HC CATH URETER SPIRAL 5FR
|
Facility
OP
|
$88.27
|
|
Service Code
|
CPT C1758
|
Hospital Charge Code |
41602268
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$29.13 |
Max. Negotiated Rate |
$121.68 |
Rate for Payer: Aetna Commercial |
$74.50
|
Rate for Payer: Aetna Medicare |
$29.13
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.13
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.69
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.18
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.50
|
Rate for Payer: CareSource Indiana of IN Medicare |
$32.04
|
Rate for Payer: Cash Price |
$54.73
|
Rate for Payer: Cash Price |
$54.73
|
Rate for Payer: Centivo All Commercial |
$45.02
|
Rate for Payer: Cigna All Commercial |
$76.18
|
Rate for Payer: CORVEL All Commercial |
$82.09
|
Rate for Payer: Coventry All Commercial |
$77.68
|
Rate for Payer: Encore All Commercial |
$81.25
|
Rate for Payer: Frontpath All Commercial |
$81.21
|
Rate for Payer: Humana ChoiceCare |
$76.24
|
Rate for Payer: Humana Medicare |
$45.02
|
Rate for Payer: Lucent All Commercial |
$45.02
|
Rate for Payer: Lutheran Preferred All Commercial |
$79.44
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$66.20
|
Rate for Payer: PHP All Commercial |
$66.94
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$34.43
|
Rate for Payer: Sagamore Health Network All Products |
$68.14
|
Rate for Payer: Signature Care EPO |
$73.26
|
Rate for Payer: Signature Care PPO |
$77.68
|
Rate for Payer: Three Rivers Preferred All Commercial |
$75.03
|
Rate for Payer: United Healthcare Commercial |
$69.56
|
Rate for Payer: United Healthcare Medicare |
$29.13
|
|
HC CATH URETER SPIRAL 5FR
|
Facility
IP
|
$88.27
|
|
Service Code
|
CPT C1758
|
Hospital Charge Code |
41602268
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$66.20 |
Max. Negotiated Rate |
$82.09 |
Rate for Payer: Aetna Commercial |
$76.27
|
Rate for Payer: Cash Price |
$54.73
|
Rate for Payer: Cigna All Commercial |
$76.18
|
Rate for Payer: CORVEL All Commercial |
$82.09
|
Rate for Payer: Coventry All Commercial |
$77.68
|
Rate for Payer: Encore All Commercial |
$81.25
|
Rate for Payer: Frontpath All Commercial |
$81.21
|
Rate for Payer: Humana ChoiceCare |
$76.24
|
Rate for Payer: Lutheran Preferred All Commercial |
$79.44
|
Rate for Payer: PHCS All Commercial |
$66.20
|
Rate for Payer: PHP All Commercial |
$66.94
|
Rate for Payer: Sagamore Health Network All Products |
$68.14
|
Rate for Payer: Signature Care EPO |
$73.26
|
Rate for Payer: Signature Care PPO |
$77.68
|
Rate for Payer: United Healthcare Commercial |
$69.56
|
|
HC CATH URETER WHISTEL 5FR
|
Facility
OP
|
$402.78
|
|
Service Code
|
CPT C1758
|
Hospital Charge Code |
41602484
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$121.68 |
Max. Negotiated Rate |
$374.59 |
Rate for Payer: Aetna Commercial |
$339.95
|
Rate for Payer: Aetna Medicare |
$132.92
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.92
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$231.32
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$251.78
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.86
|
Rate for Payer: CareSource Indiana of IN Medicare |
$146.21
|
Rate for Payer: Cash Price |
$249.72
|
Rate for Payer: Cash Price |
$249.72
|
Rate for Payer: Centivo All Commercial |
$205.42
|
Rate for Payer: Cigna All Commercial |
$347.60
|
Rate for Payer: CORVEL All Commercial |
$374.59
|
Rate for Payer: Coventry All Commercial |
$354.45
|
Rate for Payer: Encore All Commercial |
$370.76
|
Rate for Payer: Frontpath All Commercial |
$370.56
|
Rate for Payer: Humana ChoiceCare |
$347.88
|
Rate for Payer: Humana Medicare |
$205.42
|
Rate for Payer: Lucent All Commercial |
$205.42
|
Rate for Payer: Lutheran Preferred All Commercial |
$362.50
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$302.08
|
Rate for Payer: PHP All Commercial |
$305.47
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$157.08
|
Rate for Payer: Sagamore Health Network All Products |
$310.95
|
Rate for Payer: Signature Care EPO |
$334.31
