|
HC CATHETER PACING BIPOL 5FR CV
|
Facility
IP
|
$461.25
|
|
|
Service Code
|
CPT C1779
|
| Hospital Charge Code |
41607161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.94 |
| Max. Negotiated Rate |
$428.96 |
| Rate for Payer: Aetna Commercial |
$398.52
|
| Rate for Payer: Cash Price |
$285.98
|
| 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: Lutheran Preferred All Commercial |
$415.12
|
| Rate for Payer: PHCS All Commercial |
$345.94
|
| Rate for Payer: PHP All Commercial |
$349.81
|
| 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: United Healthcare Commercial |
$363.46
|
|
|
HC CATHETER PACING BIPOL 6FR RV
|
Facility
IP
|
$431.25
|
|
|
Service Code
|
CPT C1779
|
| Hospital Charge Code |
41607162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$323.44 |
| Max. Negotiated Rate |
$401.06 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Cash Price |
$267.38
|
| Rate for Payer: Cigna All Commercial |
$372.17
|
| Rate for Payer: CORVEL All Commercial |
$401.06
|
| Rate for Payer: Coventry All Commercial |
$379.50
|
| Rate for Payer: Encore All Commercial |
$396.97
|
| Rate for Payer: Frontpath All Commercial |
$396.75
|
| Rate for Payer: Humana ChoiceCare |
$372.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$388.12
|
| Rate for Payer: PHCS All Commercial |
$323.44
|
| Rate for Payer: PHP All Commercial |
$327.06
|
| Rate for Payer: Sagamore Health Network All Products |
$332.92
|
| Rate for Payer: Signature Care EPO |
$357.94
|
| Rate for Payer: Signature Care PPO |
$379.50
|
| Rate for Payer: United Healthcare Commercial |
$339.82
|
|
|
HC CATHETER PACING BIPOL 6FR RV
|
Facility
OP
|
$431.25
|
|
|
Service Code
|
CPT C1779
|
| Hospital Charge Code |
41607162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$401.06 |
| Rate for Payer: Aetna Commercial |
$363.98
|
| Rate for Payer: Aetna Medicare |
$142.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$247.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$269.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.54
|
| Rate for Payer: Cash Price |
$267.38
|
| Rate for Payer: Cash Price |
$267.38
|
| Rate for Payer: Centivo All Commercial |
$219.94
|
| Rate for Payer: Cigna All Commercial |
$372.17
|
| Rate for Payer: CORVEL All Commercial |
$401.06
|
| Rate for Payer: Coventry All Commercial |
$379.50
|
| Rate for Payer: Encore All Commercial |
$396.97
|
| Rate for Payer: Frontpath All Commercial |
$396.75
|
| Rate for Payer: Humana ChoiceCare |
$372.47
|
| Rate for Payer: Humana Medicare |
$219.94
|
| Rate for Payer: Lucent All Commercial |
$219.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$388.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$323.44
|
| Rate for Payer: PHP All Commercial |
$327.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$168.19
|
| Rate for Payer: Sagamore Health Network All Products |
$332.92
|
| Rate for Payer: Signature Care EPO |
$357.94
|
| Rate for Payer: Signature Care PPO |
$379.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$366.56
|
| Rate for Payer: United Healthcare Commercial |
$339.82
|
| Rate for Payer: United Healthcare Medicare |
$142.31
|
|
|
HC CATHETER RESPONSE 7FR CSL
|
Facility
IP
|
$1,845.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
41607163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,383.75 |
| Max. Negotiated Rate |
$1,715.85 |
| Rate for Payer: Aetna Commercial |
$1,594.08
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cigna All Commercial |
$1,592.24
|
| Rate for Payer: CORVEL All Commercial |
$1,715.85
|
| Rate for Payer: Coventry All Commercial |
$1,623.60
|
| Rate for Payer: Encore All Commercial |
$1,698.32
|
| Rate for Payer: Frontpath All Commercial |
$1,697.40
|
| Rate for Payer: Humana ChoiceCare |
$1,593.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,660.50
|
| Rate for Payer: PHCS All Commercial |
$1,383.75
|
| Rate for Payer: PHP All Commercial |
$1,399.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,424.34
|
| Rate for Payer: Signature Care EPO |
$1,531.35
