|
HC CATH TRAY FOLEY 14FR
|
Facility
IP
|
$88.92
|
|
| Hospital Charge Code |
41601028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$82.70 |
| Rate for Payer: Aetna Commercial |
$76.83
|
| Rate for Payer: Cash Price |
$55.13
|
| 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: Lutheran Preferred All Commercial |
$80.03
|
| Rate for Payer: PHCS All Commercial |
$66.69
|
| Rate for Payer: PHP All Commercial |
$67.44
|
| 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: United Healthcare Commercial |
$70.07
|
|
|
HC CATH TRAY FOLEY 16FR
|
Facility
OP
|
$129.07
|
|
| Hospital Charge Code |
41601029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$108.94
|
| Rate for Payer: Aetna Medicare |
$42.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$74.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.85
|
| Rate for Payer: Cash Price |
$80.02
|
| Rate for Payer: Cash Price |
$80.02
|
| Rate for Payer: Centivo All Commercial |
$65.83
|
| Rate for Payer: Cigna All Commercial |
$111.39
|
| Rate for Payer: CORVEL All Commercial |
$120.04
|
| Rate for Payer: Coventry All Commercial |
$113.58
|
| Rate for Payer: Encore All Commercial |
$118.81
|
| Rate for Payer: Frontpath All Commercial |
$118.74
|
| Rate for Payer: Humana ChoiceCare |
$111.48
|
| Rate for Payer: Humana Medicare |
$65.83
|
| Rate for Payer: Lucent All Commercial |
$65.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.16
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$96.80
|
| Rate for Payer: PHP All Commercial |
$97.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.34
|
| Rate for Payer: Sagamore Health Network All Products |
$99.64
|
| Rate for Payer: Signature Care EPO |
$107.13
|
| Rate for Payer: Signature Care PPO |
$113.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109.71
|
| Rate for Payer: United Healthcare Commercial |
$101.71
|
| Rate for Payer: United Healthcare Medicare |
$42.59
|
|
|
HC CATH TRAY FOLEY 16FR
|
Facility
IP
|
$129.07
|
|
| Hospital Charge Code |
41601029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$120.04 |
| Rate for Payer: Aetna Commercial |
$111.52
|
| Rate for Payer: Cash Price |
$80.02
|
| Rate for Payer: Cigna All Commercial |
$111.39
|
| Rate for Payer: CORVEL All Commercial |
$120.04
|
| Rate for Payer: Coventry All Commercial |
$113.58
|
| Rate for Payer: Encore All Commercial |
$118.81
|
| Rate for Payer: Frontpath All Commercial |
$118.74
|
| Rate for Payer: Humana ChoiceCare |
$111.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.16
|
| Rate for Payer: PHCS All Commercial |
$96.80
|
| Rate for Payer: PHP All Commercial |
$97.89
|
| Rate for Payer: Sagamore Health Network All Products |
$99.64
|
| Rate for Payer: Signature Care EPO |
$107.13
|
| Rate for Payer: Signature Care PPO |
$113.58
|
| Rate for Payer: United Healthcare Commercial |
$101.71
|
|
|
HC CATH TRAY URETHRAL 14FR
|
Facility
OP
|
$19.13
|
|
| Hospital Charge Code |
41601030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Medicare |
$6.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.94
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Centivo All Commercial |
$9.76
|
| Rate for Payer: Cigna All Commercial |
$16.51
|
| Rate for Payer: CORVEL All Commercial |
$17.79
|
| Rate for Payer: Coventry All Commercial |
$16.83
|
| Rate for Payer: Encore All Commercial |
$17.61
|
| Rate for Payer: Frontpath All Commercial |
$17.60
|
| Rate for Payer: Humana ChoiceCare |
$16.52
|
| Rate for Payer: Humana Medicare |
$9.76
|
| Rate for Payer: Lucent All Commercial |
$9.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.35
|
| Rate for Payer: PHP All Commercial |
$14.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.46
|
| Rate for Payer: Sagamore Health Network All Products |
$14.77
|
| Rate for Payer: Signature Care EPO |
$15.88
|
| Rate for Payer: Signature Care PPO |
$16.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$15.07
|
