|
HC CATH DRAIN EXPEL MULTI 12FR
|
Facility
|
IP
|
$672.00
|
|
| Hospital Charge Code |
41607841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$580.61
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna All Commercial |
$579.94
|
| Rate for Payer: CORVEL All Commercial |
$624.96
|
| Rate for Payer: Coventry All Commercial |
$591.36
|
| Rate for Payer: Encore All Commercial |
$618.58
|
| Rate for Payer: Frontpath All Commercial |
$618.24
|
| Rate for Payer: Humana ChoiceCare |
$580.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$604.80
|
| Rate for Payer: PHCS All Commercial |
$504.00
|
| Rate for Payer: PHP All Commercial |
$509.64
|
| Rate for Payer: Sagamore Health Network All Products |
$518.78
|
| Rate for Payer: Signature Care EPO |
$557.76
|
| Rate for Payer: Signature Care PPO |
$591.36
|
| Rate for Payer: United Healthcare Commercial |
$529.54
|
|
|
HC CATH DRAIN EXPEL MULTI 12FR
|
Facility
|
OP
|
$672.00
|
|
| Hospital Charge Code |
41607841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$567.17
|
| Rate for Payer: Aetna Medicare |
$215.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$208.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$385.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$420.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$247.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$236.54
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Centivo All Commercial |
$365.57
|
| Rate for Payer: Cigna All Commercial |
$579.94
|
| Rate for Payer: CORVEL All Commercial |
$624.96
|
| Rate for Payer: Coventry All Commercial |
$591.36
|
| Rate for Payer: Encore All Commercial |
$618.58
|
| Rate for Payer: Frontpath All Commercial |
$618.24
|
| Rate for Payer: Humana ChoiceCare |
$580.41
|
| Rate for Payer: Humana Medicare |
$215.04
|
| Rate for Payer: Lucent All Commercial |
$365.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$604.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$504.00
|
| Rate for Payer: PHP All Commercial |
$509.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$262.08
|
| Rate for Payer: Sagamore Health Network All Products |
$518.78
|
| Rate for Payer: Signature Care EPO |
$557.76
|
| Rate for Payer: Signature Care PPO |
$591.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$571.20
|
| Rate for Payer: United Healthcare Commercial |
$529.54
|
| Rate for Payer: United Healthcare Medicare |
$215.04
|
|
|
HC CATHETER FOLEY W/TEMP SENSOR
|
Facility
|
IP
|
$54.88
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
41606927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: Cash Price |
$32.93
|
| Rate for Payer: Cigna All Commercial |
$47.36
|
| Rate for Payer: CORVEL All Commercial |
$51.04
|
| Rate for Payer: Coventry All Commercial |
$48.29
|
| Rate for Payer: Encore All Commercial |
$50.52
|
| Rate for Payer: Frontpath All Commercial |
$50.49
|
| Rate for Payer: Humana ChoiceCare |
$47.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.39
|
| Rate for Payer: PHCS All Commercial |
$41.16
|
| Rate for Payer: PHP All Commercial |
$41.62
|
| Rate for Payer: Sagamore Health Network All Products |
$42.37
|
| Rate for Payer: Signature Care EPO |
$45.55
|
| Rate for Payer: Signature Care PPO |
$48.29
|
| Rate for Payer: United Healthcare Commercial |
$43.25
|
|
|
HC CATHETER FOLEY W/TEMP SENSOR
|
Facility
|
OP
|
$54.88
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
41606927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare |
$17.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.32
|
| Rate for Payer: Cash Price |
$32.93
|
| Rate for Payer: Cash Price |
$32.93
|
| Rate for Payer: Centivo All Commercial |
$29.85
|
| Rate for Payer: Cigna All Commercial |
$47.36
|
| Rate for Payer: CORVEL All Commercial |
$51.04
|
| Rate for Payer: Coventry All Commercial |
$48.29
|
| Rate for Payer: Encore All Commercial |
$50.52
|
| Rate for Payer: Frontpath All Commercial |
$50.49
|
