|
HC CATH DRAINAGE 8FR APDL FLEXIMA REG
|
Facility
OP
|
$532.00
|
|
| Hospital Charge Code |
41608325
|
|
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 8FR APDL FLEXIMA REG
|
Facility
IP
|
$532.00
|
|
| Hospital Charge Code |
41608325
|
|
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 TWIST HUB 8FR
|
Facility
OP
|
$315.00
|
|
| Hospital Charge Code |
41607842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$265.86
|
| Rate for Payer: Aetna Medicare |
$103.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.34
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Centivo All Commercial |
$160.65
|
| Rate for Payer: Cigna All Commercial |
$271.84
|
| Rate for Payer: CORVEL All Commercial |
$292.95
|
| Rate for Payer: Coventry All Commercial |
$277.20
|
| Rate for Payer: Encore All Commercial |
$289.96
|
| Rate for Payer: Frontpath All Commercial |
$289.80
|
| Rate for Payer: Humana ChoiceCare |
$272.07
|
| Rate for Payer: Humana Medicare |
$160.65
|
| Rate for Payer: Lucent All Commercial |
$160.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$236.25
|
| Rate for Payer: PHP All Commercial |
$238.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.85
|
| Rate for Payer: Sagamore Health Network All Products |
$243.18
|
| Rate for Payer: Signature Care EPO |
$261.45
|
| Rate for Payer: Signature Care PPO |
$277.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$267.75
|
| Rate for Payer: United Healthcare Commercial |
$248.22
|
| Rate for Payer: United Healthcare Medicare |
$103.95
|
|
|
HC CATH DRAINAGE TWIST HUB 8FR
|
Facility
IP
|
$315.00
|
|
| Hospital Charge Code |
41607842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$272.16
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna All Commercial |
$271.84
|
| Rate for Payer: CORVEL All Commercial |
$292.95
|
| Rate for Payer: Coventry All Commercial |
$277.20
|
| Rate for Payer: Encore All Commercial |
$289.96
|
| Rate for Payer: Frontpath All Commercial |
$289.80
|
| Rate for Payer: Humana ChoiceCare |
$272.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.50
|
| Rate for Payer: PHCS All Commercial |
$236.25
|
| Rate for Payer: PHP All Commercial |
$238.90
|
| Rate for Payer: Sagamore Health Network All Products |
$243.18
|
| Rate for Payer: Signature Care EPO |
$261.45
|
| Rate for Payer: Signature Care PPO |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$248.22
|
|
|
HC CATH DRAIN EXPEL MULTI 12FR
|
Facility
IP
|
$672.00
|
|
| Hospital Charge Code |
41607841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$580.61
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Cigna All Commercial |
$579.94
|
| Rate for Payer: CORVEL All Commercial |
$624.96
|
| Rate for Payer: Coventry All Commercial |
$591.36
|
| Rate for Payer: Encore All Commercial |
$618.58
|
| Rate for Payer: Frontpath All Commercial |
$618.24
|
| Rate for Payer: Humana ChoiceCare |
$580.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$604.80
|
| Rate for Payer: PHCS All Commercial |
$504.00
|
| Rate for Payer: PHP All Commercial |
$509.64
|
| Rate for Payer: Sagamore Health Network All Products |
$518.78
|
| Rate for Payer: Signature Care EPO |
$557.76
|
| Rate for Payer: Signature Care PPO |
$591.36
|
| Rate for Payer: United Healthcare Commercial |
$529.54
|
|
|
HC CATH DRAIN EXPEL MULTI 12FR
|
Facility
OP
|
$672.00
|
|
| Hospital Charge Code |
41607841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$567.17
|
| Rate for Payer: Aetna Medicare |
$221.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$221.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$385.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$420.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$255.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$243.94
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Centivo All Commercial |
$342.72
