|
HC CATH INTRAUTERINE PRESSURE
|
Facility
|
IP
|
$200.41
|
|
| Hospital Charge Code |
41602444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.31 |
| Max. Negotiated Rate |
$186.38 |
| Rate for Payer: Aetna Commercial |
$173.15
|
| Rate for Payer: Cash Price |
$120.25
|
| 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: Lutheran Preferred All Commercial |
$180.37
|
| Rate for Payer: PHCS All Commercial |
$150.31
|
| Rate for Payer: PHP All Commercial |
$151.99
|
| 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: United Healthcare Commercial |
$157.92
|
|
|
HC CATH PEDIATRIC KIT
|
Facility
|
OP
|
$18.14
|
|
| Hospital Charge Code |
41601065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$15.31
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.39
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Centivo All Commercial |
$9.87
|
| Rate for Payer: Cigna All Commercial |
$15.65
|
| Rate for Payer: CORVEL All Commercial |
$16.87
|
| Rate for Payer: Coventry All Commercial |
$15.96
|
| Rate for Payer: Encore All Commercial |
$16.70
|
| Rate for Payer: Frontpath All Commercial |
$16.69
|
| Rate for Payer: Humana ChoiceCare |
$15.67
|
| Rate for Payer: Humana Medicare |
$5.80
|
| Rate for Payer: Lucent All Commercial |
$9.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.33
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.61
|
| Rate for Payer: PHP All Commercial |
$13.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.07
|
| Rate for Payer: Sagamore Health Network All Products |
$14.00
|
| Rate for Payer: Signature Care EPO |
$15.06
|
| Rate for Payer: Signature Care PPO |
$15.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.42
|
| Rate for Payer: United Healthcare Commercial |
$14.29
|
| Rate for Payer: United Healthcare Medicare |
$5.80
|
|
|
HC CATH PEDIATRIC KIT
|
Facility
|
IP
|
$18.14
|
|
| Hospital Charge Code |
41601065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$16.87 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Cigna All Commercial |
$15.65
|
| Rate for Payer: CORVEL All Commercial |
$16.87
|
| Rate for Payer: Coventry All Commercial |
$15.96
|
| Rate for Payer: Encore All Commercial |
$16.70
|
| Rate for Payer: Frontpath All Commercial |
$16.69
|
| Rate for Payer: Humana ChoiceCare |
$15.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.33
|
| Rate for Payer: PHCS All Commercial |
$13.61
|
| Rate for Payer: PHP All Commercial |
$13.76
|
| Rate for Payer: Sagamore Health Network All Products |
$14.00
|
| Rate for Payer: Signature Care EPO |
$15.06
|
| Rate for Payer: Signature Care PPO |
$15.96
|
| Rate for Payer: United Healthcare Commercial |
$14.29
|
|
|
HC CATH PNEUMOTHORAX
|
Facility
|
IP
|
$1,243.50
|
|
| Hospital Charge Code |
41601355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$932.62 |
| Max. Negotiated Rate |
$1,156.45 |
| Rate for Payer: Aetna Commercial |
$1,074.38
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cigna All Commercial |
$1,073.14
|
| Rate for Payer: CORVEL All Commercial |
$1,156.45
|
| Rate for Payer: Coventry All Commercial |
$1,094.28
|
| Rate for Payer: Encore All Commercial |
$1,144.64
|
| Rate for Payer: Frontpath All Commercial |
$1,144.02
|
| Rate for Payer: Humana ChoiceCare |
$1,074.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,119.15
|
| Rate for Payer: PHCS All Commercial |
$932.62
|
| Rate for Payer: PHP All Commercial |
$943.07
|
| Rate for Payer: Sagamore Health Network All Products |
$959.98
|
| Rate for Payer: Signature Care EPO |
$1,032.11
|
| Rate for Payer: Signature Care PPO |
$1,094.28
|
| Rate for Payer: United Healthcare Commercial |
$979.88
|
|
|
HC CATH PNEUMOTHORAX
|
Facility
|
OP
|
$1,243.50
|
|
| Hospital Charge Code |
41601355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,156.45 |
| Rate for Payer: Aetna Commercial |
$1,049.51
|
| Rate for Payer: Aetna Medicare |
