|
HC INTERPRET 2-8 MRKRS
|
Facility
OP
|
$85.31
|
|
|
Service Code
|
CPT 88187
|
| Hospital Charge Code |
63002072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$194.73 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare |
$28.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$194.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.97
|
| Rate for Payer: Cash Price |
$52.89
|
| Rate for Payer: Cash Price |
$52.89
|
| Rate for Payer: Centivo All Commercial |
$43.51
|
| Rate for Payer: Cigna All Commercial |
$73.62
|
| Rate for Payer: CORVEL All Commercial |
$79.34
|
| Rate for Payer: Coventry All Commercial |
$75.08
|
| Rate for Payer: Encore All Commercial |
$78.53
|
| Rate for Payer: Frontpath All Commercial |
$78.49
|
| Rate for Payer: Humana ChoiceCare |
$73.68
|
| Rate for Payer: Humana Medicare |
$43.51
|
| Rate for Payer: Lucent All Commercial |
$43.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.78
|
| Rate for Payer: Managed Health Services Medicaid |
$194.73
|
| Rate for Payer: MDWise Medicaid |
$194.73
|
| Rate for Payer: PHCS All Commercial |
$63.98
|
| Rate for Payer: PHP All Commercial |
$64.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.27
|
| Rate for Payer: Sagamore Health Network All Products |
$65.86
|
| Rate for Payer: Signature Care EPO |
$70.81
|
| Rate for Payer: Signature Care PPO |
$75.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.52
|
| Rate for Payer: United Healthcare Commercial |
$67.23
|
| Rate for Payer: United Healthcare Medicare |
$28.15
|
|
|
HC INTERPRET 2-8 MRKRS
|
Facility
IP
|
$85.31
|
|
|
Service Code
|
CPT 88187
|
| Hospital Charge Code |
63002072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.98 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$73.71
|
| Rate for Payer: Cash Price |
$52.89
|
| Rate for Payer: Cigna All Commercial |
$73.62
|
| Rate for Payer: CORVEL All Commercial |
$79.34
|
| Rate for Payer: Coventry All Commercial |
$75.08
|
| Rate for Payer: Encore All Commercial |
$78.53
|
| Rate for Payer: Frontpath All Commercial |
$78.49
|
| Rate for Payer: Humana ChoiceCare |
$73.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.78
|
| Rate for Payer: PHCS All Commercial |
$63.98
|
| Rate for Payer: PHP All Commercial |
$64.70
|
| Rate for Payer: Sagamore Health Network All Products |
$65.86
|
| Rate for Payer: Signature Care EPO |
$70.81
|
| Rate for Payer: Signature Care PPO |
$75.08
|
| Rate for Payer: United Healthcare Commercial |
$67.23
|
|
|
HC INTERPRET 9-15 MRKRS
|
Facility
IP
|
$106.76
|
|
|
Service Code
|
CPT 88188
|
| Hospital Charge Code |
63002073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.07 |
| Max. Negotiated Rate |
$99.29 |
| Rate for Payer: Aetna Commercial |
$92.24
|
| Rate for Payer: Cash Price |
$66.19
|
| Rate for Payer: Cigna All Commercial |
$92.14
|
| Rate for Payer: CORVEL All Commercial |
$99.29
|
| Rate for Payer: Coventry All Commercial |
$93.95
|
| Rate for Payer: Encore All Commercial |
$98.28
|
| Rate for Payer: Frontpath All Commercial |
$98.22
|
| Rate for Payer: Humana ChoiceCare |
$92.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.09
|
| Rate for Payer: PHCS All Commercial |
$80.07
|
| Rate for Payer: PHP All Commercial |
$80.97
|
| Rate for Payer: Sagamore Health Network All Products |
$82.42
|
| Rate for Payer: Signature Care EPO |
$88.61
|
| Rate for Payer: Signature Care PPO |
$93.95
|
| Rate for Payer: United Healthcare Commercial |
$84.13
|
|
|
HC INTERPRET 9-15 MRKRS
|
Facility
OP
|
$106.76
|
|
|
Service Code
|
CPT 88188
|
| Hospital Charge Code |
63002073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$99.29 |
| Rate for Payer: Aetna Commercial |
$90.11
|
| Rate for Payer: Aetna Medicare |
$35.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.76
|
| Rate for Payer: Cash Price |
$66.19
|
| Rate for Payer: Centivo All Commercial |
$54.45
