|
HC CATH SUCT 10FR WITH CONTROL
|
Facility
OP
|
$2.50
|
|
| Hospital Charge Code |
41601020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: Aetna Medicare |
$0.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.91
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Centivo All Commercial |
$1.28
|
| Rate for Payer: Cigna All Commercial |
$2.16
|
| Rate for Payer: CORVEL All Commercial |
$2.32
|
| Rate for Payer: Coventry All Commercial |
$2.20
|
| Rate for Payer: Encore All Commercial |
$2.30
|
| Rate for Payer: Frontpath All Commercial |
$2.30
|
| Rate for Payer: Humana ChoiceCare |
$2.16
|
| Rate for Payer: Humana Medicare |
$1.28
|
| Rate for Payer: Lucent All Commercial |
$1.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1.88
|
| Rate for Payer: PHP All Commercial |
$1.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1.93
|
| Rate for Payer: Signature Care EPO |
$2.08
|
| Rate for Payer: Signature Care PPO |
$2.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.12
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
| Rate for Payer: United Healthcare Medicare |
$0.83
|
|
|
HC CATH SUCT 10FR WITH CONTROL
|
Facility
IP
|
$2.50
|
|
| Hospital Charge Code |
41601020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna All Commercial |
$2.16
|
| Rate for Payer: CORVEL All Commercial |
$2.32
|
| Rate for Payer: Coventry All Commercial |
$2.20
|
| Rate for Payer: Encore All Commercial |
$2.30
|
| Rate for Payer: Frontpath All Commercial |
$2.30
|
| Rate for Payer: Humana ChoiceCare |
$2.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.25
|
| Rate for Payer: PHCS All Commercial |
$1.88
|
| Rate for Payer: PHP All Commercial |
$1.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1.93
|
| Rate for Payer: Signature Care EPO |
$2.08
|
| Rate for Payer: Signature Care PPO |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
|
|
HC CATH SUCT 14FR WITH CONTROL
|
Facility
OP
|
$1.78
|
|
| Hospital Charge Code |
41601021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare |
$0.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.65
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Centivo All Commercial |
$0.91
|
| Rate for Payer: Cigna All Commercial |
$1.54
|
| Rate for Payer: CORVEL All Commercial |
$1.66
|
| Rate for Payer: Coventry All Commercial |
$1.57
|
| Rate for Payer: Encore All Commercial |
$1.64
|
| Rate for Payer: Frontpath All Commercial |
$1.64
|
| Rate for Payer: Humana ChoiceCare |
$1.54
|
| Rate for Payer: Humana Medicare |
$0.91
|
| Rate for Payer: Lucent All Commercial |
$0.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1.34
|
| Rate for Payer: PHP All Commercial |
$1.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1.37
|
| Rate for Payer: Signature Care EPO |
$1.48
|
| Rate for Payer: Signature Care PPO |
$1.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.51
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Medicare |
$0.59
|
|
|
HC CATH SUCT 14FR WITH CONTROL
|
Facility
IP
|
$1.78
|
|
| Hospital Charge Code |
41601021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cigna All Commercial |
$1.54
|
| Rate for Payer: CORVEL All Commercial |
$1.66
|
| Rate for Payer: Coventry All Commercial |
$1.57
|
| Rate for Payer: Encore All Commercial |
$1.64
|
| Rate for Payer: Frontpath All Commercial |
$1.64
|
| Rate for Payer: Humana ChoiceCare |
$1.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.60
|
| Rate for Payer: PHCS All Commercial |
$1.34
|
| Rate for Payer: PHP All Commercial |
$1.35
|
| Rate for Payer: Sagamore Health Network All Products |
$1.37
|
| Rate for Payer: Signature Care EPO |
$1.48
|
| Rate for Payer: Signature Care PPO |
$1.57
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
|
|
HC CATH SUCT 5/6FR WITH CONTROL
|
Facility
OP
|
$2.73
|
|
| Hospital Charge Code |