$397.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$385.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$714.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$777.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$457.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$437.71
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Centivo All Commercial |
$676.46
|
| Rate for Payer: Cigna All Commercial |
$1,073.14
|
| Rate for Payer: CORVEL All Commercial |
$1,156.45
|
| Rate for Payer: Coventry All Commercial |
$1,094.28
|
| Rate for Payer: Encore All Commercial |
$1,144.64
|
| Rate for Payer: Frontpath All Commercial |
$1,144.02
|
| Rate for Payer: Humana ChoiceCare |
$1,074.01
|
| Rate for Payer: Humana Medicare |
$397.92
|
| Rate for Payer: Lucent All Commercial |
$676.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,119.15
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$932.62
|
| Rate for Payer: PHP All Commercial |
$943.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$484.96
|
| Rate for Payer: Sagamore Health Network All Products |
$959.98
|
| Rate for Payer: Signature Care EPO |
$1,032.11
|
| Rate for Payer: Signature Care PPO |
$1,094.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,056.97
|
| Rate for Payer: United Healthcare Commercial |
$979.88
|
| Rate for Payer: United Healthcare Medicare |
$397.92
|
|
|
HC CATH SUCT 14FR WITH CONTROL
|
Facility
|
IP
|
$1.72
|
|
| Hospital Charge Code |
41601021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna All Commercial |
$1.48
|
| Rate for Payer: CORVEL All Commercial |
$1.60
|
| Rate for Payer: Coventry All Commercial |
$1.51
|
| Rate for Payer: Encore All Commercial |
$1.58
|
| Rate for Payer: Frontpath All Commercial |
$1.58
|
| Rate for Payer: Humana ChoiceCare |
$1.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.55
|
| Rate for Payer: PHCS All Commercial |
$1.29
|
| Rate for Payer: PHP All Commercial |
$1.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1.33
|
| Rate for Payer: Signature Care EPO |
$1.43
|
| Rate for Payer: Signature Care PPO |
$1.51
|
| Rate for Payer: United Healthcare Commercial |
$1.36
|
|
|
HC CATH SUCT 14FR WITH CONTROL
|
Facility
|
OP
|
$1.72
|
|
| Hospital Charge Code |
41601021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$1.45
|
| Rate for Payer: Aetna Medicare |
$0.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.61
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Centivo All Commercial |
$0.94
|
| Rate for Payer: Cigna All Commercial |
$1.48
|
| Rate for Payer: CORVEL All Commercial |
$1.60
|
| Rate for Payer: Coventry All Commercial |
$1.51
|
| Rate for Payer: Encore All Commercial |
$1.58
|
| Rate for Payer: Frontpath All Commercial |
$1.58
|
| Rate for Payer: Humana ChoiceCare |
$1.49
|
| Rate for Payer: Humana Medicare |
$0.55
|
| Rate for Payer: Lucent All Commercial |
$0.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.55
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1.29
|
| Rate for Payer: PHP All Commercial |
$1.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1.33
|
| Rate for Payer: Signature Care EPO |
$1.43
|
| Rate for Payer: Signature Care PPO |
$1.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$1.36
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
|
|
HC CATH SUCT 8FR WITH CONTROL
|
Facility
|
IP
|
$2.69
|
|
| Hospital Charge Code |
41601022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna All Commercial |
$2.32
|
| Rate for Payer: CORVEL All Commercial |
$2.50
|
| Rate for Payer: Coventry All Commercial |
$2.37
|
| Rate for Payer: Encore All Commercial |
$2.48
|
| Rate for Payer: Frontpath All Commercial |
$2.47
|
| Rate for Payer: Humana ChoiceCare |
$2.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.42
|
| Rate for Payer: PHCS All Commercial |
$2.02
|
| Rate for Payer: PHP All Commercial |
$2.04
|
