|
HC CATECHOLAMINE FRACT - PLASMA
|
Facility
|
IP
|
$306.31
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63001484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$229.73 |
| Max. Negotiated Rate |
$284.87 |
| Rate for Payer: Aetna Commercial |
$264.65
|
| Rate for Payer: Cash Price |
$183.79
|
| Rate for Payer: Cigna All Commercial |
$264.35
|
| Rate for Payer: CORVEL All Commercial |
$284.87
|
| Rate for Payer: Coventry All Commercial |
$269.55
|
| Rate for Payer: Encore All Commercial |
$281.96
|
| Rate for Payer: Frontpath All Commercial |
$281.81
|
| Rate for Payer: Humana ChoiceCare |
$264.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.68
|
| Rate for Payer: PHCS All Commercial |
$229.73
|
| Rate for Payer: PHP All Commercial |
$232.31
|
| Rate for Payer: Sagamore Health Network All Products |
$236.47
|
| Rate for Payer: Signature Care EPO |
$254.24
|
| Rate for Payer: Signature Care PPO |
$269.55
|
| Rate for Payer: United Healthcare Commercial |
$241.37
|
|
|
HC CATECHOLAMINES-24-HR
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63001485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna All Commercial |
$220.06
|
| Rate for Payer: CORVEL All Commercial |
$237.15
|
| Rate for Payer: Coventry All Commercial |
$224.40
|
| Rate for Payer: Encore All Commercial |
$234.73
|
| Rate for Payer: Frontpath All Commercial |
$234.60
|
| Rate for Payer: Humana ChoiceCare |
$220.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.50
|
| Rate for Payer: PHCS All Commercial |
$191.25
|
| Rate for Payer: PHP All Commercial |
$193.39
|
| Rate for Payer: Sagamore Health Network All Products |
$196.86
|
| Rate for Payer: Signature Care EPO |
$211.65
|
| Rate for Payer: Signature Care PPO |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$200.94
|
|
|
HC CATECHOLAMINES-24-HR
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63001485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: Aetna Commercial |
$215.22
|
| Rate for Payer: Aetna Medicare |
$81.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.76
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Centivo All Commercial |
$138.72
|
| Rate for Payer: Cigna All Commercial |
$220.06
|
| Rate for Payer: CORVEL All Commercial |
$237.15
|
| Rate for Payer: Coventry All Commercial |
$224.40
|
| Rate for Payer: Encore All Commercial |
$234.73
|
| Rate for Payer: Frontpath All Commercial |
$234.60
|
| Rate for Payer: Humana ChoiceCare |
$220.24
|
| Rate for Payer: Humana Medicare |
$81.60
|
| Rate for Payer: Lucent All Commercial |
$138.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.50
|
| Rate for Payer: Managed Health Services Medicaid |
$25.25
|
| Rate for Payer: MDWise Medicaid |
$25.25
|
| Rate for Payer: PHCS All Commercial |
$191.25
|
| Rate for Payer: PHP All Commercial |
$193.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.45
|
| Rate for Payer: Sagamore Health Network All Products |
$196.86
|
| Rate for Payer: Signature Care EPO |
$211.65
|
| Rate for Payer: Signature Care PPO |
$224.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$216.75
|
| Rate for Payer: United Healthcare Commercial |
$200.94
|
| Rate for Payer: United Healthcare Medicare |
$81.60
|
|
|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE, 24-HOUR URINE
|
Facility
|
OP
|
$74.21
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63044029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$69.02 |
| Rate for Payer: Aetna Commercial |
$62.63
|
| Rate for Payer: Aetna Medicare |
$23.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.12
|
| Rate for Payer: Cash Price |
$44.53
|
| Rate for Payer: Cash Price |
$44.53
|
| Rate for Payer: Centivo All Commercial |
$40.37
|
| Rate for Payer: Cigna All Commercial |
$64.04
|
| Rate for Payer: CORVEL All Commercial |
$69.02
|
| Rate for Payer: Coventry All Commercial |
$65.30
|
| Rate for Payer: Encore All Commercial |
$68.31
|
| Rate for Payer: Frontpath All Commercial |
$68.27
|
| Rate for Payer: Humana ChoiceCare |
$64.10
|
| Rate for Payer: Humana Medicare |
$23.75
|
| Rate for Payer: Lucent All Commercial |
$40.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.79
|
| Rate for Payer: Managed Health Services Medicaid |
$25.25
|
| Rate for Payer: MDWise Medicaid |
