|
HC CATH FOLEY 18FR 5CC
|
Facility
OP
|
$23.20
|
|
| Hospital Charge Code |
41601016
|
|
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 18FR 5CC
|
Facility
IP
|
$23.20
|
|
| Hospital Charge Code |
41601016
|
|
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 20FR 30CC
|
Facility
OP
|
$52.55
|
|
| Hospital Charge Code |
41601017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$44.35
|
| Rate for Payer: Aetna Medicare |
$17.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.08
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Centivo All Commercial |
$26.80
|
| Rate for Payer: Cigna All Commercial |
$45.35
|
| Rate for Payer: CORVEL All Commercial |
$48.87
|
| Rate for Payer: Coventry All Commercial |
$46.24
|
| Rate for Payer: Encore All Commercial |
$48.37
|
| Rate for Payer: Frontpath All Commercial |
$48.35
|
| Rate for Payer: Humana ChoiceCare |
$45.39
|
| Rate for Payer: Humana Medicare |
$26.80
|
| Rate for Payer: Lucent All Commercial |
$26.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$39.41
|
| Rate for Payer: PHP All Commercial |
$39.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.49
|
| Rate for Payer: Sagamore Health Network All Products |
$40.57
|
| Rate for Payer: Signature Care EPO |
$43.62
|
| Rate for Payer: Signature Care PPO |
$46.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44.67
|
| Rate for Payer: United Healthcare Commercial |
$41.41
|
| Rate for Payer: United Healthcare Medicare |
$17.34
|
|
|
HC CATH FOLEY 20FR 30CC
|
Facility
IP
|
$52.55
|
|
| Hospital Charge Code |
41601017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.41 |
| Max. Negotiated Rate |
$48.87 |
| Rate for Payer: Aetna Commercial |
$45.40
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Cigna All Commercial |
$45.35
|
| Rate for Payer: CORVEL All Commercial |
$48.87
|
| Rate for Payer: Coventry All Commercial |
$46.24
|
| Rate for Payer: Encore All Commercial |
$48.37
|
| Rate for Payer: Frontpath All Commercial |
$48.35
|
| Rate for Payer: Humana ChoiceCare |
$45.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.30
|
| Rate for Payer: PHCS All Commercial |
$39.41
|
| Rate for Payer: PHP All Commercial |
$39.85
|
| Rate for Payer: Sagamore Health Network All Products |
$40.57
|
| Rate for Payer: Signature Care EPO |
$43.62
|
| Rate for Payer: Signature Care PPO |
$46.24
|
| Rate for Payer: United Healthcare Commercial |
$41.41
|
|
|
HC CATH FOLEY 20FR 5CC
|
Facility
OP
|
$23.20
|
|
| Hospital Charge Code |
41601018
|
|
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 20FR 5CC
|
Facility
IP
|
$23.20
|
|
| Hospital Charge Code |
41601018
|
|
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 22FR 5CC
|
Facility
OP
|
$22.62
|
|
| Hospital Charge Code |
41601019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.09
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.21
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Centivo All Commercial |
$11.54
|
| Rate for Payer: Cigna All Commercial |
$19.52
|
| Rate for Payer: CORVEL All Commercial |
$21.04
|
| Rate for Payer: Coventry All Commercial |
$19.91
|
| Rate for Payer: Encore All Commercial |
$20.82
|
| Rate for Payer: Frontpath All Commercial |
$20.81
|
| Rate for Payer: Humana ChoiceCare |
$19.54
|
| Rate for Payer: Humana Medicare |
$11.54
|
| Rate for Payer: Lucent All Commercial |
$11.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.36
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$16.96
|
| Rate for Payer: PHP All Commercial |
$17.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.82
|
| Rate for Payer: Sagamore Health Network All Products |
$17.46
|
| Rate for Payer: Signature Care EPO |
$18.77
|
| Rate for Payer: Signature Care PPO |
$19.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.23
|
| Rate for Payer: United Healthcare Commercial |
$17.82
|
| Rate for Payer: United Healthcare Medicare |
$7.46
|
|
|
HC CATH FOLEY 22FR 5CC
|
Facility
IP
|
$22.62
|
|
| Hospital Charge Code |
41601019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$21.04 |
| Rate for Payer: Aetna Commercial |
$19.54
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cigna All Commercial |
$19.52
|
| Rate for Payer: CORVEL All Commercial |
$21.04
|
| Rate for Payer: Coventry All Commercial |
