana ChoiceCare |
$32.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.39
|
| Rate for Payer: PHCS All Commercial |
$27.82
|
| Rate for Payer: PHP All Commercial |
$28.14
|
| Rate for Payer: Sagamore Health Network All Products |
$28.64
|
| Rate for Payer: Signature Care EPO |
$30.79
|
| Rate for Payer: Signature Care PPO |
$32.65
|
| Rate for Payer: United Healthcare Commercial |
$29.23
|
|
|
HC CAT CYSTOTOME 25G ALCON
|
Facility
OP
|
$37.10
|
|
| Hospital Charge Code |
41602298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$31.31
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.47
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Centivo All Commercial |
$18.92
|
| Rate for Payer: Cigna All Commercial |
$32.02
|
| Rate for Payer: CORVEL All Commercial |
$34.50
|
| Rate for Payer: Coventry All Commercial |
$32.65
|
| Rate for Payer: Encore All Commercial |
$34.15
|
| Rate for Payer: Frontpath All Commercial |
$34.13
|
| Rate for Payer: Humana ChoiceCare |
$32.04
|
| Rate for Payer: Humana Medicare |
$18.92
|
| Rate for Payer: Lucent All Commercial |
$18.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.39
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$27.82
|
| Rate for Payer: PHP All Commercial |
$28.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.47
|
| Rate for Payer: Sagamore Health Network All Products |
$28.64
|
| Rate for Payer: Signature Care EPO |
$30.79
|
| Rate for Payer: Signature Care PPO |
$32.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.54
|
| Rate for Payer: United Healthcare Commercial |
$29.23
|
| Rate for Payer: United Healthcare Medicare |
$12.24
|
|
|
HC CAT CYSTOTOME 25G REVE
|
Facility
OP
|
$77.21
|
|
| Hospital Charge Code |
41604006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna Medicare |
$25.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.03
|
| Rate for Payer: Cash Price |
$47.87
|
| Rate for Payer: Cash Price |
$47.87
|
| Rate for Payer: Centivo All Commercial |
$39.38
|
| Rate for Payer: Cigna All Commercial |
$66.63
|
| Rate for Payer: CORVEL All Commercial |
$71.81
|
| Rate for Payer: Coventry All Commercial |
$67.94
|
| Rate for Payer: Encore All Commercial |
$71.07
|
| Rate for Payer: Frontpath All Commercial |
$71.03
|
| Rate for Payer: Humana ChoiceCare |
$66.69
|
| Rate for Payer: Humana Medicare |
$39.38
|
| Rate for Payer: Lucent All Commercial |
$39.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.49
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$57.91
|
| Rate for Payer: PHP All Commercial |
$58.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.11
|
| Rate for Payer: Sagamore Health Network All Products |
$59.61
|
| Rate for Payer: Signature Care EPO |
$64.08
|
| Rate for Payer: Signature Care PPO |
$67.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.63
|
| Rate for Payer: United Healthcare Commercial |
$60.84
|
| Rate for Payer: United Healthcare Medicare |
$25.48
|
|
|
HC CAT CYSTOTOME 25G REVE
|
Facility
IP
|
$77.21
|
|
| Hospital Charge Code |
41604006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.91 |
| Max. Negotiated Rate |
$71.81 |
| Rate for Payer: Aetna Commercial |
$66.71
|
| Rate for Payer: Cash Price |
$47.87
|
| Rate for Payer: Cigna All Commercial |
$66.63
|
| Rate for Payer: CORVEL All Commercial |
$71.81
|
| Rate for Payer: Coventry All Commercial |
$67.94
|
| Rate for Payer: Encore All Commercial |
$71.07
|
| Rate for Payer: Frontpath All Commercial |
$71.03
|
| Rate for Payer: Humana ChoiceCare |
$66.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.49
|
| Rate for Payer: PHCS All Commercial |
$57.91
|
| Rate for Payer: PHP All Commercial |
$58.56
|
| Rate for Payer: Sagamore Health Network All Products |
$59.61
|
| Rate for Payer: Signature Care EPO |
$64.08
|
| Rate for Payer: Signature Care PPO |
$67.94
|
| Rate for Payer: United Healthcare Commercial |
$60.84
|
|
|
HC CAT CYSTOTOME 25G VANTAGE
|
Facility
OP
|
$55.65
|
|
| Hospital Charge Code |
41602299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare |
$18.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Centivo All Commercial |
$28.38
|
| Rate for Payer: Cigna All Commercial |
$48.03
|
| Rate for Payer: CORVEL All Commercial |
$51.75
|
| Rate for Payer: Coventry All Commercial |
$48.97
|
| Rate for Payer: Encore All Commercial |
$51.23
|