| Rate for Payer: Humana ChoiceCare |
$47.40
|
| Rate for Payer: Humana Medicare |
$17.56
|
| Rate for Payer: Lucent All Commercial |
$29.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.39
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$41.16
|
| Rate for Payer: PHP All Commercial |
$41.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.40
|
| Rate for Payer: Sagamore Health Network All Products |
$42.37
|
| Rate for Payer: Signature Care EPO |
$45.55
|
| Rate for Payer: Signature Care PPO |
$48.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.65
|
| Rate for Payer: United Healthcare Commercial |
$43.25
|
| Rate for Payer: United Healthcare Medicare |
$17.56
|
|
|
HC CATH FIXATION DEVICE 5-14F
|
Facility
|
OP
|
$79.87
|
|
|
Service Code
|
CPT A5200
|
| Hospital Charge Code |
41607843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$74.28 |
| Rate for Payer: Aetna Commercial |
$67.41
|
| Rate for Payer: Aetna Medicare |
$25.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.11
|
| Rate for Payer: Cash Price |
$47.92
|
| Rate for Payer: Cash Price |
$47.92
|
| Rate for Payer: Centivo All Commercial |
$43.45
|
| Rate for Payer: Cigna All Commercial |
$68.93
|
| Rate for Payer: CORVEL All Commercial |
$74.28
|
| Rate for Payer: Coventry All Commercial |
$70.29
|
| Rate for Payer: Encore All Commercial |
$73.52
|
| Rate for Payer: Frontpath All Commercial |
$73.48
|
| Rate for Payer: Humana ChoiceCare |
$68.98
|
| Rate for Payer: Humana Medicare |
$25.56
|
| Rate for Payer: Lucent All Commercial |
$43.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.88
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$59.90
|
| Rate for Payer: PHP All Commercial |
$60.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.15
|
| Rate for Payer: Sagamore Health Network All Products |
$61.66
|
| Rate for Payer: Signature Care EPO |
$66.29
|
| Rate for Payer: Signature Care PPO |
$70.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.89
|
| Rate for Payer: United Healthcare Commercial |
$62.94
|
| Rate for Payer: United Healthcare Medicare |
$25.56
|
|
|
HC CATH FIXATION DEVICE 5-14F
|
Facility
|
IP
|
$79.87
|
|
|
Service Code
|
CPT A5200
|
| Hospital Charge Code |
41607843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$74.28 |
| Rate for Payer: Aetna Commercial |
$69.01
|
| Rate for Payer: Cash Price |
$47.92
|
| Rate for Payer: Cigna All Commercial |
$68.93
|
| Rate for Payer: CORVEL All Commercial |
$74.28
|
| Rate for Payer: Coventry All Commercial |
$70.29
|
| Rate for Payer: Encore All Commercial |
$73.52
|
| Rate for Payer: Frontpath All Commercial |
$73.48
|
| Rate for Payer: Humana ChoiceCare |
$68.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.88
|
| Rate for Payer: PHCS All Commercial |
$59.90
|
| Rate for Payer: PHP All Commercial |
$60.57
|
| Rate for Payer: Sagamore Health Network All Products |
$61.66
|
| Rate for Payer: Signature Care EPO |
$66.29
|
| Rate for Payer: Signature Care PPO |
$70.29
|
| Rate for Payer: United Healthcare Commercial |
$62.94
|
|
|
HC CATH FOLEY 10FR 3CC
|
Facility
|
IP
|
$24.08
|
|
| Hospital Charge Code |
41601420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$22.39 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cigna All Commercial |
$20.78
|
| Rate for Payer: CORVEL All Commercial |
$22.39
|
| Rate for Payer: Coventry All Commercial |
$21.19
|
| Rate for Payer: Encore All Commercial |
$22.17
|
| Rate for Payer: Frontpath All Commercial |
$22.15
|
| Rate for Payer: Humana ChoiceCare |
$20.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.67
|
| Rate for Payer: PHCS All Commercial |
$18.06
|
| Rate for Payer: PHP All Commercial |
$18.26
|
| Rate for Payer: Sagamore Health Network All Products |
$18.59
|
| Rate for Payer: Signature Care EPO |
$19.99
|
| Rate for Payer: Signature Care PPO |
$21.19
|
| Rate for Payer: United Healthcare Commercial |
$18.98
|
|
|
HC CATH FOLEY 10FR 3CC
|
Facility
|
OP
|
$24.08
|
|
| Hospital Charge Code |
