|
HC CATH HYSTEROSALPINGOGRAPHY
|
Facility
OP
|
$301.00
|
|
| Hospital Charge Code |
41602083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.33 |
| Max. Negotiated Rate |
$279.93 |
| Rate for Payer: Aetna Commercial |
$254.04
|
| Rate for Payer: Aetna Medicare |
$99.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$172.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$188.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.26
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Centivo All Commercial |
$153.51
|
| Rate for Payer: Cigna All Commercial |
$259.76
|
| Rate for Payer: CORVEL All Commercial |
$279.93
|
| Rate for Payer: Coventry All Commercial |
$264.88
|
| Rate for Payer: Encore All Commercial |
$277.07
|
| Rate for Payer: Frontpath All Commercial |
$276.92
|
| Rate for Payer: Humana ChoiceCare |
$259.97
|
| Rate for Payer: Humana Medicare |
$153.51
|
| Rate for Payer: Lucent All Commercial |
$153.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$270.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$225.75
|
| Rate for Payer: PHP All Commercial |
$228.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$117.39
|
| Rate for Payer: Sagamore Health Network All Products |
$232.37
|
| Rate for Payer: Signature Care EPO |
$249.83
|
| Rate for Payer: Signature Care PPO |
$264.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$255.85
|
| Rate for Payer: United Healthcare Commercial |
$237.19
|
| Rate for Payer: United Healthcare Medicare |
$99.33
|
|
|
HC CATH INTRAUTERINE PRESSURE
|
Facility
OP
|
$202.37
|
|
| Hospital Charge Code |
41602444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$188.20 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: Aetna Medicare |
$66.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$116.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$126.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.46
|
| Rate for Payer: Cash Price |
$125.47
|
| Rate for Payer: Cash Price |
$125.47
|
| Rate for Payer: Centivo All Commercial |
$103.21
|
| Rate for Payer: Cigna All Commercial |
$174.65
|
| Rate for Payer: CORVEL All Commercial |
$188.20
|
| Rate for Payer: Coventry All Commercial |
$178.09
|
| Rate for Payer: Encore All Commercial |
$186.28
|
| Rate for Payer: Frontpath All Commercial |
$186.18
|
| Rate for Payer: Humana ChoiceCare |
$174.79
|
| Rate for Payer: Humana Medicare |
$103.21
|
| Rate for Payer: Lucent All Commercial |
$103.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$182.13
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$151.78
|
| Rate for Payer: PHP All Commercial |
$153.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.92
|
| Rate for Payer: Sagamore Health Network All Products |
$156.23
|
| Rate for Payer: Signature Care EPO |
$167.97
|
| Rate for Payer: Signature Care PPO |
$178.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$172.01
|
| Rate for Payer: United Healthcare Commercial |
$159.47
|
| Rate for Payer: United Healthcare Medicare |
$66.78
|
|
|
HC CATH INTRAUTERINE PRESSURE
|
Facility
IP
|
$202.37
|
|
| Hospital Charge Code |
41602444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.78 |
| Max. Negotiated Rate |
$188.20 |
| Rate for Payer: Aetna Commercial |
$174.85
|
| Rate for Payer: Cash Price |
$125.47
|
| Rate for Payer: Cigna All Commercial |
$174.65
|
| Rate for Payer: CORVEL All Commercial |
$188.20
|
| Rate for Payer: Coventry All Commercial |
$178.09
|
| Rate for Payer: Encore All Commercial |
$186.28
|
| Rate for Payer: Frontpath All Commercial |
$186.18
|
| Rate for Payer: Humana ChoiceCare |
$174.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$182.13
|
| Rate for Payer: PHCS All Commercial |
$151.78
|
| Rate for Payer: PHP All Commercial |
$153.48
|
| Rate for Payer: Sagamore Health Network All Products |
$156.23
|
| Rate for Payer: Signature Care EPO |
$167.97
|
| Rate for Payer: Signature Care PPO |
$178.09
|
| Rate for Payer: United Healthcare Commercial |
$159.47
|
|
|
HC CATH KIT MIDLINE BARRIER
|
Facility
OP
|
$1,036.00
|
|
| Hospital Charge Code |
41608103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$963.48 |
| Rate for Payer: Aetna Commercial |
$874.38
|
| Rate for Payer: Aetna Medicare |
$341.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$341.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$594.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$647.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$393.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$376.07
