|
HC CATH BRONCO 35FR
|
Facility
IP
|
$361.20
|
|
| Hospital Charge Code |
41602335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$335.92 |
| Rate for Payer: Aetna Commercial |
$312.08
|
| Rate for Payer: Cash Price |
$223.94
|
| 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: Lutheran Preferred All Commercial |
$325.08
|
| Rate for Payer: PHCS All Commercial |
$270.90
|
| Rate for Payer: PHP All Commercial |
$273.93
|
| 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: United Healthcare Commercial |
$284.63
|
|
|
HC CATH CHOLANGIOGRAM 4.5 FR
|
Facility
OP
|
$471.60
|
|
| Hospital Charge Code |
41601900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$438.59 |
| Rate for Payer: Aetna Commercial |
$398.03
|
| Rate for Payer: Aetna Medicare |
$155.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$155.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$270.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$178.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.19
|
| Rate for Payer: Cash Price |
$292.39
|
| Rate for Payer: Cash Price |
$292.39
|
| Rate for Payer: Centivo All Commercial |
$240.52
|
| Rate for Payer: Cigna All Commercial |
$406.99
|
| Rate for Payer: CORVEL All Commercial |
$438.59
|
| Rate for Payer: Coventry All Commercial |
$415.01
|
| Rate for Payer: Encore All Commercial |
$434.11
|
| Rate for Payer: Frontpath All Commercial |
$433.87
|
| Rate for Payer: Humana ChoiceCare |
$407.32
|
| Rate for Payer: Humana Medicare |
$240.52
|
| Rate for Payer: Lucent All Commercial |
$240.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$353.70
|
| Rate for Payer: PHP All Commercial |
$357.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$183.92
|
| Rate for Payer: Sagamore Health Network All Products |
$364.08
|
| Rate for Payer: Signature Care EPO |
$391.43
|
| Rate for Payer: Signature Care PPO |
$415.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.86
|
| Rate for Payer: United Healthcare Commercial |
$371.62
|
| Rate for Payer: United Healthcare Medicare |
$155.63
|
|
|
HC CATH CHOLANGIOGRAM 4.5 FR
|
Facility
IP
|
$471.60
|
|
| Hospital Charge Code |
41601900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.70 |
| Max. Negotiated Rate |
$438.59 |
| Rate for Payer: Aetna Commercial |
$407.46
|
| Rate for Payer: Cash Price |
$292.39
|
| Rate for Payer: Cigna All Commercial |
$406.99
|
| Rate for Payer: CORVEL All Commercial |
$438.59
|
| Rate for Payer: Coventry All Commercial |
$415.01
|
| Rate for Payer: Encore All Commercial |
$434.11
|
| Rate for Payer: Frontpath All Commercial |
$433.87
|
| Rate for Payer: Humana ChoiceCare |
$407.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$424.44
|
| Rate for Payer: PHCS All Commercial |
$353.70
|
| Rate for Payer: PHP All Commercial |
$357.66
|
| Rate for Payer: Sagamore Health Network All Products |
$364.08
|
| Rate for Payer: Signature Care EPO |
$391.43
|
| Rate for Payer: Signature Care PPO |
$415.01
|
| Rate for Payer: United Healthcare Commercial |
$371.62
|
|
|
HC CATH CHOLANGIOGRAM 5.5 FR
|
Facility
OP
|
$332.33
|
|
| Hospital Charge Code |
41601901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$309.07 |
| Rate for Payer: Aetna Commercial |
$280.49
|
| Rate for Payer: Aetna Medicare |
$109.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$109.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$190.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$207.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.64
|
| Rate for Payer: Cash Price |
$206.05
|
| Rate for Payer: Cash Price |
$206.05
|
| Rate for Payer: Centivo All Commercial |
$169.49
|
| Rate for Payer: Cigna All Commercial |
$286.80
|
| Rate for Payer: CORVEL All Commercial |
$309.07
|
| Rate for Payer: Coventry All Commercial |
$292.45
|
| Rate for Payer: Encore All Commercial |
$305.91
|
| Rate for Payer: Frontpath All Commercial |
$305.74
|
| Rate for Payer: Humana ChoiceCare |
$287.03
|
| Rate for Payer: Humana Medicare |
$169.49
|
| Rate for Payer: Lucent All Commercial |
$169.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$299.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$249.25
|
