|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE, RANDOM URINE
|
Facility
OP
|
$37.11
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63044030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$34.51 |
| Rate for Payer: Aetna Commercial |
$31.32
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.25
|
| 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 |
$23.01
|
| Rate for Payer: Cash Price |
$23.01
|
| Rate for Payer: Centivo All Commercial |
$18.92
|
| Rate for Payer: Cigna All Commercial |
$32.02
|
| Rate for Payer: CORVEL All Commercial |
$34.51
|
| Rate for Payer: Coventry All Commercial |
$32.65
|
| Rate for Payer: Encore All Commercial |
$34.16
|
| Rate for Payer: Frontpath All Commercial |
$34.14
|
| Rate for Payer: Humana ChoiceCare |
$32.05
|
| Rate for Payer: Humana Medicare |
$18.92
|
| Rate for Payer: Lucent All Commercial |
$18.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.40
|
| Rate for Payer: Managed Health Services Medicaid |
$25.25
|
| Rate for Payer: MDWise Medicaid |
$25.25
|
| Rate for Payer: PHCS All Commercial |
$27.83
|
| 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 |
$28.65
|
| Rate for Payer: Signature Care EPO |
$30.80
|
| Rate for Payer: Signature Care PPO |
$32.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.54
|
| Rate for Payer: United Healthcare Commercial |
$29.24
|
| Rate for Payer: United Healthcare Medicare |
$12.25
|
|
|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE, RANDOM URINE
|
Facility
IP
|
$37.11
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63044030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$34.51 |
| Rate for Payer: Aetna Commercial |
$32.06
|
| Rate for Payer: Cash Price |
$23.01
|
| Rate for Payer: Cigna All Commercial |
$32.02
|
| Rate for Payer: CORVEL All Commercial |
$34.51
|
| Rate for Payer: Coventry All Commercial |
$32.65
|
| Rate for Payer: Encore All Commercial |
$34.16
|
| Rate for Payer: Frontpath All Commercial |
$34.14
|
| Rate for Payer: Humana ChoiceCare |
$32.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.40
|
| Rate for Payer: PHCS All Commercial |
$27.83
|
| Rate for Payer: PHP All Commercial |
$28.14
|
| Rate for Payer: Sagamore Health Network All Products |
$28.65
|
| Rate for Payer: Signature Care EPO |
$30.80
|
| Rate for Payer: Signature Care PPO |
$32.65
|
| Rate for Payer: United Healthcare Commercial |
$29.24
|
|
|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE, RANDOM URINE-B
|
Facility
IP
|
$37.10
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Cigna All Commercial |
$32.02
|
| Rate for Payer: Aetna Commercial |
$32.05
|
| Rate for Payer: Cash Price |
$23.00
|
| 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 |
$28.13
|
| 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 CATECHOLAMINES, FRACTIONATED, URINARY FREE, RANDOM URINE-B
|
Facility
OP
|
$37.10
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63044031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$34.50 |
| 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 |
$17.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| 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 |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$27.82
|
| Rate for Payer: PHP All Commercial |
$28.13
|
| 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 |
$31.53
|
| Rate for Payer: United Healthcare Commercial |
$29.23
|
| Rate for Payer: United Healthcare Medicare |
$12.24
|
|
|
HC CATECHOLAMINES-RANUR
|
Facility
OP
|
$230.88
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63001486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$214.72 |
| Rate for Payer: Aetna Commercial |
$194.86
|
| Rate for Payer: Aetna Medicare |
$76.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$25.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.81
|
| Rate for Payer: Cash Price |
$143.14
|
| Rate for Payer: Cash Price |
$143.14
|
| Rate for Payer: Centivo All Commercial |
$117.75
|