|
| Rate for Payer: Cash Price |
$642.32
|
| Rate for Payer: Cash Price |
$642.32
|
| Rate for Payer: Centivo All Commercial |
$528.36
|
| Rate for Payer: Cigna All Commercial |
$894.07
|
| Rate for Payer: CORVEL All Commercial |
$963.48
|
| Rate for Payer: Coventry All Commercial |
$911.68
|
| Rate for Payer: Encore All Commercial |
$953.64
|
| Rate for Payer: Frontpath All Commercial |
$953.12
|
| Rate for Payer: Humana ChoiceCare |
$894.79
|
| Rate for Payer: Humana Medicare |
$528.36
|
| Rate for Payer: Lucent All Commercial |
$528.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$932.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$777.00
|
| Rate for Payer: PHP All Commercial |
$785.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$404.04
|
| Rate for Payer: Sagamore Health Network All Products |
$799.79
|
| Rate for Payer: Signature Care EPO |
$859.88
|
| Rate for Payer: Signature Care PPO |
$911.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$880.60
|
| Rate for Payer: United Healthcare Commercial |
$816.37
|
| Rate for Payer: United Healthcare Medicare |
$341.88
|
|
|
HC CATH KIT MIDLINE BARRIER
|
Facility
IP
|
$1,036.00
|
|
| Hospital Charge Code |
41608103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.00 |
| Max. Negotiated Rate |
$963.48 |
| Rate for Payer: Aetna Commercial |
$895.10
|
| Rate for Payer: Cash Price |
$642.32
|
| Rate for Payer: Cigna All Commercial |
$894.07
|
| Rate for Payer: CORVEL All Commercial |
$963.48
|
| Rate for Payer: Coventry All Commercial |
$911.68
|
| Rate for Payer: Encore All Commercial |
$953.64
|
| Rate for Payer: Frontpath All Commercial |
$953.12
|
| Rate for Payer: Humana ChoiceCare |
$894.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$932.40
|
| Rate for Payer: PHCS All Commercial |
$777.00
|
| Rate for Payer: PHP All Commercial |
$785.70
|
| Rate for Payer: Sagamore Health Network All Products |
$799.79
|
| Rate for Payer: Signature Care EPO |
$859.88
|
| Rate for Payer: Signature Care PPO |
$911.68
|
| Rate for Payer: United Healthcare Commercial |
$816.37
|
|
|
HC CATH LV INNER GUIDE 6248V 90
|
Facility
IP
|
$1,022.63
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607366
|
|
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 CATH LV INNER GUIDE 6248V 90
|
Facility
OP
|
$1,022.63
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607366
|
|
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 CATH LV INNER GUIDE 6248V 90S
|
Facility
IP
|
$1,022.63
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607367
|
|
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 CATH LV INNER GUIDE 6248V 90S
|
Facility
OP
|
$1,022.63
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607367
|
|
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 CATH LV OUTER GUIDE 6250V 50S
|
Facility
IP
|
$1,171.13
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.35 |
| Max. Negotiated Rate |
$1,089.15 |
| Rate for Payer: Aetna Commercial |
$1,011.86
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Cigna All Commercial |
$1,010.69
|
| Rate for Payer: CORVEL All Commercial |
$1,089.15
|
| Rate for Payer: Coventry All Commercial |
$1,030.59
|
| Rate for Payer: Encore All Commercial |
$1,078.03
|
| Rate for Payer: Frontpath All Commercial |
$1,077.44
|
| Rate for Payer: Humana ChoiceCare |
$1,011.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,054.02
|
| Rate for Payer: PHCS All Commercial |
$878.35
|
| Rate for Payer: PHP All Commercial |
$888.18
|
| Rate for Payer: Sagamore Health Network All Products |
$904.11
|
| Rate for Payer: Signature Care EPO |
$972.04
|
| Rate for Payer: Signature Care PPO |
$1,030.59
|
| Rate for Payer: United Healthcare Commercial |
$922.85
|
|
|
HC CATH LV OUTER GUIDE 6250V 50S
|
Facility
OP
|
$1,171.13
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,089.15 |
| Rate for Payer: Aetna Commercial |
$988.43
|
| Rate for Payer: Aetna Medicare |
$386.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$386.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$672.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$732.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$444.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.12
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Centivo All Commercial |
$597.28
|
| Rate for Payer: Cigna All Commercial |
$1,010.69
|
| Rate for Payer: CORVEL All Commercial |
$1,089.15
|