|
Rate for Payer: Signature Care PPO |
$354.45
|
Rate for Payer: Three Rivers Preferred All Commercial |
$342.36
|
Rate for Payer: United Healthcare Commercial |
$317.39
|
Rate for Payer: United Healthcare Medicare |
$132.92
|
|
HC CATH URETER WHISTEL 5FR
|
Facility
IP
|
$402.78
|
|
Service Code
|
CPT C1758
|
Hospital Charge Code |
41602484
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$302.08 |
Max. Negotiated Rate |
$374.59 |
Rate for Payer: Aetna Commercial |
$348.00
|
Rate for Payer: Cash Price |
$249.72
|
Rate for Payer: Cigna All Commercial |
$347.60
|
Rate for Payer: CORVEL All Commercial |
$374.59
|
Rate for Payer: Coventry All Commercial |
$354.45
|
Rate for Payer: Encore All Commercial |
$370.76
|
Rate for Payer: Frontpath All Commercial |
$370.56
|
Rate for Payer: Humana ChoiceCare |
$347.88
|
Rate for Payer: Lutheran Preferred All Commercial |
$362.50
|
Rate for Payer: PHCS All Commercial |
$302.08
|
Rate for Payer: PHP All Commercial |
$305.47
|
Rate for Payer: Sagamore Health Network All Products |
$310.95
|
Rate for Payer: Signature Care EPO |
$334.31
|
Rate for Payer: Signature Care PPO |
$354.45
|
Rate for Payer: United Healthcare Commercial |
$317.39
|
|
HC CATH UTERINE BALOON TC013
|
Facility
OP
|
$4,662.00
|
|
Hospital Charge Code |
41602336
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$121.68 |
Max. Negotiated Rate |
$4,335.66 |
Rate for Payer: Aetna Commercial |
$3,934.73
|
Rate for Payer: Aetna Medicare |
$1,538.46
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,538.46
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,677.39
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,914.22
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,769.23
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,692.31
|
Rate for Payer: Cash Price |
$2,890.44
|
Rate for Payer: Cash Price |
$2,890.44
|
Rate for Payer: Centivo All Commercial |
$2,377.62
|
Rate for Payer: Cigna All Commercial |
$4,023.31
|
Rate for Payer: CORVEL All Commercial |
$4,335.66
|
Rate for Payer: Coventry All Commercial |
$4,102.56
|
Rate for Payer: Encore All Commercial |
$4,291.37
|
Rate for Payer: Frontpath All Commercial |
$4,289.04
|
Rate for Payer: Humana ChoiceCare |
$4,026.57
|
Rate for Payer: Humana Medicare |
$2,377.62
|
Rate for Payer: Lucent All Commercial |
$2,377.62
|
Rate for Payer: Lutheran Preferred All Commercial |
$4,195.80
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$3,496.50
|
Rate for Payer: PHP All Commercial |
$3,535.66
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,818.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,599.06
|
Rate for Payer: Signature Care EPO |
$3,869.46
|
Rate for Payer: Signature Care PPO |
$4,102.56
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,962.70
|
Rate for Payer: United Healthcare Commercial |
$3,673.66
|
Rate for Payer: United Healthcare Medicare |
$1,538.46
|
|
HC CATH UTERINE BALOON TC013
|
Facility
IP
|
$4,662.00
|
|
Hospital Charge Code |
41602336
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$3,496.50 |
Max. Negotiated Rate |
$4,335.66 |
Rate for Payer: Aetna Commercial |
$4,027.97
|
Rate for Payer: Cash Price |
$2,890.44
|
Rate for Payer: Cigna All Commercial |
$4,023.31
|
Rate for Payer: CORVEL All Commercial |
$4,335.66
|
Rate for Payer: Coventry All Commercial |
$4,102.56
|
Rate for Payer: Encore All Commercial |
$4,291.37
|
Rate for Payer: Frontpath All Commercial |
$4,289.04
|
Rate for Payer: Humana ChoiceCare |
$4,026.57
|
Rate for Payer: Lutheran Preferred All Commercial |
$4,195.80
|
Rate for Payer: PHCS All Commercial |
$3,496.50
|
Rate for Payer: PHP All Commercial |
$3,535.66
|
Rate for Payer: Sagamore Health Network All Products |
$3,599.06
|
Rate for Payer: Signature Care EPO |
$3,869.46
|
Rate for Payer: Signature Care PPO |
$4,102.56
|
Rate for Payer: United Healthcare Commercial |
$3,673.66
|
|
HC CAT PROVISC
|
Facility
IP
|
$700.00
|
|
Hospital Charge Code |
41602067
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$525.00 |
Max. Negotiated Rate |
$651.00 |