$25.25
|
| Rate for Payer: PHCS All Commercial |
$55.66
|
| Rate for Payer: PHP All Commercial |
$56.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.94
|
| Rate for Payer: Sagamore Health Network All Products |
$57.29
|
| Rate for Payer: Signature Care EPO |
$61.59
|
| Rate for Payer: Signature Care PPO |
$65.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.08
|
| Rate for Payer: United Healthcare Commercial |
$58.48
|
| Rate for Payer: United Healthcare Medicare |
$23.75
|
|
|
HC CATECHOLAMINES, FRACTIONATED, URINARY FREE, 24-HOUR URINE
|
Facility
|
IP
|
$74.21
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
63044029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$69.02 |
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Cash Price |
$44.53
|
| Rate for Payer: Cigna All Commercial |
$64.04
|
| Rate for Payer: CORVEL All Commercial |
$69.02
|
| Rate for Payer: Coventry All Commercial |
$65.30
|
| Rate for Payer: Encore All Commercial |
$68.31
|
| Rate for Payer: Frontpath All Commercial |
$68.27
|
| Rate for Payer: Humana ChoiceCare |
$64.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.79
|
| Rate for Payer: PHCS All Commercial |
$55.66
|
| Rate for Payer: PHP All Commercial |
$56.28
|
| Rate for Payer: Sagamore Health Network All Products |
$57.29
|
| Rate for Payer: Signature Care EPO |
$61.59
|
| Rate for Payer: Signature Care PPO |
$65.30
|
| Rate for Payer: United Healthcare Commercial |
$58.48
|
|
|
HC CATH 3WAY 22FR/30CC
|
Facility
|
IP
|
$63.49
|
|
| Hospital Charge Code |
41601903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.62 |
| Max. Negotiated Rate |
$59.05 |
| Rate for Payer: Aetna Commercial |
$54.86
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cigna All Commercial |
$54.79
|
| Rate for Payer: CORVEL All Commercial |
$59.05
|
| Rate for Payer: Coventry All Commercial |
$55.87
|
| Rate for Payer: Encore All Commercial |
$58.44
|
| Rate for Payer: Frontpath All Commercial |
$58.41
|
| Rate for Payer: Humana ChoiceCare |
$54.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.14
|
| Rate for Payer: PHCS All Commercial |
$47.62
|
| Rate for Payer: PHP All Commercial |
$48.15
|
| Rate for Payer: Sagamore Health Network All Products |
$49.01
|
| Rate for Payer: Signature Care EPO |
$52.70
|
| Rate for Payer: Signature Care PPO |
$55.87
|
| Rate for Payer: United Healthcare Commercial |
$50.03
|
|
|
HC CATH 3WAY 22FR/30CC
|
Facility
|
OP
|
$63.49
|
|
| Hospital Charge Code |
41601903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$59.05 |
| Rate for Payer: Aetna Commercial |
$53.59
|
| Rate for Payer: Aetna Medicare |
$20.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.35
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Centivo All Commercial |
$34.54
|
| Rate for Payer: Cigna All Commercial |
$54.79
|
| Rate for Payer: CORVEL All Commercial |
$59.05
|
| Rate for Payer: Coventry All Commercial |
$55.87
|
| Rate for Payer: Encore All Commercial |
$58.44
|
| Rate for Payer: Frontpath All Commercial |
$58.41
|
| Rate for Payer: Humana ChoiceCare |
$54.84
|
| Rate for Payer: Humana Medicare |
$20.32
|
| Rate for Payer: Lucent All Commercial |
$34.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.14
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$47.62
|
| Rate for Payer: PHP All Commercial |
$48.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.76
|
| Rate for Payer: Sagamore Health Network All Products |
$49.01
|
| Rate for Payer: Signature Care EPO |
$52.70
|
| Rate for Payer: Signature Care PPO |
$55.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.97
|
| Rate for Payer: United Healthcare Commercial |
$50.03
|
| Rate for Payer: United Healthcare Medicare |
$20.32
|
|
|
HC CATH 3WAY 24FR/30CC
|
Facility
|
OP
|
$62.79
|
|
| Hospital Charge Code |
41601904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$58.39 |
| Rate for Payer: Aetna Commercial |
$52.99
|
| Rate for Payer: Aetna Medicare |
$20.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.10
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Centivo All Commercial |
$34.16
|
| Rate for Payer: Cigna All Commercial |
$54.19
|
| Rate for Payer: CORVEL All Commercial |
$58.39
|
| Rate for Payer: Coventry All Commercial |
$55.26
|