41601412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$0.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.99
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Centivo All Commercial |
$1.39
|
| Rate for Payer: Cigna All Commercial |
$2.36
|
| Rate for Payer: CORVEL All Commercial |
$2.54
|
| Rate for Payer: Coventry All Commercial |
$2.40
|
| Rate for Payer: Encore All Commercial |
$2.51
|
| Rate for Payer: Frontpath All Commercial |
$2.51
|
| Rate for Payer: Humana ChoiceCare |
$2.36
|
| Rate for Payer: Humana Medicare |
$1.39
|
| Rate for Payer: Lucent All Commercial |
$1.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2.05
|
| Rate for Payer: PHP All Commercial |
$2.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.06
|
| Rate for Payer: Sagamore Health Network All Products |
$2.11
|
| Rate for Payer: Signature Care EPO |
$2.27
|
| Rate for Payer: Signature Care PPO |
$2.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$2.15
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
|
|
HC CATH SUCT 5/6FR WITH CONTROL
|
Facility
IP
|
$2.73
|
|
| Hospital Charge Code |
41601412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cigna All Commercial |
$2.36
|
| Rate for Payer: CORVEL All Commercial |
$2.54
|
| Rate for Payer: Coventry All Commercial |
$2.40
|
| Rate for Payer: Encore All Commercial |
$2.51
|
| Rate for Payer: Frontpath All Commercial |
$2.51
|
| Rate for Payer: Humana ChoiceCare |
$2.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.46
|
| Rate for Payer: PHCS All Commercial |
$2.05
|
| Rate for Payer: PHP All Commercial |
$2.07
|
| Rate for Payer: Sagamore Health Network All Products |
$2.11
|
| Rate for Payer: Signature Care EPO |
$2.27
|
| Rate for Payer: Signature Care PPO |
$2.40
|
| Rate for Payer: United Healthcare Commercial |
$2.15
|
|
|
HC CATH SUCT 8FR WITH CONTROL
|
Facility
IP
|
$5.88
|
|
| Hospital Charge Code |
41601022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna Commercial |
$5.08
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cigna All Commercial |
$5.07
|
| Rate for Payer: CORVEL All Commercial |
$5.47
|
| Rate for Payer: Coventry All Commercial |
$5.17
|
| Rate for Payer: Encore All Commercial |
$5.41
|
| Rate for Payer: Frontpath All Commercial |
$5.41
|
| Rate for Payer: Humana ChoiceCare |
$5.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.29
|
| Rate for Payer: PHCS All Commercial |
$4.41
|
| Rate for Payer: PHP All Commercial |
$4.46
|
| Rate for Payer: Sagamore Health Network All Products |
$4.54
|
| Rate for Payer: Signature Care EPO |
$4.88
|
| Rate for Payer: Signature Care PPO |
$5.17
|
| Rate for Payer: United Healthcare Commercial |
$4.63
|
|
|
HC CATH SUCT 8FR WITH CONTROL
|
Facility
OP
|
$5.88
|
|
| Hospital Charge Code |
41601022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$4.96
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.13
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Centivo All Commercial |
$3.00
|
| Rate for Payer: Cigna All Commercial |
$5.07
|
| Rate for Payer: CORVEL All Commercial |
$5.47
|
| Rate for Payer: Coventry All Commercial |
$5.17
|
| Rate for Payer: Encore All Commercial |
$5.41
|
| Rate for Payer: Frontpath All Commercial |
$5.41
|
| Rate for Payer: Humana ChoiceCare |
$5.08
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Lucent All Commercial |
$3.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.29
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$4.41
|
| Rate for Payer: PHP All Commercial |
$4.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.29
|
| Rate for Payer: Sagamore Health Network All Products |
$4.54
|
| Rate for Payer: Signature Care EPO |
$4.88
|
| Rate for Payer: Signature Care PPO |
$5.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$4.63
|
| Rate for Payer: United Healthcare Medicare |