41601420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$7.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.48
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Centivo All Commercial |
$13.10
|
| Rate for Payer: Cigna All Commercial |
$20.78
|
| Rate for Payer: CORVEL All Commercial |
$22.39
|
| Rate for Payer: Coventry All Commercial |
$21.19
|
| Rate for Payer: Encore All Commercial |
$22.17
|
| Rate for Payer: Frontpath All Commercial |
$22.15
|
| Rate for Payer: Humana ChoiceCare |
$20.80
|
| Rate for Payer: Humana Medicare |
$7.71
|
| Rate for Payer: Lucent All Commercial |
$13.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.67
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$18.06
|
| Rate for Payer: PHP All Commercial |
$18.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.39
|
| Rate for Payer: Sagamore Health Network All Products |
$18.59
|
| Rate for Payer: Signature Care EPO |
$19.99
|
| Rate for Payer: Signature Care PPO |
$21.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.47
|
| Rate for Payer: United Healthcare Commercial |
$18.98
|
| Rate for Payer: United Healthcare Medicare |
$7.71
|
|
|
HC CATH FOLEY 12FR 5CC
|
Facility
|
IP
|
$23.20
|
|
| Hospital Charge Code |
41601012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$21.58 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cigna All Commercial |
$20.02
|
| Rate for Payer: CORVEL All Commercial |
$21.58
|
| Rate for Payer: Coventry All Commercial |
$20.42
|
| Rate for Payer: Encore All Commercial |
$21.36
|
| Rate for Payer: Frontpath All Commercial |
$21.34
|
| Rate for Payer: Humana ChoiceCare |
$20.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.88
|
| Rate for Payer: PHCS All Commercial |
$17.40
|
| Rate for Payer: PHP All Commercial |
$17.59
|
| Rate for Payer: Sagamore Health Network All Products |
$17.91
|
| Rate for Payer: Signature Care EPO |
$19.26
|
| Rate for Payer: Signature Care PPO |
$20.42
|
| Rate for Payer: United Healthcare Commercial |
$18.28
|
|
|
HC CATH FOLEY 12FR 5CC
|
Facility
|
OP
|
$23.20
|
|
| Hospital Charge Code |
41601012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Centivo All Commercial |
$12.62
|
| Rate for Payer: Cigna All Commercial |
$20.02
|
| Rate for Payer: CORVEL All Commercial |
$21.58
|
| Rate for Payer: Coventry All Commercial |
$20.42
|
| Rate for Payer: Encore All Commercial |
$21.36
|
| Rate for Payer: Frontpath All Commercial |
$21.34
|
| Rate for Payer: Humana ChoiceCare |
$20.04
|
| Rate for Payer: Humana Medicare |
$7.42
|
| Rate for Payer: Lucent All Commercial |
$12.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.88
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.40
|
| Rate for Payer: PHP All Commercial |
$17.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.05
|
| Rate for Payer: Sagamore Health Network All Products |
$17.91
|
| Rate for Payer: Signature Care EPO |
$19.26
|
| Rate for Payer: Signature Care PPO |
$20.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.72
|
| Rate for Payer: United Healthcare Commercial |
$18.28
|
| Rate for Payer: United Healthcare Medicare |
$7.42
|
|
|
HC CATH FOLEY 14FR 5CC
|
Facility
|
OP
|
$27.09
|
|
| Hospital Charge Code |
41601013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$22.86
|
| Rate for Payer: Aetna Medicare |
$8.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.54
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Centivo All Commercial |
$14.74
|
| Rate for Payer: Cigna All Commercial |
$23.38
|
| Rate for Payer: CORVEL All Commercial |
$25.19
|
| Rate for Payer: Coventry All Commercial |
$23.84
|
| Rate for Payer: Encore All Commercial |
$24.94
|
| Rate for Payer: Frontpath All Commercial |
$24.92
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Humana Medicare |
$8.67
|
| Rate for Payer: Lucent All Commercial |
$14.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.38
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$20.32