| Rate for Payer: United Healthcare Medicare |
$6.31
|
|
|
HC CATH TRAY URETHRAL 14FR
|
Facility
IP
|
$19.13
|
|
| Hospital Charge Code |
41601030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.53
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Cigna All Commercial |
$16.51
|
| Rate for Payer: CORVEL All Commercial |
$17.79
|
| Rate for Payer: Coventry All Commercial |
$16.83
|
| Rate for Payer: Encore All Commercial |
$17.61
|
| Rate for Payer: Frontpath All Commercial |
$17.60
|
| Rate for Payer: Humana ChoiceCare |
$16.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.22
|
| Rate for Payer: PHCS All Commercial |
$14.35
|
| Rate for Payer: PHP All Commercial |
$14.51
|
| Rate for Payer: Sagamore Health Network All Products |
$14.77
|
| Rate for Payer: Signature Care EPO |
$15.88
|
| Rate for Payer: Signature Care PPO |
$16.83
|
| Rate for Payer: United Healthcare Commercial |
$15.07
|
|
|
HC CATH TROCAR 16FR
|
Facility
OP
|
$131.41
|
|
| Hospital Charge Code |
41601424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.37 |
| Max. Negotiated Rate |
$122.21 |
| Rate for Payer: Aetna Commercial |
$110.91
|
| Rate for Payer: Aetna Medicare |
$43.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.70
|
| Rate for Payer: Cash Price |
$81.47
|
| Rate for Payer: Cash Price |
$81.47
|
| Rate for Payer: Centivo All Commercial |
$67.02
|
| Rate for Payer: Cigna All Commercial |
$113.41
|
| Rate for Payer: CORVEL All Commercial |
$122.21
|
| Rate for Payer: Coventry All Commercial |
$115.64
|
| Rate for Payer: Encore All Commercial |
$120.96
|
| Rate for Payer: Frontpath All Commercial |
$120.90
|
| Rate for Payer: Humana ChoiceCare |
$113.50
|
| Rate for Payer: Humana Medicare |
$67.02
|
| Rate for Payer: Lucent All Commercial |
$67.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$98.56
|
| Rate for Payer: PHP All Commercial |
$99.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.25
|
| Rate for Payer: Sagamore Health Network All Products |
$101.45
|
| Rate for Payer: Signature Care EPO |
$109.07
|
| Rate for Payer: Signature Care PPO |
$115.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.70
|
| Rate for Payer: United Healthcare Commercial |
$103.55
|
| Rate for Payer: United Healthcare Medicare |
$43.37
|
|
|
HC CATH TROCAR 16FR
|
Facility
IP
|
$131.41
|
|
| Hospital Charge Code |
41601424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.56 |
| Max. Negotiated Rate |
$122.21 |
| Rate for Payer: Aetna Commercial |
$113.54
|
| Rate for Payer: Cash Price |
$81.47
|
| Rate for Payer: Cigna All Commercial |
$113.41
|
| Rate for Payer: CORVEL All Commercial |
$122.21
|
| Rate for Payer: Coventry All Commercial |
$115.64
|
| Rate for Payer: Encore All Commercial |
$120.96
|
| Rate for Payer: Frontpath All Commercial |
$120.90
|
| Rate for Payer: Humana ChoiceCare |
$113.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.27
|
| Rate for Payer: PHCS All Commercial |
$98.56
|
| Rate for Payer: PHP All Commercial |
$99.66
|
| Rate for Payer: Sagamore Health Network All Products |
$101.45
|
| Rate for Payer: Signature Care EPO |
$109.07
|
| Rate for Payer: Signature Care PPO |
$115.64
|
| Rate for Payer: United Healthcare Commercial |
$103.55
|
|
|
HC CATH TROCAR 20FR
|
Facility
OP
|
$160.51
|
|
| Hospital Charge Code |
41601031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.97 |
| Max. Negotiated Rate |
$149.27 |
| Rate for Payer: Aetna Commercial |
$135.47
|
| Rate for Payer: Aetna Medicare |
$52.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.27
|
| Rate for Payer: Cash Price |
$99.52
|
| Rate for Payer: Cash Price |
$99.52
|
| Rate for Payer: Centivo All Commercial |
$81.86
|
| Rate for Payer: Cigna All Commercial |
$138.52
|
| Rate for Payer: CORVEL All Commercial |
$149.27
|
| Rate for Payer: Coventry All Commercial |
$141.25
|
| Rate for Payer: Encore All Commercial |
$147.75
|
| Rate for Payer: Frontpath All Commercial |
$147.67
|
| Rate for Payer: Humana ChoiceCare |