| Rate for Payer: Sagamore Health Network All Products |
$2.08
|
| Rate for Payer: Signature Care EPO |
$2.23
|
| Rate for Payer: Signature Care PPO |
$2.37
|
| Rate for Payer: United Healthcare Commercial |
$2.12
|
|
|
HC CATH SUCT 8FR WITH CONTROL
|
Facility
|
OP
|
$2.69
|
|
| Hospital Charge Code |
41601022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$2.27
|
| Rate for Payer: Aetna Medicare |
$0.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.95
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Centivo All Commercial |
$1.46
|
| Rate for Payer: Cigna All Commercial |
$2.32
|
| Rate for Payer: CORVEL All Commercial |
$2.50
|
| Rate for Payer: Coventry All Commercial |
$2.37
|
| Rate for Payer: Encore All Commercial |
$2.48
|
| Rate for Payer: Frontpath All Commercial |
$2.47
|
| Rate for Payer: Humana ChoiceCare |
$2.32
|
| Rate for Payer: Humana Medicare |
$0.86
|
| Rate for Payer: Lucent All Commercial |
$1.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.42
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$2.02
|
| Rate for Payer: PHP All Commercial |
$2.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.05
|
| Rate for Payer: Sagamore Health Network All Products |
$2.08
|
| Rate for Payer: Signature Care EPO |
$2.23
|
| Rate for Payer: Signature Care PPO |
$2.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.29
|
| Rate for Payer: United Healthcare Commercial |
$2.12
|
| Rate for Payer: United Healthcare Medicare |
$0.86
|
|
|
HC CATH SUCT CLOSED
|
Facility
|
OP
|
$106.89
|
|
| Hospital Charge Code |
41601212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$90.22
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$61.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.63
|
| Rate for Payer: Cash Price |
$64.13
|
| Rate for Payer: Cash Price |
$64.13
|
| Rate for Payer: Centivo All Commercial |
$58.15
|
| Rate for Payer: Cigna All Commercial |
$92.25
|
| Rate for Payer: CORVEL All Commercial |
$99.41
|
| Rate for Payer: Coventry All Commercial |
$94.06
|
| Rate for Payer: Encore All Commercial |
$98.39
|
| Rate for Payer: Frontpath All Commercial |
$98.34
|
| Rate for Payer: Humana ChoiceCare |
$92.32
|
| Rate for Payer: Humana Medicare |
$34.20
|
| Rate for Payer: Lucent All Commercial |
$58.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$80.17
|
| Rate for Payer: PHP All Commercial |
$81.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.69
|
| Rate for Payer: Sagamore Health Network All Products |
$82.52
|
| Rate for Payer: Signature Care EPO |
$88.72
|
| Rate for Payer: Signature Care PPO |
$94.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.86
|
| Rate for Payer: United Healthcare Commercial |
$84.23
|
| Rate for Payer: United Healthcare Medicare |
$34.20
|
|
|
HC CATH SUCT CLOSED
|
Facility
|
IP
|
$106.89
|
|
| Hospital Charge Code |
41601212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.17 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$92.35
|
| Rate for Payer: Cash Price |
$64.13
|
| Rate for Payer: Cigna All Commercial |
$92.25
|
| Rate for Payer: CORVEL All Commercial |
$99.41
|
| Rate for Payer: Coventry All Commercial |
$94.06
|
| Rate for Payer: Encore All Commercial |
$98.39
|
| Rate for Payer: Frontpath All Commercial |
$98.34
|
| Rate for Payer: Humana ChoiceCare |
$92.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.20
|
| Rate for Payer: PHCS All Commercial |
$80.17
|
| Rate for Payer: PHP All Commercial |
$81.07
|
| Rate for Payer: Sagamore Health Network All Products |
$82.52
|
| Rate for Payer: Signature Care EPO |
$88.72
|
| Rate for Payer: Signature Care PPO |
$94.06
|
| Rate for Payer: United Healthcare Commercial |
$84.23
|
|
|
HC CATH TIEMANN/COUDE 14FR
|
Facility
|
IP
|
$90.02
|
|
| Hospital Charge Code |
41601024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$83.72 |
| Rate for Payer: Aetna Commercial |
$77.78