|
| Rate for Payer: PHP All Commercial |
$20.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.57
|
| Rate for Payer: Sagamore Health Network All Products |
$20.91
|
| Rate for Payer: Signature Care EPO |
$22.48
|
| Rate for Payer: Signature Care PPO |
$23.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.03
|
| Rate for Payer: United Healthcare Commercial |
$21.35
|
| Rate for Payer: United Healthcare Medicare |
$8.67
|
|
|
HC CATH FOLEY 14FR 5CC
|
Facility
|
IP
|
$27.09
|
|
| Hospital Charge Code |
41601013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$25.19 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cigna All Commercial |
$23.38
|
| Rate for Payer: CORVEL All Commercial |
$25.19
|
| Rate for Payer: Coventry All Commercial |
$23.84
|
| Rate for Payer: Encore All Commercial |
$24.94
|
| Rate for Payer: Frontpath All Commercial |
$24.92
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.38
|
| Rate for Payer: PHCS All Commercial |
$20.32
|
| Rate for Payer: PHP All Commercial |
$20.55
|
| Rate for Payer: Sagamore Health Network All Products |
$20.91
|
| Rate for Payer: Signature Care EPO |
$22.48
|
| Rate for Payer: Signature Care PPO |
$23.84
|
| Rate for Payer: United Healthcare Commercial |
$21.35
|
|
|
HC CATH FOLEY 16FR 5CC
|
Facility
|
OP
|
$23.24
|
|
| Hospital Charge Code |
41601014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$19.61
|
| Rate for Payer: Aetna Medicare |
$7.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.18
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Centivo All Commercial |
$12.64
|
| Rate for Payer: Cigna All Commercial |
$20.06
|
| Rate for Payer: CORVEL All Commercial |
$21.61
|
| Rate for Payer: Coventry All Commercial |
$20.45
|
| Rate for Payer: Encore All Commercial |
$21.39
|
| Rate for Payer: Frontpath All Commercial |
$21.38
|
| Rate for Payer: Humana ChoiceCare |
$20.07
|
| Rate for Payer: Humana Medicare |
$7.44
|
| Rate for Payer: Lucent All Commercial |
$12.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.92
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.43
|
| Rate for Payer: PHP All Commercial |
$17.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.06
|
| Rate for Payer: Sagamore Health Network All Products |
$17.94
|
| Rate for Payer: Signature Care EPO |
$19.29
|
| Rate for Payer: Signature Care PPO |
$20.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.75
|
| Rate for Payer: United Healthcare Commercial |
$18.31
|
| Rate for Payer: United Healthcare Medicare |
$7.44
|
|
|
HC CATH FOLEY 16FR 5CC
|
Facility
|
IP
|
$23.24
|
|
| Hospital Charge Code |
41601014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$20.08
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cigna All Commercial |
$20.06
|
| Rate for Payer: CORVEL All Commercial |
$21.61
|
| Rate for Payer: Coventry All Commercial |
$20.45
|
| Rate for Payer: Encore All Commercial |
$21.39
|
| Rate for Payer: Frontpath All Commercial |
$21.38
|
| Rate for Payer: Humana ChoiceCare |
$20.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.92
|
| Rate for Payer: PHCS All Commercial |
$17.43
|
| Rate for Payer: PHP All Commercial |
$17.63
|
| Rate for Payer: Sagamore Health Network All Products |
$17.94
|
| Rate for Payer: Signature Care EPO |
$19.29
|
| Rate for Payer: Signature Care PPO |
$20.45
|
| Rate for Payer: United Healthcare Commercial |
$18.31
|
|
|
HC CATH FOLEY 18FR 30CC
|
Facility
|
OP
|
$51.25
|
|
| Hospital Charge Code |
41601015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$47.66 |
| Rate for Payer: Aetna Commercial |
$43.26
|
| Rate for Payer: Aetna Medicare |
$16.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.04
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Centivo All Commercial |
$27.88
|
| Rate for Payer: Cigna All Commercial |
$44.23
|
| Rate for Payer: CORVEL All Commercial |
$47.66
|
| Rate for Payer: Coventry All Commercial |
$45.10
|
| Rate for Payer: Encore All Commercial |