|
| Rate for Payer: Cigna All Commercial |
$579.94
|
| Rate for Payer: CORVEL All Commercial |
$624.96
|
| Rate for Payer: Coventry All Commercial |
$591.36
|
| Rate for Payer: Encore All Commercial |
$618.58
|
| Rate for Payer: Frontpath All Commercial |
$618.24
|
| Rate for Payer: Humana ChoiceCare |
$580.41
|
| Rate for Payer: Humana Medicare |
$342.72
|
| Rate for Payer: Lucent All Commercial |
$342.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$604.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$504.00
|
| Rate for Payer: PHP All Commercial |
$509.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$262.08
|
| Rate for Payer: Sagamore Health Network All Products |
$518.78
|
| Rate for Payer: Signature Care EPO |
$557.76
|
| Rate for Payer: Signature Care PPO |
$591.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$571.20
|
| Rate for Payer: United Healthcare Commercial |
$529.54
|
| Rate for Payer: United Healthcare Medicare |
$221.76
|
|
|
HC CATH EPIDURAL
|
Facility
OP
|
$148.79
|
|
| Hospital Charge Code |
41602164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.10 |
| Max. Negotiated Rate |
$138.37 |
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Medicare |
$49.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.01
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Centivo All Commercial |
$75.88
|
| Rate for Payer: Cigna All Commercial |
$128.41
|
| Rate for Payer: CORVEL All Commercial |
$138.37
|
| Rate for Payer: Coventry All Commercial |
$130.94
|
| Rate for Payer: Encore All Commercial |
$136.96
|
| Rate for Payer: Frontpath All Commercial |
$136.89
|
| Rate for Payer: Humana ChoiceCare |
$128.51
|
| Rate for Payer: Humana Medicare |
$75.88
|
| Rate for Payer: Lucent All Commercial |
$75.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.91
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$111.59
|
| Rate for Payer: PHP All Commercial |
$112.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.03
|
| Rate for Payer: Sagamore Health Network All Products |
$114.87
|
| Rate for Payer: Signature Care EPO |
$123.50
|
| Rate for Payer: Signature Care PPO |
$130.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.47
|
| Rate for Payer: United Healthcare Commercial |
$117.25
|
| Rate for Payer: United Healthcare Medicare |
$49.10
|
|
|
HC CATH EPIDURAL
|
Facility
IP
|
$148.79
|
|
| Hospital Charge Code |
41602164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.59 |
| Max. Negotiated Rate |
$138.37 |
| Rate for Payer: Aetna Commercial |
$128.55
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cigna All Commercial |
$128.41
|
| Rate for Payer: CORVEL All Commercial |
$138.37
|
| Rate for Payer: Coventry All Commercial |
$130.94
|
| Rate for Payer: Encore All Commercial |
$136.96
|
| Rate for Payer: Frontpath All Commercial |
$136.89
|
| Rate for Payer: Humana ChoiceCare |
$128.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.91
|
| Rate for Payer: PHCS All Commercial |
$111.59
|
| Rate for Payer: PHP All Commercial |
$112.84
|
| Rate for Payer: Sagamore Health Network All Products |
$114.87
|
| Rate for Payer: Signature Care EPO |
$123.50
|
| Rate for Payer: Signature Care PPO |
$130.94
|
| Rate for Payer: United Healthcare Commercial |
$117.25
|
|
|
HC CATH EPIDURAL FLEX-TIP PLUS
|
Facility
OP
|
$92.40
|
|
| Hospital Charge Code |
41602311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$77.99
|
| Rate for Payer: Aetna Medicare |
$30.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.54
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Centivo All Commercial |
$47.12
|
| Rate for Payer: Cigna All Commercial |
$79.74
|
| Rate for Payer: CORVEL All Commercial |
$85.93
|
| Rate for Payer: Coventry All Commercial |
$81.31
|
| Rate for Payer: Encore All Commercial |
$85.05
|
| Rate for Payer: Frontpath All Commercial |
$85.01
|