Rate for Payer: Aetna Commercial |
$604.80
|
Rate for Payer: Cash Price |
$434.00
|
Rate for Payer: Cigna All Commercial |
$604.10
|
Rate for Payer: CORVEL All Commercial |
$651.00
|
Rate for Payer: Coventry All Commercial |
$616.00
|
Rate for Payer: Encore All Commercial |
$644.35
|
Rate for Payer: Frontpath All Commercial |
$644.00
|
Rate for Payer: Humana ChoiceCare |
$604.59
|
Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
Rate for Payer: PHCS All Commercial |
$525.00
|
Rate for Payer: PHP All Commercial |
$530.88
|
Rate for Payer: Sagamore Health Network All Products |
$540.40
|
Rate for Payer: Signature Care EPO |
$581.00
|
Rate for Payer: Signature Care PPO |
$616.00
|
Rate for Payer: United Healthcare Commercial |
$551.60
|
|
HC CAT PROVISC
|
Facility
OP
|
$700.00
|
|
Hospital Charge Code |
41602067
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$121.68 |
Max. Negotiated Rate |
$651.00 |
Rate for Payer: Aetna Commercial |
$590.80
|
Rate for Payer: Aetna Medicare |
$231.00
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.00
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$402.01
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.57
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.65
|
Rate for Payer: CareSource Indiana of IN Medicare |
$254.10
|
Rate for Payer: Cash Price |
$434.00
|
Rate for Payer: Cash Price |
$434.00
|
Rate for Payer: Centivo All Commercial |
$357.00
|
Rate for Payer: Cigna All Commercial |
$604.10
|
Rate for Payer: CORVEL All Commercial |
$651.00
|
Rate for Payer: Coventry All Commercial |
$616.00
|
Rate for Payer: Encore All Commercial |
$644.35
|
Rate for Payer: Frontpath All Commercial |
$644.00
|
Rate for Payer: Humana ChoiceCare |
$604.59
|
Rate for Payer: Humana Medicare |
$357.00
|
Rate for Payer: Lucent All Commercial |
$357.00
|
Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$525.00
|
Rate for Payer: PHP All Commercial |
$530.88
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$273.00
|
Rate for Payer: Sagamore Health Network All Products |
$540.40
|
Rate for Payer: Signature Care EPO |
$581.00
|
Rate for Payer: Signature Care PPO |
$616.00
|
Rate for Payer: Three Rivers Preferred All Commercial |
$595.00
|
Rate for Payer: United Healthcare Commercial |
$551.60
|
Rate for Payer: United Healthcare Medicare |
$231.00
|
|
HC CAT PUPIL EXPANDER / MALYUGIN RING 6.25
|
Facility
IP
|
$962.50
|
|
Hospital Charge Code |
41602072
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$721.88 |
Max. Negotiated Rate |
$895.12 |
Rate for Payer: Aetna Commercial |
$831.60
|
Rate for Payer: Cash Price |
$596.75
|
Rate for Payer: Cigna All Commercial |
$830.64
|
Rate for Payer: CORVEL All Commercial |
$895.12
|
Rate for Payer: Coventry All Commercial |
$847.00
|
Rate for Payer: Encore All Commercial |
$885.98
|
Rate for Payer: Frontpath All Commercial |
$885.50
|
Rate for Payer: Humana ChoiceCare |
$831.31
|
Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
Rate for Payer: PHCS All Commercial |
$721.88
|
Rate for Payer: PHP All Commercial |
$729.96
|
Rate for Payer: Sagamore Health Network All Products |
$743.05
|
Rate for Payer: Signature Care EPO |
$798.88
|
Rate for Payer: Signature Care PPO |
$847.00
|
Rate for Payer: United Healthcare Commercial |
$758.45
|
|
HC CAT PUPIL EXPANDER / MALYUGIN RING 6.25
|
Facility
OP
|
$962.50
|
|
Hospital Charge Code |
41602072
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$121.68 |
Max. Negotiated Rate |
$895.12 |
Rate for Payer: Aetna Commercial |
$812.35
|
Rate for Payer: Aetna Medicare |
$317.62
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.62
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$552.76
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.27
|
Rate for Payer: CareSource Indiana of IN Medicare |
$349.39
|
Rate for Payer: Cash Price |
$596.75
|
Rate for Payer: Cash Price |
$596.75
|
Rate for Payer: Centivo All Commercial |
$490.88
|
Rate for Payer: Cigna All Commercial |
$830.64
|
Rate for Payer: CORVEL All Commercial |
$895.12
|
Rate for Payer: Coventry All Commercial |