|
| Rate for Payer: Signature Care PPO |
$1,623.60
|
| Rate for Payer: United Healthcare Commercial |
$1,453.86
|
|
|
HC CATHETER RESPONSE 7FR CSL
|
Facility
OP
|
$1,845.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
41607163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,715.85 |
| Rate for Payer: Aetna Commercial |
$1,557.18
|
| Rate for Payer: Aetna Medicare |
$608.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$608.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,059.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,153.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$700.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$669.74
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Centivo All Commercial |
$940.95
|
| Rate for Payer: Cigna All Commercial |
$1,592.24
|
| Rate for Payer: CORVEL All Commercial |
$1,715.85
|
| Rate for Payer: Coventry All Commercial |
$1,623.60
|
| Rate for Payer: Encore All Commercial |
$1,698.32
|
| Rate for Payer: Frontpath All Commercial |
$1,697.40
|
| Rate for Payer: Humana ChoiceCare |
$1,593.53
|
| Rate for Payer: Humana Medicare |
$940.95
|
| Rate for Payer: Lucent All Commercial |
$940.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,660.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,383.75
|
| Rate for Payer: PHP All Commercial |
$1,399.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$719.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,424.34
|
| Rate for Payer: Signature Care EPO |
$1,531.35
|
| Rate for Payer: Signature Care PPO |
$1,623.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,568.25
|
| Rate for Payer: United Healthcare Commercial |
$1,453.86
|
| Rate for Payer: United Healthcare Medicare |
$608.85
|
|
|
HC CATH EXTERNAL MALE LG
|
Facility
IP
|
$10.64
|
|
| Hospital Charge Code |
41601793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$9.19
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna All Commercial |
$9.18
|
| Rate for Payer: CORVEL All Commercial |
$9.90
|
| Rate for Payer: Coventry All Commercial |
$9.36
|
| Rate for Payer: Encore All Commercial |
$9.79
|
| Rate for Payer: Frontpath All Commercial |
$9.79
|
| Rate for Payer: Humana ChoiceCare |
$9.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.58
|
| Rate for Payer: PHCS All Commercial |
$7.98
|
| Rate for Payer: PHP All Commercial |
$8.07
|
| Rate for Payer: Sagamore Health Network All Products |
$8.21
|
| Rate for Payer: Signature Care EPO |
$8.83
|
| Rate for Payer: Signature Care PPO |
$9.36
|
| Rate for Payer: United Healthcare Commercial |
$8.38
|
|
|
HC CATH EXTERNAL MALE LG
|
Facility
OP
|
$10.64
|
|
| Hospital Charge Code |
41601793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.98
|
| Rate for Payer: Aetna Medicare |
$3.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.86
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Centivo All Commercial |
$5.43
|
| Rate for Payer: Cigna All Commercial |
$9.18
|
| Rate for Payer: CORVEL All Commercial |
$9.90
|
| Rate for Payer: Coventry All Commercial |
$9.36
|
| Rate for Payer: Encore All Commercial |
$9.79
|
| Rate for Payer: Frontpath All Commercial |
$9.79
|
| Rate for Payer: Humana ChoiceCare |
$9.19
|
| Rate for Payer: Humana Medicare |
$5.43
|
| Rate for Payer: Lucent All Commercial |
$5.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.98
|
| Rate for Payer: PHP All Commercial |
$8.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.15
|
| Rate for Payer: Sagamore Health Network All Products |
$8.21
|
| Rate for Payer: Signature Care EPO |
$8.83
|
| Rate for Payer: Signature Care PPO |
$9.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.04
|
| Rate for Payer: United Healthcare Commercial |
$8.38
|
| Rate for Payer: United Healthcare Medicare |
$3.51
|
|
|
HC CATH FIXATION DEVICE 5-14F
|
Facility
OP
|
$79.87
|
|
|
Service Code
|
CPT A5200
|
| Hospital Charge Code |
41607843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.36 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$67.41
|