$1.94
|
|
|
HC CATH SUCT CLOSED
|
Facility
OP
|
$106.89
|
|
| Hospital Charge Code |
41601212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.27 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$90.22
|
| Rate for Payer: Aetna Medicare |
$35.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.80
|
| Rate for Payer: Cash Price |
$66.27
|
| Rate for Payer: Cash Price |
$66.27
|
| Rate for Payer: Centivo All Commercial |
$54.51
|
| Rate for Payer: Cigna All Commercial |
$92.25
|
| Rate for Payer: CORVEL All Commercial |
$99.41
|
| Rate for Payer: Coventry All Commercial |
$94.06
|
| Rate for Payer: Encore All Commercial |
$98.39
|
| Rate for Payer: Frontpath All Commercial |
$98.34
|
| Rate for Payer: Humana ChoiceCare |
$92.32
|
| Rate for Payer: Humana Medicare |
$54.51
|
| Rate for Payer: Lucent All Commercial |
$54.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$80.17
|
| Rate for Payer: PHP All Commercial |
$81.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.69
|
| Rate for Payer: Sagamore Health Network All Products |
$82.52
|
| Rate for Payer: Signature Care EPO |
$88.72
|
| Rate for Payer: Signature Care PPO |
$94.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.86
|
| Rate for Payer: United Healthcare Commercial |
$84.23
|
| Rate for Payer: United Healthcare Medicare |
$35.27
|
|
|
HC CATH SUCT CLOSED
|
Facility
IP
|
$106.89
|
|
| Hospital Charge Code |
41601212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.17 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$92.35
|
| Rate for Payer: Cash Price |
$66.27
|
| Rate for Payer: Cigna All Commercial |
$92.25
|
| Rate for Payer: CORVEL All Commercial |
$99.41
|
| Rate for Payer: Coventry All Commercial |
$94.06
|
| Rate for Payer: Encore All Commercial |
$98.39
|
| Rate for Payer: Frontpath All Commercial |
$98.34
|
| Rate for Payer: Humana ChoiceCare |
$92.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.20
|
| Rate for Payer: PHCS All Commercial |
$80.17
|
| Rate for Payer: PHP All Commercial |
$81.07
|
| Rate for Payer: Sagamore Health Network All Products |
$82.52
|
| Rate for Payer: Signature Care EPO |
$88.72
|
| Rate for Payer: Signature Care PPO |
$94.06
|
| Rate for Payer: United Healthcare Commercial |
$84.23
|
|
|
HC CATH SUCTION 14FR KIT
|
Facility
OP
|
$7.54
|
|
| Hospital Charge Code |
41601023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$6.36
|
| Rate for Payer: Aetna Medicare |
$2.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.74
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Centivo All Commercial |
$3.85
|
| Rate for Payer: Cigna All Commercial |
$6.51
|
| Rate for Payer: CORVEL All Commercial |
$7.01
|
| Rate for Payer: Coventry All Commercial |
$6.64
|
| Rate for Payer: Encore All Commercial |
$6.94
|
| Rate for Payer: Frontpath All Commercial |
$6.94
|
| Rate for Payer: Humana ChoiceCare |
$6.51
|
| Rate for Payer: Humana Medicare |
$3.85
|
| Rate for Payer: Lucent All Commercial |
$3.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.79
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$5.66
|
| Rate for Payer: PHP All Commercial |
$5.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.94
|
| Rate for Payer: Sagamore Health Network All Products |
$5.82
|
| Rate for Payer: Signature Care EPO |
$6.26
|
| Rate for Payer: Signature Care PPO |
$6.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.41
|
| Rate for Payer: United Healthcare Commercial |
$5.94
|
| Rate for Payer: United Healthcare Medicare |
$2.49
|
|
|
HC CATH SUCTION 14FR KIT
|
Facility
IP
|
$7.54
|
|
| Hospital Charge Code |
41601023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna All Commercial |
$6.51
|
| Rate for Payer: CORVEL All Commercial |
$7.01
|
| Rate for Payer: Coventry All Commercial |
$6.64
|
| Rate for Payer: Encore All Commercial |