$847.00
|
Rate for Payer: Encore All Commercial |
$885.98
|
Rate for Payer: Frontpath All Commercial |
$885.50
|
Rate for Payer: Humana ChoiceCare |
$831.31
|
Rate for Payer: Humana Medicare |
$490.88
|
Rate for Payer: Lucent All Commercial |
$490.88
|
Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$721.88
|
Rate for Payer: PHP All Commercial |
$729.96
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
Rate for Payer: Sagamore Health Network All Products |
$743.05
|
Rate for Payer: Signature Care EPO |
$798.88
|
Rate for Payer: Signature Care PPO |
$847.00
|
Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
Rate for Payer: United Healthcare Commercial |
$758.45
|
Rate for Payer: United Healthcare Medicare |
$317.62
|
|
HC CAT PUPIL EXPANDER / MALYUGIN RING 7.0
|
Facility
OP
|
$1,250.00
|
|
Hospital Charge Code |
41603094
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$121.68 |
Max. Negotiated Rate |
$1,162.50 |
Rate for Payer: Aetna Commercial |
$1,055.00
|
Rate for Payer: Aetna Medicare |
$412.50
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$412.50
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$717.88
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$781.38
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$474.38
|
Rate for Payer: CareSource Indiana of IN Medicare |
$453.75
|
Rate for Payer: Cash Price |
$775.00
|
Rate for Payer: Cash Price |
$775.00
|
Rate for Payer: Centivo All Commercial |
$637.50
|
Rate for Payer: Cigna All Commercial |
$1,078.75
|
Rate for Payer: CORVEL All Commercial |
$1,162.50
|
Rate for Payer: Coventry All Commercial |
$1,100.00
|
Rate for Payer: Encore All Commercial |
$1,150.62
|
Rate for Payer: Frontpath All Commercial |
$1,150.00
|
Rate for Payer: Humana ChoiceCare |
$1,079.62
|
Rate for Payer: Humana Medicare |
$637.50
|
Rate for Payer: Lucent All Commercial |
$637.50
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$937.50
|
Rate for Payer: PHP All Commercial |
$948.00
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$487.50
|
Rate for Payer: Sagamore Health Network All Products |
$965.00
|
Rate for Payer: Signature Care EPO |
$1,037.50
|
Rate for Payer: Signature Care PPO |
$1,100.00
|
Rate for Payer: Three Rivers Preferred All Commercial |
$1,062.50
|
Rate for Payer: United Healthcare Commercial |
$985.00
|
Rate for Payer: United Healthcare Medicare |
$412.50
|
|
HC CAT PUPIL EXPANDER / MALYUGIN RING 7.0
|
Facility
IP
|
$1,250.00
|
|
Hospital Charge Code |
41603094
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$937.50 |
Max. Negotiated Rate |
$1,162.50 |
Rate for Payer: Aetna Commercial |
$1,080.00
|
Rate for Payer: Cash Price |
$775.00
|
Rate for Payer: Cigna All Commercial |
$1,078.75
|
Rate for Payer: CORVEL All Commercial |
$1,162.50
|
Rate for Payer: Coventry All Commercial |
$1,100.00
|
Rate for Payer: Encore All Commercial |
$1,150.62
|
Rate for Payer: Frontpath All Commercial |
$1,150.00
|
Rate for Payer: Humana ChoiceCare |
$1,079.62
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
Rate for Payer: PHCS All Commercial |
$937.50
|
Rate for Payer: PHP All Commercial |
$948.00
|
Rate for Payer: Sagamore Health Network All Products |
$965.00
|
Rate for Payer: Signature Care EPO |
$1,037.50
|
Rate for Payer: Signature Care PPO |
$1,100.00
|
Rate for Payer: United Healthcare Commercial |
$985.00
|
|
HC CAT VISCOAT
|
Facility
OP
|
$700.00
|
|
Hospital Charge Code |
41602068
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$121.68 |
Max. Negotiated Rate |
$651.00 |
Rate for Payer: Aetna Commercial |
$590.80
|
Rate for Payer: Aetna Medicare |
$231.00
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.00
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$402.01
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.57
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.65
|
Rate for Payer: CareSource Indiana of IN Medicare |
$254.10
|
Rate for Payer: Cash Price |
$434.00
|
Rate for Payer: Cash Price |
$434.00
|
Rate for Payer: Centivo All Commercial |
$357.00
|