| Rate for Payer: Encore All Commercial |
$57.80
|
| Rate for Payer: Frontpath All Commercial |
$57.77
|
| Rate for Payer: Humana ChoiceCare |
$54.23
|
| Rate for Payer: Humana Medicare |
$20.09
|
| Rate for Payer: Lucent All Commercial |
$34.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.51
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$47.09
|
| Rate for Payer: PHP All Commercial |
$47.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.49
|
| Rate for Payer: Sagamore Health Network All Products |
$48.47
|
| Rate for Payer: Signature Care EPO |
$52.12
|
| Rate for Payer: Signature Care PPO |
$55.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.37
|
| Rate for Payer: United Healthcare Commercial |
$49.48
|
| Rate for Payer: United Healthcare Medicare |
$20.09
|
|
|
HC CATH 3WAY 24FR/30CC
|
Facility
|
IP
|
$62.79
|
|
| Hospital Charge Code |
41601904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.09 |
| Max. Negotiated Rate |
$58.39 |
| Rate for Payer: Aetna Commercial |
$54.25
|
| Rate for Payer: Cash Price |
$37.67
|
| Rate for Payer: Cigna All Commercial |
$54.19
|
| Rate for Payer: CORVEL All Commercial |
$58.39
|
| Rate for Payer: Coventry All Commercial |
$55.26
|
| Rate for Payer: Encore All Commercial |
$57.80
|
| Rate for Payer: Frontpath All Commercial |
$57.77
|
| Rate for Payer: Humana ChoiceCare |
$54.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.51
|
| Rate for Payer: PHCS All Commercial |
$47.09
|
| Rate for Payer: PHP All Commercial |
$47.62
|
| Rate for Payer: Sagamore Health Network All Products |
$48.47
|
| Rate for Payer: Signature Care EPO |
$52.12
|
| Rate for Payer: Signature Care PPO |
$55.26
|
| Rate for Payer: United Healthcare Commercial |
$49.48
|
|
|
HC CATH 3WAY 24FR/30CC SILICONE
|
Facility
|
OP
|
$72.24
|
|
| Hospital Charge Code |
41601905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$60.97
|
| Rate for Payer: Aetna Medicare |
$23.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.43
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Centivo All Commercial |
$39.30
|
| Rate for Payer: Cigna All Commercial |
$62.34
|
| Rate for Payer: CORVEL All Commercial |
$67.18
|
| Rate for Payer: Coventry All Commercial |
$63.57
|
| Rate for Payer: Encore All Commercial |
$66.50
|
| Rate for Payer: Frontpath All Commercial |
$66.46
|
| Rate for Payer: Humana ChoiceCare |
$62.39
|
| Rate for Payer: Humana Medicare |
$23.12
|
| Rate for Payer: Lucent All Commercial |
$39.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.02
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$54.18
|
| Rate for Payer: PHP All Commercial |
$54.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.17
|
| Rate for Payer: Sagamore Health Network All Products |
$55.77
|
| Rate for Payer: Signature Care EPO |
$59.96
|
| Rate for Payer: Signature Care PPO |
$63.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.40
|
| Rate for Payer: United Healthcare Commercial |
$56.93
|
| Rate for Payer: United Healthcare Medicare |
$23.12
|
|
|
HC CATH 3WAY 24FR/30CC SILICONE
|
Facility
|
IP
|
$72.24
|
|
| Hospital Charge Code |
41601905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.18 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cigna All Commercial |
$62.34
|
| Rate for Payer: CORVEL All Commercial |
$67.18
|
| Rate for Payer: Coventry All Commercial |
$63.57
|
| Rate for Payer: Encore All Commercial |
$66.50
|
| Rate for Payer: Frontpath All Commercial |
$66.46
|
| Rate for Payer: Humana ChoiceCare |
$62.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.02
|
| Rate for Payer: PHCS All Commercial |
$54.18
|
| Rate for Payer: PHP All Commercial |
$54.79
|
| Rate for Payer: Sagamore Health Network All Products |
$55.77
|
| Rate for Payer: Signature Care EPO |
$59.96
|
| Rate for Payer: Signature Care PPO |
$63.57
|
| Rate for Payer: United Healthcare Commercial |
$56.93
|
|
|
HC CATH ADULT FEMALE KIT
|
Facility
|
OP
|
$11.56
|
|
| Hospital Charge Code |
41601064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Aetna Medicare |
$3.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.07
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Centivo All Commercial |
$6.29
|
| Rate for Payer: Cigna All Commercial |
$9.98
|