$6.94
|
| Rate for Payer: Frontpath All Commercial |
$6.94
|
| Rate for Payer: Humana ChoiceCare |
$6.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.79
|
| Rate for Payer: PHCS All Commercial |
$5.66
|
| Rate for Payer: PHP All Commercial |
$5.72
|
| Rate for Payer: Sagamore Health Network All Products |
$5.82
|
| Rate for Payer: Signature Care EPO |
$6.26
|
| Rate for Payer: Signature Care PPO |
$6.64
|
| Rate for Payer: United Healthcare Commercial |
$5.94
|
|
|
HC CATH SUPRA PUBIC 14FR
|
Facility
IP
|
$299.25
|
|
| Hospital Charge Code |
41602265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.44 |
| Max. Negotiated Rate |
$278.30 |
| Rate for Payer: Aetna Commercial |
$258.55
|
| Rate for Payer: Cash Price |
$185.54
|
| Rate for Payer: Cigna All Commercial |
$258.25
|
| Rate for Payer: CORVEL All Commercial |
$278.30
|
| Rate for Payer: Coventry All Commercial |
$263.34
|
| Rate for Payer: Encore All Commercial |
$275.46
|
| Rate for Payer: Frontpath All Commercial |
$275.31
|
| Rate for Payer: Humana ChoiceCare |
$258.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$269.32
|
| Rate for Payer: PHCS All Commercial |
$224.44
|
| Rate for Payer: PHP All Commercial |
$226.95
|
| Rate for Payer: Sagamore Health Network All Products |
$231.02
|
| Rate for Payer: Signature Care EPO |
$248.38
|
| Rate for Payer: Signature Care PPO |
$263.34
|
| Rate for Payer: United Healthcare Commercial |
$235.81
|
|
|
HC CATH SUPRA PUBIC 14FR
|
Facility
OP
|
$299.25
|
|
| Hospital Charge Code |
41602265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.75 |
| Max. Negotiated Rate |
$278.30 |
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: Aetna Medicare |
$98.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$171.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.63
|
| Rate for Payer: Cash Price |
$185.54
|
| Rate for Payer: Cash Price |
$185.54
|
| Rate for Payer: Centivo All Commercial |
$152.62
|
| Rate for Payer: Cigna All Commercial |
$258.25
|
| Rate for Payer: CORVEL All Commercial |
$278.30
|
| Rate for Payer: Coventry All Commercial |
$263.34
|
| Rate for Payer: Encore All Commercial |
$275.46
|
| Rate for Payer: Frontpath All Commercial |
$275.31
|
| Rate for Payer: Humana ChoiceCare |
$258.46
|
| Rate for Payer: Humana Medicare |
$152.62
|
| Rate for Payer: Lucent All Commercial |
$152.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$269.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$224.44
|
| Rate for Payer: PHP All Commercial |
$226.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.71
|
| Rate for Payer: Sagamore Health Network All Products |
$231.02
|
| Rate for Payer: Signature Care EPO |
$248.38
|
| Rate for Payer: Signature Care PPO |
$263.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$254.36
|
| Rate for Payer: United Healthcare Commercial |
$235.81
|
| Rate for Payer: United Healthcare Medicare |
$98.75
|
|
|
HC CATH TIEMANN/COUDE 14FR
|
Facility
OP
|
$76.93
|
|
| Hospital Charge Code |
41601024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$64.93
|
| Rate for Payer: Aetna Medicare |
$25.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.93
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Centivo All Commercial |
$39.23
|
| Rate for Payer: Cigna All Commercial |
$66.39
|
| Rate for Payer: CORVEL All Commercial |
$71.54
|
| Rate for Payer: Coventry All Commercial |
$67.70
|
| Rate for Payer: Encore All Commercial |
$70.81
|
| Rate for Payer: Frontpath All Commercial |
$70.78
|
| Rate for Payer: Humana ChoiceCare |
$66.44
|
| Rate for Payer: Humana Medicare |
$39.23
|
| Rate for Payer: Lucent All Commercial |
$39.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$57.70
|
| Rate for Payer: PHP All Commercial |
$58.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.00
|