$19.91
|
| Rate for Payer: Encore All Commercial |
$20.82
|
| Rate for Payer: Frontpath All Commercial |
$20.81
|
| Rate for Payer: Humana ChoiceCare |
$19.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.36
|
| Rate for Payer: PHCS All Commercial |
$16.96
|
| Rate for Payer: PHP All Commercial |
$17.16
|
| Rate for Payer: Sagamore Health Network All Products |
$17.46
|
| Rate for Payer: Signature Care EPO |
$18.77
|
| Rate for Payer: Signature Care PPO |
$19.91
|
| Rate for Payer: United Healthcare Commercial |
$17.82
|
|
|
HC CATH FOLEY 24FR 30CC
|
Facility
OP
|
$54.28
|
|
| Hospital Charge Code |
41601421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna Medicare |
$17.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.70
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Centivo All Commercial |
$27.68
|
| Rate for Payer: Cigna All Commercial |
$46.84
|
| Rate for Payer: CORVEL All Commercial |
$50.48
|
| Rate for Payer: Coventry All Commercial |
$47.77
|
| Rate for Payer: Encore All Commercial |
$49.96
|
| Rate for Payer: Frontpath All Commercial |
$49.94
|
| Rate for Payer: Humana ChoiceCare |
$46.88
|
| Rate for Payer: Humana Medicare |
$27.68
|
| Rate for Payer: Lucent All Commercial |
$27.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.71
|
| Rate for Payer: PHP All Commercial |
$41.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.17
|
| Rate for Payer: Sagamore Health Network All Products |
$41.90
|
| Rate for Payer: Signature Care EPO |
$45.05
|
| Rate for Payer: Signature Care PPO |
$47.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.14
|
| Rate for Payer: United Healthcare Commercial |
$42.77
|
| Rate for Payer: United Healthcare Medicare |
$17.91
|
|
|
HC CATH FOLEY 24FR 30CC
|
Facility
IP
|
$54.28
|
|
| Hospital Charge Code |
41601421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.71 |
| Max. Negotiated Rate |
$50.48 |
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Cigna All Commercial |
$46.84
|
| Rate for Payer: CORVEL All Commercial |
$50.48
|
| Rate for Payer: Coventry All Commercial |
$47.77
|
| Rate for Payer: Encore All Commercial |
$49.96
|
| Rate for Payer: Frontpath All Commercial |
$49.94
|
| Rate for Payer: Humana ChoiceCare |
$46.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.85
|
| Rate for Payer: PHCS All Commercial |
$40.71
|
| Rate for Payer: PHP All Commercial |
$41.17
|
| Rate for Payer: Sagamore Health Network All Products |
$41.90
|
| Rate for Payer: Signature Care EPO |
$45.05
|
| Rate for Payer: Signature Care PPO |
$47.77
|
| Rate for Payer: United Healthcare Commercial |
$42.77
|
|
|
HC CATH FOLEY 24FR 5CC
|
Facility
OP
|
$23.20
|
|
| Hospital Charge Code |
41601422
|
|
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 24FR 5CC
|
Facility
IP
|
$23.20
|
|
| Hospital Charge Code |
41601422
|
|
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 8F/3CC
|
Facility
OP
|
$24.86
|
|
| Hospital Charge Code |
41601423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.02
|
| Rate for Payer: Cash Price |
$15.41
|
| Rate for Payer: Cash Price |
$15.41
|
| Rate for Payer: Centivo All Commercial |
$12.68
|
| Rate for Payer: Cigna All Commercial |
$21.45
|
| Rate for Payer: CORVEL All Commercial |
$23.12
|
| Rate for Payer: Coventry All Commercial |
$21.88
|
| Rate for Payer: Encore All Commercial |
$22.88
|
| Rate for Payer: Frontpath All Commercial |
$22.87
|
| Rate for Payer: Humana ChoiceCare |
$21.47
|
| Rate for Payer: Humana Medicare |
$12.68
|
| Rate for Payer: Lucent All Commercial |
$12.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.37
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$18.64
|
| Rate for Payer: PHP All Commercial |
$18.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.70
|
| Rate for Payer: Sagamore Health Network All Products |
$19.19
|
| Rate for Payer: Signature Care EPO |
$20.63
|
| Rate for Payer: Signature Care PPO |
$21.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.13
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
|
|
HC CATH FOLEY 8F/3CC
|
Facility
IP
|
$24.86
|
|
| Hospital Charge Code |
41601423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$23.12 |
| Rate for Payer: Aetna Commercial |
$21.48
|
| Rate for Payer: Cash Price |
$15.41
|