| Rate for Payer: CORVEL All Commercial |
$10.75
|
| Rate for Payer: Coventry All Commercial |
$10.17
|
| Rate for Payer: Encore All Commercial |
$10.64
|
| Rate for Payer: Frontpath All Commercial |
$10.64
|
| Rate for Payer: Humana ChoiceCare |
$9.98
|
| Rate for Payer: Humana Medicare |
$3.70
|
| Rate for Payer: Lucent All Commercial |
$6.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.40
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$8.67
|
| Rate for Payer: PHP All Commercial |
$8.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.51
|
| Rate for Payer: Sagamore Health Network All Products |
$8.92
|
| Rate for Payer: Signature Care EPO |
$9.59
|
| Rate for Payer: Signature Care PPO |
$10.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$9.11
|
| Rate for Payer: United Healthcare Medicare |
$3.70
|
|
|
HC CATH ADULT FEMALE KIT
|
Facility
|
IP
|
$11.56
|
|
| Hospital Charge Code |
41601064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$10.75 |
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Cigna All Commercial |
$9.98
|
| Rate for Payer: CORVEL All Commercial |
$10.75
|
| Rate for Payer: Coventry All Commercial |
$10.17
|
| Rate for Payer: Encore All Commercial |
$10.64
|
| Rate for Payer: Frontpath All Commercial |
$10.64
|
| Rate for Payer: Humana ChoiceCare |
$9.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.40
|
| Rate for Payer: PHCS All Commercial |
$8.67
|
| Rate for Payer: PHP All Commercial |
$8.77
|
| Rate for Payer: Sagamore Health Network All Products |
$8.92
|
| Rate for Payer: Signature Care EPO |
$9.59
|
| Rate for Payer: Signature Care PPO |
$10.17
|
| Rate for Payer: United Healthcare Commercial |
$9.11
|
|
|
HC CATH ARTERIAL KIT
|
Facility
|
IP
|
$457.80
|
|
| Hospital Charge Code |
41601263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.35 |
| Max. Negotiated Rate |
$425.75 |
| Rate for Payer: Aetna Commercial |
$395.54
|
| Rate for Payer: Cash Price |
$274.68
|
| Rate for Payer: Cigna All Commercial |
$395.08
|
| Rate for Payer: CORVEL All Commercial |
$425.75
|
| Rate for Payer: Coventry All Commercial |
$402.86
|
| Rate for Payer: Encore All Commercial |
$421.40
|
| Rate for Payer: Frontpath All Commercial |
$421.18
|
| Rate for Payer: Humana ChoiceCare |
$395.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.02
|
| Rate for Payer: PHCS All Commercial |
$343.35
|
| Rate for Payer: PHP All Commercial |
$347.20
|
| Rate for Payer: Sagamore Health Network All Products |
$353.42
|
| Rate for Payer: Signature Care EPO |
$379.97
|
| Rate for Payer: Signature Care PPO |
$402.86
|
| Rate for Payer: United Healthcare Commercial |
$360.75
|
|
|
HC CATH ARTERIAL KIT
|
Facility
|
OP
|
$457.80
|
|
| Hospital Charge Code |
41601263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$425.75 |
| Rate for Payer: Aetna Commercial |
$386.38
|
| Rate for Payer: Aetna Medicare |
$146.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$262.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$286.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$168.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$161.15
|
| Rate for Payer: Cash Price |
$274.68
|
| Rate for Payer: Cash Price |
$274.68
|
| Rate for Payer: Centivo All Commercial |
$249.04
|
| Rate for Payer: Cigna All Commercial |
$395.08
|
| Rate for Payer: CORVEL All Commercial |
$425.75
|
| Rate for Payer: Coventry All Commercial |
$402.86
|
| Rate for Payer: Encore All Commercial |
$421.40
|
| Rate for Payer: Frontpath All Commercial |
$421.18
|
| Rate for Payer: Humana ChoiceCare |
$395.40
|
| Rate for Payer: Humana Medicare |
$146.50
|
| Rate for Payer: Lucent All Commercial |
$249.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.02
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$343.35
|
| Rate for Payer: PHP All Commercial |
$347.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$178.54
|
| Rate for Payer: Sagamore Health Network All Products |
$353.42
|
| Rate for Payer: Signature Care EPO |
$379.97
|
| Rate for Payer: Signature Care PPO |
$402.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$389.13
|
| Rate for Payer: United Healthcare Commercial |
$360.75
|
| Rate for Payer: United Healthcare Medicare |
$146.50
|
|
|
HC CATH BALLOON DILATION SPYGLASS 6.0MM