| Rate for Payer: Cigna All Commercial |
$199.25
|
| Rate for Payer: CORVEL All Commercial |
$214.72
|
| Rate for Payer: Coventry All Commercial |
$203.17
|
| Rate for Payer: Encore All Commercial |
$212.52
|
| Rate for Payer: Frontpath All Commercial |
$212.41
|
| Rate for Payer: Humana ChoiceCare |
$199.41
|
| Rate for Payer: Humana Medicare |
$117.75
|
| Rate for Payer: Lucent All Commercial |
$117.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.79
|
| Rate for Payer: Managed Health Services Medicaid |
$25.25
|
| Rate for Payer: MDWise Medicaid |
$25.25
|
| Rate for Payer: PHCS All Commercial |
$173.16
|
| Rate for Payer: PHP All Commercial |
$175.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.04
|
| Rate for Payer: Sagamore Health Network All Products |
$178.24
|
| Rate for Payer: Signature Care EPO |
$191.63
|
| Rate for Payer: Signature Care PPO |
$203.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$196.25
|
| Rate for Payer: United Healthcare Commercial |
$181.93
|
| Rate for Payer: United Healthcare Medicare |
$76.19
|
|
|
HC CATECHOLAMINES-RANUR
|
Facility
IP
|
$230.88
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63001486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.16 |
| Max. Negotiated Rate |
$214.72 |
| Rate for Payer: Aetna Commercial |
$199.48
|
| Rate for Payer: Cash Price |
$143.14
|
| Rate for Payer: Cigna All Commercial |
$199.25
|
| Rate for Payer: CORVEL All Commercial |
$214.72
|
| Rate for Payer: Coventry All Commercial |
$203.17
|
| Rate for Payer: Encore All Commercial |
$212.52
|
| Rate for Payer: Frontpath All Commercial |
$212.41
|
| Rate for Payer: Humana ChoiceCare |
$199.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.79
|
| Rate for Payer: PHCS All Commercial |
$173.16
|
| Rate for Payer: PHP All Commercial |
$175.10
|
| Rate for Payer: Sagamore Health Network All Products |
$178.24
|
| Rate for Payer: Signature Care EPO |
$191.63
|
| Rate for Payer: Signature Care PPO |
$203.17
|
| Rate for Payer: United Healthcare Commercial |
$181.93
|
|
|
HC CATH 3WAY 22FR/30CC
|
Facility
OP
|
$64.89
|
|
| Hospital Charge Code |
41601903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$54.77
|
| Rate for Payer: Aetna Medicare |
$21.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.56
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Centivo All Commercial |
$33.09
|
| Rate for Payer: Cigna All Commercial |
$56.00
|
| Rate for Payer: CORVEL All Commercial |
$60.35
|
| Rate for Payer: Coventry All Commercial |
$57.10
|
| Rate for Payer: Encore All Commercial |
$59.73
|
| Rate for Payer: Frontpath All Commercial |
$59.70
|
| Rate for Payer: Humana ChoiceCare |
$56.05
|
| Rate for Payer: Humana Medicare |
$33.09
|
| Rate for Payer: Lucent All Commercial |
$33.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$48.67
|
| Rate for Payer: PHP All Commercial |
$49.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.31
|
| Rate for Payer: Sagamore Health Network All Products |
$50.10
|
| Rate for Payer: Signature Care EPO |
$53.86
|
| Rate for Payer: Signature Care PPO |
$57.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.16
|
| Rate for Payer: United Healthcare Commercial |
$51.13
|
| Rate for Payer: United Healthcare Medicare |
$21.41
|
|
|
HC CATH 3WAY 22FR/30CC
|
Facility
IP
|
$64.89
|
|
| Hospital Charge Code |
41601903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.67 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: Aetna Commercial |
$56.06
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cigna All Commercial |
$56.00
|
| Rate for Payer: CORVEL All Commercial |
$60.35
|
| Rate for Payer: Coventry All Commercial |
$57.10
|
| Rate for Payer: Encore All Commercial |
$59.73
|
| Rate for Payer: Frontpath All Commercial |
$59.70
|
| Rate for Payer: Humana ChoiceCare |
$56.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.40
|
| Rate for Payer: PHCS All Commercial |
$48.67
|
| Rate for Payer: PHP All Commercial |