|
| Rate for Payer: Cash Price |
$54.01
|
| Rate for Payer: Cigna All Commercial |
$77.69
|
| Rate for Payer: CORVEL All Commercial |
$83.72
|
| Rate for Payer: Coventry All Commercial |
$79.22
|
| Rate for Payer: Encore All Commercial |
$82.86
|
| Rate for Payer: Frontpath All Commercial |
$82.82
|
| Rate for Payer: Humana ChoiceCare |
$77.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.02
|
| Rate for Payer: PHCS All Commercial |
$67.52
|
| Rate for Payer: PHP All Commercial |
$68.27
|
| Rate for Payer: Sagamore Health Network All Products |
$69.50
|
| Rate for Payer: Signature Care EPO |
$74.72
|
| Rate for Payer: Signature Care PPO |
$79.22
|
| Rate for Payer: United Healthcare Commercial |
$70.94
|
|
|
HC CATH TIEMANN/COUDE 14FR
|
Facility
|
OP
|
$90.02
|
|
| Hospital Charge Code |
41601024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.91 |
| Max. Negotiated Rate |
$83.72 |
| Rate for Payer: Aetna Commercial |
$75.98
|
| Rate for Payer: Aetna Medicare |
$28.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.69
|
| Rate for Payer: Cash Price |
$54.01
|
| Rate for Payer: Cash Price |
$54.01
|
| Rate for Payer: Centivo All Commercial |
$48.97
|
| Rate for Payer: Cigna All Commercial |
$77.69
|
| Rate for Payer: CORVEL All Commercial |
$83.72
|
| Rate for Payer: Coventry All Commercial |
$79.22
|
| Rate for Payer: Encore All Commercial |
$82.86
|
| Rate for Payer: Frontpath All Commercial |
$82.82
|
| Rate for Payer: Humana ChoiceCare |
$77.75
|
| Rate for Payer: Humana Medicare |
$28.81
|
| Rate for Payer: Lucent All Commercial |
$48.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.02
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$67.52
|
| Rate for Payer: PHP All Commercial |
$68.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.11
|
| Rate for Payer: Sagamore Health Network All Products |
$69.50
|
| Rate for Payer: Signature Care EPO |
$74.72
|
| Rate for Payer: Signature Care PPO |
$79.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.52
|
| Rate for Payer: United Healthcare Commercial |
$70.94
|
| Rate for Payer: United Healthcare Medicare |
$28.81
|
|
|
HC CATH TIEMANN/COUDE 16FR
|
Facility
|
OP
|
$75.25
|
|
| Hospital Charge Code |
41601025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$69.98 |
| Rate for Payer: Aetna Commercial |
$63.51
|
| Rate for Payer: Aetna Medicare |
$24.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$43.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.49
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Centivo All Commercial |
$40.94
|
| Rate for Payer: Cigna All Commercial |
$64.94
|
| Rate for Payer: CORVEL All Commercial |
$69.98
|
| Rate for Payer: Coventry All Commercial |
$66.22
|
| Rate for Payer: Encore All Commercial |
$69.27
|
| Rate for Payer: Frontpath All Commercial |
$69.23
|
| Rate for Payer: Humana ChoiceCare |
$64.99
|
| Rate for Payer: Humana Medicare |
$24.08
|
| Rate for Payer: Lucent All Commercial |
$40.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.72
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$56.44
|
| Rate for Payer: PHP All Commercial |
$57.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.35
|
| Rate for Payer: Sagamore Health Network All Products |
$58.09
|
| Rate for Payer: Signature Care EPO |
$62.46
|
| Rate for Payer: Signature Care PPO |
$66.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.96
|
| Rate for Payer: United Healthcare Commercial |
$59.30
|
| Rate for Payer: United Healthcare Medicare |
$24.08
|
|
|
HC CATH TIEMANN/COUDE 16FR
|
Facility
|
IP
|
$75.25
|
|
| Hospital Charge Code |
41601025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$69.98 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cigna All Commercial |
$64.94
|
| Rate for Payer: CORVEL All Commercial |
$69.98
|
| Rate for Payer: Coventry All Commercial |
$66.22
|
| Rate for Payer: Encore All Commercial |