| Rate for Payer: PHP All Commercial |
$252.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$129.61
|
| Rate for Payer: Sagamore Health Network All Products |
$256.56
|
| Rate for Payer: Signature Care EPO |
$275.83
|
| Rate for Payer: Signature Care PPO |
$292.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$282.48
|
| Rate for Payer: United Healthcare Commercial |
$261.88
|
| Rate for Payer: United Healthcare Medicare |
$109.67
|
|
|
HC CATH CHOLANGIOGRAM 5.5 FR
|
Facility
IP
|
$332.33
|
|
| Hospital Charge Code |
41601901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$309.07 |
| Rate for Payer: Aetna Commercial |
$287.13
|
| Rate for Payer: Cash Price |
$206.05
|
| Rate for Payer: Cigna All Commercial |
$286.80
|
| Rate for Payer: CORVEL All Commercial |
$309.07
|
| Rate for Payer: Coventry All Commercial |
$292.45
|
| Rate for Payer: Encore All Commercial |
$305.91
|
| Rate for Payer: Frontpath All Commercial |
$305.74
|
| Rate for Payer: Humana ChoiceCare |
$287.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$299.10
|
| Rate for Payer: PHCS All Commercial |
$249.25
|
| Rate for Payer: PHP All Commercial |
$252.04
|
| Rate for Payer: Sagamore Health Network All Products |
$256.56
|
| Rate for Payer: Signature Care EPO |
$275.83
|
| Rate for Payer: Signature Care PPO |
$292.45
|
| Rate for Payer: United Healthcare Commercial |
$261.88
|
|
|
HC CATH COUNCIL TIP 16FR 5CC
|
Facility
OP
|
$84.98
|
|
| Hospital Charge Code |
41601902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$71.72
|
| Rate for Payer: Aetna Medicare |
$28.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.85
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Centivo All Commercial |
$43.34
|
| Rate for Payer: Cigna All Commercial |
$73.34
|
| Rate for Payer: CORVEL All Commercial |
$79.03
|
| Rate for Payer: Coventry All Commercial |
$74.78
|
| Rate for Payer: Encore All Commercial |
$78.22
|
| Rate for Payer: Frontpath All Commercial |
$78.18
|
| Rate for Payer: Humana ChoiceCare |
$73.40
|
| Rate for Payer: Humana Medicare |
$43.34
|
| Rate for Payer: Lucent All Commercial |
$43.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$63.74
|
| Rate for Payer: PHP All Commercial |
$64.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.14
|
| Rate for Payer: Sagamore Health Network All Products |
$65.60
|
| Rate for Payer: Signature Care EPO |
$70.53
|
| Rate for Payer: Signature Care PPO |
$74.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.23
|
| Rate for Payer: United Healthcare Commercial |
$66.96
|
| Rate for Payer: United Healthcare Medicare |
$28.04
|
|
|
HC CATH COUNCIL TIP 16FR 5CC
|
Facility
IP
|
$84.98
|
|
| Hospital Charge Code |
41601902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.74 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna Commercial |
$73.42
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cigna All Commercial |
$73.34
|
| Rate for Payer: CORVEL All Commercial |
$79.03
|
| Rate for Payer: Coventry All Commercial |
$74.78
|
| Rate for Payer: Encore All Commercial |
$78.22
|
| Rate for Payer: Frontpath All Commercial |
$78.18
|
| Rate for Payer: Humana ChoiceCare |
$73.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.48
|
| Rate for Payer: PHCS All Commercial |
$63.74
|
| Rate for Payer: PHP All Commercial |
$64.45
|
| Rate for Payer: Sagamore Health Network All Products |
$65.60
|
| Rate for Payer: Signature Care EPO |
$70.53
|
| Rate for Payer: Signature Care PPO |
$74.78
|
| Rate for Payer: United Healthcare Commercial |
$66.96
|
|
|
HC CATH COUNCIL TIP 18FR 5CC
|
Facility
OP
|
$84.98
|
|
| Hospital Charge Code |
41602476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$71.72
|
| Rate for Payer: Aetna Medicare |
$28.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.85
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Centivo All Commercial |
$43.34
|
| Rate for Payer: Cigna All Commercial |
$73.34
|
| Rate for Payer: CORVEL All Commercial |
$79.03
|
| Rate for Payer: Coventry All Commercial |
$74.78
|
| Rate for Payer: Encore All Commercial |
$78.22
|
| Rate for Payer: Frontpath All Commercial |
$78.18
|
| Rate for Payer: Humana ChoiceCare |
$73.40
|