| Rate for Payer: Humana ChoiceCare |
$79.81
|
| Rate for Payer: Humana Medicare |
$47.12
|
| Rate for Payer: Lucent All Commercial |
$47.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.16
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$69.30
|
| Rate for Payer: PHP All Commercial |
$70.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.04
|
| Rate for Payer: Sagamore Health Network All Products |
$71.33
|
| Rate for Payer: Signature Care EPO |
$76.69
|
| Rate for Payer: Signature Care PPO |
$81.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.54
|
| Rate for Payer: United Healthcare Commercial |
$72.81
|
| Rate for Payer: United Healthcare Medicare |
$30.49
|
|
|
HC CATH EPIDURAL FLEX-TIP PLUS
|
Facility
IP
|
$92.40
|
|
| Hospital Charge Code |
41602311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$85.93 |
| Rate for Payer: Aetna Commercial |
$79.83
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cigna All Commercial |
$79.74
|
| Rate for Payer: CORVEL All Commercial |
$85.93
|
| Rate for Payer: Coventry All Commercial |
$81.31
|
| Rate for Payer: Encore All Commercial |
$85.05
|
| Rate for Payer: Frontpath All Commercial |
$85.01
|
| Rate for Payer: Humana ChoiceCare |
$79.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.16
|
| Rate for Payer: PHCS All Commercial |
$69.30
|
| Rate for Payer: PHP All Commercial |
$70.08
|
| Rate for Payer: Sagamore Health Network All Products |
$71.33
|
| Rate for Payer: Signature Care EPO |
$76.69
|
| Rate for Payer: Signature Care PPO |
$81.31
|
| Rate for Payer: United Healthcare Commercial |
$72.81
|
|
|
HC CATHETER BALLOON 6FR 2-LUMEN
|
Facility
OP
|
$513.26
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$477.33 |
| Rate for Payer: Aetna Commercial |
$433.19
|
| Rate for Payer: Aetna Medicare |
$169.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$169.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$294.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.31
|
| Rate for Payer: Cash Price |
$318.22
|
| Rate for Payer: Cash Price |
$318.22
|
| Rate for Payer: Centivo All Commercial |
$261.76
|
| Rate for Payer: Cigna All Commercial |
$442.94
|
| Rate for Payer: CORVEL All Commercial |
$477.33
|
| Rate for Payer: Coventry All Commercial |
$451.67
|
| Rate for Payer: Encore All Commercial |
$472.46
|
| Rate for Payer: Frontpath All Commercial |
$472.20
|
| Rate for Payer: Humana ChoiceCare |
$443.30
|
| Rate for Payer: Humana Medicare |
$261.76
|
| Rate for Payer: Lucent All Commercial |
$261.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.93
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$384.94
|
| Rate for Payer: PHP All Commercial |
$389.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.17
|
| Rate for Payer: Sagamore Health Network All Products |
$396.24
|
| Rate for Payer: Signature Care EPO |
$426.01
|
| Rate for Payer: Signature Care PPO |
$451.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$436.27
|
| Rate for Payer: United Healthcare Commercial |
$404.45
|
| Rate for Payer: United Healthcare Medicare |
$169.38
|
|
|
HC CATHETER BALLOON 6FR 2-LUMEN
|
Facility
IP
|
$513.26
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.94 |
| Max. Negotiated Rate |
$477.33 |
| Rate for Payer: Aetna Commercial |
$443.46
|
| Rate for Payer: Cash Price |
$318.22
|
| Rate for Payer: Cigna All Commercial |
$442.94
|
| Rate for Payer: CORVEL All Commercial |
$477.33
|
| Rate for Payer: Coventry All Commercial |
$451.67
|
| Rate for Payer: Encore All Commercial |
$472.46
|
| Rate for Payer: Frontpath All Commercial |
$472.20
|
| Rate for Payer: Humana ChoiceCare |
$443.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.93
|
| Rate for Payer: PHCS All Commercial |
$384.94
|
| Rate for Payer: PHP All Commercial |
$389.26
|
| Rate for Payer: Sagamore Health Network All Products |
$396.24
|