|
| Rate for Payer: Cigna All Commercial |
$92.14
|
| Rate for Payer: CORVEL All Commercial |
$99.29
|
| Rate for Payer: Coventry All Commercial |
$93.95
|
| Rate for Payer: Encore All Commercial |
$98.28
|
| Rate for Payer: Frontpath All Commercial |
$98.22
|
| Rate for Payer: Humana ChoiceCare |
$92.21
|
| Rate for Payer: Humana Medicare |
$54.45
|
| Rate for Payer: Lucent All Commercial |
$54.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.09
|
| Rate for Payer: PHCS All Commercial |
$80.07
|
| Rate for Payer: PHP All Commercial |
$80.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.64
|
| Rate for Payer: Sagamore Health Network All Products |
$82.42
|
| Rate for Payer: Signature Care EPO |
$88.61
|
| Rate for Payer: Signature Care PPO |
$93.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.75
|
| Rate for Payer: United Healthcare Commercial |
$84.13
|
| Rate for Payer: United Healthcare Medicare |
$35.23
|
|
|
HC INTERPULSE HANDPIECE W/COAXIAL TIP
|
Facility
IP
|
$265.63
|
|
| Hospital Charge Code |
41601243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.22 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Cash Price |
$164.69
|
| Rate for Payer: Cigna All Commercial |
$229.24
|
| Rate for Payer: CORVEL All Commercial |
$247.04
|
| Rate for Payer: Coventry All Commercial |
$233.75
|
| Rate for Payer: Encore All Commercial |
$244.51
|
| Rate for Payer: Frontpath All Commercial |
$244.38
|
| Rate for Payer: Humana ChoiceCare |
$229.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.07
|
| Rate for Payer: PHCS All Commercial |
$199.22
|
| Rate for Payer: PHP All Commercial |
$201.45
|
| Rate for Payer: Sagamore Health Network All Products |
$205.07
|
| Rate for Payer: Signature Care EPO |
$220.47
|
| Rate for Payer: Signature Care PPO |
$233.75
|
| Rate for Payer: United Healthcare Commercial |
$209.32
|
|
|
HC INTERPULSE HANDPIECE W/COAXIAL TIP
|
Facility
OP
|
$265.63
|
|
| Hospital Charge Code |
41601243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.66 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Aetna Commercial |
$224.19
|
| Rate for Payer: Aetna Medicare |
$87.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$152.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.42
|
| Rate for Payer: Cash Price |
$164.69
|
| Rate for Payer: Cash Price |
$164.69
|
| Rate for Payer: Centivo All Commercial |
$135.47
|
| Rate for Payer: Cigna All Commercial |
$229.24
|
| Rate for Payer: CORVEL All Commercial |
$247.04
|
| Rate for Payer: Coventry All Commercial |
$233.75
|
| Rate for Payer: Encore All Commercial |
$244.51
|
| Rate for Payer: Frontpath All Commercial |
$244.38
|
| Rate for Payer: Humana ChoiceCare |
$229.42
|
| Rate for Payer: Humana Medicare |
$135.47
|
| Rate for Payer: Lucent All Commercial |
$135.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.07
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$199.22
|
| Rate for Payer: PHP All Commercial |
$201.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.60
|
| Rate for Payer: Sagamore Health Network All Products |
$205.07
|
| Rate for Payer: Signature Care EPO |
$220.47
|
| Rate for Payer: Signature Care PPO |
$233.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$225.79
|
| Rate for Payer: United Healthcare Commercial |
$209.32
|
| Rate for Payer: United Healthcare Medicare |
$87.66
|
|
|
HC INTERSTIM ANTENNA 37092
|
Facility
OP
|
$560.00
|
|
| Hospital Charge Code |
41603385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$472.64
|
| Rate for Payer: Aetna Medicare |
$184.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$350.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.28
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Centivo All Commercial |
$285.60
|
| Rate for Payer: Cigna All Commercial |
$483.28
|
| Rate for Payer: CORVEL All Commercial |
$520.80
|