| Rate for Payer: Humana Medicare |
$43.34
|
| Rate for Payer: Lucent All Commercial |
$43.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$63.74
|
| Rate for Payer: PHP All Commercial |
$64.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.14
|
| Rate for Payer: Sagamore Health Network All Products |
$65.60
|
| Rate for Payer: Signature Care EPO |
$70.53
|
| Rate for Payer: Signature Care PPO |
$74.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.23
|
| Rate for Payer: United Healthcare Commercial |
$66.96
|
| Rate for Payer: United Healthcare Medicare |
$28.04
|
|
|
HC CATH COUNCIL TIP 18FR 5CC
|
Facility
IP
|
$84.98
|
|
| Hospital Charge Code |
41602476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.74 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna Commercial |
$73.42
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cigna All Commercial |
$73.34
|
| Rate for Payer: CORVEL All Commercial |
$79.03
|
| Rate for Payer: Coventry All Commercial |
$74.78
|
| Rate for Payer: Encore All Commercial |
$78.22
|
| Rate for Payer: Frontpath All Commercial |
$78.18
|
| Rate for Payer: Humana ChoiceCare |
$73.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.48
|
| Rate for Payer: PHCS All Commercial |
$63.74
|
| Rate for Payer: PHP All Commercial |
$64.45
|
| Rate for Payer: Sagamore Health Network All Products |
$65.60
|
| Rate for Payer: Signature Care EPO |
$70.53
|
| Rate for Payer: Signature Care PPO |
$74.78
|
| Rate for Payer: United Healthcare Commercial |
$66.96
|
|
|
HC CATH COUNCIL TIP 20FR 5CC
|
Facility
OP
|
$84.98
|
|
| Hospital Charge Code |
41602074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$71.72
|
| Rate for Payer: Aetna Medicare |
$28.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.85
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Centivo All Commercial |
$43.34
|
| Rate for Payer: Cigna All Commercial |
$73.34
|
| Rate for Payer: CORVEL All Commercial |
$79.03
|
| Rate for Payer: Coventry All Commercial |
$74.78
|
| Rate for Payer: Encore All Commercial |
$78.22
|
| Rate for Payer: Frontpath All Commercial |
$78.18
|
| Rate for Payer: Humana ChoiceCare |
$73.40
|
| Rate for Payer: Humana Medicare |
$43.34
|
| Rate for Payer: Lucent All Commercial |
$43.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$63.74
|
| Rate for Payer: PHP All Commercial |
$64.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.14
|
| Rate for Payer: Sagamore Health Network All Products |
$65.60
|
| Rate for Payer: Signature Care EPO |
$70.53
|
| Rate for Payer: Signature Care PPO |
$74.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.23
|
| Rate for Payer: United Healthcare Commercial |
$66.96
|
| Rate for Payer: United Healthcare Medicare |
$28.04
|
|
|
HC CATH COUNCIL TIP 20FR 5CC
|
Facility
IP
|
$84.98
|
|
| Hospital Charge Code |
41602074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.74 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna Commercial |
$73.42
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cigna All Commercial |
$73.34
|
| Rate for Payer: CORVEL All Commercial |
$79.03
|
| Rate for Payer: Coventry All Commercial |
$74.78
|
| Rate for Payer: Encore All Commercial |
$78.22
|
| Rate for Payer: Frontpath All Commercial |
$78.18
|
| Rate for Payer: Humana ChoiceCare |
$73.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.48
|
| Rate for Payer: PHCS All Commercial |
$63.74
|
| Rate for Payer: PHP All Commercial |
$64.45
|
| Rate for Payer: Sagamore Health Network All Products |
$65.60
|
| Rate for Payer: Signature Care EPO |
$70.53
|
| Rate for Payer: Signature Care PPO |
$74.78
|
| Rate for Payer: United Healthcare Commercial |
$66.96
|
|
|
HC CATH CPS AIM SL INN 90 E 59CM
|
Facility
OP
|
$1,053.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$979.29 |
| Rate for Payer: Aetna Commercial |
$888.73
|
| Rate for Payer: Aetna Medicare |
$347.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$347.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$604.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$658.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$399.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$382.24