Rate for Payer: Cigna All Commercial |
$604.10
|
Rate for Payer: CORVEL All Commercial |
$651.00
|
Rate for Payer: Coventry All Commercial |
$616.00
|
Rate for Payer: Encore All Commercial |
$644.35
|
Rate for Payer: Frontpath All Commercial |
$644.00
|
Rate for Payer: Humana ChoiceCare |
$604.59
|
Rate for Payer: Humana Medicare |
$357.00
|
Rate for Payer: Lucent All Commercial |
$357.00
|
Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$525.00
|
Rate for Payer: PHP All Commercial |
$530.88
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$273.00
|
Rate for Payer: Sagamore Health Network All Products |
$540.40
|
Rate for Payer: Signature Care EPO |
$581.00
|
Rate for Payer: Signature Care PPO |
$616.00
|
Rate for Payer: Three Rivers Preferred All Commercial |
$595.00
|
Rate for Payer: United Healthcare Commercial |
$551.60
|
Rate for Payer: United Healthcare Medicare |
$231.00
|
|
HC CAT VISCOAT
|
Facility
IP
|
$700.00
|
|
Hospital Charge Code |
41602068
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$525.00 |
Max. Negotiated Rate |
$651.00 |
Rate for Payer: Aetna Commercial |
$604.80
|
Rate for Payer: Cash Price |
$434.00
|
Rate for Payer: Cigna All Commercial |
$604.10
|
Rate for Payer: CORVEL All Commercial |
$651.00
|
Rate for Payer: Coventry All Commercial |
$616.00
|
Rate for Payer: Encore All Commercial |
$644.35
|
Rate for Payer: Frontpath All Commercial |
$644.00
|
Rate for Payer: Humana ChoiceCare |
$604.59
|
Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
Rate for Payer: PHCS All Commercial |
$525.00
|
Rate for Payer: PHP All Commercial |
$530.88
|
Rate for Payer: Sagamore Health Network All Products |
$540.40
|
Rate for Payer: Signature Care EPO |
$581.00
|
Rate for Payer: Signature Care PPO |
$616.00
|
Rate for Payer: United Healthcare Commercial |
$551.60
|
|
HC CAUTERY 2.75
|
Facility
OP
|
$23.84
|
|
Hospital Charge Code |
41608106
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$7.87 |
Max. Negotiated Rate |
$121.68 |
Rate for Payer: Aetna Commercial |
$20.12
|
Rate for Payer: Aetna Medicare |
$7.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.69
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.90
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.05
|
Rate for Payer: CareSource Indiana of IN Medicare |
$8.65
|
Rate for Payer: Cash Price |
$14.78
|
Rate for Payer: Cash Price |
$14.78
|
Rate for Payer: Centivo All Commercial |
$12.16
|
Rate for Payer: Cigna All Commercial |
$20.57
|
Rate for Payer: CORVEL All Commercial |
$22.17
|
Rate for Payer: Coventry All Commercial |
$20.98
|
Rate for Payer: Encore All Commercial |
$21.94
|
Rate for Payer: Frontpath All Commercial |
$21.93
|
Rate for Payer: Humana ChoiceCare |
$20.59
|
Rate for Payer: Humana Medicare |
$12.16
|
Rate for Payer: Lucent All Commercial |
$12.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$21.46
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$17.88
|
Rate for Payer: PHP All Commercial |
$18.08
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$9.30
|
Rate for Payer: Sagamore Health Network All Products |
$18.40
|
Rate for Payer: Signature Care EPO |
$19.79
|
Rate for Payer: Signature Care PPO |
$20.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$20.26
|
Rate for Payer: United Healthcare Commercial |
$18.79
|
Rate for Payer: United Healthcare Medicare |
$7.87
|
|
HC CAUTERY 2.75
|
Facility
IP
|
$23.84
|
|
Hospital Charge Code |
41608106
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$17.88 |
Max. Negotiated Rate |
$22.17 |
Rate for Payer: Aetna Commercial |
$20.60
|
Rate for Payer: Cash Price |
$14.78
|
Rate for Payer: Cigna All Commercial |
$20.57
|
Rate for Payer: CORVEL All Commercial |
$22.17
|
Rate for Payer: Coventry All Commercial |
$20.98
|
Rate for Payer: Encore All Commercial |
$21.94
|
Rate for Payer: Frontpath All Commercial |
$21.93
|
Rate for Payer: Humana ChoiceCare |
$20.59
|
Rate for Payer: Lutheran Preferred All Commercial |
$21.46
|
Rate for Payer: PHCS All Commercial |
$17.88
|
Rate for Payer: PHP All Commercial |
$18.08
|