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$801.80
|
| Rate for Payer: Aetna Medicare |
$304.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$294.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$545.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$593.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$349.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$334.40
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Centivo All Commercial |
$516.80
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.51
|
| Rate for Payer: Humana Medicare |
$304.00
|
| Rate for Payer: Lucent All Commercial |
$516.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$370.50
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$807.50
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
| Rate for Payer: United Healthcare Medicare |
$304.00
|
|
|
HC CATH BALLOON DILATION SPYGLASS 6.0MM
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$820.80
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
|
|
HC CATH BALLOON DILATION SPYGLASS 7.0MM
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$801.80
|
| Rate for Payer: Aetna Medicare |
$304.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$294.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$545.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$593.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$349.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$334.40
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Centivo All Commercial |
$516.80
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.51
|
| Rate for Payer: Humana Medicare |
$304.00
|
| Rate for Payer: Lucent All Commercial |
$516.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$370.50
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$807.50
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
| Rate for Payer: United Healthcare Medicare |
$304.00
|
|
|
HC CATH BALLOON DILATION SPYGLASS 7.0MM
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$820.80
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
|
|
HC CATH BALLOON DILATION SPYGLASS 8.0MM
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$801.80
|
| Rate for Payer: Aetna Medicare |
$304.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$294.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$545.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$593.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$349.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$334.40
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Centivo All Commercial |
$516.80
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.51
|
| Rate for Payer: Humana Medicare |
$304.00
|
| Rate for Payer: Lucent All Commercial |
$516.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$370.50
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$807.50
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
| Rate for Payer: United Healthcare Medicare |
$304.00
|
|
|
HC CATH BALLOON DILATION SPYGLASS 8.0MM
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
41608354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna Commercial |
$820.80
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna All Commercial |
$819.85
|
| Rate for Payer: CORVEL All Commercial |
$883.50
|
| Rate for Payer: Coventry All Commercial |
$836.00
|
| Rate for Payer: Encore All Commercial |
$874.48
|
| Rate for Payer: Frontpath All Commercial |
$874.00
|
| Rate for Payer: Humana ChoiceCare |
$820.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$855.00
|
| Rate for Payer: PHCS All Commercial |
$712.50
|
| Rate for Payer: PHP All Commercial |
$720.48
|
| Rate for Payer: Sagamore Health Network All Products |
$733.40
|
| Rate for Payer: Signature Care EPO |
$788.50
|
| Rate for Payer: Signature Care PPO |
$836.00
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
|
|
HC CATH CHOLANGIOGRAM 4.5 FR
|
Facility
|
IP
|
$408.10
|
|
| Hospital Charge Code |
41601900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.07 |
| Max. Negotiated Rate |
$379.53 |
| Rate for Payer: Aetna Commercial |
$352.60
|
| Rate for Payer: Cash Price |
$244.86
|
| Rate for Payer: Cigna All Commercial |
$352.19
|
| Rate for Payer: CORVEL All Commercial |