|
| Rate for Payer: Cash Price |
$652.86
|
| Rate for Payer: Cash Price |
$652.86
|
| Rate for Payer: Centivo All Commercial |
$537.03
|
| Rate for Payer: Cigna All Commercial |
$908.74
|
| Rate for Payer: CORVEL All Commercial |
$979.29
|
| Rate for Payer: Coventry All Commercial |
$926.64
|
| Rate for Payer: Encore All Commercial |
$969.29
|
| Rate for Payer: Frontpath All Commercial |
$968.76
|
| Rate for Payer: Humana ChoiceCare |
$909.48
|
| Rate for Payer: Humana Medicare |
$537.03
|
| Rate for Payer: Lucent All Commercial |
$537.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$947.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$789.75
|
| Rate for Payer: PHP All Commercial |
$798.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$410.67
|
| Rate for Payer: Sagamore Health Network All Products |
$812.92
|
| Rate for Payer: Signature Care EPO |
$873.99
|
| Rate for Payer: Signature Care PPO |
$926.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$895.05
|
| Rate for Payer: United Healthcare Commercial |
$829.76
|
| Rate for Payer: United Healthcare Medicare |
$347.49
|
|
|
HC CATH CPS AIM SL INN 90 E 59CM
|
Facility
IP
|
$1,053.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$789.75 |
| Max. Negotiated Rate |
$979.29 |
| Rate for Payer: Aetna Commercial |
$909.79
|
| Rate for Payer: Cash Price |
$652.86
|
| Rate for Payer: Cigna All Commercial |
$908.74
|
| Rate for Payer: CORVEL All Commercial |
$979.29
|
| Rate for Payer: Coventry All Commercial |
$926.64
|
| Rate for Payer: Encore All Commercial |
$969.29
|
| Rate for Payer: Frontpath All Commercial |
$968.76
|
| Rate for Payer: Humana ChoiceCare |
$909.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$947.70
|
| Rate for Payer: PHCS All Commercial |
$789.75
|
| Rate for Payer: PHP All Commercial |
$798.60
|
| Rate for Payer: Sagamore Health Network All Products |
$812.92
|
| Rate for Payer: Signature Care EPO |
$873.99
|
| Rate for Payer: Signature Care PPO |
$926.64
|
| Rate for Payer: United Healthcare Commercial |
$829.76
|
|
|
HC CATH CPS AIM SL INN ACUTE 59CM
|
Facility
IP
|
$1,053.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$789.75 |
| Max. Negotiated Rate |
$979.29 |
| Rate for Payer: Aetna Commercial |
$909.79
|
| Rate for Payer: Cash Price |
$652.86
|
| Rate for Payer: Cigna All Commercial |
$908.74
|
| Rate for Payer: CORVEL All Commercial |
$979.29
|
| Rate for Payer: Coventry All Commercial |
$926.64
|
| Rate for Payer: Encore All Commercial |
$969.29
|
| Rate for Payer: Frontpath All Commercial |
$968.76
|
| Rate for Payer: Humana ChoiceCare |
$909.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$947.70
|
| Rate for Payer: PHCS All Commercial |
$789.75
|
| Rate for Payer: PHP All Commercial |
$798.60
|
| Rate for Payer: Sagamore Health Network All Products |
$812.92
|
| Rate for Payer: Signature Care EPO |
$873.99
|
| Rate for Payer: Signature Care PPO |
$926.64
|
| Rate for Payer: United Healthcare Commercial |
$829.76
|
|
|
HC CATH CPS AIM SL INN ACUTE 59CM
|
Facility
OP
|
$1,053.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$979.29 |
| Rate for Payer: Aetna Commercial |
$888.73
|
| Rate for Payer: Aetna Medicare |
$347.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$347.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$604.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$658.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$399.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$382.24
|
| Rate for Payer: Cash Price |
$652.86
|
| Rate for Payer: Cash Price |
$652.86
|
| Rate for Payer: Centivo All Commercial |
$537.03
|
| Rate for Payer: Cigna All Commercial |
$908.74
|
| Rate for Payer: CORVEL All Commercial |
$979.29
|
| Rate for Payer: Coventry All Commercial |
$926.64
|
| Rate for Payer: Encore All Commercial |
$969.29
|
| Rate for Payer: Frontpath All Commercial |
$968.76
|
| Rate for Payer: Humana ChoiceCare |
$909.48
|
| Rate for Payer: Humana Medicare |
$537.03
|
| Rate for Payer: Lucent All Commercial |
$537.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$947.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$789.75
|