| Rate for Payer: Coventry All Commercial |
$1,030.59
|
| Rate for Payer: Encore All Commercial |
$1,078.03
|
| Rate for Payer: Frontpath All Commercial |
$1,077.44
|
| Rate for Payer: Humana ChoiceCare |
$1,011.50
|
| Rate for Payer: Humana Medicare |
$597.28
|
| Rate for Payer: Lucent All Commercial |
$597.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,054.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$878.35
|
| Rate for Payer: PHP All Commercial |
$888.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$456.74
|
| Rate for Payer: Sagamore Health Network All Products |
$904.11
|
| Rate for Payer: Signature Care EPO |
$972.04
|
| Rate for Payer: Signature Care PPO |
$1,030.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$995.46
|
| Rate for Payer: United Healthcare Commercial |
$922.85
|
| Rate for Payer: United Healthcare Medicare |
$386.47
|
|
|
HC CATH LV OUTER GUIDE 6250V EH
|
Facility
OP
|
$1,171.13
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,089.15 |
| Rate for Payer: Aetna Commercial |
$988.43
|
| Rate for Payer: Aetna Medicare |
$386.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$386.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$672.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$732.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$444.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.12
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Centivo All Commercial |
$597.28
|
| Rate for Payer: Cigna All Commercial |
$1,010.69
|
| Rate for Payer: CORVEL All Commercial |
$1,089.15
|
| Rate for Payer: Coventry All Commercial |
$1,030.59
|
| Rate for Payer: Encore All Commercial |
$1,078.03
|
| Rate for Payer: Frontpath All Commercial |
$1,077.44
|
| Rate for Payer: Humana ChoiceCare |
$1,011.50
|
| Rate for Payer: Humana Medicare |
$597.28
|
| Rate for Payer: Lucent All Commercial |
$597.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,054.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$878.35
|
| Rate for Payer: PHP All Commercial |
$888.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$456.74
|
| Rate for Payer: Sagamore Health Network All Products |
$904.11
|
| Rate for Payer: Signature Care EPO |
$972.04
|
| Rate for Payer: Signature Care PPO |
$1,030.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$995.46
|
| Rate for Payer: United Healthcare Commercial |
$922.85
|
| Rate for Payer: United Healthcare Medicare |
$386.47
|
|
|
HC CATH LV OUTER GUIDE 6250V EH
|
Facility
IP
|
$1,171.13
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.35 |
| Max. Negotiated Rate |
$1,089.15 |
| Rate for Payer: Aetna Commercial |
$1,011.86
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Cigna All Commercial |
$1,010.69
|
| Rate for Payer: CORVEL All Commercial |
$1,089.15
|
| Rate for Payer: Coventry All Commercial |
$1,030.59
|
| Rate for Payer: Encore All Commercial |
$1,078.03
|
| Rate for Payer: Frontpath All Commercial |
$1,077.44
|
| Rate for Payer: Humana ChoiceCare |
$1,011.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,054.02
|
| Rate for Payer: PHCS All Commercial |
$878.35
|
| Rate for Payer: PHP All Commercial |
$888.18
|
| Rate for Payer: Sagamore Health Network All Products |
$904.11
|
| Rate for Payer: Signature Care EPO |
$972.04
|
| Rate for Payer: Signature Care PPO |
$1,030.59
|
| Rate for Payer: United Healthcare Commercial |
$922.85
|
|
|
HC CATH LV OUTER GUIDE 6250V MB2X
|
Facility
OP
|
$1,171.13
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,089.15 |
| Rate for Payer: Aetna Commercial |
$988.43
|
| Rate for Payer: Aetna Medicare |
$386.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$386.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$672.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$732.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$444.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.12
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Centivo All Commercial |
$597.28
|
| Rate for Payer: Cigna All Commercial |
$1,010.69
|
| Rate for Payer: CORVEL All Commercial |
$1,089.15
|
| Rate for Payer: Coventry All Commercial |
$1,030.59
|
| Rate for Payer: Encore All Commercial |
$1,078.03
|
| Rate for Payer: Frontpath All Commercial |
$1,077.44
|
| Rate for Payer: Humana ChoiceCare |
$1,011.50
|
| Rate for Payer: Humana Medicare |
$597.28
|
| Rate for Payer: Lucent All Commercial |
$597.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,054.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$878.35