$47.18
|
| Rate for Payer: Frontpath All Commercial |
$47.15
|
| Rate for Payer: Humana ChoiceCare |
$44.26
|
| Rate for Payer: Humana Medicare |
$16.40
|
| Rate for Payer: Lucent All Commercial |
$27.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.12
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$38.44
|
| Rate for Payer: PHP All Commercial |
$38.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.99
|
| Rate for Payer: Sagamore Health Network All Products |
$39.56
|
| Rate for Payer: Signature Care EPO |
$42.54
|
| Rate for Payer: Signature Care PPO |
$45.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.56
|
| Rate for Payer: United Healthcare Commercial |
$40.38
|
| Rate for Payer: United Healthcare Medicare |
$16.40
|
|
|
HC CATH FOLEY 18FR 30CC
|
Facility
|
IP
|
$51.25
|
|
| Hospital Charge Code |
41601015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$47.66 |
| Rate for Payer: Aetna Commercial |
$44.28
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Cigna All Commercial |
$44.23
|
| Rate for Payer: CORVEL All Commercial |
$47.66
|
| Rate for Payer: Coventry All Commercial |
$45.10
|
| Rate for Payer: Encore All Commercial |
$47.18
|
| Rate for Payer: Frontpath All Commercial |
$47.15
|
| Rate for Payer: Humana ChoiceCare |
$44.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.12
|
| Rate for Payer: PHCS All Commercial |
$38.44
|
| Rate for Payer: PHP All Commercial |
$38.87
|
| Rate for Payer: Sagamore Health Network All Products |
$39.56
|
| Rate for Payer: Signature Care EPO |
$42.54
|
| Rate for Payer: Signature Care PPO |
$45.10
|
| Rate for Payer: United Healthcare Commercial |
$40.38
|
|
|
HC CATH FOLEY 18FR 5CC
|
Facility
|
IP
|
$23.20
|
|
| Hospital Charge Code |
41601016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$21.58 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cigna All Commercial |
$20.02
|
| Rate for Payer: CORVEL All Commercial |
$21.58
|
| Rate for Payer: Coventry All Commercial |
$20.42
|
| Rate for Payer: Encore All Commercial |
$21.36
|
| Rate for Payer: Frontpath All Commercial |
$21.34
|
| Rate for Payer: Humana ChoiceCare |
$20.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.88
|
| Rate for Payer: PHCS All Commercial |
$17.40
|
| Rate for Payer: PHP All Commercial |
$17.59
|
| Rate for Payer: Sagamore Health Network All Products |
$17.91
|
| Rate for Payer: Signature Care EPO |
$19.26
|
| Rate for Payer: Signature Care PPO |
$20.42
|
| Rate for Payer: United Healthcare Commercial |
$18.28
|
|
|
HC CATH FOLEY 18FR 5CC
|
Facility
|
OP
|
$23.20
|
|
| Hospital Charge Code |
41601016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Centivo All Commercial |
$12.62
|
| Rate for Payer: Cigna All Commercial |
$20.02
|
| Rate for Payer: CORVEL All Commercial |
$21.58
|
| Rate for Payer: Coventry All Commercial |
$20.42
|
| Rate for Payer: Encore All Commercial |
$21.36
|
| Rate for Payer: Frontpath All Commercial |
$21.34
|
| Rate for Payer: Humana ChoiceCare |
$20.04
|
| Rate for Payer: Humana Medicare |
$7.42
|
| Rate for Payer: Lucent All Commercial |
$12.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.88
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.40
|
| Rate for Payer: PHP All Commercial |
$17.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.05
|
| Rate for Payer: Sagamore Health Network All Products |
$17.91
|
| Rate for Payer: Signature Care EPO |
$19.26
|
| Rate for Payer: Signature Care PPO |
$20.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.72
|
| Rate for Payer: United Healthcare Commercial |
$18.28
|
| Rate for Payer: United Healthcare Medicare |
$7.42
|
|
|
HC CATH FOLEY 24FR 5CC
|
Facility
|
IP
|
$23.24
|
|
| Hospital Charge Code |
41601422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$20.08
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cigna All Commercial |
$20.06
|
| Rate for Payer: CORVEL All Commercial |
$21.61
|
| Rate for Payer: Coventry All Commercial |