| Rate for Payer: PHP All Commercial |
$798.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$410.67
|
| Rate for Payer: Sagamore Health Network All Products |
$812.92
|
| Rate for Payer: Signature Care EPO |
$873.99
|
| Rate for Payer: Signature Care PPO |
$926.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$895.05
|
| Rate for Payer: United Healthcare Commercial |
$829.76
|
| Rate for Payer: United Healthcare Medicare |
$347.49
|
|
|
HC CATH CPS AIM SL INN OBT 59CM
|
Facility
IP
|
$1,053.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$789.75 |
| Max. Negotiated Rate |
$979.29 |
| Rate for Payer: Aetna Commercial |
$909.79
|
| Rate for Payer: Cash Price |
$652.86
|
| Rate for Payer: Cigna All Commercial |
$908.74
|
| Rate for Payer: CORVEL All Commercial |
$979.29
|
| Rate for Payer: Coventry All Commercial |
$926.64
|
| Rate for Payer: Encore All Commercial |
$969.29
|
| Rate for Payer: Frontpath All Commercial |
$968.76
|
| Rate for Payer: Humana ChoiceCare |
$909.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$947.70
|
| Rate for Payer: PHCS All Commercial |
$789.75
|
| Rate for Payer: PHP All Commercial |
$798.60
|
| Rate for Payer: Sagamore Health Network All Products |
$812.92
|
| Rate for Payer: Signature Care EPO |
$873.99
|
| Rate for Payer: Signature Care PPO |
$926.64
|
| Rate for Payer: United Healthcare Commercial |
$829.76
|
|
|
HC CATH CPS AIM SL INN OBT 59CM
|
Facility
OP
|
$1,053.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$979.29 |
| Rate for Payer: Aetna Commercial |
$888.73
|
| Rate for Payer: Aetna Medicare |
$347.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$347.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$604.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$658.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$399.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$382.24
|
| Rate for Payer: Cash Price |
$652.86
|
| Rate for Payer: Cash Price |
$652.86
|
| Rate for Payer: Centivo All Commercial |
$537.03
|
| Rate for Payer: Cigna All Commercial |
$908.74
|
| Rate for Payer: CORVEL All Commercial |
$979.29
|
| Rate for Payer: Coventry All Commercial |
$926.64
|
| Rate for Payer: Encore All Commercial |
$969.29
|
| Rate for Payer: Frontpath All Commercial |
$968.76
|
| Rate for Payer: Humana ChoiceCare |
$909.48
|
| Rate for Payer: Humana Medicare |
$537.03
|
| Rate for Payer: Lucent All Commercial |
$537.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$947.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$789.75
|
| Rate for Payer: PHP All Commercial |
$798.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$410.67
|
| Rate for Payer: Sagamore Health Network All Products |
$812.92
|
| Rate for Payer: Signature Care EPO |
$873.99
|
| Rate for Payer: Signature Care PPO |
$926.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$895.05
|
| Rate for Payer: United Healthcare Commercial |
$829.76
|
| Rate for Payer: United Healthcare Medicare |
$347.49
|
|
|
HC CATH CURL 62 CM
|
Facility
OP
|
$982.17
|
|
| Hospital Charge Code |
41602492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$913.42 |
| Rate for Payer: Aetna Commercial |
$828.95
|
| Rate for Payer: Aetna Medicare |
$324.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$324.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$564.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$613.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$372.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$356.53
|
| Rate for Payer: Cash Price |
$608.95
|
| Rate for Payer: Cash Price |
$608.95
|
| Rate for Payer: Centivo All Commercial |
$500.91
|
| Rate for Payer: Cigna All Commercial |
$847.61
|
| Rate for Payer: CORVEL All Commercial |
$913.42
|
| Rate for Payer: Coventry All Commercial |
$864.31
|
| Rate for Payer: Encore All Commercial |
$904.09
|
| Rate for Payer: Frontpath All Commercial |
$903.60
|
| Rate for Payer: Humana ChoiceCare |
$848.30
|
| Rate for Payer: Humana Medicare |
$500.91
|
| Rate for Payer: Lucent All Commercial |
$500.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$883.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$736.63
|