| Rate for Payer: Signature Care EPO |
$426.01
|
| Rate for Payer: Signature Care PPO |
$451.67
|
| Rate for Payer: United Healthcare Commercial |
$404.45
|
|
|
HC CATHETER BALLOON ATTAIN 6215
|
Facility
OP
|
$421.88
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
41607369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna Commercial |
$356.07
|
| Rate for Payer: Aetna Medicare |
$139.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$242.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.14
|
| Rate for Payer: Cash Price |
$261.57
|
| Rate for Payer: Cash Price |
$261.57
|
| Rate for Payer: Centivo All Commercial |
$215.16
|
| Rate for Payer: Cigna All Commercial |
$364.08
|
| Rate for Payer: CORVEL All Commercial |
$392.35
|
| Rate for Payer: Coventry All Commercial |
$371.25
|
| Rate for Payer: Encore All Commercial |
$388.34
|
| Rate for Payer: Frontpath All Commercial |
$388.13
|
| Rate for Payer: Humana ChoiceCare |
$364.38
|
| Rate for Payer: Humana Medicare |
$215.16
|
| Rate for Payer: Lucent All Commercial |
$215.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.69
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$316.41
|
| Rate for Payer: PHP All Commercial |
$319.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.53
|
| Rate for Payer: Sagamore Health Network All Products |
$325.69
|
| Rate for Payer: Signature Care EPO |
$350.16
|
| Rate for Payer: Signature Care PPO |
$371.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$358.60
|
| Rate for Payer: United Healthcare Commercial |
$332.44
|
| Rate for Payer: United Healthcare Medicare |
$139.22
|
|
|
HC CATHETER BALLOON ATTAIN 6215
|
Facility
IP
|
$421.88
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
41607369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.41 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna Commercial |
$364.50
|
| Rate for Payer: Cash Price |
$261.57
|
| Rate for Payer: Cigna All Commercial |
$364.08
|
| Rate for Payer: CORVEL All Commercial |
$392.35
|
| Rate for Payer: Coventry All Commercial |
$371.25
|
| Rate for Payer: Encore All Commercial |
$388.34
|
| Rate for Payer: Frontpath All Commercial |
$388.13
|
| Rate for Payer: Humana ChoiceCare |
$364.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.69
|
| Rate for Payer: PHCS All Commercial |
$316.41
|
| Rate for Payer: PHP All Commercial |
$319.95
|
| Rate for Payer: Sagamore Health Network All Products |
$325.69
|
| Rate for Payer: Signature Care EPO |
$350.16
|
| Rate for Payer: Signature Care PPO |
$371.25
|
| Rate for Payer: United Healthcare Commercial |
$332.44
|
|
|
HC CATHETER BALLOON ATTAIN 6225
|
Facility
IP
|
$421.88
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
41607370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.41 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna Commercial |
$364.50
|
| Rate for Payer: Cash Price |
$261.57
|
| Rate for Payer: Cigna All Commercial |
$364.08
|
| Rate for Payer: CORVEL All Commercial |
$392.35
|
| Rate for Payer: Coventry All Commercial |
$371.25
|
| Rate for Payer: Encore All Commercial |
$388.34
|
| Rate for Payer: Frontpath All Commercial |
$388.13
|
| Rate for Payer: Humana ChoiceCare |
$364.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.69
|
| Rate for Payer: PHCS All Commercial |
$316.41
|
| Rate for Payer: PHP All Commercial |
$319.95
|
| Rate for Payer: Sagamore Health Network All Products |
$325.69
|
| Rate for Payer: Signature Care EPO |
$350.16
|
| Rate for Payer: Signature Care PPO |
$371.25
|
| Rate for Payer: United Healthcare Commercial |
$332.44
|
|
|
HC CATHETER BALLOON ATTAIN 6225
|
Facility
OP
|
$421.88
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
41607370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna Commercial |
$356.07
|
| Rate for Payer: Aetna Medicare |
