|
HC BALLOON DILATION 12-15
|
Facility
|
IP
|
$964.80
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.60 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$833.59
|
| Rate for Payer: Cash Price |
$578.88
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
|
|
HC BALLOON DILATION 12-15
|
Facility
|
OP
|
$964.80
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$814.29
|
| Rate for Payer: Aetna Medicare |
$308.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$299.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$554.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$355.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.61
|
| Rate for Payer: Cash Price |
$578.88
|
| Rate for Payer: Cash Price |
$578.88
|
| Rate for Payer: Centivo All Commercial |
$524.85
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Humana Medicare |
$308.74
|
| Rate for Payer: Lucent All Commercial |
$524.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.27
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.08
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
| Rate for Payer: United Healthcare Medicare |
$308.74
|
|
|
HC BALLOON DILATION FIXED 15-18MM
|
Facility
|
IP
|
$964.80
|
|
| Hospital Charge Code |
41608247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.60 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$833.59
|
| Rate for Payer: Cash Price |
$578.88
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
|
|
HC BALLOON DILATION FIXED 15-18MM
|
Facility
|
OP
|
$964.80
|
|
| Hospital Charge Code |
41608247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$814.29
|
| Rate for Payer: Aetna Medicare |
$308.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$299.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$554.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$355.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.61
|
| Rate for Payer: Cash Price |
$578.88
|
| Rate for Payer: Cash Price |
$578.88
|
| Rate for Payer: Centivo All Commercial |
$524.85
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Humana Medicare |
$308.74
|
| Rate for Payer: Lucent All Commercial |
$524.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.27
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.08
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
| Rate for Payer: United Healthcare Medicare |
$308.74
|
|
|
HC BALLOON DILATION GUIDE 10-12MM
|
Facility
|
OP
|
$1,099.35
|
|
| Hospital Charge Code |
41608249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Aetna Medicare |
$351.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$340.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$631.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$687.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$404.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$386.97
|
| Rate for Payer: Cash Price |
$659.61
|
| Rate for Payer: Cash Price |
$659.61
|
| Rate for Payer: Centivo All Commercial |
$598.05
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Humana Medicare |
$351.79
|
| Rate for Payer: Lucent All Commercial |
$598.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.41
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$428.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$934.45
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
| Rate for Payer: United Healthcare Medicare |
$351.79
|
|
|
HC BALLOON DILATION GUIDE 10-12MM
|
Facility
|
IP
|
$1,099.35
|
|
| Hospital Charge Code |
41608249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$824.51 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$949.84
|
| Rate for Payer: Cash Price |
$659.61
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.41
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
|
|
HC BALLOON DILATION GUIDE 12-15MM
|
Facility
|
IP
|
$1,099.35
|
|
| Hospital Charge Code |
41608250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$824.51 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$949.84
|
| Rate for Payer: Cash Price |
$659.61
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.41
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
|
|
HC BALLOON DILATION GUIDE 12-15MM
|
Facility
|
OP
|
$1,099.35
|
|
| Hospital Charge Code |
41608250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Aetna Medicare |
$351.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$340.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$631.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$687.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$404.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$386.97
|
| Rate for Payer: Cash Price |
$659.61
|
| Rate for Payer: Cash Price |
$659.61
|
| Rate for Payer: Centivo All Commercial |
$598.05
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Humana Medicare |
$351.79
|