| Rate for Payer: PHP All Commercial |
$744.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$383.05
|
| Rate for Payer: Sagamore Health Network All Products |
$758.24
|
| Rate for Payer: Signature Care EPO |
$815.20
|
| Rate for Payer: Signature Care PPO |
$864.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$834.84
|
| Rate for Payer: United Healthcare Commercial |
$773.95
|
| Rate for Payer: United Healthcare Medicare |
$324.12
|
|
|
HC CATH CURL 62 CM
|
Facility
IP
|
$982.17
|
|
| Hospital Charge Code |
41602492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$736.63 |
| Max. Negotiated Rate |
$913.42 |
| Rate for Payer: Aetna Commercial |
$848.59
|
| Rate for Payer: Cash Price |
$608.95
|
| Rate for Payer: Cigna All Commercial |
$847.61
|
| Rate for Payer: CORVEL All Commercial |
$913.42
|
| Rate for Payer: Coventry All Commercial |
$864.31
|
| Rate for Payer: Encore All Commercial |
$904.09
|
| Rate for Payer: Frontpath All Commercial |
$903.60
|
| Rate for Payer: Humana ChoiceCare |
$848.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$883.95
|
| Rate for Payer: PHCS All Commercial |
$736.63
|
| Rate for Payer: PHP All Commercial |
$744.88
|
| Rate for Payer: Sagamore Health Network All Products |
$758.24
|
| Rate for Payer: Signature Care EPO |
$815.20
|
| Rate for Payer: Signature Care PPO |
$864.31
|
| Rate for Payer: United Healthcare Commercial |
$773.95
|
|
|
HC CATH CVP MULTI LUMEN
|
Facility
IP
|
$54.22
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41602224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$50.42 |
| Rate for Payer: Aetna Commercial |
$46.85
|
| Rate for Payer: Cash Price |
$33.62
|
| Rate for Payer: Cigna All Commercial |
$46.79
|
| Rate for Payer: CORVEL All Commercial |
$50.42
|
| Rate for Payer: Coventry All Commercial |
$47.71
|
| Rate for Payer: Encore All Commercial |
$49.91
|
| Rate for Payer: Frontpath All Commercial |
$49.88
|
| Rate for Payer: Humana ChoiceCare |
$46.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.80
|
| Rate for Payer: PHCS All Commercial |
$40.66
|
| Rate for Payer: PHP All Commercial |
$41.12
|
| Rate for Payer: Sagamore Health Network All Products |
$41.86
|
| Rate for Payer: Signature Care EPO |
$45.00
|
| Rate for Payer: Signature Care PPO |
$47.71
|
| Rate for Payer: United Healthcare Commercial |
$42.73
|
|
|
HC CATH CVP MULTI LUMEN
|
Facility
OP
|
$54.22
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41602224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.76
|
| Rate for Payer: Aetna Medicare |
$17.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.68
|
| Rate for Payer: Cash Price |
$33.62
|
| Rate for Payer: Cash Price |
$33.62
|
| Rate for Payer: Centivo All Commercial |
$27.65
|
| Rate for Payer: Cigna All Commercial |
$46.79
|
| Rate for Payer: CORVEL All Commercial |
$50.42
|
| Rate for Payer: Coventry All Commercial |
$47.71
|
| Rate for Payer: Encore All Commercial |
$49.91
|
| Rate for Payer: Frontpath All Commercial |
$49.88
|
| Rate for Payer: Humana ChoiceCare |
$46.83
|
| Rate for Payer: Humana Medicare |
$27.65
|
| Rate for Payer: Lucent All Commercial |
$27.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.66
|
| Rate for Payer: PHP All Commercial |
$41.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.15
|
| Rate for Payer: Sagamore Health Network All Products |
$41.86
|
| Rate for Payer: Signature Care EPO |
$45.00
|
| Rate for Payer: Signature Care PPO |
$47.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.09
|
| Rate for Payer: United Healthcare Commercial |
$42.73
|
| Rate for Payer: United Healthcare Medicare |
$17.89
|
|
|
HC CATH DRAINAGE 10FR APDL FLEXIMA REG
|
Facility
OP
|
$532.00
|
|
| Hospital Charge Code |
41608326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$494.76 |
| Rate for Payer: Aetna Commercial |
$449.01
|
| Rate for Payer: Aetna Medicare |
$175.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$305.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$332.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.12
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Centivo All Commercial |
$271.32
|
| Rate for Payer: Cigna All Commercial |