| Rate for Payer: Aetna Medicare |
$26.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.99
|
| Rate for Payer: Cash Price |
$49.52
|
| Rate for Payer: Cash Price |
$49.52
|
| Rate for Payer: Centivo All Commercial |
$40.73
|
| Rate for Payer: Cigna All Commercial |
$68.93
|
| Rate for Payer: CORVEL All Commercial |
$74.28
|
| Rate for Payer: Coventry All Commercial |
$70.29
|
| Rate for Payer: Encore All Commercial |
$73.52
|
| Rate for Payer: Frontpath All Commercial |
$73.48
|
| Rate for Payer: Humana ChoiceCare |
$68.98
|
| Rate for Payer: Humana Medicare |
$40.73
|
| Rate for Payer: Lucent All Commercial |
$40.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$59.90
|
| Rate for Payer: PHP All Commercial |
$60.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.15
|
| Rate for Payer: Sagamore Health Network All Products |
$61.66
|
| Rate for Payer: Signature Care EPO |
$66.29
|
| Rate for Payer: Signature Care PPO |
$70.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.89
|
| Rate for Payer: United Healthcare Commercial |
$62.94
|
| Rate for Payer: United Healthcare Medicare |
$26.36
|
|
|
HC CATH FIXATION DEVICE 5-14F
|
Facility
IP
|
$79.87
|
|
|
Service Code
|
CPT A5200
|
| Hospital Charge Code |
41607843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$74.28 |
| Rate for Payer: Aetna Commercial |
$69.01
|
| Rate for Payer: Cash Price |
$49.52
|
| Rate for Payer: Cigna All Commercial |
$68.93
|
| Rate for Payer: CORVEL All Commercial |
$74.28
|
| Rate for Payer: Coventry All Commercial |
$70.29
|
| Rate for Payer: Encore All Commercial |
$73.52
|
| Rate for Payer: Frontpath All Commercial |
$73.48
|
| Rate for Payer: Humana ChoiceCare |
$68.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.88
|
| Rate for Payer: PHCS All Commercial |
$59.90
|
| Rate for Payer: PHP All Commercial |
$60.57
|
| Rate for Payer: Sagamore Health Network All Products |
$61.66
|
| Rate for Payer: Signature Care EPO |
$66.29
|
| Rate for Payer: Signature Care PPO |
$70.29
|
| Rate for Payer: United Healthcare Commercial |
$62.94
|
|
|
HC CATH FOGARTY 4F
|
Facility
OP
|
$710.50
|
|
| Hospital Charge Code |
41602322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$660.76 |
| Rate for Payer: Aetna Commercial |
$599.66
|
| Rate for Payer: Aetna Medicare |
$234.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$234.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$408.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$444.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$269.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$257.91
|
| Rate for Payer: Cash Price |
$440.51
|
| Rate for Payer: Cash Price |
$440.51
|
| Rate for Payer: Centivo All Commercial |
$362.36
|
| Rate for Payer: Cigna All Commercial |
$613.16
|
| Rate for Payer: CORVEL All Commercial |
$660.76
|
| Rate for Payer: Coventry All Commercial |
$625.24
|
| Rate for Payer: Encore All Commercial |
$654.02
|
| Rate for Payer: Frontpath All Commercial |
$653.66
|
| Rate for Payer: Humana ChoiceCare |
$613.66
|
| Rate for Payer: Humana Medicare |
$362.36
|
| Rate for Payer: Lucent All Commercial |
$362.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$639.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$532.88
|
| Rate for Payer: PHP All Commercial |
$538.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$277.10
|
| Rate for Payer: Sagamore Health Network All Products |
$548.51
|
| Rate for Payer: Signature Care EPO |
$589.72
|
| Rate for Payer: Signature Care PPO |
$625.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$603.92
|
| Rate for Payer: United Healthcare Commercial |
$559.87
|
| Rate for Payer: United Healthcare Medicare |
$234.46
|
|
|
HC CATH FOGARTY 4F
|
Facility
IP
|
$710.50
|
|
| Hospital Charge Code |
41602322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.88 |
| Max. Negotiated Rate |
$660.76 |
| Rate for Payer: Aetna Commercial |
$613.87
|
| Rate for Payer: Cash Price |
$440.51
|
| Rate for Payer: Cigna All Commercial |
$613.16
|
| Rate for Payer: CORVEL All Commercial |