$139.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$242.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.14
|
| Rate for Payer: Cash Price |
$261.57
|
| Rate for Payer: Cash Price |
$261.57
|
| Rate for Payer: Centivo All Commercial |
$215.16
|
| Rate for Payer: Cigna All Commercial |
$364.08
|
| Rate for Payer: CORVEL All Commercial |
$392.35
|
| Rate for Payer: Coventry All Commercial |
$371.25
|
| Rate for Payer: Encore All Commercial |
$388.34
|
| Rate for Payer: Frontpath All Commercial |
$388.13
|
| Rate for Payer: Humana ChoiceCare |
$364.38
|
| Rate for Payer: Humana Medicare |
$215.16
|
| Rate for Payer: Lucent All Commercial |
$215.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.69
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$316.41
|
| Rate for Payer: PHP All Commercial |
$319.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.53
|
| Rate for Payer: Sagamore Health Network All Products |
$325.69
|
| Rate for Payer: Signature Care EPO |
$350.16
|
| Rate for Payer: Signature Care PPO |
$371.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$358.60
|
| Rate for Payer: United Healthcare Commercial |
$332.44
|
| Rate for Payer: United Healthcare Medicare |
$139.22
|
|
|
HC CATHETER FOLEY 24FR 30CC 2 WAY
|
Facility
IP
|
$73.07
|
|
| Hospital Charge Code |
41601828
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$67.96 |
| Rate for Payer: Aetna Commercial |
$63.13
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna All Commercial |
$63.06
|
| Rate for Payer: CORVEL All Commercial |
$67.96
|
| Rate for Payer: Coventry All Commercial |
$64.30
|
| Rate for Payer: Encore All Commercial |
$67.26
|
| Rate for Payer: Frontpath All Commercial |
$67.22
|
| Rate for Payer: Humana ChoiceCare |
$63.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.76
|
| Rate for Payer: PHCS All Commercial |
$54.80
|
| Rate for Payer: PHP All Commercial |
$55.42
|
| Rate for Payer: Sagamore Health Network All Products |
$56.41
|
| Rate for Payer: Signature Care EPO |
$60.65
|
| Rate for Payer: Signature Care PPO |
$64.30
|
| Rate for Payer: United Healthcare Commercial |
$57.58
|
|
|
HC CATHETER FOLEY 24FR 30CC 2 WAY
|
Facility
OP
|
$73.07
|
|
| Hospital Charge Code |
41601828
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$61.67
|
| Rate for Payer: Aetna Medicare |
$24.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.52
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Centivo All Commercial |
$37.27
|
| Rate for Payer: Cigna All Commercial |
$63.06
|
| Rate for Payer: CORVEL All Commercial |
$67.96
|
| Rate for Payer: Coventry All Commercial |
$64.30
|
| Rate for Payer: Encore All Commercial |
$67.26
|
| Rate for Payer: Frontpath All Commercial |
$67.22
|
| Rate for Payer: Humana ChoiceCare |
$63.11
|
| Rate for Payer: Humana Medicare |
$37.27
|
| Rate for Payer: Lucent All Commercial |
$37.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.76
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$54.80
|
| Rate for Payer: PHP All Commercial |
$55.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.50
|
| Rate for Payer: Sagamore Health Network All Products |
$56.41
|
| Rate for Payer: Signature Care EPO |
$60.65
|
| Rate for Payer: Signature Care PPO |
$64.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.11
|
| Rate for Payer: United Healthcare Commercial |
$57.58
|
| Rate for Payer: United Healthcare Medicare |
$24.11
|
|
|
HC CATHETER FOLEY W/TEMP SENSOR
|
Facility
IP
|
$54.88
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
41606927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: Cash Price |
$34.03
|
| Rate for Payer: Cigna All Commercial |
$47.36
|
| Rate for Payer: CORVEL All Commercial |
$51.04
|
| Rate for Payer: Coventry All Commercial |
$48.29
|
| Rate for Payer: Encore All Commercial |
$50.52
|
| Rate for Payer: Frontpath All Commercial |
$50.49
|
| Rate for Payer: Humana ChoiceCare |