| Rate for Payer: Lucent All Commercial |
$598.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.41
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$428.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$934.45
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
| Rate for Payer: United Healthcare Medicare |
$351.79
|
|
|
HC BALLOON DILATION GUIDE 8-10MM
|
Facility
|
OP
|
$1,099.35
|
|
| Hospital Charge Code |
41608248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Aetna Medicare |
$351.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$340.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$631.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$687.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$404.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$386.97
|
| Rate for Payer: Cash Price |
$659.61
|
| Rate for Payer: Cash Price |
$659.61
|
| Rate for Payer: Centivo All Commercial |
$598.05
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Humana Medicare |
$351.79
|
| Rate for Payer: Lucent All Commercial |
$598.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.41
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$428.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$934.45
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
| Rate for Payer: United Healthcare Medicare |
$351.79
|
|
|
HC BALLOON DILATION GUIDE 8-10MM
|
Facility
|
IP
|
$1,099.35
|
|
| Hospital Charge Code |
41608248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$824.51 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$949.84
|
| Rate for Payer: Cash Price |
$659.61
|
| Rate for Payer: Cigna All Commercial |
$948.74
|
| Rate for Payer: CORVEL All Commercial |
$1,022.40
|
| Rate for Payer: Coventry All Commercial |
$967.43
|
| Rate for Payer: Encore All Commercial |
$1,011.95
|
| Rate for Payer: Frontpath All Commercial |
$1,011.40
|
| Rate for Payer: Humana ChoiceCare |
$949.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$989.41
|
| Rate for Payer: PHCS All Commercial |
$824.51
|
| Rate for Payer: PHP All Commercial |
$833.75
|
| Rate for Payer: Sagamore Health Network All Products |
$848.70
|
| Rate for Payer: Signature Care EPO |
$912.46
|
| Rate for Payer: Signature Care PPO |
$967.43
|
| Rate for Payer: United Healthcare Commercial |
$866.29
|
|
|
HC BALLOON DILATION W/WIRE 8-10
|
Facility
|
IP
|
$964.80
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.60 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$833.59
|
| Rate for Payer: Cash Price |
$578.88
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
|
|
HC BALLOON DILATION W/WIRE 8-10
|
Facility
|
OP
|
$964.80
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$897.26 |
| Rate for Payer: Aetna Commercial |
$814.29
|
| Rate for Payer: Aetna Medicare |
$308.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$299.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$554.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$355.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.61
|
| Rate for Payer: Cash Price |
$578.88
|
| Rate for Payer: Cash Price |
$578.88
|
| Rate for Payer: Centivo All Commercial |
$524.85
|
| Rate for Payer: Cigna All Commercial |
$832.62
|
| Rate for Payer: CORVEL All Commercial |
$897.26
|
| Rate for Payer: Coventry All Commercial |
$849.02
|
| Rate for Payer: Encore All Commercial |
$888.10
|
| Rate for Payer: Frontpath All Commercial |
$887.62
|
| Rate for Payer: Humana ChoiceCare |
$833.30
|
| Rate for Payer: Humana Medicare |
$308.74
|
| Rate for Payer: Lucent All Commercial |
$524.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.32
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$723.60
|
| Rate for Payer: PHP All Commercial |
$731.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.27
|
| Rate for Payer: Sagamore Health Network All Products |
$744.83
|
| Rate for Payer: Signature Care EPO |
$800.78
|
| Rate for Payer: Signature Care PPO |
$849.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.08
|
| Rate for Payer: United Healthcare Commercial |
$760.26
|
| Rate for Payer: United Healthcare Medicare |
$308.74
|
|
|
HC BANDAGE ACE DOUBLE 6 IN
|
Facility
|
OP
|
$43.05
|
|
| Hospital Charge Code |
41601811
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna Commercial |
$36.33
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.15
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Centivo All Commercial |
$23.42
|
| Rate for Payer: Cigna All Commercial |
$37.15
|
| Rate for Payer: CORVEL All Commercial |
$40.04
|
| Rate for Payer: Coventry All Commercial |
$37.88
|
| Rate for Payer: Encore All Commercial |
$39.63
|
| Rate for Payer: Frontpath All Commercial |
$39.61
|
| Rate for Payer: Humana ChoiceCare |
$37.18
|
| Rate for Payer: Humana Medicare |
$13.78
|
| Rate for Payer: Lucent All Commercial |