$660.76
|
| Rate for Payer: Coventry All Commercial |
$625.24
|
| Rate for Payer: Encore All Commercial |
$654.02
|
| Rate for Payer: Frontpath All Commercial |
$653.66
|
| Rate for Payer: Humana ChoiceCare |
$613.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$639.45
|
| Rate for Payer: PHCS All Commercial |
$532.88
|
| Rate for Payer: PHP All Commercial |
$538.84
|
| Rate for Payer: Sagamore Health Network All Products |
$548.51
|
| Rate for Payer: Signature Care EPO |
$589.72
|
| Rate for Payer: Signature Care PPO |
$625.24
|
| Rate for Payer: United Healthcare Commercial |
$559.87
|
|
|
HC CATH FOGARTY 5F
|
Facility
OP
|
$710.50
|
|
| Hospital Charge Code |
41602103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$660.76 |
| Rate for Payer: Aetna Commercial |
$599.66
|
| Rate for Payer: Aetna Medicare |
$234.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$234.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$408.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$444.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$269.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$257.91
|
| Rate for Payer: Cash Price |
$440.51
|
| Rate for Payer: Cash Price |
$440.51
|
| Rate for Payer: Centivo All Commercial |
$362.36
|
| Rate for Payer: Cigna All Commercial |
$613.16
|
| Rate for Payer: CORVEL All Commercial |
$660.76
|
| Rate for Payer: Coventry All Commercial |
$625.24
|
| Rate for Payer: Encore All Commercial |
$654.02
|
| Rate for Payer: Frontpath All Commercial |
$653.66
|
| Rate for Payer: Humana ChoiceCare |
$613.66
|
| Rate for Payer: Humana Medicare |
$362.36
|
| Rate for Payer: Lucent All Commercial |
$362.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$639.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$532.88
|
| Rate for Payer: PHP All Commercial |
$538.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$277.10
|
| Rate for Payer: Sagamore Health Network All Products |
$548.51
|
| Rate for Payer: Signature Care EPO |
$589.72
|
| Rate for Payer: Signature Care PPO |
$625.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$603.92
|
| Rate for Payer: United Healthcare Commercial |
$559.87
|
| Rate for Payer: United Healthcare Medicare |
$234.46
|
|
|
HC CATH FOGARTY 5F
|
Facility
IP
|
$710.50
|
|
| Hospital Charge Code |
41602103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.88 |
| Max. Negotiated Rate |
$660.76 |
| Rate for Payer: Aetna Commercial |
$613.87
|
| Rate for Payer: Cash Price |
$440.51
|
| Rate for Payer: Cigna All Commercial |
$613.16
|
| Rate for Payer: CORVEL All Commercial |
$660.76
|
| Rate for Payer: Coventry All Commercial |
$625.24
|
| Rate for Payer: Encore All Commercial |
$654.02
|
| Rate for Payer: Frontpath All Commercial |
$653.66
|
| Rate for Payer: Humana ChoiceCare |
$613.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$639.45
|
| Rate for Payer: PHCS All Commercial |
$532.88
|
| Rate for Payer: PHP All Commercial |
$538.84
|
| Rate for Payer: Sagamore Health Network All Products |
$548.51
|
| Rate for Payer: Signature Care EPO |
$589.72
|
| Rate for Payer: Signature Care PPO |
$625.24
|
| Rate for Payer: United Healthcare Commercial |
$559.87
|
|
|
HC CATH FOGERTY 5FR BALLOON
|
Facility
OP
|
$1,033.60
|
|
| Hospital Charge Code |
41601860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$961.25 |
| Rate for Payer: Aetna Commercial |
$872.36
|
| Rate for Payer: Aetna Medicare |
$341.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$341.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$593.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$646.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$392.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$375.20
|
| Rate for Payer: Cash Price |
$640.83
|
| Rate for Payer: Cash Price |
$640.83
|
| Rate for Payer: Centivo All Commercial |
$527.14
|
| Rate for Payer: Cigna All Commercial |
$892.00
|
| Rate for Payer: CORVEL All Commercial |
$961.25
|
| Rate for Payer: Coventry All Commercial |
$909.57
|