| Rate for Payer: Coventry All Commercial |
$492.80
|
| Rate for Payer: Encore All Commercial |
$515.48
|
| Rate for Payer: Frontpath All Commercial |
$515.20
|
| Rate for Payer: Humana ChoiceCare |
$483.67
|
| Rate for Payer: Humana Medicare |
$285.60
|
| Rate for Payer: Lucent All Commercial |
$285.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$420.00
|
| Rate for Payer: PHP All Commercial |
$424.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.40
|
| Rate for Payer: Sagamore Health Network All Products |
$432.32
|
| Rate for Payer: Signature Care EPO |
$464.80
|
| Rate for Payer: Signature Care PPO |
$492.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$476.00
|
| Rate for Payer: United Healthcare Commercial |
$441.28
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
|
|
HC INTERSTIM ANTENNA 37092
|
Facility
IP
|
$560.00
|
|
| Hospital Charge Code |
41603385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$483.84
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cigna All Commercial |
$483.28
|
| Rate for Payer: CORVEL All Commercial |
$520.80
|
| Rate for Payer: Coventry All Commercial |
$492.80
|
| Rate for Payer: Encore All Commercial |
$515.48
|
| Rate for Payer: Frontpath All Commercial |
$515.20
|
| Rate for Payer: Humana ChoiceCare |
$483.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: PHCS All Commercial |
$420.00
|
| Rate for Payer: PHP All Commercial |
$424.70
|
| Rate for Payer: Sagamore Health Network All Products |
$432.32
|
| Rate for Payer: Signature Care EPO |
$464.80
|
| Rate for Payer: Signature Care PPO |
$492.80
|
| Rate for Payer: United Healthcare Commercial |
$441.28
|
|
|
HC INTERSTIM CBL MINI HOOK 357501
|
Facility
OP
|
$280.00
|
|
| Hospital Charge Code |
41603381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$236.32
|
| Rate for Payer: Aetna Medicare |
$92.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$160.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.64
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Centivo All Commercial |
$142.80
|
| Rate for Payer: Cigna All Commercial |
$241.64
|
| Rate for Payer: CORVEL All Commercial |
$260.40
|
| Rate for Payer: Coventry All Commercial |
$246.40
|
| Rate for Payer: Encore All Commercial |
$257.74
|
| Rate for Payer: Frontpath All Commercial |
$257.60
|
| Rate for Payer: Humana ChoiceCare |
$241.84
|
| Rate for Payer: Humana Medicare |
$142.80
|
| Rate for Payer: Lucent All Commercial |
$142.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$252.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$210.00
|
| Rate for Payer: PHP All Commercial |
$212.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.20
|
| Rate for Payer: Sagamore Health Network All Products |
$216.16
|
| Rate for Payer: Signature Care EPO |
$232.40
|
| Rate for Payer: Signature Care PPO |
$246.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$220.64
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
|
|
HC INTERSTIM CBL MINI HOOK 357501
|
Facility
IP
|
$280.00
|
|
| Hospital Charge Code |
41603381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$260.40 |
| Rate for Payer: Aetna Commercial |
$241.92
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cigna All Commercial |
$241.64
|
| Rate for Payer: CORVEL All Commercial |
$260.40
|
| Rate for Payer: Coventry All Commercial |
$246.40
|
| Rate for Payer: Encore All Commercial |
$257.74
|
| Rate for Payer: Frontpath All Commercial |
$257.60
|
| Rate for Payer: Humana ChoiceCare |
$241.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$252.00
|
| Rate for Payer: PHCS All Commercial |
$210.00
|
| Rate for Payer: PHP All Commercial |
$212.35
|
| Rate for Payer: Sagamore Health Network All Products |
$216.16
|
| Rate for Payer: Signature Care EPO |
$232.40
|
| Rate for Payer: Signature Care PPO |
$246.40
|
| Rate for Payer: United Healthcare Commercial |