$49.21
|
| Rate for Payer: Sagamore Health Network All Products |
$50.10
|
| Rate for Payer: Signature Care EPO |
$53.86
|
| Rate for Payer: Signature Care PPO |
$57.10
|
| Rate for Payer: United Healthcare Commercial |
$51.13
|
|
|
HC CATH 3WAY 24FR/30CC
|
Facility
OP
|
$62.79
|
|
| Hospital Charge Code |
41601904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$52.99
|
| Rate for Payer: Aetna Medicare |
$20.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.79
|
| Rate for Payer: Cash Price |
$38.93
|
| Rate for Payer: Cash Price |
$38.93
|
| Rate for Payer: Centivo All Commercial |
$32.02
|
| Rate for Payer: Cigna All Commercial |
$54.19
|
| Rate for Payer: CORVEL All Commercial |
$58.39
|
| Rate for Payer: Coventry All Commercial |
$55.26
|
| Rate for Payer: Encore All Commercial |
$57.80
|
| Rate for Payer: Frontpath All Commercial |
$57.77
|
| Rate for Payer: Humana ChoiceCare |
$54.23
|
| Rate for Payer: Humana Medicare |
$32.02
|
| Rate for Payer: Lucent All Commercial |
$32.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$47.09
|
| Rate for Payer: PHP All Commercial |
$47.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.49
|
| Rate for Payer: Sagamore Health Network All Products |
$48.47
|
| Rate for Payer: Signature Care EPO |
$52.12
|
| Rate for Payer: Signature Care PPO |
$55.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.37
|
| Rate for Payer: United Healthcare Commercial |
$49.48
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
|
|
HC CATH 3WAY 24FR/30CC
|
Facility
IP
|
$62.79
|
|
| Hospital Charge Code |
41601904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.09 |
| Max. Negotiated Rate |
$58.39 |
| Rate for Payer: Aetna Commercial |
$54.25
|
| Rate for Payer: Cash Price |
$38.93
|
| Rate for Payer: Cigna All Commercial |
$54.19
|
| Rate for Payer: CORVEL All Commercial |
$58.39
|
| Rate for Payer: Coventry All Commercial |
$55.26
|
| Rate for Payer: Encore All Commercial |
$57.80
|
| Rate for Payer: Frontpath All Commercial |
$57.77
|
| Rate for Payer: Humana ChoiceCare |
$54.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.51
|
| Rate for Payer: PHCS All Commercial |
$47.09
|
| Rate for Payer: PHP All Commercial |
$47.62
|
| Rate for Payer: Sagamore Health Network All Products |
$48.47
|
| Rate for Payer: Signature Care EPO |
$52.12
|
| Rate for Payer: Signature Care PPO |
$55.26
|
| Rate for Payer: United Healthcare Commercial |
$49.48
|
|
|
HC CATH 3WAY 24FR/30CC SILICONE
|
Facility
OP
|
$72.21
|
|
| Hospital Charge Code |
41601905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$60.95
|
| Rate for Payer: Aetna Medicare |
$23.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.21
|
| Rate for Payer: Cash Price |
$44.77
|
| Rate for Payer: Cash Price |
$44.77
|
| Rate for Payer: Centivo All Commercial |
$36.83
|
| Rate for Payer: Cigna All Commercial |
$62.32
|
| Rate for Payer: CORVEL All Commercial |
$67.16
|
| Rate for Payer: Coventry All Commercial |
$63.54
|
| Rate for Payer: Encore All Commercial |
$66.47
|
| Rate for Payer: Frontpath All Commercial |
$66.43
|
| Rate for Payer: Humana ChoiceCare |
$62.37
|
| Rate for Payer: Humana Medicare |
$36.83
|
| Rate for Payer: Lucent All Commercial |
$36.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.99
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$54.16
|
| Rate for Payer: PHP All Commercial |
$54.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.16
|
| Rate for Payer: Sagamore Health Network All Products |
$55.75
|
| Rate for Payer: Signature Care EPO |
$59.93
|
| Rate for Payer: Signature Care PPO |
$63.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.38
|
| Rate for Payer: United Healthcare Commercial |
$56.90
|
| Rate for Payer: United Healthcare Medicare |
$23.83
|
|
|
HC CATH 3WAY 24FR/30CC SILICONE
|
Facility
IP
|
$72.21
|
|
| Hospital Charge Code |
41601905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$62.39
|
| Rate for Payer: Cash Price |
$44.77
|