|
| Rate for Payer: PHP All Commercial |
$888.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$456.74
|
| Rate for Payer: Sagamore Health Network All Products |
$904.11
|
| Rate for Payer: Signature Care EPO |
$972.04
|
| Rate for Payer: Signature Care PPO |
$1,030.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$995.46
|
| Rate for Payer: United Healthcare Commercial |
$922.85
|
| Rate for Payer: United Healthcare Medicare |
$386.47
|
|
|
HC CATH LV OUTER GUIDE 6250V MB2X
|
Facility
IP
|
$1,171.13
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.35 |
| Max. Negotiated Rate |
$1,089.15 |
| Rate for Payer: Aetna Commercial |
$1,011.86
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Cigna All Commercial |
$1,010.69
|
| Rate for Payer: CORVEL All Commercial |
$1,089.15
|
| Rate for Payer: Coventry All Commercial |
$1,030.59
|
| Rate for Payer: Encore All Commercial |
$1,078.03
|
| Rate for Payer: Frontpath All Commercial |
$1,077.44
|
| Rate for Payer: Humana ChoiceCare |
$1,011.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,054.02
|
| Rate for Payer: PHCS All Commercial |
$878.35
|
| Rate for Payer: PHP All Commercial |
$888.18
|
| Rate for Payer: Sagamore Health Network All Products |
$904.11
|
| Rate for Payer: Signature Care EPO |
$972.04
|
| Rate for Payer: Signature Care PPO |
$1,030.59
|
| Rate for Payer: United Healthcare Commercial |
$922.85
|
|
|
HC CATH LV OUTER GUIDE 6250V MPR
|
Facility
OP
|
$1,171.13
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,089.15 |
| Rate for Payer: Aetna Commercial |
$988.43
|
| Rate for Payer: Aetna Medicare |
$386.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$386.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$672.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$732.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$444.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.12
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Centivo All Commercial |
$597.28
|
| Rate for Payer: Cigna All Commercial |
$1,010.69
|
| Rate for Payer: CORVEL All Commercial |
$1,089.15
|
| Rate for Payer: Coventry All Commercial |
$1,030.59
|
| Rate for Payer: Encore All Commercial |
$1,078.03
|
| Rate for Payer: Frontpath All Commercial |
$1,077.44
|
| Rate for Payer: Humana ChoiceCare |
$1,011.50
|
| Rate for Payer: Humana Medicare |
$597.28
|
| Rate for Payer: Lucent All Commercial |
$597.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,054.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$878.35
|
| Rate for Payer: PHP All Commercial |
$888.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$456.74
|
| Rate for Payer: Sagamore Health Network All Products |
$904.11
|
| Rate for Payer: Signature Care EPO |
$972.04
|
| Rate for Payer: Signature Care PPO |
$1,030.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$995.46
|
| Rate for Payer: United Healthcare Commercial |
$922.85
|
| Rate for Payer: United Healthcare Medicare |
$386.47
|
|
|
HC CATH LV OUTER GUIDE 6250V MPR
|
Facility
IP
|
$1,171.13
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.35 |
| Max. Negotiated Rate |
$1,089.15 |
| Rate for Payer: Aetna Commercial |
$1,011.86
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Cigna All Commercial |
$1,010.69
|
| Rate for Payer: CORVEL All Commercial |
$1,089.15
|
| Rate for Payer: Coventry All Commercial |
$1,030.59
|
| Rate for Payer: Encore All Commercial |
$1,078.03
|
| Rate for Payer: Frontpath All Commercial |
$1,077.44
|
| Rate for Payer: Humana ChoiceCare |
$1,011.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,054.02
|
| Rate for Payer: PHCS All Commercial |
$878.35
|
| Rate for Payer: PHP All Commercial |
$888.18
|
| Rate for Payer: Sagamore Health Network All Products |
$904.11
|
| Rate for Payer: Signature Care EPO |
$972.04
|
| Rate for Payer: Signature Care PPO |
$1,030.59
|
| Rate for Payer: United Healthcare Commercial |
$922.85
|
|
|
HC CATH LV OUTER GUIDE 6250V MPX
|
Facility
IP
|
$1,171.13
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.35 |
| Max. Negotiated Rate |
$1,089.15 |
| Rate for Payer: Aetna Commercial |
$1,011.86
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Cigna All Commercial |
$1,010.69
|
| Rate for Payer: CORVEL All Commercial |
$1,089.15
|
| Rate for Payer: Coventry All Commercial |
$1,030.59
|
| Rate for Payer: Encore All Commercial |
$1,078.03
|
| Rate for Payer: Frontpath All Commercial |
$1,077.44
|