$220.64
|
|
|
HC INTERSTIM CBL TEST STIM 357625
|
Facility
IP
|
$560.00
|
|
| Hospital Charge Code |
41603380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$483.84
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cigna All Commercial |
$483.28
|
| Rate for Payer: CORVEL All Commercial |
$520.80
|
| Rate for Payer: Coventry All Commercial |
$492.80
|
| Rate for Payer: Encore All Commercial |
$515.48
|
| Rate for Payer: Frontpath All Commercial |
$515.20
|
| Rate for Payer: Humana ChoiceCare |
$483.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: PHCS All Commercial |
$420.00
|
| Rate for Payer: PHP All Commercial |
$424.70
|
| Rate for Payer: Sagamore Health Network All Products |
$432.32
|
| Rate for Payer: Signature Care EPO |
$464.80
|
| Rate for Payer: Signature Care PPO |
$492.80
|
| Rate for Payer: United Healthcare Commercial |
$441.28
|
|
|
HC INTERSTIM CBL TEST STIM 357625
|
Facility
OP
|
$560.00
|
|
| Hospital Charge Code |
41603380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.64
|
| Rate for Payer: Aetna Medicare |
$184.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$350.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.28
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Centivo All Commercial |
$285.60
|
| Rate for Payer: Cigna All Commercial |
$483.28
|
| Rate for Payer: CORVEL All Commercial |
$520.80
|
| Rate for Payer: Coventry All Commercial |
$492.80
|
| Rate for Payer: Encore All Commercial |
$515.48
|
| Rate for Payer: Frontpath All Commercial |
$515.20
|
| Rate for Payer: Humana ChoiceCare |
$483.67
|
| Rate for Payer: Humana Medicare |
$285.60
|
| Rate for Payer: Lucent All Commercial |
$285.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$420.00
|
| Rate for Payer: PHP All Commercial |
$424.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.40
|
| Rate for Payer: Sagamore Health Network All Products |
$432.32
|
| Rate for Payer: Signature Care EPO |
$464.80
|
| Rate for Payer: Signature Care PPO |
$492.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$476.00
|
| Rate for Payer: United Healthcare Commercial |
$441.28
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
|
|
HC INTERSTIM LEAD 3889-28
|
Facility
OP
|
$12,546.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
41603378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$11,667.78 |
| Rate for Payer: Aetna Commercial |
$10,588.82
|
| Rate for Payer: Aetna Medicare |
$4,140.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,140.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,205.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,842.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,761.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,554.20
|
| Rate for Payer: Cash Price |
$7,778.52
|
| Rate for Payer: Cash Price |
$7,778.52
|
| Rate for Payer: Centivo All Commercial |
$6,398.46
|
| Rate for Payer: Cigna All Commercial |
$10,827.20
|
| Rate for Payer: CORVEL All Commercial |
$11,667.78
|
| Rate for Payer: Coventry All Commercial |
$11,040.48
|
| Rate for Payer: Encore All Commercial |
$11,548.59
|
| Rate for Payer: Frontpath All Commercial |
$11,542.32
|
| Rate for Payer: Humana ChoiceCare |
$10,835.98
|
| Rate for Payer: Humana Medicare |
$6,398.46
|
| Rate for Payer: Lucent All Commercial |
$6,398.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,291.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,409.50
|
| Rate for Payer: PHP All Commercial |
$9,514.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,892.94
|
| Rate for Payer: Sagamore Health Network All Products |
$9,685.51
|
| Rate for Payer: Signature Care EPO |
$10,413.18
|
| Rate for Payer: Signature Care PPO |
$11,040.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,664.10
|
| Rate for Payer: United Healthcare Commercial |
$9,886.25
|