$459.12
|
| Rate for Payer: CORVEL All Commercial |
$494.76
|
| Rate for Payer: Coventry All Commercial |
$468.16
|
| Rate for Payer: Encore All Commercial |
$489.71
|
| Rate for Payer: Frontpath All Commercial |
$489.44
|
| Rate for Payer: Humana ChoiceCare |
$459.49
|
| Rate for Payer: Humana Medicare |
$271.32
|
| Rate for Payer: Lucent All Commercial |
$271.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$399.00
|
| Rate for Payer: PHP All Commercial |
$403.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$207.48
|
| Rate for Payer: Sagamore Health Network All Products |
$410.70
|
| Rate for Payer: Signature Care EPO |
$441.56
|
| Rate for Payer: Signature Care PPO |
$468.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$452.20
|
| Rate for Payer: United Healthcare Commercial |
$419.22
|
| Rate for Payer: United Healthcare Medicare |
$175.56
|
|
|
HC CATH DRAINAGE 10FR APDL FLEXIMA REG
|
Facility
IP
|
$532.00
|
|
| Hospital Charge Code |
41608326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$494.76 |
| Rate for Payer: Aetna Commercial |
$459.65
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Cigna All Commercial |
$459.12
|
| Rate for Payer: CORVEL All Commercial |
$494.76
|
| Rate for Payer: Coventry All Commercial |
$468.16
|
| Rate for Payer: Encore All Commercial |
$489.71
|
| Rate for Payer: Frontpath All Commercial |
$489.44
|
| Rate for Payer: Humana ChoiceCare |
$459.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.80
|
| Rate for Payer: PHCS All Commercial |
$399.00
|
| Rate for Payer: PHP All Commercial |
$403.47
|
| Rate for Payer: Sagamore Health Network All Products |
$410.70
|
| Rate for Payer: Signature Care EPO |
$441.56
|
| Rate for Payer: Signature Care PPO |
$468.16
|
| Rate for Payer: United Healthcare Commercial |
$419.22
|
|
|
HC CATH DRAINAGE 12FR APDL FLEXIMA REG
|
Facility
IP
|
$532.00
|
|
| Hospital Charge Code |
41608327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$494.76 |
| Rate for Payer: Aetna Commercial |
$459.65
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Cigna All Commercial |
$459.12
|
| Rate for Payer: CORVEL All Commercial |
$494.76
|
| Rate for Payer: Coventry All Commercial |
$468.16
|
| Rate for Payer: Encore All Commercial |
$489.71
|
| Rate for Payer: Frontpath All Commercial |
$489.44
|
| Rate for Payer: Humana ChoiceCare |
$459.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.80
|
| Rate for Payer: PHCS All Commercial |
$399.00
|
| Rate for Payer: PHP All Commercial |
$403.47
|
| Rate for Payer: Sagamore Health Network All Products |
$410.70
|
| Rate for Payer: Signature Care EPO |
$441.56
|
| Rate for Payer: Signature Care PPO |
$468.16
|
| Rate for Payer: United Healthcare Commercial |
$419.22
|
|
|
HC CATH DRAINAGE 12FR APDL FLEXIMA REG
|
Facility
OP
|
$532.00
|
|
| Hospital Charge Code |
41608327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$494.76 |
| Rate for Payer: Aetna Commercial |
$449.01
|
| Rate for Payer: Aetna Medicare |
$175.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$305.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$332.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.12
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Centivo All Commercial |
$271.32
|
| Rate for Payer: Cigna All Commercial |
$459.12
|
| Rate for Payer: CORVEL All Commercial |
$494.76
|
| Rate for Payer: Coventry All Commercial |
$468.16
|
| Rate for Payer: Encore All Commercial |
$489.71
|
| Rate for Payer: Frontpath All Commercial |
$489.44
|
| Rate for Payer: Humana ChoiceCare |
$459.49
|
| Rate for Payer: Humana Medicare |
$271.32
|
| Rate for Payer: Lucent All Commercial |
$271.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$399.00
|
| Rate for Payer: PHP All Commercial |
$403.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$207.48
|
| Rate for Payer: Sagamore Health Network All Products |
$410.70
|
| Rate for Payer: Signature Care EPO |
$441.56
|
| Rate for Payer: Signature Care PPO |
$468.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$452.20
|
| Rate for Payer: United Healthcare Commercial |
$419.22
|
| Rate for Payer: United Healthcare Medicare |
$175.56
|
|