| Rate for Payer: Frontpath All Commercial |
$51.20
|
| Rate for Payer: Humana ChoiceCare |
$48.06
|
| Rate for Payer: Humana Medicare |
$28.38
|
| Rate for Payer: Lucent All Commercial |
$28.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$41.74
|
| Rate for Payer: PHP All Commercial |
$42.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.70
|
| Rate for Payer: Sagamore Health Network All Products |
$42.96
|
| Rate for Payer: Signature Care EPO |
$46.19
|
| Rate for Payer: Signature Care PPO |
$48.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.30
|
| Rate for Payer: United Healthcare Commercial |
$43.85
|
| Rate for Payer: United Healthcare Medicare |
$18.36
|
|
|
HC CAT CYSTOTOME 25G VANTAGE
|
Facility
IP
|
$55.65
|
|
| Hospital Charge Code |
41602299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$51.75 |
| Rate for Payer: Aetna Commercial |
$48.08
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna All Commercial |
$48.03
|
| Rate for Payer: CORVEL All Commercial |
$51.75
|
| Rate for Payer: Coventry All Commercial |
$48.97
|
| Rate for Payer: Encore All Commercial |
$51.23
|
| Rate for Payer: Frontpath All Commercial |
$51.20
|
| Rate for Payer: Humana ChoiceCare |
$48.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.08
|
| Rate for Payer: PHCS All Commercial |
$41.74
|
| Rate for Payer: PHP All Commercial |
$42.20
|
| Rate for Payer: Sagamore Health Network All Products |
$42.96
|
| Rate for Payer: Signature Care EPO |
$46.19
|
| Rate for Payer: Signature Care PPO |
$48.97
|
| Rate for Payer: United Healthcare Commercial |
$43.85
|
|
|
HC CAT DRAPE INCISE 65X10
|
Facility
OP
|
$223.16
|
|
| Hospital Charge Code |
41604007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.64 |
| Max. Negotiated Rate |
$207.54 |
| Rate for Payer: Aetna Commercial |
$188.35
|
| Rate for Payer: Aetna Medicare |
$73.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$128.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.01
|
| Rate for Payer: Cash Price |
$138.36
|
| Rate for Payer: Cash Price |
$138.36
|
| Rate for Payer: Centivo All Commercial |
$113.81
|
| Rate for Payer: Cigna All Commercial |
$192.59
|
| Rate for Payer: CORVEL All Commercial |
$207.54
|
| Rate for Payer: Coventry All Commercial |
$196.38
|
| Rate for Payer: Encore All Commercial |
$205.42
|
| Rate for Payer: Frontpath All Commercial |
$205.31
|
| Rate for Payer: Humana ChoiceCare |
$192.74
|
| Rate for Payer: Humana Medicare |
$113.81
|
| Rate for Payer: Lucent All Commercial |
$113.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$167.37
|
| Rate for Payer: PHP All Commercial |
$169.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.03
|
| Rate for Payer: Sagamore Health Network All Products |
$172.28
|
| Rate for Payer: Signature Care EPO |
$185.22
|
| Rate for Payer: Signature Care PPO |
$196.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$189.69
|
| Rate for Payer: United Healthcare Commercial |
$175.85
|
| Rate for Payer: United Healthcare Medicare |
$73.64
|
|
|
HC CAT DRAPE INCISE 65X10
|
Facility
IP
|
$223.16
|
|
| Hospital Charge Code |
41604007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.37 |
| Max. Negotiated Rate |
$207.54 |
| Rate for Payer: Aetna Commercial |
$192.81
|
| Rate for Payer: Cash Price |
$138.36
|
| Rate for Payer: Cigna All Commercial |
$192.59
|
| Rate for Payer: CORVEL All Commercial |
$207.54
|
| Rate for Payer: Coventry All Commercial |
$196.38
|
| Rate for Payer: Encore All Commercial |
$205.42
|
| Rate for Payer: Frontpath All Commercial |
$205.31
|
| Rate for Payer: Humana ChoiceCare |
$192.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.84
|
| Rate for Payer: PHCS All Commercial |
$167.37
|
| Rate for Payer: PHP All Commercial |
$169.24
|
| Rate for Payer: Sagamore Health Network All Products |
$172.28
|
| Rate for Payer: Signature Care EPO |
$185.22
|
| Rate for Payer: Signature Care PPO |
$196.38
|
| Rate for Payer: United Healthcare Commercial |
$175.85
|
|
|
HC CAT DUOVISC VANTAGE
|
Facility
OP
|
$945.00
|
|
| Hospital Charge Code |
41602066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$797.58
|
| Rate for Payer: Aetna Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$542.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$590.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$358.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$343.04