| Rate for Payer: Cigna All Commercial |
$21.45
|
| Rate for Payer: CORVEL All Commercial |
$23.12
|
| Rate for Payer: Coventry All Commercial |
$21.88
|
| Rate for Payer: Encore All Commercial |
$22.88
|
| Rate for Payer: Frontpath All Commercial |
$22.87
|
| Rate for Payer: Humana ChoiceCare |
$21.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.37
|
| Rate for Payer: PHCS All Commercial |
$18.64
|
| Rate for Payer: PHP All Commercial |
$18.85
|
| Rate for Payer: Sagamore Health Network All Products |
$19.19
|
| Rate for Payer: Signature Care EPO |
$20.63
|
| Rate for Payer: Signature Care PPO |
$21.88
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
|
|
HC CATH GUIDE SITE SEL PACING C
|
Facility
OP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,566.68
|
| Rate for Payer: Aetna Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,066.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,160.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.82
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Centivo All Commercial |
$946.69
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Humana Medicare |
$946.69
|
| Rate for Payer: Lucent All Commercial |
$946.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$723.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,577.81
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
| Rate for Payer: United Healthcare Medicare |
$612.56
|
|
|
HC CATH GUIDE SITE SEL PACING C
|
Facility
IP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,392.19 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
|
|
HC CATH GUIDE SITE SEL PACING EH
|
Facility
IP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,392.19 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
|
|
HC CATH GUIDE SITE SEL PACING EH
|
Facility
OP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,566.68
|
| Rate for Payer: Aetna Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,066.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,160.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.82
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Centivo All Commercial |
$946.69
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Humana Medicare |
$946.69
|
| Rate for Payer: Lucent All Commercial |
$946.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$723.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,577.81
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
| Rate for Payer: United Healthcare Medicare |
$612.56
|
|
|
HC CATH GUIDE SITE SEL PACING MP
|
Facility
IP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,392.19 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
|
|
HC CATH GUIDE SITE SEL PACING MP
|
Facility
OP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,566.68
|
| Rate for Payer: Aetna Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,066.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,160.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.82
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Centivo All Commercial |
$946.69
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Humana Medicare |
$946.69
|
| Rate for Payer: Lucent All Commercial |
$946.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$723.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,577.81
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
| Rate for Payer: United Healthcare Medicare |
$612.56
|
|
|
HC CATH GUIDE SITE SEL PACING RT
|
Facility
IP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,392.19 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
|
|
HC CATH GUIDE SITE SEL PACING RT
|
Facility
OP
|
$1,856.25
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,726.31 |
| Rate for Payer: Aetna Commercial |
$1,566.68
|
| Rate for Payer: Aetna Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$612.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,066.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,160.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.82
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Cash Price |
$1,150.88
|
| Rate for Payer: Centivo All Commercial |
$946.69
|
| Rate for Payer: Cigna All Commercial |
$1,601.94
|
| Rate for Payer: CORVEL All Commercial |
$1,726.31
|
| Rate for Payer: Coventry All Commercial |