| Rate for Payer: Cigna All Commercial |
$62.32
|
| Rate for Payer: CORVEL All Commercial |
$67.16
|
| Rate for Payer: Coventry All Commercial |
$63.54
|
| Rate for Payer: Encore All Commercial |
$66.47
|
| Rate for Payer: Frontpath All Commercial |
$66.43
|
| Rate for Payer: Humana ChoiceCare |
$62.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.99
|
| Rate for Payer: PHCS All Commercial |
$54.16
|
| Rate for Payer: PHP All Commercial |
$54.76
|
| Rate for Payer: Sagamore Health Network All Products |
$55.75
|
| Rate for Payer: Signature Care EPO |
$59.93
|
| Rate for Payer: Signature Care PPO |
$63.54
|
| Rate for Payer: United Healthcare Commercial |
$56.90
|
|
|
HC CATH ADULT FEMALE KIT
|
Facility
OP
|
$11.56
|
|
| Hospital Charge Code |
41601064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Aetna Medicare |
$3.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.20
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Centivo All Commercial |
$5.90
|
| Rate for Payer: Cigna All Commercial |
$9.98
|
| Rate for Payer: CORVEL All Commercial |
$10.75
|
| Rate for Payer: Coventry All Commercial |
$10.17
|
| Rate for Payer: Encore All Commercial |
$10.64
|
| Rate for Payer: Frontpath All Commercial |
$10.64
|
| Rate for Payer: Humana ChoiceCare |
$9.98
|
| Rate for Payer: Humana Medicare |
$5.90
|
| Rate for Payer: Lucent All Commercial |
$5.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.67
|
| Rate for Payer: PHP All Commercial |
$8.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.51
|
| Rate for Payer: Sagamore Health Network All Products |
$8.92
|
| Rate for Payer: Signature Care EPO |
$9.59
|
| Rate for Payer: Signature Care PPO |
$10.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$9.11
|
| Rate for Payer: United Healthcare Medicare |
$3.81
|
|
|
HC CATH ADULT FEMALE KIT
|
Facility
IP
|
$11.56
|
|
| Hospital Charge Code |
41601064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$10.75 |
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Cigna All Commercial |
$9.98
|
| Rate for Payer: CORVEL All Commercial |
$10.75
|
| Rate for Payer: Coventry All Commercial |
$10.17
|
| Rate for Payer: Encore All Commercial |
$10.64
|
| Rate for Payer: Frontpath All Commercial |
$10.64
|
| Rate for Payer: Humana ChoiceCare |
$9.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.40
|
| Rate for Payer: PHCS All Commercial |
$8.67
|
| Rate for Payer: PHP All Commercial |
$8.77
|
| Rate for Payer: Sagamore Health Network All Products |
$8.92
|
| Rate for Payer: Signature Care EPO |
$9.59
|
| Rate for Payer: Signature Care PPO |
$10.17
|
| Rate for Payer: United Healthcare Commercial |
$9.11
|
|
|
HC CATH ARTERIAL KIT
|
Facility
OP
|
$301.00
|
|
| Hospital Charge Code |
41601263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.33 |
| Max. Negotiated Rate |
$279.93 |
| Rate for Payer: Aetna Commercial |
$254.04
|
| Rate for Payer: Aetna Medicare |
$99.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$172.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$188.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.26
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Centivo All Commercial |
$153.51
|
| Rate for Payer: Cigna All Commercial |
$259.76
|
| Rate for Payer: CORVEL All Commercial |
$279.93
|
| Rate for Payer: Coventry All Commercial |
$264.88
|
| Rate for Payer: Encore All Commercial |
$277.07
|
| Rate for Payer: Frontpath All Commercial |
$276.92
|
| Rate for Payer: Humana ChoiceCare |
$259.97
|
| Rate for Payer: Humana Medicare |
$153.51
|
| Rate for Payer: Lucent All Commercial |
$153.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$270.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$225.75
|
| Rate for Payer: PHP All Commercial |
$228.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$117.39
|
| Rate for Payer: Sagamore Health Network All Products |
$232.37
|
| Rate for Payer: Signature Care EPO |
$249.83
|
| Rate for Payer: Signature Care PPO |