| Rate for Payer: Sagamore Health Network All Products |
$59.39
|
| Rate for Payer: Signature Care EPO |
$63.85
|
| Rate for Payer: Signature Care PPO |
$67.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.39
|
| Rate for Payer: United Healthcare Commercial |
$60.62
|
| Rate for Payer: United Healthcare Medicare |
$25.39
|
|
|
HC CATH TIEMANN/COUDE 14FR
|
Facility
IP
|
$76.93
|
|
| Hospital Charge Code |
41601024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.70 |
| Max. Negotiated Rate |
$71.54 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna All Commercial |
$66.39
|
| Rate for Payer: CORVEL All Commercial |
$71.54
|
| Rate for Payer: Coventry All Commercial |
$67.70
|
| Rate for Payer: Encore All Commercial |
$70.81
|
| Rate for Payer: Frontpath All Commercial |
$70.78
|
| Rate for Payer: Humana ChoiceCare |
$66.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.24
|
| Rate for Payer: PHCS All Commercial |
$57.70
|
| Rate for Payer: PHP All Commercial |
$58.34
|
| Rate for Payer: Sagamore Health Network All Products |
$59.39
|
| Rate for Payer: Signature Care EPO |
$63.85
|
| Rate for Payer: Signature Care PPO |
$67.70
|
| Rate for Payer: United Healthcare Commercial |
$60.62
|
|
|
HC CATH TIEMANN/COUDE 16FR
|
Facility
IP
|
$76.93
|
|
| Hospital Charge Code |
41601025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.70 |
| Max. Negotiated Rate |
$71.54 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna All Commercial |
$66.39
|
| Rate for Payer: CORVEL All Commercial |
$71.54
|
| Rate for Payer: Coventry All Commercial |
$67.70
|
| Rate for Payer: Encore All Commercial |
$70.81
|
| Rate for Payer: Frontpath All Commercial |
$70.78
|
| Rate for Payer: Humana ChoiceCare |
$66.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.24
|
| Rate for Payer: PHCS All Commercial |
$57.70
|
| Rate for Payer: PHP All Commercial |
$58.34
|
| Rate for Payer: Sagamore Health Network All Products |
$59.39
|
| Rate for Payer: Signature Care EPO |
$63.85
|
| Rate for Payer: Signature Care PPO |
$67.70
|
| Rate for Payer: United Healthcare Commercial |
$60.62
|
|
|
HC CATH TIEMANN/COUDE 16FR
|
Facility
OP
|
$76.93
|
|
| Hospital Charge Code |
41601025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$64.93
|
| Rate for Payer: Aetna Medicare |
$25.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.93
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Centivo All Commercial |
$39.23
|
| Rate for Payer: Cigna All Commercial |
$66.39
|
| Rate for Payer: CORVEL All Commercial |
$71.54
|
| Rate for Payer: Coventry All Commercial |
$67.70
|
| Rate for Payer: Encore All Commercial |
$70.81
|
| Rate for Payer: Frontpath All Commercial |
$70.78
|
| Rate for Payer: Humana ChoiceCare |
$66.44
|
| Rate for Payer: Humana Medicare |
$39.23
|
| Rate for Payer: Lucent All Commercial |
$39.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$57.70
|
| Rate for Payer: PHP All Commercial |
$58.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.00
|
| Rate for Payer: Sagamore Health Network All Products |
$59.39
|
| Rate for Payer: Signature Care EPO |
$63.85
|
| Rate for Payer: Signature Care PPO |
$67.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.39
|
| Rate for Payer: United Healthcare Commercial |
$60.62
|
| Rate for Payer: United Healthcare Medicare |
$25.39
|
|
|
HC CATH TIEMANN/COUDE 18FR
|
Facility
OP
|
$76.93
|
|
| Hospital Charge Code |
41601026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$64.93
|
| Rate for Payer: Aetna Medicare |
$25.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.93
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Centivo All Commercial |
$39.23
|
| Rate for Payer: Cigna All Commercial |
$66.39
|
| Rate for Payer: CORVEL All Commercial |
$71.54
|
| Rate for Payer: Coventry All Commercial |
$67.70
|