$23.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.74
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$32.29
|
| Rate for Payer: PHP All Commercial |
$32.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.79
|
| Rate for Payer: Sagamore Health Network All Products |
$33.23
|
| Rate for Payer: Signature Care EPO |
$35.73
|
| Rate for Payer: Signature Care PPO |
$37.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.59
|
| Rate for Payer: United Healthcare Commercial |
$33.92
|
| Rate for Payer: United Healthcare Medicare |
$13.78
|
|
|
HC BANDAGE ACE DOUBLE 6 IN
|
Facility
|
IP
|
$43.05
|
|
| Hospital Charge Code |
41601811
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.29 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cigna All Commercial |
$37.15
|
| Rate for Payer: CORVEL All Commercial |
$40.04
|
| Rate for Payer: Coventry All Commercial |
$37.88
|
| Rate for Payer: Encore All Commercial |
$39.63
|
| Rate for Payer: Frontpath All Commercial |
$39.61
|
| Rate for Payer: Humana ChoiceCare |
$37.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.74
|
| Rate for Payer: PHCS All Commercial |
$32.29
|
| Rate for Payer: PHP All Commercial |
$32.65
|
| Rate for Payer: Sagamore Health Network All Products |
$33.23
|
| Rate for Payer: Signature Care EPO |
$35.73
|
| Rate for Payer: Signature Care PPO |
$37.88
|
| Rate for Payer: United Healthcare Commercial |
$33.92
|
|
|
HC BARIATRIC (ALL) BED /DAY
|
Facility
|
IP
|
$356.43
|
|
| Hospital Charge Code |
2337557
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$267.32 |
| Max. Negotiated Rate |
$331.48 |
| Rate for Payer: Aetna Commercial |
$307.96
|
| Rate for Payer: Cash Price |
$213.86
|
| Rate for Payer: Cigna All Commercial |
$307.60
|
| Rate for Payer: CORVEL All Commercial |
$331.48
|
| Rate for Payer: Coventry All Commercial |
$313.66
|
| Rate for Payer: Encore All Commercial |
$328.09
|
| Rate for Payer: Frontpath All Commercial |
$327.92
|
| Rate for Payer: Humana ChoiceCare |
$307.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.79
|
| Rate for Payer: PHCS All Commercial |
$267.32
|
| Rate for Payer: PHP All Commercial |
$270.32
|
| Rate for Payer: Sagamore Health Network All Products |
$275.16
|
| Rate for Payer: Signature Care EPO |
$295.84
|
| Rate for Payer: Signature Care PPO |
$313.66
|
| Rate for Payer: United Healthcare Commercial |
$280.87
|
|
|
HC BARIATRIC (ALL) BED /DAY
|
Facility
|
OP
|
$356.43
|
|
| Hospital Charge Code |
2337557
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$331.48 |
| Rate for Payer: Aetna Commercial |
$300.83
|
| Rate for Payer: Aetna Medicare |
$114.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$204.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$222.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.46
|
| Rate for Payer: Cash Price |
$213.86
|
| Rate for Payer: Cash Price |
$213.86
|
| Rate for Payer: Centivo All Commercial |
$193.90
|
| Rate for Payer: Cigna All Commercial |
$307.60
|
| Rate for Payer: CORVEL All Commercial |
$331.48
|
| Rate for Payer: Coventry All Commercial |
$313.66
|
| Rate for Payer: Encore All Commercial |
$328.09
|
| Rate for Payer: Frontpath All Commercial |
$327.92
|
| Rate for Payer: Humana ChoiceCare |
$307.85
|
| Rate for Payer: Humana Medicare |
$114.06
|
| Rate for Payer: Lucent All Commercial |
$193.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.79
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$267.32
|
| Rate for Payer: PHP All Commercial |
$270.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.01
|
| Rate for Payer: Sagamore Health Network All Products |
$275.16
|
| Rate for Payer: Signature Care EPO |
$295.84
|
| Rate for Payer: Signature Care PPO |
$313.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$302.97
|
| Rate for Payer: United Healthcare Commercial |
$280.87
|
| Rate for Payer: United Healthcare Medicare |
$114.06
|
|
|
HC BART HENSELAE ABS
|
Facility
|
IP
|
$407.27
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
63001921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$305.45 |
| Max. Negotiated Rate |
$378.76 |
| Rate for Payer: Aetna Commercial |
$351.88
|
| Rate for Payer: Cash Price |
$244.36
|
| Rate for Payer: Cigna All Commercial |
$351.47
|
| Rate for Payer: CORVEL All Commercial |
$378.76
|
| Rate for Payer: Coventry All Commercial |
$358.40
|
| Rate for Payer: Encore All Commercial |
$374.89
|
| Rate for Payer: Frontpath All Commercial |
$374.69
|
| Rate for Payer: Humana ChoiceCare |
$351.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$366.54
|
| Rate for Payer: PHCS All Commercial |
$305.45
|
| Rate for Payer: PHP All Commercial |
$308.87
|
| Rate for Payer: Sagamore Health Network All Products |
$314.41
|
| Rate for Payer: Signature Care EPO |
$338.03
|
| Rate for Payer: Signature Care PPO |
$358.40
|
| Rate for Payer: United Healthcare Commercial |