$138.63
|
| Rate for Payer: Humana Medicare |
$81.86
|
| Rate for Payer: Lucent All Commercial |
$81.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$120.38
|
| Rate for Payer: PHP All Commercial |
$121.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.60
|
| Rate for Payer: Sagamore Health Network All Products |
$123.91
|
| Rate for Payer: Signature Care EPO |
$133.22
|
| Rate for Payer: Signature Care PPO |
$141.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.43
|
| Rate for Payer: United Healthcare Commercial |
$126.48
|
| Rate for Payer: United Healthcare Medicare |
$52.97
|
|
|
HC CATH TROCAR 20FR
|
Facility
IP
|
$160.51
|
|
| Hospital Charge Code |
41601031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$149.27 |
| Rate for Payer: Aetna Commercial |
$138.68
|
| Rate for Payer: Cash Price |
$99.52
|
| Rate for Payer: Cigna All Commercial |
$138.52
|
| Rate for Payer: CORVEL All Commercial |
$149.27
|
| Rate for Payer: Coventry All Commercial |
$141.25
|
| Rate for Payer: Encore All Commercial |
$147.75
|
| Rate for Payer: Frontpath All Commercial |
$147.67
|
| Rate for Payer: Humana ChoiceCare |
$138.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.46
|
| Rate for Payer: PHCS All Commercial |
$120.38
|
| Rate for Payer: PHP All Commercial |
$121.73
|
| Rate for Payer: Sagamore Health Network All Products |
$123.91
|
| Rate for Payer: Signature Care EPO |
$133.22
|
| Rate for Payer: Signature Care PPO |
$141.25
|
| Rate for Payer: United Healthcare Commercial |
$126.48
|
|
|
HC CATH TROCAR 24FR
|
Facility
OP
|
$163.79
|
|
| Hospital Charge Code |
41601425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$152.32 |
| Rate for Payer: Aetna Commercial |
$138.24
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.46
|
| Rate for Payer: Cash Price |
$101.55
|
| Rate for Payer: Cash Price |
$101.55
|
| Rate for Payer: Centivo All Commercial |
$83.53
|
| Rate for Payer: Cigna All Commercial |
$141.35
|
| Rate for Payer: CORVEL All Commercial |
$152.32
|
| Rate for Payer: Coventry All Commercial |
$144.14
|
| Rate for Payer: Encore All Commercial |
$150.77
|
| Rate for Payer: Frontpath All Commercial |
$150.69
|
| Rate for Payer: Humana ChoiceCare |
$141.47
|
| Rate for Payer: Humana Medicare |
$83.53
|
| Rate for Payer: Lucent All Commercial |
$83.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.41
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$122.84
|
| Rate for Payer: PHP All Commercial |
$124.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.88
|
| Rate for Payer: Sagamore Health Network All Products |
$126.45
|
| Rate for Payer: Signature Care EPO |
$135.95
|
| Rate for Payer: Signature Care PPO |
$144.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.22
|
| Rate for Payer: United Healthcare Commercial |
$129.07
|
| Rate for Payer: United Healthcare Medicare |
$54.05
|
|
|
HC CATH TROCAR 24FR
|
Facility
IP
|
$163.79
|
|
| Hospital Charge Code |
41601425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.84 |
| Max. Negotiated Rate |
$152.32 |
| Rate for Payer: Aetna Commercial |
$141.51
|
| Rate for Payer: Cash Price |
$101.55
|
| Rate for Payer: Cigna All Commercial |
$141.35
|
| Rate for Payer: CORVEL All Commercial |
$152.32
|
| Rate for Payer: Coventry All Commercial |
$144.14
|
| Rate for Payer: Encore All Commercial |
$150.77
|
| Rate for Payer: Frontpath All Commercial |
$150.69
|
| Rate for Payer: Humana ChoiceCare |
$141.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.41
|
| Rate for Payer: PHCS All Commercial |
$122.84
|
| Rate for Payer: PHP All Commercial |
$124.22
|
| Rate for Payer: Sagamore Health Network All Products |
$126.45
|
| Rate for Payer: Signature Care EPO |
$135.95
|
| Rate for Payer: Signature Care PPO |
$144.14
|
| Rate for Payer: United Healthcare Commercial |
$129.07
|
|
|
HC CATH TROCAR 28FR
|
Facility
IP
|
$167.13
|
|
| Hospital Charge Code |
41601032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.35 |