| Rate for Payer: Encore All Commercial |
$951.43
|
| Rate for Payer: Frontpath All Commercial |
$950.91
|
| Rate for Payer: Humana ChoiceCare |
$892.72
|
| Rate for Payer: Humana Medicare |
$527.14
|
| Rate for Payer: Lucent All Commercial |
$527.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$930.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$775.20
|
| Rate for Payer: PHP All Commercial |
$783.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$403.10
|
| Rate for Payer: Sagamore Health Network All Products |
$797.94
|
| Rate for Payer: Signature Care EPO |
$857.89
|
| Rate for Payer: Signature Care PPO |
$909.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$878.56
|
| Rate for Payer: United Healthcare Commercial |
$814.48
|
| Rate for Payer: United Healthcare Medicare |
$341.09
|
|
|
HC CATH FOGERTY 5FR BALLOON
|
Facility
IP
|
$1,033.60
|
|
| Hospital Charge Code |
41601860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$961.25 |
| Rate for Payer: Aetna Commercial |
$893.03
|
| Rate for Payer: Cash Price |
$640.83
|
| Rate for Payer: Cigna All Commercial |
$892.00
|
| Rate for Payer: CORVEL All Commercial |
$961.25
|
| Rate for Payer: Coventry All Commercial |
$909.57
|
| Rate for Payer: Encore All Commercial |
$951.43
|
| Rate for Payer: Frontpath All Commercial |
$950.91
|
| Rate for Payer: Humana ChoiceCare |
$892.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$930.24
|
| Rate for Payer: PHCS All Commercial |
$775.20
|
| Rate for Payer: PHP All Commercial |
$783.88
|
| Rate for Payer: Sagamore Health Network All Products |
$797.94
|
| Rate for Payer: Signature Care EPO |
$857.89
|
| Rate for Payer: Signature Care PPO |
$909.57
|
| Rate for Payer: United Healthcare Commercial |
$814.48
|
|
|
HC CATH FOLEY 10FR 3CC
|
Facility
OP
|
$24.07
|
|
| Hospital Charge Code |
41601420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$7.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.74
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Centivo All Commercial |
$12.28
|
| Rate for Payer: Cigna All Commercial |
$20.77
|
| Rate for Payer: CORVEL All Commercial |
$22.39
|
| Rate for Payer: Coventry All Commercial |
$21.18
|
| Rate for Payer: Encore All Commercial |
$22.16
|
| Rate for Payer: Frontpath All Commercial |
$22.14
|
| Rate for Payer: Humana ChoiceCare |
$20.79
|
| Rate for Payer: Humana Medicare |
$12.28
|
| Rate for Payer: Lucent All Commercial |
$12.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.66
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$18.05
|
| Rate for Payer: PHP All Commercial |
$18.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.39
|
| Rate for Payer: Sagamore Health Network All Products |
$18.58
|
| Rate for Payer: Signature Care EPO |
$19.98
|
| Rate for Payer: Signature Care PPO |
$21.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.46
|
| Rate for Payer: United Healthcare Commercial |
$18.97
|
| Rate for Payer: United Healthcare Medicare |
$7.94
|
|
|
HC CATH FOLEY 10FR 3CC
|
Facility
IP
|
$24.07
|
|
| Hospital Charge Code |
41601420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$22.39 |
| Rate for Payer: Aetna Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cigna All Commercial |
$20.77
|
| Rate for Payer: CORVEL All Commercial |
$22.39
|
| Rate for Payer: Coventry All Commercial |
$21.18
|
| Rate for Payer: Encore All Commercial |
$22.16
|
| Rate for Payer: Frontpath All Commercial |
$22.14
|
| Rate for Payer: Humana ChoiceCare |
$20.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.66
|
| Rate for Payer: PHCS All Commercial |
$18.05
|
| Rate for Payer: PHP All Commercial |
$18.25
|
| Rate for Payer: Sagamore Health Network All Products |
$18.58
|
| Rate for Payer: Signature Care EPO |
$19.98
|
| Rate for Payer: Signature Care PPO |
$21.18
|
| Rate for Payer: United Healthcare Commercial |
$18.97
|
|
|
HC CATH FOLEY 12FR 5CC
|
Facility
OP
|
$23.20
|
|
| Hospital Charge Code |
41601012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.42