| Rate for Payer: Humana ChoiceCare |
$1,011.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,054.02
|
| Rate for Payer: PHCS All Commercial |
$878.35
|
| Rate for Payer: PHP All Commercial |
$888.18
|
| Rate for Payer: Sagamore Health Network All Products |
$904.11
|
| Rate for Payer: Signature Care EPO |
$972.04
|
| Rate for Payer: Signature Care PPO |
$1,030.59
|
| Rate for Payer: United Healthcare Commercial |
$922.85
|
|
|
HC CATH LV OUTER GUIDE 6250V MPX
|
Facility
OP
|
$1,171.13
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,089.15 |
| Rate for Payer: Aetna Commercial |
$988.43
|
| Rate for Payer: Aetna Medicare |
$386.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$386.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$672.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$732.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$444.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.12
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Cash Price |
$726.10
|
| Rate for Payer: Centivo All Commercial |
$597.28
|
| Rate for Payer: Cigna All Commercial |
$1,010.69
|
| Rate for Payer: CORVEL All Commercial |
$1,089.15
|
| Rate for Payer: Coventry All Commercial |
$1,030.59
|
| Rate for Payer: Encore All Commercial |
$1,078.03
|
| Rate for Payer: Frontpath All Commercial |
$1,077.44
|
| Rate for Payer: Humana ChoiceCare |
$1,011.50
|
| Rate for Payer: Humana Medicare |
$597.28
|
| Rate for Payer: Lucent All Commercial |
$597.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,054.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$878.35
|
| Rate for Payer: PHP All Commercial |
$888.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$456.74
|
| Rate for Payer: Sagamore Health Network All Products |
$904.11
|
| Rate for Payer: Signature Care EPO |
$972.04
|
| Rate for Payer: Signature Care PPO |
$1,030.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$995.46
|
| Rate for Payer: United Healthcare Commercial |
$922.85
|
| Rate for Payer: United Healthcare Medicare |
$386.47
|
|
|
HC CATH PEDIATRIC KIT
|
Facility
OP
|
$18.73
|
|
| Hospital Charge Code |
41601065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.81
|
| Rate for Payer: Aetna Medicare |
$6.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.80
|
| Rate for Payer: Cash Price |
$11.61
|
| Rate for Payer: Cash Price |
$11.61
|
| Rate for Payer: Centivo All Commercial |
$9.55
|
| Rate for Payer: Cigna All Commercial |
$16.16
|
| Rate for Payer: CORVEL All Commercial |
$17.42
|
| Rate for Payer: Coventry All Commercial |
$16.48
|
| Rate for Payer: Encore All Commercial |
$17.24
|
| Rate for Payer: Frontpath All Commercial |
$17.23
|
| Rate for Payer: Humana ChoiceCare |
$16.18
|
| Rate for Payer: Humana Medicare |
$9.55
|
| Rate for Payer: Lucent All Commercial |
$9.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.86
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.05
|
| Rate for Payer: PHP All Commercial |
$14.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.30
|
| Rate for Payer: Sagamore Health Network All Products |
$14.46
|
| Rate for Payer: Signature Care EPO |
$15.55
|
| Rate for Payer: Signature Care PPO |
$16.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.92
|
| Rate for Payer: United Healthcare Commercial |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$6.18
|
|
|
HC CATH PEDIATRIC KIT
|
Facility
IP
|
$18.73
|
|
| Hospital Charge Code |
41601065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$17.42 |
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Cash Price |
$11.61
|
| Rate for Payer: Cigna All Commercial |
$16.16
|
| Rate for Payer: CORVEL All Commercial |
$17.42
|
| Rate for Payer: Coventry All Commercial |
$16.48
|
| Rate for Payer: Encore All Commercial |
$17.24
|
| Rate for Payer: Frontpath All Commercial |
$17.23
|
| Rate for Payer: Humana ChoiceCare |
$16.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.86
|
| Rate for Payer: PHCS All Commercial |
$14.05
|
| Rate for Payer: PHP All Commercial |
$14.20
|
| Rate for Payer: Sagamore Health Network All Products |
$14.46
|
| Rate for Payer: Signature Care EPO |
$15.55
|
| Rate for Payer: Signature Care PPO |
$16.48
|
| Rate for Payer: United Healthcare Commercial |
$14.76
|
|
|
HC CATH PNEUMOTHORAX
|
Facility
OP
|
$1,192.50
|
|
| Hospital Charge Code |
41601355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,109.02 |
| Rate for Payer: Aetna Commercial |
$1,006.47
|
| Rate for Payer: Aetna Medicare |