$264.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$255.85
|
| Rate for Payer: United Healthcare Commercial |
$237.19
|
| Rate for Payer: United Healthcare Medicare |
$99.33
|
|
|
HC CATH ARTERIAL KIT
|
Facility
IP
|
$301.00
|
|
| Hospital Charge Code |
41601263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$279.93 |
| Rate for Payer: Aetna Commercial |
$260.06
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cigna All Commercial |
$259.76
|
| Rate for Payer: CORVEL All Commercial |
$279.93
|
| Rate for Payer: Coventry All Commercial |
$264.88
|
| Rate for Payer: Encore All Commercial |
$277.07
|
| Rate for Payer: Frontpath All Commercial |
$276.92
|
| Rate for Payer: Humana ChoiceCare |
$259.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$270.90
|
| Rate for Payer: PHCS All Commercial |
$225.75
|
| Rate for Payer: PHP All Commercial |
$228.28
|
| Rate for Payer: Sagamore Health Network All Products |
$232.37
|
| Rate for Payer: Signature Care EPO |
$249.83
|
| Rate for Payer: Signature Care PPO |
$264.88
|
| Rate for Payer: United Healthcare Commercial |
$237.19
|
|
|
HC CATH BALLOON DILATION SPYGLASS 6.0MM
|
Facility
IP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$820.80
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
|
|
HC CATH BALLOON DILATION SPYGLASS 6.0MM
|
Facility
OP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$801.80
|
| Rate for Payer: Aetna Medicare |
$313.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$313.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$545.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$593.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.85
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Centivo All Commercial |
$484.50
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.52
|
| Rate for Payer: Humana Medicare |
$484.50
|
| Rate for Payer: Lucent All Commercial |
$484.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$370.50
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$807.50
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
| Rate for Payer: United Healthcare Medicare |
$313.50
|
|
|
HC CATH BALLOON DILATION SPYGLASS 7.0MM
|
Facility
OP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$801.80
|
| Rate for Payer: Aetna Medicare |
$313.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$313.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$545.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$593.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.85
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Centivo All Commercial |
$484.50
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.52
|
| Rate for Payer: Humana Medicare |
$484.50
|
| Rate for Payer: Lucent All Commercial |
$484.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$370.50
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$807.50
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
| Rate for Payer: United Healthcare Medicare |
$313.50
|
|
|
HC CATH BALLOON DILATION SPYGLASS 7.0MM
|
Facility
IP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$820.80
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
|
|
HC CATH BALLOON DILATION SPYGLASS 8.0MM
|
Facility
OP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$801.80
|
| Rate for Payer: Aetna Medicare |
$313.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$313.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$545.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$593.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.85
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Centivo All Commercial |
$484.50
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.52
|
| Rate for Payer: Humana Medicare |
$484.50
|
| Rate for Payer: Lucent All Commercial |
$484.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$370.50
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$807.50
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