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Centivo All Commercial |
$11.83
|
| Rate for Payer: Cigna All Commercial |
$20.02
|
| Rate for Payer: CORVEL All Commercial |
$21.58
|
| Rate for Payer: Coventry All Commercial |
$20.42
|
| Rate for Payer: Encore All Commercial |
$21.36
|
| Rate for Payer: Frontpath All Commercial |
$21.34
|
| Rate for Payer: Humana ChoiceCare |
$20.04
|
| Rate for Payer: Humana Medicare |
$11.83
|
| Rate for Payer: Lucent All Commercial |
$11.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.40
|
| Rate for Payer: PHP All Commercial |
$17.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.05
|
| Rate for Payer: Sagamore Health Network All Products |
$17.91
|
| Rate for Payer: Signature Care EPO |
$19.26
|
| Rate for Payer: Signature Care PPO |
$20.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.72
|
| Rate for Payer: United Healthcare Commercial |
$18.28
|
| Rate for Payer: United Healthcare Medicare |
$7.66
|
|
|
HC CATH FOLEY 12FR 5CC
|
Facility
IP
|
$23.20
|
|
| Hospital Charge Code |
41601012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$21.58 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cigna All Commercial |
$20.02
|
| Rate for Payer: CORVEL All Commercial |
$21.58
|
| Rate for Payer: Coventry All Commercial |
$20.42
|
| Rate for Payer: Encore All Commercial |
$21.36
|
| Rate for Payer: Frontpath All Commercial |
$21.34
|
| Rate for Payer: Humana ChoiceCare |
$20.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.88
|
| Rate for Payer: PHCS All Commercial |
$17.40
|
| Rate for Payer: PHP All Commercial |
$17.59
|
| Rate for Payer: Sagamore Health Network All Products |
$17.91
|
| Rate for Payer: Signature Care EPO |
$19.26
|
| Rate for Payer: Signature Care PPO |
$20.42
|
| Rate for Payer: United Healthcare Commercial |
$18.28
|
|
|
HC CATH FOLEY 14FR 5CC
|
Facility
IP
|
$23.99
|
|
| Hospital Charge Code |
41601013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Aetna Commercial |
$20.73
|
| Rate for Payer: Cash Price |
$14.87
|
| Rate for Payer: Cigna All Commercial |
$20.70
|
| Rate for Payer: CORVEL All Commercial |
$22.31
|
| Rate for Payer: Coventry All Commercial |
$21.11
|
| Rate for Payer: Encore All Commercial |
$22.08
|
| Rate for Payer: Frontpath All Commercial |
$22.07
|
| Rate for Payer: Humana ChoiceCare |
$20.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.59
|
| Rate for Payer: PHCS All Commercial |
$17.99
|
| Rate for Payer: PHP All Commercial |
$18.19
|
| Rate for Payer: Sagamore Health Network All Products |
$18.52
|
| Rate for Payer: Signature Care EPO |
$19.91
|
| Rate for Payer: Signature Care PPO |
$21.11
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
|
|
HC CATH FOLEY 14FR 5CC
|
Facility
OP
|
$23.99
|
|
| Hospital Charge Code |
41601013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$20.25
|
| Rate for Payer: Aetna Medicare |
$7.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.71
|
| Rate for Payer: Cash Price |
$14.87
|
| Rate for Payer: Cash Price |
$14.87
|
| Rate for Payer: Centivo All Commercial |
$12.23
|
| Rate for Payer: Cigna All Commercial |
$20.70
|
| Rate for Payer: CORVEL All Commercial |
$22.31
|
| Rate for Payer: Coventry All Commercial |
$21.11
|
| Rate for Payer: Encore All Commercial |
$22.08
|
| Rate for Payer: Frontpath All Commercial |
$22.07
|
| Rate for Payer: Humana ChoiceCare |
$20.72
|
| Rate for Payer: Humana Medicare |
$12.23
|
| Rate for Payer: Lucent All Commercial |
$12.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.99
|
| Rate for Payer: PHP All Commercial |
$18.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.36
|
| Rate for Payer: Sagamore Health Network All Products |
$18.52
|
| Rate for Payer: Signature Care EPO |
$19.91
|
| Rate for Payer: Signature Care PPO |
$21.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
| Rate for Payer: United Healthcare Medicare |
$7.92
|
|
|
HC CATH FOLEY 16FR 5CC
|
Facility
OP
|
$23.99
|
|
| Hospital Charge Code |
41601014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$20.25
|
| Rate for Payer: Aetna Medicare |