$393.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$393.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$684.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$745.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$452.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$432.88
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Centivo All Commercial |
$608.18
|
| Rate for Payer: Cigna All Commercial |
$1,029.13
|
| Rate for Payer: CORVEL All Commercial |
$1,109.02
|
| Rate for Payer: Coventry All Commercial |
$1,049.40
|
| Rate for Payer: Encore All Commercial |
$1,097.70
|
| Rate for Payer: Frontpath All Commercial |
$1,097.10
|
| Rate for Payer: Humana ChoiceCare |
$1,029.96
|
| Rate for Payer: Humana Medicare |
$608.18
|
| Rate for Payer: Lucent All Commercial |
$608.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,073.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$894.38
|
| Rate for Payer: PHP All Commercial |
$904.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$465.08
|
| Rate for Payer: Sagamore Health Network All Products |
$920.61
|
| Rate for Payer: Signature Care EPO |
$989.78
|
| Rate for Payer: Signature Care PPO |
$1,049.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,013.62
|
| Rate for Payer: United Healthcare Commercial |
$939.69
|
| Rate for Payer: United Healthcare Medicare |
$393.52
|
|
|
HC CATH PNEUMOTHORAX
|
Facility
IP
|
$1,192.50
|
|
| Hospital Charge Code |
41601355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$894.38 |
| Max. Negotiated Rate |
$1,109.02 |
| Rate for Payer: Aetna Commercial |
$1,030.32
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cigna All Commercial |
$1,029.13
|
| Rate for Payer: CORVEL All Commercial |
$1,109.02
|
| Rate for Payer: Coventry All Commercial |
$1,049.40
|
| Rate for Payer: Encore All Commercial |
$1,097.70
|
| Rate for Payer: Frontpath All Commercial |
$1,097.10
|
| Rate for Payer: Humana ChoiceCare |
$1,029.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,073.25
|
| Rate for Payer: PHCS All Commercial |
$894.38
|
| Rate for Payer: PHP All Commercial |
$904.39
|
| Rate for Payer: Sagamore Health Network All Products |
$920.61
|
| Rate for Payer: Signature Care EPO |
$989.78
|
| Rate for Payer: Signature Care PPO |
$1,049.40
|
| Rate for Payer: United Healthcare Commercial |
$939.69
|
|
|
HC CATH RADIAL ARTERY
|
Facility
OP
|
$112.00
|
|
| Hospital Charge Code |
41601431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$94.53
|
| Rate for Payer: Aetna Medicare |
$36.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.66
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Centivo All Commercial |
$57.12
|
| Rate for Payer: Cigna All Commercial |
$96.66
|
| Rate for Payer: CORVEL All Commercial |
$104.16
|
| Rate for Payer: Coventry All Commercial |
$98.56
|
| Rate for Payer: Encore All Commercial |
$103.10
|
| Rate for Payer: Frontpath All Commercial |
$103.04
|
| Rate for Payer: Humana ChoiceCare |
$96.73
|
| Rate for Payer: Humana Medicare |
$57.12
|
| Rate for Payer: Lucent All Commercial |
$57.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$84.00
|
| Rate for Payer: PHP All Commercial |
$84.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.68
|
| Rate for Payer: Sagamore Health Network All Products |
$86.46
|
| Rate for Payer: Signature Care EPO |
$92.96
|
| Rate for Payer: Signature Care PPO |
$98.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.20
|
| Rate for Payer: United Healthcare Commercial |
$88.26
|
| Rate for Payer: United Healthcare Medicare |
$36.96
|
|
|
HC CATH RADIAL ARTERY
|
Facility
IP
|
$112.00
|
|
| Hospital Charge Code |
41601431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$104.16 |
| Rate for Payer: Aetna Commercial |
$96.77
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Cigna All Commercial |
$96.66
|
| Rate for Payer: CORVEL All Commercial |
$104.16
|
| Rate for Payer: Coventry All Commercial |
$98.56
|
| Rate for Payer: Encore All Commercial |
$103.10
|
| Rate for Payer: Frontpath All Commercial |
$103.04
|
| Rate for Payer: Humana ChoiceCare |
$96.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.80
|
| Rate for Payer: PHCS All Commercial |
$84.00
|
| Rate for Payer: PHP All Commercial |
$84.94
|
| Rate for Payer: Sagamore Health Network All Products |
$86.46
|
| Rate for Payer: Signature Care EPO |
$92.96
|
| Rate for Payer: Signature Care PPO |
$98.56
|
| Rate for Payer: United Healthcare Commercial |
$88.26
|
|