$1,633.50
|
| Rate for Payer: Encore All Commercial |
$1,708.68
|
| Rate for Payer: Frontpath All Commercial |
$1,707.75
|
| Rate for Payer: Humana ChoiceCare |
$1,603.24
|
| Rate for Payer: Humana Medicare |
$946.69
|
| Rate for Payer: Lucent All Commercial |
$946.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,392.19
|
| Rate for Payer: PHP All Commercial |
$1,407.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$723.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,433.02
|
| Rate for Payer: Signature Care EPO |
$1,540.69
|
| Rate for Payer: Signature Care PPO |
$1,633.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,577.81
|
| Rate for Payer: United Healthcare Commercial |
$1,462.72
|
| Rate for Payer: United Healthcare Medicare |
$612.56
|
|
|
HC CATH HICKMAN SINGLE LUMEN
|
Facility
OP
|
$1,095.00
|
|
|
Service Code
|
CPT A4300
|
| Hospital Charge Code |
41602264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,018.35 |
| Rate for Payer: Aetna Commercial |
$924.18
|
| Rate for Payer: Aetna Medicare |
$361.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$361.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$628.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$684.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$415.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$397.48
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Centivo All Commercial |
$558.45
|
| Rate for Payer: Cigna All Commercial |
$944.98
|
| Rate for Payer: CORVEL All Commercial |
$1,018.35
|
| Rate for Payer: Coventry All Commercial |
$963.60
|
| Rate for Payer: Encore All Commercial |
$1,007.95
|
| Rate for Payer: Frontpath All Commercial |
$1,007.40
|
| Rate for Payer: Humana ChoiceCare |
$945.75
|
| Rate for Payer: Humana Medicare |
$558.45
|
| Rate for Payer: Lucent All Commercial |
$558.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$821.25
|
| Rate for Payer: PHP All Commercial |
$830.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.05
|
| Rate for Payer: Sagamore Health Network All Products |
$845.34
|
| Rate for Payer: Signature Care EPO |
$908.85
|
| Rate for Payer: Signature Care PPO |
$963.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$930.75
|
| Rate for Payer: United Healthcare Commercial |
$862.86
|
| Rate for Payer: United Healthcare Medicare |
$361.35
|
|
|
HC CATH HICKMAN SINGLE LUMEN
|
Facility
IP
|
$1,095.00
|
|
|
Service Code
|
CPT A4300
|
| Hospital Charge Code |
41602264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$821.25 |
| Max. Negotiated Rate |
$1,018.35 |
| Rate for Payer: Aetna Commercial |
$946.08
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna All Commercial |
$944.98
|
| Rate for Payer: CORVEL All Commercial |
$1,018.35
|
| Rate for Payer: Coventry All Commercial |
$963.60
|
| Rate for Payer: Encore All Commercial |
$1,007.95
|
| Rate for Payer: Frontpath All Commercial |
$1,007.40
|
| Rate for Payer: Humana ChoiceCare |
$945.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.50
|
| Rate for Payer: PHCS All Commercial |
$821.25
|
| Rate for Payer: PHP All Commercial |
$830.45
|
| Rate for Payer: Sagamore Health Network All Products |
$845.34
|
| Rate for Payer: Signature Care EPO |
$908.85
|
| Rate for Payer: Signature Care PPO |
$963.60
|
| Rate for Payer: United Healthcare Commercial |
$862.86
|
|
|
HC CATH HYSTEROSALPINGOGRAPHY
|
Facility
IP
|
$301.00
|
|
| Hospital Charge Code |
41602083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$279.93 |
| Rate for Payer: Aetna Commercial |
$260.06
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cigna All Commercial |
$259.76
|
| Rate for Payer: CORVEL All Commercial |
$279.93
|
| Rate for Payer: Coventry All Commercial |
$264.88
|
| Rate for Payer: Encore All Commercial |
$277.07
|
| Rate for Payer: Frontpath All Commercial |
$276.92
|
| Rate for Payer: Humana ChoiceCare |
$259.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$270.90
|
| Rate for Payer: PHCS All Commercial |
$225.75
|
| Rate for Payer: PHP All Commercial |
$228.28
|
| Rate for Payer: Sagamore Health Network All Products |
$232.37
|
| Rate for Payer: Signature Care EPO |
$249.83
|
| Rate for Payer: Signature Care PPO |
$264.88
|
| Rate for Payer: United Healthcare Commercial |
$237.19
|
|