$69.27
|
| Rate for Payer: Frontpath All Commercial |
$69.23
|
| Rate for Payer: Humana ChoiceCare |
$64.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.72
|
| Rate for Payer: PHCS All Commercial |
$56.44
|
| Rate for Payer: PHP All Commercial |
$57.07
|
| Rate for Payer: Sagamore Health Network All Products |
$58.09
|
| Rate for Payer: Signature Care EPO |
$62.46
|
| Rate for Payer: Signature Care PPO |
$66.22
|
| Rate for Payer: United Healthcare Commercial |
$59.30
|
|
|
HC CATH TIEMANN/COUDE 18FR
|
Facility
|
IP
|
$75.25
|
|
| Hospital Charge Code |
41601026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$69.98 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cigna All Commercial |
$64.94
|
| Rate for Payer: CORVEL All Commercial |
$69.98
|
| Rate for Payer: Coventry All Commercial |
$66.22
|
| Rate for Payer: Encore All Commercial |
$69.27
|
| Rate for Payer: Frontpath All Commercial |
$69.23
|
| Rate for Payer: Humana ChoiceCare |
$64.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.72
|
| Rate for Payer: PHCS All Commercial |
$56.44
|
| Rate for Payer: PHP All Commercial |
$57.07
|
| Rate for Payer: Sagamore Health Network All Products |
$58.09
|
| Rate for Payer: Signature Care EPO |
$62.46
|
| Rate for Payer: Signature Care PPO |
$66.22
|
| Rate for Payer: United Healthcare Commercial |
$59.30
|
|
|
HC CATH TIEMANN/COUDE 18FR
|
Facility
|
OP
|
$75.25
|
|
| Hospital Charge Code |
41601026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$69.98 |
| Rate for Payer: Aetna Commercial |
$63.51
|
| Rate for Payer: Aetna Medicare |
$24.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$43.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.49
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Centivo All Commercial |
$40.94
|
| Rate for Payer: Cigna All Commercial |
$64.94
|
| Rate for Payer: CORVEL All Commercial |
$69.98
|
| Rate for Payer: Coventry All Commercial |
$66.22
|
| Rate for Payer: Encore All Commercial |
$69.27
|
| Rate for Payer: Frontpath All Commercial |
$69.23
|
| Rate for Payer: Humana ChoiceCare |
$64.99
|
| Rate for Payer: Humana Medicare |
$24.08
|
| Rate for Payer: Lucent All Commercial |
$40.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.72
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$56.44
|
| Rate for Payer: PHP All Commercial |
$57.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.35
|
| Rate for Payer: Sagamore Health Network All Products |
$58.09
|
| Rate for Payer: Signature Care EPO |
$62.46
|
| Rate for Payer: Signature Care PPO |
$66.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.96
|
| Rate for Payer: United Healthcare Commercial |
$59.30
|
| Rate for Payer: United Healthcare Medicare |
$24.08
|
|
|
HC CATH TIEMANN/COUDE 20FR
|
Facility
|
IP
|
$75.25
|
|
| Hospital Charge Code |
41601027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$69.98 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cigna All Commercial |
$64.94
|
| Rate for Payer: CORVEL All Commercial |
$69.98
|
| Rate for Payer: Coventry All Commercial |
$66.22
|
| Rate for Payer: Encore All Commercial |
$69.27
|
| Rate for Payer: Frontpath All Commercial |
$69.23
|
| Rate for Payer: Humana ChoiceCare |
$64.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.72
|
| Rate for Payer: PHCS All Commercial |
$56.44
|
| Rate for Payer: PHP All Commercial |
$57.07
|
| Rate for Payer: Sagamore Health Network All Products |
$58.09
|
| Rate for Payer: Signature Care EPO |
$62.46
|
| Rate for Payer: Signature Care PPO |
$66.22
|
| Rate for Payer: United Healthcare Commercial |
$59.30
|
|
|
HC CATH TIEMANN/COUDE 20FR
|
Facility
|
OP
|
$75.25
|
|
| Hospital Charge Code |
41601027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$69.98 |
| Rate for Payer: Aetna Commercial |
$63.51
|
| Rate for Payer: Aetna Medicare |