| Max. Negotiated Rate |
$155.43 |
| Rate for Payer: Aetna Commercial |
$144.40
|
| Rate for Payer: Cash Price |
$103.62
|
| Rate for Payer: Cigna All Commercial |
$144.23
|
| Rate for Payer: CORVEL All Commercial |
$155.43
|
| Rate for Payer: Coventry All Commercial |
$147.07
|
| Rate for Payer: Encore All Commercial |
$153.84
|
| Rate for Payer: Frontpath All Commercial |
$153.76
|
| Rate for Payer: Humana ChoiceCare |
$144.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.42
|
| Rate for Payer: PHCS All Commercial |
$125.35
|
| Rate for Payer: PHP All Commercial |
$126.75
|
| Rate for Payer: Sagamore Health Network All Products |
$129.02
|
| Rate for Payer: Signature Care EPO |
$138.72
|
| Rate for Payer: Signature Care PPO |
$147.07
|
| Rate for Payer: United Healthcare Commercial |
$131.70
|
|
|
HC CATH TROCAR 28FR
|
Facility
OP
|
$167.13
|
|
| Hospital Charge Code |
41601032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.15 |
| Max. Negotiated Rate |
$155.43 |
| Rate for Payer: Aetna Commercial |
$141.06
|
| Rate for Payer: Aetna Medicare |
$55.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.67
|
| Rate for Payer: Cash Price |
$103.62
|
| Rate for Payer: Cash Price |
$103.62
|
| Rate for Payer: Centivo All Commercial |
$85.24
|
| Rate for Payer: Cigna All Commercial |
$144.23
|
| Rate for Payer: CORVEL All Commercial |
$155.43
|
| Rate for Payer: Coventry All Commercial |
$147.07
|
| Rate for Payer: Encore All Commercial |
$153.84
|
| Rate for Payer: Frontpath All Commercial |
$153.76
|
| Rate for Payer: Humana ChoiceCare |
$144.35
|
| Rate for Payer: Humana Medicare |
$85.24
|
| Rate for Payer: Lucent All Commercial |
$85.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.42
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$125.35
|
| Rate for Payer: PHP All Commercial |
$126.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.18
|
| Rate for Payer: Sagamore Health Network All Products |
$129.02
|
| Rate for Payer: Signature Care EPO |
$138.72
|
| Rate for Payer: Signature Care PPO |
$147.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.06
|
| Rate for Payer: United Healthcare Commercial |
$131.70
|
| Rate for Payer: United Healthcare Medicare |
$55.15
|
|
|
HC CATH TROCAR 32FR
|
Facility
IP
|
$170.46
|
|
| Hospital Charge Code |
41601033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$158.53 |
| Rate for Payer: Aetna Commercial |
$147.28
|
| Rate for Payer: Cash Price |
$105.69
|
| Rate for Payer: Cigna All Commercial |
$147.11
|
| Rate for Payer: CORVEL All Commercial |
$158.53
|
| Rate for Payer: Coventry All Commercial |
$150.00
|
| Rate for Payer: Encore All Commercial |
$156.91
|
| Rate for Payer: Frontpath All Commercial |
$156.82
|
| Rate for Payer: Humana ChoiceCare |
$147.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.41
|
| Rate for Payer: PHCS All Commercial |
$127.84
|
| Rate for Payer: PHP All Commercial |
$129.28
|
| Rate for Payer: Sagamore Health Network All Products |
$131.60
|
| Rate for Payer: Signature Care EPO |
$141.48
|
| Rate for Payer: Signature Care PPO |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$134.32
|
|
|
HC CATH TROCAR 32FR
|
Facility
OP
|
$170.46
|
|
| Hospital Charge Code |
41601033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$158.53 |
| Rate for Payer: Aetna Commercial |
$143.87
|
| Rate for Payer: Aetna Medicare |
$56.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.88
|
| Rate for Payer: Cash Price |
$105.69
|
| Rate for Payer: Cash Price |
$105.69
|
| Rate for Payer: Centivo All Commercial |
$86.93
|
| Rate for Payer: Cigna All Commercial |
$147.11
|
| Rate for Payer: CORVEL All Commercial |
$158.53
|
| Rate for Payer: Coventry All Commercial |
$150.00
|
| Rate for Payer: Encore All Commercial |
$156.91
|
| Rate for Payer: Frontpath All Commercial |
$156.82
|
| Rate for Payer: Humana ChoiceCare |
$147.23
|
| Rate for Payer: Humana Medicare |