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Centivo All Commercial |
$481.95
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Humana Medicare |
$481.95
|
| Rate for Payer: Lucent All Commercial |
$481.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$368.55
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$803.25
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
| Rate for Payer: United Healthcare Medicare |
$311.85
|
|
|
HC CAT DUOVISC VANTAGE
|
Facility
IP
|
$945.00
|
|
| Hospital Charge Code |
41602066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.75 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$816.48
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
|
|
HC CATECHOLAMINE FRACT - PLASMA
|
Facility
OP
|
$306.31
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63001484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$284.86 |
| Rate for Payer: Aetna Commercial |
$258.52
|
| Rate for Payer: Aetna Medicare |
$101.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.19
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Centivo All Commercial |
$156.22
|
| Rate for Payer: Cigna All Commercial |
$264.34
|
| Rate for Payer: CORVEL All Commercial |
$284.86
|
| Rate for Payer: Coventry All Commercial |
$269.55
|
| Rate for Payer: Encore All Commercial |
$281.95
|
| Rate for Payer: Frontpath All Commercial |
$281.80
|
| Rate for Payer: Humana ChoiceCare |
$264.56
|
| Rate for Payer: Humana Medicare |
$156.22
|
| Rate for Payer: Lucent All Commercial |
$156.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.68
|
| Rate for Payer: Managed Health Services Medicaid |
$25.25
|
| Rate for Payer: MDWise Medicaid |
$25.25
|
| Rate for Payer: PHCS All Commercial |
$229.73
|
| Rate for Payer: PHP All Commercial |
$232.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.46
|
| Rate for Payer: Sagamore Health Network All Products |
$236.47
|
| Rate for Payer: Signature Care EPO |
$254.23
|
| Rate for Payer: Signature Care PPO |
$269.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.36
|
| Rate for Payer: United Healthcare Commercial |
$241.37
|
| Rate for Payer: United Healthcare Medicare |
$101.08
|
|
|
HC CATECHOLAMINE FRACT - PLASMA
|
Facility
IP
|
$306.31
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63001484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$229.73 |
| Max. Negotiated Rate |
$284.86 |
| Rate for Payer: Aetna Commercial |
$264.65
|
| Rate for Payer: Cash Price |
$189.91
|
| Rate for Payer: Cigna All Commercial |
$264.34
|
| Rate for Payer: CORVEL All Commercial |
$284.86
|
| Rate for Payer: Coventry All Commercial |
$269.55
|
| Rate for Payer: Encore All Commercial |
$281.95
|
| Rate for Payer: Frontpath All Commercial |
$281.80
|
| Rate for Payer: Humana ChoiceCare |
$264.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.68
|
| Rate for Payer: PHCS All Commercial |
$229.73
|
| Rate for Payer: PHP All Commercial |
$232.30
|
| Rate for Payer: Sagamore Health Network All Products |
$236.47
|
| Rate for Payer: Signature Care EPO |
$254.23
|
| Rate for Payer: Signature Care PPO |
$269.55
|
| Rate for Payer: United Healthcare Commercial |
$241.37
|
|
|
HC CATECHOLAMINES-24-HR
|
Facility
IP
|
$255.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63001485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Cigna All Commercial |
$220.06
|
| Rate for Payer: CORVEL All Commercial |
$237.15
|
| Rate for Payer: Coventry All Commercial |
$224.40
|
| Rate for Payer: Encore All Commercial |
$234.73
|
| Rate for Payer: Frontpath All Commercial |
$234.60
|
| Rate for Payer: Humana ChoiceCare |
$220.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.50
|
| Rate for Payer: PHCS All Commercial |
$191.25
|
| Rate for Payer: PHP All Commercial |
$193.39
|
| Rate for Payer: Sagamore Health Network All Products |
$196.86
|
| Rate for Payer: Signature Care EPO |
$211.65
|
| Rate for Payer: Signature Care PPO |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$200.94
|
|
|
HC CATECHOLAMINES-24-HR
|
Facility
OP
|
$255.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63001485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: Aetna Commercial |
$215.22
|
| Rate for Payer: Aetna Medicare |