| Rate for Payer: Encore All Commercial |
$70.81
|
| Rate for Payer: Frontpath All Commercial |
$70.78
|
| Rate for Payer: Humana ChoiceCare |
$66.44
|
| Rate for Payer: Humana Medicare |
$39.23
|
| Rate for Payer: Lucent All Commercial |
$39.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$57.70
|
| Rate for Payer: PHP All Commercial |
$58.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.00
|
| Rate for Payer: Sagamore Health Network All Products |
$59.39
|
| Rate for Payer: Signature Care EPO |
$63.85
|
| Rate for Payer: Signature Care PPO |
$67.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.39
|
| Rate for Payer: United Healthcare Commercial |
$60.62
|
| Rate for Payer: United Healthcare Medicare |
$25.39
|
|
|
HC CATH TIEMANN/COUDE 18FR
|
Facility
IP
|
$76.93
|
|
| Hospital Charge Code |
41601026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.70 |
| Max. Negotiated Rate |
$71.54 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna All Commercial |
$66.39
|
| Rate for Payer: CORVEL All Commercial |
$71.54
|
| Rate for Payer: Coventry All Commercial |
$67.70
|
| Rate for Payer: Encore All Commercial |
$70.81
|
| Rate for Payer: Frontpath All Commercial |
$70.78
|
| Rate for Payer: Humana ChoiceCare |
$66.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.24
|
| Rate for Payer: PHCS All Commercial |
$57.70
|
| Rate for Payer: PHP All Commercial |
$58.34
|
| Rate for Payer: Sagamore Health Network All Products |
$59.39
|
| Rate for Payer: Signature Care EPO |
$63.85
|
| Rate for Payer: Signature Care PPO |
$67.70
|
| Rate for Payer: United Healthcare Commercial |
$60.62
|
|
|
HC CATH TIEMANN/COUDE 20FR
|
Facility
IP
|
$76.93
|
|
| Hospital Charge Code |
41601027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.70 |
| Max. Negotiated Rate |
$71.54 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna All Commercial |
$66.39
|
| Rate for Payer: CORVEL All Commercial |
$71.54
|
| Rate for Payer: Coventry All Commercial |
$67.70
|
| Rate for Payer: Encore All Commercial |
$70.81
|
| Rate for Payer: Frontpath All Commercial |
$70.78
|
| Rate for Payer: Humana ChoiceCare |
$66.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.24
|
| Rate for Payer: PHCS All Commercial |
$57.70
|
| Rate for Payer: PHP All Commercial |
$58.34
|
| Rate for Payer: Sagamore Health Network All Products |
$59.39
|
| Rate for Payer: Signature Care EPO |
$63.85
|
| Rate for Payer: Signature Care PPO |
$67.70
|
| Rate for Payer: United Healthcare Commercial |
$60.62
|
|
|
HC CATH TIEMANN/COUDE 20FR
|
Facility
OP
|
$76.93
|
|
| Hospital Charge Code |
41601027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$64.93
|
| Rate for Payer: Aetna Medicare |
$25.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.93
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Centivo All Commercial |
$39.23
|
| Rate for Payer: Cigna All Commercial |
$66.39
|
| Rate for Payer: CORVEL All Commercial |
$71.54
|
| Rate for Payer: Coventry All Commercial |
$67.70
|
| Rate for Payer: Encore All Commercial |
$70.81
|
| Rate for Payer: Frontpath All Commercial |
$70.78
|
| Rate for Payer: Humana ChoiceCare |
$66.44
|
| Rate for Payer: Humana Medicare |
$39.23
|
| Rate for Payer: Lucent All Commercial |
$39.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$57.70
|
| Rate for Payer: PHP All Commercial |
$58.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.00
|
| Rate for Payer: Sagamore Health Network All Products |
$59.39
|
| Rate for Payer: Signature Care EPO |
$63.85
|
| Rate for Payer: Signature Care PPO |
$67.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.39
|
| Rate for Payer: United Healthcare Commercial |
$60.62
|
| Rate for Payer: United Healthcare Medicare |
$25.39
|
|
|
HC CATH TIPLESS BALLOON 6FR
|
Facility
OP
|
$751.75
|
|
| Hospital Charge Code |