$320.93
|
|
|
HC BART HENSELAE ABS
|
Facility
|
OP
|
$407.27
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
63001921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$378.76 |
| Rate for Payer: Aetna Commercial |
$343.74
|
| Rate for Payer: Aetna Medicare |
$130.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$187.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.36
|
| Rate for Payer: Cash Price |
$244.36
|
| Rate for Payer: Cash Price |
$244.36
|
| Rate for Payer: Centivo All Commercial |
$221.55
|
| Rate for Payer: Cigna All Commercial |
$351.47
|
| Rate for Payer: CORVEL All Commercial |
$378.76
|
| Rate for Payer: Coventry All Commercial |
$358.40
|
| Rate for Payer: Encore All Commercial |
$374.89
|
| Rate for Payer: Frontpath All Commercial |
$374.69
|
| Rate for Payer: Humana ChoiceCare |
$351.76
|
| Rate for Payer: Humana Medicare |
$130.33
|
| Rate for Payer: Lucent All Commercial |
$221.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$366.54
|
| Rate for Payer: Managed Health Services Medicaid |
$10.18
|
| Rate for Payer: MDWise Medicaid |
$10.18
|
| Rate for Payer: PHCS All Commercial |
$305.45
|
| Rate for Payer: PHP All Commercial |
$308.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$158.84
|
| Rate for Payer: Sagamore Health Network All Products |
$314.41
|
| Rate for Payer: Signature Care EPO |
$338.03
|
| Rate for Payer: Signature Care PPO |
$358.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$346.18
|
| Rate for Payer: United Healthcare Commercial |
$320.93
|
| Rate for Payer: United Healthcare Medicare |
$130.33
|
|
|
HC BASIC METABOLIC-CA TOTAL
|
Facility
|
IP
|
$110.42
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
63001088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.81 |
| Max. Negotiated Rate |
$102.69 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Cash Price |
$66.25
|
| Rate for Payer: Cigna All Commercial |
$95.29
|
| Rate for Payer: CORVEL All Commercial |
$102.69
|
| Rate for Payer: Coventry All Commercial |
$97.17
|
| Rate for Payer: Encore All Commercial |
$101.64
|
| Rate for Payer: Frontpath All Commercial |
$101.59
|
| Rate for Payer: Humana ChoiceCare |
$95.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.38
|
| Rate for Payer: PHCS All Commercial |
$82.81
|
| Rate for Payer: PHP All Commercial |
$83.74
|
| Rate for Payer: Sagamore Health Network All Products |
$85.24
|
| Rate for Payer: Signature Care EPO |
$91.65
|
| Rate for Payer: Signature Care PPO |
$97.17
|
| Rate for Payer: United Healthcare Commercial |
$87.01
|
|
|
HC BASIC METABOLIC-CA TOTAL
|
Facility
|
OP
|
$110.42
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
63001088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$102.69 |
| Rate for Payer: Aetna Commercial |
$93.19
|
| Rate for Payer: Aetna Medicare |
$35.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$50.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.87
|
| Rate for Payer: Cash Price |
$66.25
|
| Rate for Payer: Cash Price |
$66.25
|
| Rate for Payer: Centivo All Commercial |
$60.07
|
| Rate for Payer: Cigna All Commercial |
$95.29
|
| Rate for Payer: CORVEL All Commercial |
$102.69
|
| Rate for Payer: Coventry All Commercial |
$97.17
|
| Rate for Payer: Encore All Commercial |
$101.64
|
| Rate for Payer: Frontpath All Commercial |
$101.59
|
| Rate for Payer: Humana ChoiceCare |
$95.37
|
| Rate for Payer: Humana Medicare |
$35.33
|
| Rate for Payer: Lucent All Commercial |
$60.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.38
|
| Rate for Payer: Managed Health Services Medicaid |
$8.46
|
| Rate for Payer: MDWise Medicaid |
$8.46
|
| Rate for Payer: PHCS All Commercial |
$82.81
|
| Rate for Payer: PHP All Commercial |
$83.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.06
|
| Rate for Payer: Sagamore Health Network All Products |
$85.24
|
| Rate for Payer: Signature Care EPO |
$91.65
|
| Rate for Payer: Signature Care PPO |
$97.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.86
|
| Rate for Payer: United Healthcare Commercial |
$87.01
|
| Rate for Payer: United Healthcare Medicare |
$35.33
|
|
|
HC BATH SALTS PANEL-URINE
|
Facility
|
OP
|
$194.22
|
|
|
Service Code
|
CPT 80371
|
| Hospital Charge Code |
63001431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.21 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$62.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$89.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.37
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Centivo All Commercial |
$105.66
|
| Rate for Payer: Cigna All Commercial |
$167.61
|
| Rate for Payer: CORVEL All Commercial |
$180.62
|
| Rate for Payer: Coventry All Commercial |
$170.91
|
| Rate for Payer: Encore All Commercial |
$178.78
|
| Rate for Payer: Frontpath All Commercial |
$178.68
|
| Rate for Payer: Humana ChoiceCare |