$24.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$43.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.49
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Centivo All Commercial |
$40.94
|
| Rate for Payer: Cigna All Commercial |
$64.94
|
| Rate for Payer: CORVEL All Commercial |
$69.98
|
| Rate for Payer: Coventry All Commercial |
$66.22
|
| Rate for Payer: Encore All Commercial |
$69.27
|
| Rate for Payer: Frontpath All Commercial |
$69.23
|
| Rate for Payer: Humana ChoiceCare |
$64.99
|
| Rate for Payer: Humana Medicare |
$24.08
|
| Rate for Payer: Lucent All Commercial |
$40.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.72
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$56.44
|
| Rate for Payer: PHP All Commercial |
$57.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.35
|
| Rate for Payer: Sagamore Health Network All Products |
$58.09
|
| Rate for Payer: Signature Care EPO |
$62.46
|
| Rate for Payer: Signature Care PPO |
$66.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.96
|
| Rate for Payer: United Healthcare Commercial |
$59.30
|
| Rate for Payer: United Healthcare Medicare |
$24.08
|
|
|
HC CATH TRAY FOLEY 14FR
|
Facility
|
IP
|
$118.98
|
|
| Hospital Charge Code |
41601028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$110.65 |
| Rate for Payer: Aetna Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$71.39
|
| Rate for Payer: Cigna All Commercial |
$102.68
|
| Rate for Payer: CORVEL All Commercial |
$110.65
|
| Rate for Payer: Coventry All Commercial |
$104.70
|
| Rate for Payer: Encore All Commercial |
$109.52
|
| Rate for Payer: Frontpath All Commercial |
$109.46
|
| Rate for Payer: Humana ChoiceCare |
$102.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.08
|
| Rate for Payer: PHCS All Commercial |
$89.23
|
| Rate for Payer: PHP All Commercial |
$90.23
|
| Rate for Payer: Sagamore Health Network All Products |
$91.85
|
| Rate for Payer: Signature Care EPO |
$98.75
|
| Rate for Payer: Signature Care PPO |
$104.70
|
| Rate for Payer: United Healthcare Commercial |
$93.76
|
|
|
HC CATH TRAY FOLEY 14FR
|
Facility
|
OP
|
$118.98
|
|
| Hospital Charge Code |
41601028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$110.65 |
| Rate for Payer: Aetna Commercial |
$100.42
|
| Rate for Payer: Aetna Medicare |
$38.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$68.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.88
|
| Rate for Payer: Cash Price |
$71.39
|
| Rate for Payer: Cash Price |
$71.39
|
| Rate for Payer: Centivo All Commercial |
$64.73
|
| Rate for Payer: Cigna All Commercial |
$102.68
|
| Rate for Payer: CORVEL All Commercial |
$110.65
|
| Rate for Payer: Coventry All Commercial |
$104.70
|
| Rate for Payer: Encore All Commercial |
$109.52
|
| Rate for Payer: Frontpath All Commercial |
$109.46
|
| Rate for Payer: Humana ChoiceCare |
$102.76
|
| Rate for Payer: Humana Medicare |
$38.07
|
| Rate for Payer: Lucent All Commercial |
$64.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.08
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$89.23
|
| Rate for Payer: PHP All Commercial |
$90.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.40
|
| Rate for Payer: Sagamore Health Network All Products |
$91.85
|
| Rate for Payer: Signature Care EPO |
$98.75
|
| Rate for Payer: Signature Care PPO |
$104.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.13
|
| Rate for Payer: United Healthcare Commercial |
$93.76
|
| Rate for Payer: United Healthcare Medicare |
$38.07
|
|
|
HC CATH TRAY FOLEY 16FR
|
Facility
|
IP
|
$129.07
|
|
| Hospital Charge Code |
41601029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$120.04 |
| Rate for Payer: Aetna Commercial |
$111.52
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cigna All Commercial |
$111.39
|
| Rate for Payer: CORVEL All Commercial |
$120.04
|
| Rate for Payer: Coventry All Commercial |
$113.58
|