41602263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$699.13 |
| Rate for Payer: Aetna Commercial |
$634.48
|
| Rate for Payer: Aetna Medicare |
$248.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$248.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$431.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$469.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$285.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$272.89
|
| Rate for Payer: Cash Price |
$466.09
|
| Rate for Payer: Cash Price |
$466.09
|
| Rate for Payer: Centivo All Commercial |
$383.39
|
| Rate for Payer: Cigna All Commercial |
$648.76
|
| Rate for Payer: CORVEL All Commercial |
$699.13
|
| Rate for Payer: Coventry All Commercial |
$661.54
|
| Rate for Payer: Encore All Commercial |
$691.99
|
| Rate for Payer: Frontpath All Commercial |
$691.61
|
| Rate for Payer: Humana ChoiceCare |
$649.29
|
| Rate for Payer: Humana Medicare |
$383.39
|
| Rate for Payer: Lucent All Commercial |
$383.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$676.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$563.81
|
| Rate for Payer: PHP All Commercial |
$570.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$293.18
|
| Rate for Payer: Sagamore Health Network All Products |
$580.35
|
| Rate for Payer: Signature Care EPO |
$623.95
|
| Rate for Payer: Signature Care PPO |
$661.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$638.99
|
| Rate for Payer: United Healthcare Commercial |
$592.38
|
| Rate for Payer: United Healthcare Medicare |
$248.08
|
|
|
HC CATH TIPLESS BALLOON 6FR
|
Facility
IP
|
$751.75
|
|
| Hospital Charge Code |
41602263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$563.81 |
| Max. Negotiated Rate |
$699.13 |
| Rate for Payer: Aetna Commercial |
$649.51
|
| Rate for Payer: Cash Price |
$466.09
|
| Rate for Payer: Cigna All Commercial |
$648.76
|
| Rate for Payer: CORVEL All Commercial |
$699.13
|
| Rate for Payer: Coventry All Commercial |
$661.54
|
| Rate for Payer: Encore All Commercial |
$691.99
|
| Rate for Payer: Frontpath All Commercial |
$691.61
|
| Rate for Payer: Humana ChoiceCare |
$649.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$676.58
|
| Rate for Payer: PHCS All Commercial |
$563.81
|
| Rate for Payer: PHP All Commercial |
$570.13
|
| Rate for Payer: Sagamore Health Network All Products |
$580.35
|
| Rate for Payer: Signature Care EPO |
$623.95
|
| Rate for Payer: Signature Care PPO |
$661.54
|
| Rate for Payer: United Healthcare Commercial |
$592.38
|
|
|
HC CATH TRAY FOLEY 14FR
|
Facility
OP
|
$88.92
|
|
| Hospital Charge Code |
41601028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.34 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Medicare |
$29.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.28
|
| Rate for Payer: Cash Price |
$55.13
|
| Rate for Payer: Cash Price |
$55.13
|
| Rate for Payer: Centivo All Commercial |
$45.35
|
| Rate for Payer: Cigna All Commercial |
$76.74
|
| Rate for Payer: CORVEL All Commercial |
$82.70
|
| Rate for Payer: Coventry All Commercial |
$78.25
|
| Rate for Payer: Encore All Commercial |
$81.85
|
| Rate for Payer: Frontpath All Commercial |
$81.81
|
| Rate for Payer: Humana ChoiceCare |
$76.80
|
| Rate for Payer: Humana Medicare |
$45.35
|
| Rate for Payer: Lucent All Commercial |
$45.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$66.69
|
| Rate for Payer: PHP All Commercial |
$67.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.68
|
| Rate for Payer: Sagamore Health Network All Products |
$68.65
|
| Rate for Payer: Signature Care EPO |
$73.80
|
| Rate for Payer: Signature Care PPO |
$78.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75.58
|
| Rate for Payer: United Healthcare Commercial |
$70.07
|
| Rate for Payer: United Healthcare Medicare |
$29.34
|
|