Rate for Payer: Sagamore Health Network All Products |
$18.40
|
Rate for Payer: Signature Care EPO |
$19.79
|
Rate for Payer: Signature Care PPO |
$20.98
|
Rate for Payer: United Healthcare Commercial |
$18.79
|
|
HC CAUTERY ELEC 2.75
|
Facility
OP
|
$23.84
|
|
Hospital Charge Code |
41608107
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$7.87 |
Max. Negotiated Rate |
$121.68 |
Rate for Payer: Aetna Commercial |
$20.12
|
Rate for Payer: Aetna Medicare |
$7.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.69
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.90
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.05
|
Rate for Payer: CareSource Indiana of IN Medicare |
$8.65
|
Rate for Payer: Cash Price |
$14.78
|
Rate for Payer: Cash Price |
$14.78
|
Rate for Payer: Centivo All Commercial |
$12.16
|
Rate for Payer: Cigna All Commercial |
$20.57
|
Rate for Payer: CORVEL All Commercial |
$22.17
|
Rate for Payer: Coventry All Commercial |
$20.98
|
Rate for Payer: Encore All Commercial |
$21.94
|
Rate for Payer: Frontpath All Commercial |
$21.93
|
Rate for Payer: Humana ChoiceCare |
$20.59
|
Rate for Payer: Humana Medicare |
$12.16
|
Rate for Payer: Lucent All Commercial |
$12.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$21.46
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$17.88
|
Rate for Payer: PHP All Commercial |
$18.08
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$9.30
|
Rate for Payer: Sagamore Health Network All Products |
$18.40
|
Rate for Payer: Signature Care EPO |
$19.79
|
Rate for Payer: Signature Care PPO |
$20.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$20.26
|
Rate for Payer: United Healthcare Commercial |
$18.79
|
Rate for Payer: United Healthcare Medicare |
$7.87
|
|
HC CAUTERY ELEC 2.75
|
Facility
IP
|
$23.84
|
|
Hospital Charge Code |
41608107
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$17.88 |
Max. Negotiated Rate |
$22.17 |
Rate for Payer: Aetna Commercial |
$20.60
|
Rate for Payer: Cash Price |
$14.78
|
Rate for Payer: Cigna All Commercial |
$20.57
|
Rate for Payer: CORVEL All Commercial |
$22.17
|
Rate for Payer: Coventry All Commercial |
$20.98
|
Rate for Payer: Encore All Commercial |
$21.94
|
Rate for Payer: Frontpath All Commercial |
$21.93
|
Rate for Payer: Humana ChoiceCare |
$20.59
|
Rate for Payer: Lutheran Preferred All Commercial |
$21.46
|
Rate for Payer: PHCS All Commercial |
$17.88
|
Rate for Payer: PHP All Commercial |
$18.08
|
Rate for Payer: Sagamore Health Network All Products |
$18.40
|
Rate for Payer: Signature Care EPO |
$19.79
|
Rate for Payer: Signature Care PPO |
$20.98
|
Rate for Payer: United Healthcare Commercial |
$18.79
|
|
HC CAUTERY ELECTRODE BALL 5 INCH
|
Facility
OP
|
$61.27
|
|
Hospital Charge Code |
41601821
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$20.22 |
Max. Negotiated Rate |
$96.84 |
Rate for Payer: Aetna Commercial |
$51.71
|
Rate for Payer: Aetna Medicare |
$20.22
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.22
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.19
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.30
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.25
|
Rate for Payer: CareSource Indiana of IN Medicare |
$22.24
|
Rate for Payer: Cash Price |
$37.99
|
Rate for Payer: Cash Price |
$37.99
|
Rate for Payer: Centivo All Commercial |
$31.25
|
Rate for Payer: Cigna All Commercial |
$52.88
|
Rate for Payer: CORVEL All Commercial |
$56.98
|
Rate for Payer: Coventry All Commercial |
$53.92
|
Rate for Payer: Encore All Commercial |
$56.40
|
Rate for Payer: Frontpath All Commercial |
$56.37
|
Rate for Payer: Humana ChoiceCare |
$52.92
|
Rate for Payer: Humana Medicare |
$31.25
|
Rate for Payer: Lucent All Commercial |
$31.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$55.14
|
Rate for Payer: Managed Health Services Medicaid |
$96.84
|
Rate for Payer: MDWise Medicaid |
$96.84
|
Rate for Payer: PHCS All Commercial |
$45.95
|
Rate for Payer: PHP All Commercial |
$46.47
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$23.90
|