$20.45
|
| Rate for Payer: Encore All Commercial |
$21.39
|
| Rate for Payer: Frontpath All Commercial |
$21.38
|
| Rate for Payer: Humana ChoiceCare |
$20.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.92
|
| Rate for Payer: PHCS All Commercial |
$17.43
|
| Rate for Payer: PHP All Commercial |
$17.63
|
| Rate for Payer: Sagamore Health Network All Products |
$17.94
|
| Rate for Payer: Signature Care EPO |
$19.29
|
| Rate for Payer: Signature Care PPO |
$20.45
|
| Rate for Payer: United Healthcare Commercial |
$18.31
|
|
|
HC CATH FOLEY 24FR 5CC
|
Facility
|
OP
|
$23.24
|
|
| Hospital Charge Code |
41601422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$19.61
|
| Rate for Payer: Aetna Medicare |
$7.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.18
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Centivo All Commercial |
$12.64
|
| Rate for Payer: Cigna All Commercial |
$20.06
|
| Rate for Payer: CORVEL All Commercial |
$21.61
|
| Rate for Payer: Coventry All Commercial |
$20.45
|
| Rate for Payer: Encore All Commercial |
$21.39
|
| Rate for Payer: Frontpath All Commercial |
$21.38
|
| Rate for Payer: Humana ChoiceCare |
$20.07
|
| Rate for Payer: Humana Medicare |
$7.44
|
| Rate for Payer: Lucent All Commercial |
$12.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.92
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.43
|
| Rate for Payer: PHP All Commercial |
$17.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.06
|
| Rate for Payer: Sagamore Health Network All Products |
$17.94
|
| Rate for Payer: Signature Care EPO |
$19.29
|
| Rate for Payer: Signature Care PPO |
$20.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.75
|
| Rate for Payer: United Healthcare Commercial |
$18.31
|
| Rate for Payer: United Healthcare Medicare |
$7.44
|
|
|
HC CATH FOLEY 8F/3CC
|
Facility
|
IP
|
$24.08
|
|
| Hospital Charge Code |
41601423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$22.39 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cigna All Commercial |
$20.78
|
| Rate for Payer: CORVEL All Commercial |
$22.39
|
| Rate for Payer: Coventry All Commercial |
$21.19
|
| Rate for Payer: Encore All Commercial |
$22.17
|
| Rate for Payer: Frontpath All Commercial |
$22.15
|
| Rate for Payer: Humana ChoiceCare |
$20.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.67
|
| Rate for Payer: PHCS All Commercial |
$18.06
|
| Rate for Payer: PHP All Commercial |
$18.26
|
| Rate for Payer: Sagamore Health Network All Products |
$18.59
|
| Rate for Payer: Signature Care EPO |
$19.99
|
| Rate for Payer: Signature Care PPO |
$21.19
|
| Rate for Payer: United Healthcare Commercial |
$18.98
|
|
|
HC CATH FOLEY 8F/3CC
|
Facility
|
OP
|
$24.08
|
|
| Hospital Charge Code |
41601423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$7.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.48
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Centivo All Commercial |
$13.10
|
| Rate for Payer: Cigna All Commercial |
$20.78
|
| Rate for Payer: CORVEL All Commercial |
$22.39
|
| Rate for Payer: Coventry All Commercial |
$21.19
|
| Rate for Payer: Encore All Commercial |
$22.17
|
| Rate for Payer: Frontpath All Commercial |
$22.15
|
| Rate for Payer: Humana ChoiceCare |
$20.80
|
| Rate for Payer: Humana Medicare |
$7.71
|
| Rate for Payer: Lucent All Commercial |
$13.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.67
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$18.06
|
| Rate for Payer: PHP All Commercial |
$18.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.39
|
| Rate for Payer: Sagamore Health Network All Products |
$18.59
|
| Rate for Payer: Signature Care EPO |
$19.99
|
| Rate for Payer: Signature Care PPO |
$21.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.47
|
| Rate for Payer: United Healthcare Commercial |
$18.98
|
| Rate for Payer: United Healthcare Medicare |
$7.71
|
|
|
HC CATH HICKMAN SINGLE LUMEN 9FR
|
Facility
|