$167.75
|
| Rate for Payer: Humana Medicare |
$62.15
|
| Rate for Payer: Lucent All Commercial |
$105.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.80
|
| Rate for Payer: PHCS All Commercial |
$145.66
|
| Rate for Payer: PHP All Commercial |
$147.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.75
|
| Rate for Payer: Sagamore Health Network All Products |
$149.94
|
| Rate for Payer: Signature Care EPO |
$161.20
|
| Rate for Payer: Signature Care PPO |
$170.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.09
|
| Rate for Payer: United Healthcare Commercial |
$153.05
|
| Rate for Payer: United Healthcare Medicare |
$62.15
|
|
|
HC BATH SALTS PANEL-URINE
|
Facility
|
IP
|
$194.22
|
|
|
Service Code
|
CPT 80371
|
| Hospital Charge Code |
63001431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.66 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Aetna Commercial |
$167.81
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cigna All Commercial |
$167.61
|
| Rate for Payer: CORVEL All Commercial |
$180.62
|
| Rate for Payer: Coventry All Commercial |
$170.91
|
| Rate for Payer: Encore All Commercial |
$178.78
|
| Rate for Payer: Frontpath All Commercial |
$178.68
|
| Rate for Payer: Humana ChoiceCare |
$167.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.80
|
| Rate for Payer: PHCS All Commercial |
$145.66
|
| Rate for Payer: PHP All Commercial |
$147.30
|
| Rate for Payer: Sagamore Health Network All Products |
$149.94
|
| Rate for Payer: Signature Care EPO |
$161.20
|
| Rate for Payer: Signature Care PPO |
$170.91
|
| Rate for Payer: United Healthcare Commercial |
$153.05
|
|
|
HC BATH SALTS PANEL-URINE
|
Facility
|
OP
|
$194.22
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.21 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$62.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$89.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.37
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Centivo All Commercial |
$105.66
|
| Rate for Payer: Cigna All Commercial |
$167.61
|
| Rate for Payer: CORVEL All Commercial |
$180.62
|
| Rate for Payer: Coventry All Commercial |
$170.91
|
| Rate for Payer: Encore All Commercial |
$178.78
|
| Rate for Payer: Frontpath All Commercial |
$178.68
|
| Rate for Payer: Humana ChoiceCare |
$167.75
|
| Rate for Payer: Humana Medicare |
$62.15
|
| Rate for Payer: Lucent All Commercial |
$105.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.80
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$145.66
|
| Rate for Payer: PHP All Commercial |
$147.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.75
|
| Rate for Payer: Sagamore Health Network All Products |
$149.94
|
| Rate for Payer: Signature Care EPO |
$161.20
|
| Rate for Payer: Signature Care PPO |
$170.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.09
|
| Rate for Payer: United Healthcare Commercial |
$153.05
|
| Rate for Payer: United Healthcare Medicare |
$62.15
|
|
|
HC BATH SALTS PANEL-URINE
|
Facility
|
IP
|
$194.22
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.66 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Aetna Commercial |
$167.81
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cigna All Commercial |
$167.61
|
| Rate for Payer: CORVEL All Commercial |
$180.62
|
| Rate for Payer: Coventry All Commercial |
$170.91
|
| Rate for Payer: Encore All Commercial |
$178.78
|
| Rate for Payer: Frontpath All Commercial |
$178.68
|
| Rate for Payer: Humana ChoiceCare |
$167.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.80
|
| Rate for Payer: PHCS All Commercial |
$145.66
|
| Rate for Payer: PHP All Commercial |
$147.30
|
| Rate for Payer: Sagamore Health Network All Products |
$149.94
|
| Rate for Payer: Signature Care EPO |
$161.20
|
| Rate for Payer: Signature Care PPO |
$170.91
|
| Rate for Payer: United Healthcare Commercial |
$153.05
|
|
|
HC BB TAKS NON THREADED ACFS
|
Facility
|
IP
|
$584.50
|
|
| Hospital Charge Code |
41601268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.38 |
| Max. Negotiated Rate |
$543.59 |
| Rate for Payer: Aetna Commercial |
$505.01
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Cigna All Commercial |
$504.42
|
| Rate for Payer: CORVEL All Commercial |
$543.59
|
| Rate for Payer: Coventry All Commercial |
$514.36
|
| Rate for Payer: Encore All Commercial |
$538.03
|
| Rate for Payer: Frontpath All Commercial |
$537.74
|
| Rate for Payer: Humana ChoiceCare |
$504.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.05
|
| Rate for Payer: PHCS All Commercial |
$438.38
|
| Rate for Payer: PHP All Commercial |
$443.28
|
| Rate for Payer: Sagamore Health Network All Products |
$451.23
|
| Rate for Payer: Signature Care EPO |
$485.13
|
| Rate for Payer: Signature Care PPO |
$514.36
|
| Rate for Payer: United Healthcare Commercial |
$460.59
|
|