Rate for Payer: Sagamore Health Network All Products |
$47.30
|
Rate for Payer: Signature Care EPO |
$50.85
|
Rate for Payer: Signature Care PPO |
$53.92
|
Rate for Payer: Three Rivers Preferred All Commercial |
$52.08
|
Rate for Payer: United Healthcare Commercial |
$48.28
|
Rate for Payer: United Healthcare Medicare |
$20.22
|
|
HC CAUTERY ELECTRODE BALL 5 INCH
|
Facility
IP
|
$61.27
|
|
Hospital Charge Code |
41601821
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$45.95 |
Max. Negotiated Rate |
$56.98 |
Rate for Payer: Aetna Commercial |
$52.94
|
Rate for Payer: Cash Price |
$37.99
|
Rate for Payer: Cigna All Commercial |
$52.88
|
Rate for Payer: CORVEL All Commercial |
$56.98
|
Rate for Payer: Coventry All Commercial |
$53.92
|
Rate for Payer: Encore All Commercial |
$56.40
|
Rate for Payer: Frontpath All Commercial |
$56.37
|
Rate for Payer: Humana ChoiceCare |
$52.92
|
Rate for Payer: Lutheran Preferred All Commercial |
$55.14
|
Rate for Payer: PHCS All Commercial |
$45.95
|
Rate for Payer: PHP All Commercial |
$46.47
|
Rate for Payer: Sagamore Health Network All Products |
$47.30
|
Rate for Payer: Signature Care EPO |
$50.85
|
Rate for Payer: Signature Care PPO |
$53.92
|
Rate for Payer: United Healthcare Commercial |
$48.28
|
|
HC CAUTERY ELECTRODE EXTENDED BLADE 6.5 IN
|
Facility
OP
|
$46.04
|
|
Hospital Charge Code |
41601814
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$15.19 |
Max. Negotiated Rate |
$96.84 |
Rate for Payer: Aetna Commercial |
$38.86
|
Rate for Payer: Aetna Medicare |
$15.19
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.19
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.44
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.78
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.47
|
Rate for Payer: CareSource Indiana of IN Medicare |
$16.71
|
Rate for Payer: Cash Price |
$28.55
|
Rate for Payer: Cash Price |
$28.55
|
Rate for Payer: Centivo All Commercial |
$23.48
|
Rate for Payer: Cigna All Commercial |
$39.73
|
Rate for Payer: CORVEL All Commercial |
$42.82
|
Rate for Payer: Coventry All Commercial |
$40.52
|
Rate for Payer: Encore All Commercial |
$42.38
|
Rate for Payer: Frontpath All Commercial |
$42.36
|
Rate for Payer: Humana ChoiceCare |
$39.76
|
Rate for Payer: Humana Medicare |
$23.48
|
Rate for Payer: Lucent All Commercial |
$23.48
|
Rate for Payer: Lutheran Preferred All Commercial |
$41.44
|
Rate for Payer: Managed Health Services Medicaid |
$96.84
|
Rate for Payer: MDWise Medicaid |
$96.84
|
Rate for Payer: PHCS All Commercial |
$34.53
|
Rate for Payer: PHP All Commercial |
$34.92
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$17.96
|
Rate for Payer: Sagamore Health Network All Products |
$35.54
|
Rate for Payer: Signature Care EPO |
$38.21
|
Rate for Payer: Signature Care PPO |
$40.52
|
Rate for Payer: Three Rivers Preferred All Commercial |
$39.13
|
Rate for Payer: United Healthcare Commercial |
$36.28
|
Rate for Payer: United Healthcare Medicare |
$15.19
|
|
HC CAUTERY ELECTRODE EXTENDED BLADE 6.5 IN
|
Facility
IP
|
$46.04
|
|
Hospital Charge Code |
41601814
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$34.53 |
Max. Negotiated Rate |
$42.82 |
Rate for Payer: Aetna Commercial |
$39.78
|
Rate for Payer: Cash Price |
$28.55
|
Rate for Payer: Cigna All Commercial |
$39.73
|
Rate for Payer: CORVEL All Commercial |
$42.82
|
Rate for Payer: Coventry All Commercial |
$40.52
|
Rate for Payer: Encore All Commercial |
$42.38
|
Rate for Payer: Frontpath All Commercial |
$42.36
|
Rate for Payer: Humana ChoiceCare |
$39.76
|
Rate for Payer: Lutheran Preferred All Commercial |
$41.44
|
Rate for Payer: PHCS All Commercial |
$34.53
|
Rate for Payer: PHP All Commercial |
$34.92
|
Rate for Payer: Sagamore Health Network All Products |
$35.54
|
Rate for Payer: Signature Care EPO |
$38.21
|
Rate for Payer: Signature Care PPO |
$40.52
|
Rate for Payer: United Healthcare Commercial |
$36.28
|
|
HC CAUTERY EXTEND 6.5
|
Facility
OP
|
$30.22
|
|
Hospital Charge Code |
41608108
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$9.97 |