$7.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.71
|
| Rate for Payer: Cash Price |
$14.87
|
| Rate for Payer: Cash Price |
$14.87
|
| Rate for Payer: Centivo All Commercial |
$12.23
|
| Rate for Payer: Cigna All Commercial |
$20.70
|
| Rate for Payer: CORVEL All Commercial |
$22.31
|
| Rate for Payer: Coventry All Commercial |
$21.11
|
| Rate for Payer: Encore All Commercial |
$22.08
|
| Rate for Payer: Frontpath All Commercial |
$22.07
|
| Rate for Payer: Humana ChoiceCare |
$20.72
|
| Rate for Payer: Humana Medicare |
$12.23
|
| Rate for Payer: Lucent All Commercial |
$12.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.99
|
| Rate for Payer: PHP All Commercial |
$18.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.36
|
| Rate for Payer: Sagamore Health Network All Products |
$18.52
|
| Rate for Payer: Signature Care EPO |
$19.91
|
| Rate for Payer: Signature Care PPO |
$21.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
| Rate for Payer: United Healthcare Medicare |
$7.92
|
|
|
HC CATH FOLEY 16FR 5CC
|
Facility
IP
|
$23.99
|
|
| Hospital Charge Code |
41601014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Aetna Commercial |
$20.73
|
| Rate for Payer: Cash Price |
$14.87
|
| Rate for Payer: Cigna All Commercial |
$20.70
|
| Rate for Payer: CORVEL All Commercial |
$22.31
|
| Rate for Payer: Coventry All Commercial |
$21.11
|
| Rate for Payer: Encore All Commercial |
$22.08
|
| Rate for Payer: Frontpath All Commercial |
$22.07
|
| Rate for Payer: Humana ChoiceCare |
$20.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.59
|
| Rate for Payer: PHCS All Commercial |
$17.99
|
| Rate for Payer: PHP All Commercial |
$18.19
|
| Rate for Payer: Sagamore Health Network All Products |
$18.52
|
| Rate for Payer: Signature Care EPO |
$19.91
|
| Rate for Payer: Signature Care PPO |
$21.11
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
|
|
HC CATH FOLEY 18FR 30CC
|
Facility
IP
|
$51.25
|
|
| Hospital Charge Code |
41601015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$47.66 |
| Rate for Payer: Aetna Commercial |
$44.28
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cigna All Commercial |
$44.23
|
| Rate for Payer: CORVEL All Commercial |
$47.66
|
| Rate for Payer: Coventry All Commercial |
$45.10
|
| Rate for Payer: Encore All Commercial |
$47.18
|
| Rate for Payer: Frontpath All Commercial |
$47.15
|
| Rate for Payer: Humana ChoiceCare |
$44.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.12
|
| Rate for Payer: PHCS All Commercial |
$38.44
|
| Rate for Payer: PHP All Commercial |
$38.87
|
| Rate for Payer: Sagamore Health Network All Products |
$39.56
|
| Rate for Payer: Signature Care EPO |
$42.54
|
| Rate for Payer: Signature Care PPO |
$45.10
|
| Rate for Payer: United Healthcare Commercial |
$40.38
|
|
|
HC CATH FOLEY 18FR 30CC
|
Facility
OP
|
$51.25
|
|
| Hospital Charge Code |
41601015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$43.26
|
| Rate for Payer: Aetna Medicare |
$16.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.60
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Centivo All Commercial |
$26.14
|
| Rate for Payer: Cigna All Commercial |
$44.23
|
| Rate for Payer: CORVEL All Commercial |
$47.66
|
| Rate for Payer: Coventry All Commercial |
$45.10
|
| Rate for Payer: Encore All Commercial |
$47.18
|
| Rate for Payer: Frontpath All Commercial |
$47.15
|
| Rate for Payer: Humana ChoiceCare |
$44.26
|
| Rate for Payer: Humana Medicare |
$26.14
|
| Rate for Payer: Lucent All Commercial |
$26.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$38.44
|
| Rate for Payer: PHP All Commercial |
$38.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.99
|
| Rate for Payer: Sagamore Health Network All Products |
$39.56
|
| Rate for Payer: Signature Care EPO |
$42.54
|
| Rate for Payer: Signature Care PPO |
$45.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.56
|
| Rate for Payer: United Healthcare Commercial |
$40.38
|
| Rate for Payer: United Healthcare Medicare |
$16.91
|
|