$84.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$146.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.56
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Centivo All Commercial |
$130.05
|
| Rate for Payer: Cigna All Commercial |
$220.06
|
| Rate for Payer: CORVEL All Commercial |
$237.15
|
| Rate for Payer: Coventry All Commercial |
$224.40
|
| Rate for Payer: Encore All Commercial |
$234.73
|
| Rate for Payer: Frontpath All Commercial |
$234.60
|
| Rate for Payer: Humana ChoiceCare |
$220.24
|
| Rate for Payer: Humana Medicare |
$130.05
|
| Rate for Payer: Lucent All Commercial |
$130.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.50
|
| Rate for Payer: Managed Health Services Medicaid |
$25.25
|
| Rate for Payer: MDWise Medicaid |
$25.25
|
| Rate for Payer: PHCS All Commercial |
$191.25
|
| Rate for Payer: PHP All Commercial |
$193.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.45
|
| Rate for Payer: Sagamore Health Network All Products |
$196.86
|
| Rate for Payer: Signature Care EPO |
$211.65
|
| Rate for Payer: Signature Care PPO |
$224.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$216.75
|
| Rate for Payer: United Healthcare Commercial |
$200.94
|
| Rate for Payer: United Healthcare Medicare |
$84.15
|
|
|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE, 24-HOUR URINE
|
Facility
OP
|
$74.21
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63044029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.49 |
| Max. Negotiated Rate |
$69.01 |
| Rate for Payer: Aetna Commercial |
$62.63
|
| Rate for Payer: Aetna Medicare |
$24.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.94
|
| Rate for Payer: Cash Price |
$46.01
|
| Rate for Payer: Cash Price |
$46.01
|
| Rate for Payer: Centivo All Commercial |
$37.84
|
| Rate for Payer: Cigna All Commercial |
$64.04
|
| Rate for Payer: CORVEL All Commercial |
$69.01
|
| Rate for Payer: Coventry All Commercial |
$65.30
|
| Rate for Payer: Encore All Commercial |
$68.31
|
| Rate for Payer: Frontpath All Commercial |
$68.27
|
| Rate for Payer: Humana ChoiceCare |
$64.09
|
| Rate for Payer: Humana Medicare |
$37.84
|
| Rate for Payer: Lucent All Commercial |
$37.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.78
|
| Rate for Payer: Managed Health Services Medicaid |
$25.25
|
| Rate for Payer: MDWise Medicaid |
$25.25
|
| Rate for Payer: PHCS All Commercial |
$55.65
|
| Rate for Payer: PHP All Commercial |
$56.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.94
|
| Rate for Payer: Sagamore Health Network All Products |
$57.29
|
| Rate for Payer: Signature Care EPO |
$61.59
|
| Rate for Payer: Signature Care PPO |
$65.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.07
|
| Rate for Payer: United Healthcare Commercial |
$58.47
|
| Rate for Payer: United Healthcare Medicare |
$24.49
|
|
|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE, 24-HOUR URINE
|
Facility
IP
|
$74.21
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63044029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$69.01 |
| Rate for Payer: Aetna Commercial |
$64.11
|
| Rate for Payer: Cash Price |
$46.01
|
| Rate for Payer: Cigna All Commercial |
$64.04
|
| Rate for Payer: CORVEL All Commercial |
$69.01
|
| Rate for Payer: Coventry All Commercial |
$65.30
|
| Rate for Payer: Encore All Commercial |
$68.31
|
| Rate for Payer: Frontpath All Commercial |
$68.27
|
| Rate for Payer: Humana ChoiceCare |
$64.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.78
|
| Rate for Payer: PHCS All Commercial |
$55.65
|
| Rate for Payer: PHP All Commercial |
$56.28
|
| Rate for Payer: Sagamore Health Network All Products |
$57.29
|
| Rate for Payer: Signature Care EPO |
$61.59
|
| Rate for Payer: Signature Care PPO |
$65.30
|
| Rate for Payer: United Healthcare Commercial |
$58.47
|
|
|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE AND VANILLYLMANDELIC ACID (VMA), 24-HOUR URINE
|
Facility
OP
|
$48.58
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63044027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Medicare |
$16.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.64
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Centivo All Commercial |
$24.78
|
| Rate for Payer: Cigna All Commercial |
$41.93
|
| Rate for Payer: CORVEL All Commercial |
$45.18
|
| Rate for Payer: Coventry All Commercial |
$42.75
|
| Rate for Payer: Encore All Commercial |