$379.53
|
| Rate for Payer: Coventry All Commercial |
$359.13
|
| Rate for Payer: Encore All Commercial |
$375.66
|
| Rate for Payer: Frontpath All Commercial |
$375.45
|
| Rate for Payer: Humana ChoiceCare |
$352.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.29
|
| Rate for Payer: PHCS All Commercial |
$306.07
|
| Rate for Payer: PHP All Commercial |
$309.50
|
| Rate for Payer: Sagamore Health Network All Products |
$315.05
|
| Rate for Payer: Signature Care EPO |
$338.72
|
| Rate for Payer: Signature Care PPO |
$359.13
|
| Rate for Payer: United Healthcare Commercial |
$321.58
|
|
|
HC CATH CHOLANGIOGRAM 4.5 FR
|
Facility
|
OP
|
$408.10
|
|
| Hospital Charge Code |
41601900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$379.53 |
| Rate for Payer: Aetna Commercial |
$344.44
|
| Rate for Payer: Aetna Medicare |
$130.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$234.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.65
|
| Rate for Payer: Cash Price |
$244.86
|
| Rate for Payer: Cash Price |
$244.86
|
| Rate for Payer: Centivo All Commercial |
$222.01
|
| Rate for Payer: Cigna All Commercial |
$352.19
|
| Rate for Payer: CORVEL All Commercial |
$379.53
|
| Rate for Payer: Coventry All Commercial |
$359.13
|
| Rate for Payer: Encore All Commercial |
$375.66
|
| Rate for Payer: Frontpath All Commercial |
$375.45
|
| Rate for Payer: Humana ChoiceCare |
$352.48
|
| Rate for Payer: Humana Medicare |
$130.59
|
| Rate for Payer: Lucent All Commercial |
$222.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.29
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$306.07
|
| Rate for Payer: PHP All Commercial |
$309.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.16
|
| Rate for Payer: Sagamore Health Network All Products |
$315.05
|
| Rate for Payer: Signature Care EPO |
$338.72
|
| Rate for Payer: Signature Care PPO |
$359.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$346.88
|
| Rate for Payer: United Healthcare Commercial |
$321.58
|
| Rate for Payer: United Healthcare Medicare |
$130.59
|
|
|
HC CATH DRAINAGE TWIST HUB 8FR
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
41607842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$272.16
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna All Commercial |
$271.85
|
| Rate for Payer: CORVEL All Commercial |
$292.95
|
| Rate for Payer: Coventry All Commercial |
$277.20
|
| Rate for Payer: Encore All Commercial |
$289.96
|
| Rate for Payer: Frontpath All Commercial |
$289.80
|
| Rate for Payer: Humana ChoiceCare |
$272.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.50
|
| Rate for Payer: PHCS All Commercial |
$236.25
|
| Rate for Payer: PHP All Commercial |
$238.90
|
| Rate for Payer: Sagamore Health Network All Products |
$243.18
|
| Rate for Payer: Signature Care EPO |
$261.45
|
| Rate for Payer: Signature Care PPO |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$248.22
|
|
|
HC CATH DRAINAGE TWIST HUB 8FR
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
41607842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$265.86
|
| Rate for Payer: Aetna Medicare |
$100.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$180.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.88
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Centivo All Commercial |
$171.36
|
| Rate for Payer: Cigna All Commercial |
$271.85
|
| Rate for Payer: CORVEL All Commercial |
$292.95
|
| Rate for Payer: Coventry All Commercial |
$277.20
|
| Rate for Payer: Encore All Commercial |
$289.96
|
| Rate for Payer: Frontpath All Commercial |
$289.80
|
| Rate for Payer: Humana ChoiceCare |
$272.07
|
| Rate for Payer: Humana Medicare |
$100.80
|
| Rate for Payer: Lucent All Commercial |
$171.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$236.25
|
| Rate for Payer: PHP All Commercial |
$238.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.85
|
| Rate for Payer: Sagamore Health Network All Products |
$243.18
|
| Rate for Payer: Signature Care EPO |
$261.45
|
| Rate for Payer: Signature Care PPO |
$277.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$267.75
|
| Rate for Payer: United Healthcare Commercial |
$248.22
|
| Rate for Payer: United Healthcare Medicare |
$100.80
|
|