OP
|
$728.00
|
|
| Hospital Charge Code |
41608428
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$677.04 |
| Rate for Payer: Aetna Commercial |
$614.43
|
| Rate for Payer: Aetna Medicare |
$232.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$225.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$418.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$455.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$267.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$256.26
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Centivo All Commercial |
$396.03
|
| Rate for Payer: Cigna All Commercial |
$628.26
|
| Rate for Payer: CORVEL All Commercial |
$677.04
|
| Rate for Payer: Coventry All Commercial |
$640.64
|
| Rate for Payer: Encore All Commercial |
$670.12
|
| Rate for Payer: Frontpath All Commercial |
$669.76
|
| Rate for Payer: Humana ChoiceCare |
$628.77
|
| Rate for Payer: Humana Medicare |
$232.96
|
| Rate for Payer: Lucent All Commercial |
$396.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$655.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$546.00
|
| Rate for Payer: PHP All Commercial |
$552.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$283.92
|
| Rate for Payer: Sagamore Health Network All Products |
$562.02
|
| Rate for Payer: Signature Care EPO |
$604.24
|
| Rate for Payer: Signature Care PPO |
$640.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$618.80
|
| Rate for Payer: United Healthcare Commercial |
$573.66
|
| Rate for Payer: United Healthcare Medicare |
$232.96
|
|
|
HC CATH HICKMAN SINGLE LUMEN 9FR
|
Facility
|
IP
|
$728.00
|
|
| Hospital Charge Code |
41608428
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$677.04 |
| Rate for Payer: Aetna Commercial |
$628.99
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna All Commercial |
$628.26
|
| Rate for Payer: CORVEL All Commercial |
$677.04
|
| Rate for Payer: Coventry All Commercial |
$640.64
|
| Rate for Payer: Encore All Commercial |
$670.12
|
| Rate for Payer: Frontpath All Commercial |
$669.76
|
| Rate for Payer: Humana ChoiceCare |
$628.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$655.20
|
| Rate for Payer: PHCS All Commercial |
$546.00
|
| Rate for Payer: PHP All Commercial |
$552.12
|
| Rate for Payer: Sagamore Health Network All Products |
$562.02
|
| Rate for Payer: Signature Care EPO |
$604.24
|
| Rate for Payer: Signature Care PPO |
$640.64
|
| Rate for Payer: United Healthcare Commercial |
$573.66
|
|
|
HC CATH INTRAUTERINE PRESSURE
|
Facility
|
OP
|
$200.41
|
|
| Hospital Charge Code |
41602444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$186.38 |
| Rate for Payer: Aetna Commercial |
$169.15
|
| Rate for Payer: Aetna Medicare |
$64.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$62.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$115.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.54
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Centivo All Commercial |
$109.02
|
| Rate for Payer: Cigna All Commercial |
$172.95
|
| Rate for Payer: CORVEL All Commercial |
$186.38
|
| Rate for Payer: Coventry All Commercial |
$176.36
|
| Rate for Payer: Encore All Commercial |
$184.48
|
| Rate for Payer: Frontpath All Commercial |
$184.38
|
| Rate for Payer: Humana ChoiceCare |
$173.09
|
| Rate for Payer: Humana Medicare |
$64.13
|
| Rate for Payer: Lucent All Commercial |
$109.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$180.37
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$150.31
|
| Rate for Payer: PHP All Commercial |
$151.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.16
|
| Rate for Payer: Sagamore Health Network All Products |
$154.72
|
| Rate for Payer: Signature Care EPO |
$166.34
|
| Rate for Payer: Signature Care PPO |
$176.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$170.35
|
| Rate for Payer: United Healthcare Commercial |
$157.92
|
| Rate for Payer: United Healthcare Medicare |
$64.13
|
|