$86.93
|
| Rate for Payer: Lucent All Commercial |
$86.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.41
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$127.84
|
| Rate for Payer: PHP All Commercial |
$129.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.48
|
| Rate for Payer: Sagamore Health Network All Products |
$131.60
|
| Rate for Payer: Signature Care EPO |
$141.48
|
| Rate for Payer: Signature Care PPO |
$150.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144.89
|
| Rate for Payer: United Healthcare Commercial |
$134.32
|
| Rate for Payer: United Healthcare Medicare |
$56.25
|
|
|
HC CATH UMBILICAL 3.5FR
|
Facility
IP
|
$109.54
|
|
| Hospital Charge Code |
41601455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$101.87 |
| Rate for Payer: Aetna Commercial |
$94.64
|
| Rate for Payer: Cash Price |
$67.92
|
| Rate for Payer: Cigna All Commercial |
$94.53
|
| Rate for Payer: CORVEL All Commercial |
$101.87
|
| Rate for Payer: Coventry All Commercial |
$96.40
|
| Rate for Payer: Encore All Commercial |
$100.83
|
| Rate for Payer: Frontpath All Commercial |
$100.78
|
| Rate for Payer: Humana ChoiceCare |
$94.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.59
|
| Rate for Payer: PHCS All Commercial |
$82.16
|
| Rate for Payer: PHP All Commercial |
$83.08
|
| Rate for Payer: Sagamore Health Network All Products |
$84.56
|
| Rate for Payer: Signature Care EPO |
$90.92
|
| Rate for Payer: Signature Care PPO |
$96.40
|
| Rate for Payer: United Healthcare Commercial |
$86.32
|
|
|
HC CATH UMBILICAL 3.5FR
|
Facility
OP
|
$109.54
|
|
| Hospital Charge Code |
41601455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$92.45
|
| Rate for Payer: Aetna Medicare |
$36.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.76
|
| Rate for Payer: Cash Price |
$67.92
|
| Rate for Payer: Cash Price |
$67.92
|
| Rate for Payer: Centivo All Commercial |
$55.87
|
| Rate for Payer: Cigna All Commercial |
$94.53
|
| Rate for Payer: CORVEL All Commercial |
$101.87
|
| Rate for Payer: Coventry All Commercial |
$96.40
|
| Rate for Payer: Encore All Commercial |
$100.83
|
| Rate for Payer: Frontpath All Commercial |
$100.78
|
| Rate for Payer: Humana ChoiceCare |
$94.61
|
| Rate for Payer: Humana Medicare |
$55.87
|
| Rate for Payer: Lucent All Commercial |
$55.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$82.16
|
| Rate for Payer: PHP All Commercial |
$83.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.72
|
| Rate for Payer: Sagamore Health Network All Products |
$84.56
|
| Rate for Payer: Signature Care EPO |
$90.92
|
| Rate for Payer: Signature Care PPO |
$96.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.11
|
| Rate for Payer: United Healthcare Commercial |
$86.32
|
| Rate for Payer: United Healthcare Medicare |
$36.15
|
|
|
HC CATH URETER CONE 8.0FR/4.8 FR
|
Facility
OP
|
$86.45
|
|
| Hospital Charge Code |
41602485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna Medicare |
$28.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.38
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Centivo All Commercial |
$44.09
|
| Rate for Payer: Cigna All Commercial |
$74.61
|
| Rate for Payer: CORVEL All Commercial |
$80.40
|
| Rate for Payer: Coventry All Commercial |
$76.08
|
| Rate for Payer: Encore All Commercial |
$79.58
|
| Rate for Payer: Frontpath All Commercial |
$79.53
|
| Rate for Payer: Humana ChoiceCare |
$74.67
|
| Rate for Payer: Humana Medicare |
$44.09
|
| Rate for Payer: Lucent All Commercial |
$44.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$64.84
|
| Rate for Payer: PHP All Commercial |
$65.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.72
|
| Rate for Payer: Sagamore Health Network All Products |
$66.74
|
| Rate for Payer: Signature Care EPO |
$71.75
|
| Rate for Payer: Signature Care PPO |
$76.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.48
|
| Rate for Payer: United Healthcare Commercial |
$68.12