Max. Negotiated Rate |
$121.68 |
Rate for Payer: Aetna Commercial |
$25.51
|
Rate for Payer: Aetna Medicare |
$9.97
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.97
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.36
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.89
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.47
|
Rate for Payer: CareSource Indiana of IN Medicare |
$10.97
|
Rate for Payer: Cash Price |
$18.74
|
Rate for Payer: Cash Price |
$18.74
|
Rate for Payer: Centivo All Commercial |
$15.41
|
Rate for Payer: Cigna All Commercial |
$26.08
|
Rate for Payer: CORVEL All Commercial |
$28.10
|
Rate for Payer: Coventry All Commercial |
$26.59
|
Rate for Payer: Encore All Commercial |
$27.82
|
Rate for Payer: Frontpath All Commercial |
$27.80
|
Rate for Payer: Humana ChoiceCare |
$26.10
|
Rate for Payer: Humana Medicare |
$15.41
|
Rate for Payer: Lucent All Commercial |
$15.41
|
Rate for Payer: Lutheran Preferred All Commercial |
$27.20
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$22.66
|
Rate for Payer: PHP All Commercial |
$22.92
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$11.79
|
Rate for Payer: Sagamore Health Network All Products |
$23.33
|
Rate for Payer: Signature Care EPO |
$25.08
|
Rate for Payer: Signature Care PPO |
$26.59
|
Rate for Payer: Three Rivers Preferred All Commercial |
$25.69
|
Rate for Payer: United Healthcare Commercial |
$23.81
|
Rate for Payer: United Healthcare Medicare |
$9.97
|
|
HC CAUTERY EXTEND 6.5
|
Facility
IP
|
$30.22
|
|
Hospital Charge Code |
41608108
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$22.66 |
Max. Negotiated Rate |
$28.10 |
Rate for Payer: Aetna Commercial |
$26.11
|
Rate for Payer: Cash Price |
$18.74
|
Rate for Payer: Cigna All Commercial |
$26.08
|
Rate for Payer: CORVEL All Commercial |
$28.10
|
Rate for Payer: Coventry All Commercial |
$26.59
|
Rate for Payer: Encore All Commercial |
$27.82
|
Rate for Payer: Frontpath All Commercial |
$27.80
|
Rate for Payer: Humana ChoiceCare |
$26.10
|
Rate for Payer: Lutheran Preferred All Commercial |
$27.20
|
Rate for Payer: PHCS All Commercial |
$22.66
|
Rate for Payer: PHP All Commercial |
$22.92
|
Rate for Payer: Sagamore Health Network All Products |
$23.33
|
Rate for Payer: Signature Care EPO |
$25.08
|
Rate for Payer: Signature Care PPO |
$26.59
|
Rate for Payer: United Healthcare Commercial |
$23.81
|
|
HC CAUTERY FORCE TRI VERSE
|
Facility
OP
|
$299.36
|
|
Hospital Charge Code |
41601866
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$98.79 |
Max. Negotiated Rate |
$278.40 |
Rate for Payer: Aetna Commercial |
$252.66
|
Rate for Payer: Aetna Medicare |
$98.79
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.79
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$171.92
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.13
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.61
|
Rate for Payer: CareSource Indiana of IN Medicare |
$108.67
|
Rate for Payer: Cash Price |
$185.60
|
Rate for Payer: Cash Price |
$185.60
|
Rate for Payer: Centivo All Commercial |
$152.67
|
Rate for Payer: Cigna All Commercial |
$258.35
|
Rate for Payer: CORVEL All Commercial |
$278.40
|
Rate for Payer: Coventry All Commercial |
$263.44
|
Rate for Payer: Encore All Commercial |
$275.56
|
Rate for Payer: Frontpath All Commercial |
$275.41
|
Rate for Payer: Humana ChoiceCare |
$258.56
|
Rate for Payer: Humana Medicare |
$152.67
|
Rate for Payer: Lucent All Commercial |
$152.67
|
Rate for Payer: Lutheran Preferred All Commercial |
$269.42
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$224.52
|
Rate for Payer: PHP All Commercial |
$227.03
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$116.75
|
Rate for Payer: Sagamore Health Network All Products |
$231.11
|
Rate for Payer: Signature Care EPO |
$248.47
|
Rate for Payer: Signature Care PPO |
$263.44
|
Rate for Payer: Three Rivers Preferred All Commercial |
$254.46
|
Rate for Payer: United Healthcare Commercial |
$235.90
|
Rate for Payer: United Healthcare Medicare |
$98.79
|
|