$47.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.39
|
| Rate for Payer: PHCS All Commercial |
$41.16
|
| Rate for Payer: PHP All Commercial |
$41.62
|
| Rate for Payer: Sagamore Health Network All Products |
$42.37
|
| Rate for Payer: Signature Care EPO |
$45.55
|
| Rate for Payer: Signature Care PPO |
$48.29
|
| Rate for Payer: United Healthcare Commercial |
$43.25
|
|
|
HC CATHETER FOLEY W/TEMP SENSOR
|
Facility
OP
|
$54.88
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
41606927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.92
|
| Rate for Payer: Cash Price |
$34.03
|
| Rate for Payer: Cash Price |
$34.03
|
| Rate for Payer: Centivo All Commercial |
$27.99
|
| Rate for Payer: Cigna All Commercial |
$47.36
|
| Rate for Payer: CORVEL All Commercial |
$51.04
|
| Rate for Payer: Coventry All Commercial |
$48.29
|
| Rate for Payer: Encore All Commercial |
$50.52
|
| Rate for Payer: Frontpath All Commercial |
$50.49
|
| Rate for Payer: Humana ChoiceCare |
$47.40
|
| Rate for Payer: Humana Medicare |
$27.99
|
| Rate for Payer: Lucent All Commercial |
$27.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.39
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$41.16
|
| Rate for Payer: PHP All Commercial |
$41.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.40
|
| Rate for Payer: Sagamore Health Network All Products |
$42.37
|
| Rate for Payer: Signature Care EPO |
$45.55
|
| Rate for Payer: Signature Care PPO |
$48.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.65
|
| Rate for Payer: United Healthcare Commercial |
$43.25
|
| Rate for Payer: United Healthcare Medicare |
$18.11
|
|
|
HC CATHETER IMPULSE 5FR 100CM
|
Facility
OP
|
$37.50
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
41607160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna Medicare |
$12.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.61
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Centivo All Commercial |
$19.12
|
| Rate for Payer: Cigna All Commercial |
$32.36
|
| Rate for Payer: CORVEL All Commercial |
$34.88
|
| Rate for Payer: Coventry All Commercial |
$33.00
|
| Rate for Payer: Encore All Commercial |
$34.52
|
| Rate for Payer: Frontpath All Commercial |
$34.50
|
| Rate for Payer: Humana ChoiceCare |
$32.39
|
| Rate for Payer: Humana Medicare |
$19.12
|
| Rate for Payer: Lucent All Commercial |
$19.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$28.12
|
| Rate for Payer: PHP All Commercial |
$28.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.62
|
| Rate for Payer: Sagamore Health Network All Products |
$28.95
|
| Rate for Payer: Signature Care EPO |
$31.12
|
| Rate for Payer: Signature Care PPO |
$33.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.88
|
| Rate for Payer: United Healthcare Commercial |
$29.55
|
| Rate for Payer: United Healthcare Medicare |
$12.38
|
|
|
HC CATHETER IMPULSE 5FR 100CM
|
Facility
IP
|
$37.50
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
41607160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cigna All Commercial |
$32.36
|
| Rate for Payer: CORVEL All Commercial |
$34.88
|
| Rate for Payer: Coventry All Commercial |
$33.00
|
| Rate for Payer: Encore All Commercial |
$34.52
|
| Rate for Payer: Frontpath All Commercial |
$34.50
|
| Rate for Payer: Humana ChoiceCare |
$32.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.75
|
| Rate for Payer: PHCS All Commercial |
$28.12
|
| Rate for Payer: PHP All Commercial |
$28.44
|
| Rate for Payer: Sagamore Health Network All Products |
$28.95
|
| Rate for Payer: Signature Care EPO |
$31.12
|
| Rate for Payer: Signature Care PPO |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$29.55
|
|
|
HC CATHETER LV INNER GUIDE 6248V
|
Facility
IP
|
$1,022.63
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$766.97 |
| Max. Negotiated Rate |
$951.05 |