|
| Rate for Payer: United Healthcare Medicare |
$28.53
|
|
|
HC CATH URETER CONE 8.0FR/4.8 FR
|
Facility
IP
|
$86.45
|
|
| Hospital Charge Code |
41602485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.84 |
| Max. Negotiated Rate |
$80.40 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cigna All Commercial |
$74.61
|
| Rate for Payer: CORVEL All Commercial |
$80.40
|
| Rate for Payer: Coventry All Commercial |
$76.08
|
| Rate for Payer: Encore All Commercial |
$79.58
|
| Rate for Payer: Frontpath All Commercial |
$79.53
|
| Rate for Payer: Humana ChoiceCare |
$74.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.80
|
| Rate for Payer: PHCS All Commercial |
$64.84
|
| Rate for Payer: PHP All Commercial |
$65.56
|
| Rate for Payer: Sagamore Health Network All Products |
$66.74
|
| Rate for Payer: Signature Care EPO |
$71.75
|
| Rate for Payer: Signature Care PPO |
$76.08
|
| Rate for Payer: United Healthcare Commercial |
$68.12
|
|
|
HC CATH URETER HEAD HUNTER MIN 5
|
Facility
OP
|
$186.20
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
41602266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$173.17 |
| Rate for Payer: Aetna Commercial |
$157.15
|
| Rate for Payer: Aetna Medicare |
$61.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$116.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.59
|
| Rate for Payer: Cash Price |
$115.44
|
| Rate for Payer: Cash Price |
$115.44
|
| Rate for Payer: Centivo All Commercial |
$94.96
|
| Rate for Payer: Cigna All Commercial |
$160.69
|
| Rate for Payer: CORVEL All Commercial |
$173.17
|
| Rate for Payer: Coventry All Commercial |
$163.86
|
| Rate for Payer: Encore All Commercial |
$171.40
|
| Rate for Payer: Frontpath All Commercial |
$171.30
|
| Rate for Payer: Humana ChoiceCare |
$160.82
|
| Rate for Payer: Humana Medicare |
$94.96
|
| Rate for Payer: Lucent All Commercial |
$94.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$139.65
|
| Rate for Payer: PHP All Commercial |
$141.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.62
|
| Rate for Payer: Sagamore Health Network All Products |
$143.75
|
| Rate for Payer: Signature Care EPO |
$154.55
|
| Rate for Payer: Signature Care PPO |
$163.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158.27
|
| Rate for Payer: United Healthcare Commercial |
$146.73
|
| Rate for Payer: United Healthcare Medicare |
$61.45
|
|
|
HC CATH URETER HEAD HUNTER MIN 5
|
Facility
IP
|
$186.20
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
41602266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$173.17 |
| Rate for Payer: Aetna Commercial |
$160.88
|
| Rate for Payer: Cash Price |
$115.44
|
| Rate for Payer: Cigna All Commercial |
$160.69
|
| Rate for Payer: CORVEL All Commercial |
$173.17
|
| Rate for Payer: Coventry All Commercial |
$163.86
|
| Rate for Payer: Encore All Commercial |
$171.40
|
| Rate for Payer: Frontpath All Commercial |
$171.30
|
| Rate for Payer: Humana ChoiceCare |
$160.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.58
|
| Rate for Payer: PHCS All Commercial |
$139.65
|
| Rate for Payer: PHP All Commercial |
$141.21
|
| Rate for Payer: Sagamore Health Network All Products |
$143.75
|
| Rate for Payer: Signature Care EPO |
$154.55
|
| Rate for Payer: Signature Care PPO |
$163.86
|
| Rate for Payer: United Healthcare Commercial |
$146.73
|
|
|
HC CATH URETER OPEN END 5 FR
|
Facility
IP
|
$73.15
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
41601838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.86 |
| Max. Negotiated Rate |
$68.03 |
| Rate for Payer: Aetna Commercial |
$63.20
|
| Rate for Payer: Cash Price |
$45.35
|
| Rate for Payer: Cigna All Commercial |
$63.13
|
| Rate for Payer: CORVEL All Commercial |
$68.03
|
| Rate for Payer: Coventry All Commercial |
$64.37
|
| Rate for Payer: Encore All Commercial |
$67.33
|
| Rate for Payer: Frontpath All Commercial |
$67.30
|
| Rate for Payer: Humana ChoiceCare |