$44.72
|
| Rate for Payer: Frontpath All Commercial |
$44.70
|
| Rate for Payer: Humana ChoiceCare |
$41.96
|
| Rate for Payer: Humana Medicare |
$24.78
|
| Rate for Payer: Lucent All Commercial |
$24.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.72
|
| Rate for Payer: Managed Health Services Medicaid |
$25.25
|
| Rate for Payer: MDWise Medicaid |
$25.25
|
| Rate for Payer: PHCS All Commercial |
$36.44
|
| Rate for Payer: PHP All Commercial |
$36.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.95
|
| Rate for Payer: Sagamore Health Network All Products |
$37.51
|
| Rate for Payer: Signature Care EPO |
$40.32
|
| Rate for Payer: Signature Care PPO |
$42.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.30
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
| Rate for Payer: United Healthcare Medicare |
$16.03
|
|
|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE AND VANILLYLMANDELIC ACID (VMA), 24-HOUR URINE
|
Facility
IP
|
$48.58
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63044027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Aetna Commercial |
$41.98
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Cigna All Commercial |
$41.93
|
| Rate for Payer: CORVEL All Commercial |
$45.18
|
| Rate for Payer: Coventry All Commercial |
$42.75
|
| Rate for Payer: Encore All Commercial |
$44.72
|
| Rate for Payer: Frontpath All Commercial |
$44.70
|
| Rate for Payer: Humana ChoiceCare |
$41.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.72
|
| Rate for Payer: PHCS All Commercial |
$36.44
|
| Rate for Payer: PHP All Commercial |
$36.85
|
| Rate for Payer: Sagamore Health Network All Products |
$37.51
|
| Rate for Payer: Signature Care EPO |
$40.32
|
| Rate for Payer: Signature Care PPO |
$42.75
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
|
|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE AND VANILLYLMANDELIC ACID (VMA), 24-HOUR URINE-B
|
Facility
IP
|
$48.57
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
63044028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$45.17 |
| Rate for Payer: Aetna Commercial |
$41.97
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Cigna All Commercial |
$41.92
|
| Rate for Payer: CORVEL All Commercial |
$45.17
|
| Rate for Payer: Coventry All Commercial |
$42.74
|
| Rate for Payer: Encore All Commercial |
$44.71
|
| Rate for Payer: Frontpath All Commercial |
$44.69
|
| Rate for Payer: Humana ChoiceCare |
$41.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.72
|
| Rate for Payer: PHCS All Commercial |
$36.43
|
| Rate for Payer: PHP All Commercial |
$36.84
|
| Rate for Payer: Sagamore Health Network All Products |
$37.50
|
| Rate for Payer: Signature Care EPO |
$40.32
|
| Rate for Payer: Signature Care PPO |
$42.74
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
|
|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE AND VANILLYLMANDELIC ACID (VMA), 24-HOUR URINE-B
|
Facility
OP
|
$48.57
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
63044028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$45.17 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Medicare |
$16.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.63
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Centivo All Commercial |
$24.77
|
| Rate for Payer: Cigna All Commercial |
$41.92
|
| Rate for Payer: CORVEL All Commercial |
$45.17
|
| Rate for Payer: Coventry All Commercial |
$42.74
|
| Rate for Payer: Encore All Commercial |
$44.71
|
| Rate for Payer: Frontpath All Commercial |
$44.69
|
| Rate for Payer: Humana ChoiceCare |
$41.95
|
| Rate for Payer: Humana Medicare |
$24.77
|
| Rate for Payer: Lucent All Commercial |
$24.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.72
|
| Rate for Payer: Managed Health Services Medicaid |
$14.18
|
| Rate for Payer: MDWise Medicaid |
$14.18
|
| Rate for Payer: PHCS All Commercial |
$36.43
|
| Rate for Payer: PHP All Commercial |
$36.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.94
|
| Rate for Payer: Sagamore Health Network All Products |
$37.50
|
| Rate for Payer: Signature Care EPO |
$40.32
|
| Rate for Payer: Signature Care PPO |
$42.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.29
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
| Rate for Payer: United Healthcare Medicare |
$16.03
|
|