| Rate for Payer: Aetna Commercial |
$883.55
|
| Rate for Payer: Cash Price |
$634.03
|
| Rate for Payer: Cigna All Commercial |
$882.53
|
| Rate for Payer: CORVEL All Commercial |
$951.05
|
| Rate for Payer: Coventry All Commercial |
$899.91
|
| Rate for Payer: Encore All Commercial |
$941.33
|
| Rate for Payer: Frontpath All Commercial |
$940.82
|
| Rate for Payer: Humana ChoiceCare |
$883.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$920.37
|
| Rate for Payer: PHCS All Commercial |
$766.97
|
| Rate for Payer: PHP All Commercial |
$775.56
|
| Rate for Payer: Sagamore Health Network All Products |
$789.47
|
| Rate for Payer: Signature Care EPO |
$848.78
|
| Rate for Payer: Signature Care PPO |
$899.91
|
| Rate for Payer: United Healthcare Commercial |
$805.83
|
|
|
HC CATHETER LV INNER GUIDE 6248V
|
Facility
OP
|
$1,022.63
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$951.05 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Medicare |
$337.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$337.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$587.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$639.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$388.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$371.21
|
| Rate for Payer: Cash Price |
$634.03
|
| Rate for Payer: Cash Price |
$634.03
|
| Rate for Payer: Centivo All Commercial |
$521.54
|
| Rate for Payer: Cigna All Commercial |
$882.53
|
| Rate for Payer: CORVEL All Commercial |
$951.05
|
| Rate for Payer: Coventry All Commercial |
$899.91
|
| Rate for Payer: Encore All Commercial |
$941.33
|
| Rate for Payer: Frontpath All Commercial |
$940.82
|
| Rate for Payer: Humana ChoiceCare |
$883.25
|
| Rate for Payer: Humana Medicare |
$521.54
|
| Rate for Payer: Lucent All Commercial |
$521.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$920.37
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$766.97
|
| Rate for Payer: PHP All Commercial |
$775.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$398.83
|
| Rate for Payer: Sagamore Health Network All Products |
$789.47
|
| Rate for Payer: Signature Care EPO |
$848.78
|
| Rate for Payer: Signature Care PPO |
$899.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$869.24
|
| Rate for Payer: United Healthcare Commercial |
$805.83
|
| Rate for Payer: United Healthcare Medicare |
$337.47
|
|
|
HC CATHETER PACING BIPOL 5FR CV
|
Facility
OP
|
$461.25
|
|
|
Service Code
|
CPT C1779
|
| Hospital Charge Code |
41607161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$428.96 |
| Rate for Payer: Aetna Commercial |
$389.30
|
| Rate for Payer: Aetna Medicare |
$152.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$264.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$288.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.43
|
| Rate for Payer: Cash Price |
$285.98
|
| Rate for Payer: Cash Price |
$285.98
|
| Rate for Payer: Centivo All Commercial |
$235.24
|
| Rate for Payer: Cigna All Commercial |
$398.06
|
| Rate for Payer: CORVEL All Commercial |
$428.96
|
| Rate for Payer: Coventry All Commercial |
$405.90
|
| Rate for Payer: Encore All Commercial |
$424.58
|
| Rate for Payer: Frontpath All Commercial |
$424.35
|
| Rate for Payer: Humana ChoiceCare |
$398.38
|
| Rate for Payer: Humana Medicare |
$235.24
|
| Rate for Payer: Lucent All Commercial |
$235.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$345.94
|
| Rate for Payer: PHP All Commercial |
$349.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$179.89
|
| Rate for Payer: Sagamore Health Network All Products |
$356.08
|
| Rate for Payer: Signature Care EPO |
$382.84
|
| Rate for Payer: Signature Care PPO |
$405.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$392.06
|
| Rate for Payer: United Healthcare Commercial |
$363.46
|
| Rate for Payer: United Healthcare Medicare |
$152.21
|
|