$63.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.84
|
| Rate for Payer: PHCS All Commercial |
$54.86
|
| Rate for Payer: PHP All Commercial |
$55.48
|
| Rate for Payer: Sagamore Health Network All Products |
$56.47
|
| Rate for Payer: Signature Care EPO |
$60.71
|
| Rate for Payer: Signature Care PPO |
$64.37
|
| Rate for Payer: United Healthcare Commercial |
$57.64
|
|
|
HC CATH URETER OPEN END 5 FR
|
Facility
OP
|
$73.15
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
41601838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$61.74
|
| Rate for Payer: Aetna Medicare |
$24.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.55
|
| Rate for Payer: Cash Price |
$45.35
|
| Rate for Payer: Cash Price |
$45.35
|
| Rate for Payer: Centivo All Commercial |
$37.31
|
| Rate for Payer: Cigna All Commercial |
$63.13
|
| Rate for Payer: CORVEL All Commercial |
$68.03
|
| Rate for Payer: Coventry All Commercial |
$64.37
|
| Rate for Payer: Encore All Commercial |
$67.33
|
| Rate for Payer: Frontpath All Commercial |
$67.30
|
| Rate for Payer: Humana ChoiceCare |
$63.18
|
| Rate for Payer: Humana Medicare |
$37.31
|
| Rate for Payer: Lucent All Commercial |
$37.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$54.86
|
| Rate for Payer: PHP All Commercial |
$55.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.53
|
| Rate for Payer: Sagamore Health Network All Products |
$56.47
|
| Rate for Payer: Signature Care EPO |
$60.71
|
| Rate for Payer: Signature Care PPO |
$64.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.18
|
| Rate for Payer: United Healthcare Commercial |
$57.64
|
| Rate for Payer: United Healthcare Medicare |
$24.14
|
|
|
HC CATH URETER OPEN END 6FR
|
Facility
IP
|
$73.15
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
41602267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.86 |
| Max. Negotiated Rate |
$68.03 |
| Rate for Payer: Aetna Commercial |
$63.20
|
| Rate for Payer: Cash Price |
$45.35
|
| Rate for Payer: Cigna All Commercial |
$63.13
|
| Rate for Payer: CORVEL All Commercial |
$68.03
|
| Rate for Payer: Coventry All Commercial |
$64.37
|
| Rate for Payer: Encore All Commercial |
$67.33
|
| Rate for Payer: Frontpath All Commercial |
$67.30
|
| Rate for Payer: Humana ChoiceCare |
$63.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.84
|
| Rate for Payer: PHCS All Commercial |
$54.86
|
| Rate for Payer: PHP All Commercial |
$55.48
|
| Rate for Payer: Sagamore Health Network All Products |
$56.47
|
| Rate for Payer: Signature Care EPO |
$60.71
|
| Rate for Payer: Signature Care PPO |
$64.37
|
| Rate for Payer: United Healthcare Commercial |
$57.64
|
|
|
HC CATH URETER OPEN END 6FR
|
Facility
OP
|
$73.15
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
41602267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$61.74
|
| Rate for Payer: Aetna Medicare |
$24.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.55
|
| Rate for Payer: Cash Price |
$45.35
|
| Rate for Payer: Cash Price |
$45.35
|
| Rate for Payer: Centivo All Commercial |
$37.31
|
| Rate for Payer: Cigna All Commercial |
$63.13
|
| Rate for Payer: CORVEL All Commercial |
$68.03
|
| Rate for Payer: Coventry All Commercial |
$64.37
|
| Rate for Payer: Encore All Commercial |
$67.33
|
| Rate for Payer: Frontpath All Commercial |
$67.30
|
| Rate for Payer: Humana ChoiceCare |
$63.18
|
| Rate for Payer: Humana Medicare |
$37.31
|
| Rate for Payer: Lucent All Commercial |
$37.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$54.86
|
| Rate for Payer: PHP All Commercial |
$55.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.53
|
| Rate for Payer: Sagamore Health Network All Products |
$56.47
|
| Rate for Payer: Signature Care EPO |
$60.71
|
| Rate for Payer: Signature Care PPO |
$64.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.18
|
| Rate for Payer: United Healthcare Commercial |
$57.64
|
| Rate for Payer: United Healthcare Medicare |
$24.14
|
|