| Rate for Payer: Encore All Commercial |
$118.81
|
| Rate for Payer: Frontpath All Commercial |
$118.74
|
| Rate for Payer: Humana ChoiceCare |
$111.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.16
|
| Rate for Payer: PHCS All Commercial |
$96.80
|
| Rate for Payer: PHP All Commercial |
$97.89
|
| Rate for Payer: Sagamore Health Network All Products |
$99.64
|
| Rate for Payer: Signature Care EPO |
$107.13
|
| Rate for Payer: Signature Care PPO |
$113.58
|
| Rate for Payer: United Healthcare Commercial |
$101.71
|
|
|
HC CATH TRAY FOLEY 16FR
|
Facility
|
OP
|
$129.07
|
|
| Hospital Charge Code |
41601029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$120.04 |
| Rate for Payer: Aetna Commercial |
$108.94
|
| Rate for Payer: Aetna Medicare |
$41.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.43
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Centivo All Commercial |
$70.21
|
| Rate for Payer: Cigna All Commercial |
$111.39
|
| Rate for Payer: CORVEL All Commercial |
$120.04
|
| Rate for Payer: Coventry All Commercial |
$113.58
|
| Rate for Payer: Encore All Commercial |
$118.81
|
| Rate for Payer: Frontpath All Commercial |
$118.74
|
| Rate for Payer: Humana ChoiceCare |
$111.48
|
| Rate for Payer: Humana Medicare |
$41.30
|
| Rate for Payer: Lucent All Commercial |
$70.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.16
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$96.80
|
| Rate for Payer: PHP All Commercial |
$97.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.34
|
| Rate for Payer: Sagamore Health Network All Products |
$99.64
|
| Rate for Payer: Signature Care EPO |
$107.13
|
| Rate for Payer: Signature Care PPO |
$113.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109.71
|
| Rate for Payer: United Healthcare Commercial |
$101.71
|
| Rate for Payer: United Healthcare Medicare |
$41.30
|
|
|
HC CATH TRAY URETHRAL 14FR
|
Facility
|
OP
|
$18.53
|
|
| Hospital Charge Code |
41601030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$15.64
|
| Rate for Payer: Aetna Medicare |
$5.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.52
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Centivo All Commercial |
$10.08
|
| Rate for Payer: Cigna All Commercial |
$15.99
|
| Rate for Payer: CORVEL All Commercial |
$17.23
|
| Rate for Payer: Coventry All Commercial |
$16.31
|
| Rate for Payer: Encore All Commercial |
$17.06
|
| Rate for Payer: Frontpath All Commercial |
$17.05
|
| Rate for Payer: Humana ChoiceCare |
$16.00
|
| Rate for Payer: Humana Medicare |
$5.93
|
| Rate for Payer: Lucent All Commercial |
$10.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.68
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.90
|
| Rate for Payer: PHP All Commercial |
$14.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.23
|
| Rate for Payer: Sagamore Health Network All Products |
$14.31
|
| Rate for Payer: Signature Care EPO |
$15.38
|
| Rate for Payer: Signature Care PPO |
$16.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$14.60
|
| Rate for Payer: United Healthcare Medicare |
$5.93
|
|
|
HC CATH TRAY URETHRAL 14FR
|
Facility
|
IP
|
$18.53
|
|
| Hospital Charge Code |
41601030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna All Commercial |
$15.99
|
| Rate for Payer: CORVEL All Commercial |
$17.23
|
| Rate for Payer: Coventry All Commercial |
$16.31
|
| Rate for Payer: Encore All Commercial |
$17.06
|
| Rate for Payer: Frontpath All Commercial |
$17.05
|
| Rate for Payer: Humana ChoiceCare |
$16.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.68
|
| Rate for Payer: PHCS All Commercial |
$13.90
|
| Rate for Payer: PHP All Commercial |
$14.05
|
| Rate for Payer: Sagamore Health Network All Products |
$14.31
|
| Rate for Payer: Signature Care EPO |
$15.38
|
| Rate for Payer: Signature Care PPO |
$16.31
|
| Rate for Payer: United Healthcare Commercial |
$14.60
|
|