| Rate for Payer: United Healthcare Medicare |
$313.50
|
|
|
HC CATH BALLOON DILATION SPYGLASS 8.0MM
|
Facility
IP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$820.80
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
|
|
HC CATH BALLOON VENOGRAPHY
|
Facility
IP
|
$145.80
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
41607577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.35 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Aetna Commercial |
$125.97
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cigna All Commercial |
$125.83
|
| Rate for Payer: CORVEL All Commercial |
$135.59
|
| Rate for Payer: Coventry All Commercial |
$128.30
|
| Rate for Payer: Encore All Commercial |
$134.21
|
| Rate for Payer: Frontpath All Commercial |
$134.14
|
| Rate for Payer: Humana ChoiceCare |
$125.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.22
|
| Rate for Payer: PHCS All Commercial |
$109.35
|
| Rate for Payer: PHP All Commercial |
$110.57
|
| Rate for Payer: Sagamore Health Network All Products |
$112.56
|
| Rate for Payer: Signature Care EPO |
$121.01
|
| Rate for Payer: Signature Care PPO |
$128.30
|
| Rate for Payer: United Healthcare Commercial |
$114.89
|
|
|
HC CATH BALLOON VENOGRAPHY
|
Facility
OP
|
$145.80
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
41607577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.11 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Aetna Commercial |
$123.06
|
| Rate for Payer: Aetna Medicare |
$48.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.93
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Centivo All Commercial |
$74.36
|
| Rate for Payer: Cigna All Commercial |
$125.83
|
| Rate for Payer: CORVEL All Commercial |
$135.59
|
| Rate for Payer: Coventry All Commercial |
$128.30
|
| Rate for Payer: Encore All Commercial |
$134.21
|
| Rate for Payer: Frontpath All Commercial |
$134.14
|
| Rate for Payer: Humana ChoiceCare |
$125.93
|
| Rate for Payer: Humana Medicare |
$74.36
|
| Rate for Payer: Lucent All Commercial |
$74.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$109.35
|
| Rate for Payer: PHP All Commercial |
$110.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.86
|
| Rate for Payer: Sagamore Health Network All Products |
$112.56
|
| Rate for Payer: Signature Care EPO |
$121.01
|
| Rate for Payer: Signature Care PPO |
$128.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.93
|
| Rate for Payer: United Healthcare Commercial |
$114.89
|
| Rate for Payer: United Healthcare Medicare |
$48.11
|
|
|
HC CATH BRONCO 35FR
|
Facility
OP
|
$361.20
|
|
| Hospital Charge Code |
41602335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.20 |
| Max. Negotiated Rate |
$335.92 |
| Rate for Payer: Aetna Commercial |
$304.85
|
| Rate for Payer: Aetna Medicare |
$119.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$207.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.12
|
| Rate for Payer: Cash Price |
$223.94
|
| Rate for Payer: Cash Price |
$223.94
|
| Rate for Payer: Centivo All Commercial |
$184.21
|
| Rate for Payer: Cigna All Commercial |
$311.72
|
| Rate for Payer: CORVEL All Commercial |
$335.92
|
| Rate for Payer: Coventry All Commercial |
$317.86
|
| Rate for Payer: Encore All Commercial |
$332.48
|
| Rate for Payer: Frontpath All Commercial |
$332.30
|
| Rate for Payer: Humana ChoiceCare |
$311.97
|
| Rate for Payer: Humana Medicare |
$184.21
|
| Rate for Payer: Lucent All Commercial |
$184.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$270.90
|
| Rate for Payer: PHP All Commercial |
$273.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.87
|
| Rate for Payer: Sagamore Health Network All Products |
$278.85
|
| Rate for Payer: Signature Care EPO |
$299.80
|
| Rate for Payer: Signature Care PPO |
$317.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.02
|
| Rate for Payer: United Healthcare Commercial |
$284.63
|
| Rate for Payer: United Healthcare Medicare |
$119.20
|
|