| Rate for Payer: United Healthcare Medicare |
$4,140.18
|
|
|
HC INTERSTIM LEAD 3889-28
|
Facility
IP
|
$12,546.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
41603378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,409.50 |
| Max. Negotiated Rate |
$11,667.78 |
| Rate for Payer: Aetna Commercial |
$10,839.74
|
| Rate for Payer: Cash Price |
$7,778.52
|
| Rate for Payer: Cigna All Commercial |
$10,827.20
|
| Rate for Payer: CORVEL All Commercial |
$11,667.78
|
| Rate for Payer: Coventry All Commercial |
$11,040.48
|
| Rate for Payer: Encore All Commercial |
$11,548.59
|
| Rate for Payer: Frontpath All Commercial |
$11,542.32
|
| Rate for Payer: Humana ChoiceCare |
$10,835.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,291.40
|
| Rate for Payer: PHCS All Commercial |
$9,409.50
|
| Rate for Payer: PHP All Commercial |
$9,514.89
|
| Rate for Payer: Sagamore Health Network All Products |
$9,685.51
|
| Rate for Payer: Signature Care EPO |
$10,413.18
|
| Rate for Payer: Signature Care PPO |
$11,040.48
|
| Rate for Payer: United Healthcare Commercial |
$9,886.25
|
|
|
HC INTERSTIM LL IPG 3058
|
Facility
OP
|
$3,435.00
|
|
|
Service Code
|
CPT C1767
|
| Hospital Charge Code |
41603384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,194.55 |
| Rate for Payer: Aetna Commercial |
$2,899.14
|
| Rate for Payer: Aetna Medicare |
$1,133.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,133.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,972.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,147.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,303.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,246.90
|
| Rate for Payer: Cash Price |
$2,129.70
|
| Rate for Payer: Cash Price |
$2,129.70
|
| Rate for Payer: Centivo All Commercial |
$1,751.85
|
| Rate for Payer: Cigna All Commercial |
$2,964.40
|
| Rate for Payer: CORVEL All Commercial |
$3,194.55
|
| Rate for Payer: Coventry All Commercial |
$3,022.80
|
| Rate for Payer: Encore All Commercial |
$3,161.92
|
| Rate for Payer: Frontpath All Commercial |
$3,160.20
|
| Rate for Payer: Humana ChoiceCare |
$2,966.81
|
| Rate for Payer: Humana Medicare |
$1,751.85
|
| Rate for Payer: Lucent All Commercial |
$1,751.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,091.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,576.25
|
| Rate for Payer: PHP All Commercial |
$2,605.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,339.65
|
| Rate for Payer: Sagamore Health Network All Products |
$2,651.82
|
| Rate for Payer: Signature Care EPO |
$2,851.05
|
| Rate for Payer: Signature Care PPO |
$3,022.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,919.75
|
| Rate for Payer: United Healthcare Commercial |
$2,706.78
|
| Rate for Payer: United Healthcare Medicare |
$1,133.55
|
|
|
HC INTERSTIM LL IPG 3058
|
Facility
IP
|
$3,435.00
|
|
|
Service Code
|
CPT C1767
|
| Hospital Charge Code |
41603384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,576.25 |
| Max. Negotiated Rate |
$3,194.55 |
| Rate for Payer: Aetna Commercial |
$2,967.84
|
| Rate for Payer: Cash Price |
$2,129.70
|
| Rate for Payer: Cigna All Commercial |
$2,964.40
|
| Rate for Payer: CORVEL All Commercial |
$3,194.55
|
| Rate for Payer: Coventry All Commercial |
$3,022.80
|
| Rate for Payer: Encore All Commercial |
$3,161.92
|
| Rate for Payer: Frontpath All Commercial |
$3,160.20
|
| Rate for Payer: Humana ChoiceCare |
$2,966.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,091.50
|
| Rate for Payer: PHCS All Commercial |
$2,576.25
|
| Rate for Payer: PHP All Commercial |
$2,605.10
|
| Rate for Payer: Sagamore Health Network All Products |
$2,651.82
|
| Rate for Payer: Signature Care EPO |
$2,851.05
|
| Rate for Payer: Signature Care PPO |
$3,022.80
|
| Rate for Payer: United Healthcare Commercial |
$2,706.78
|
|
|
HC INTERSTIM PERIPH ACCESS 355018
|
Facility
OP
|
$1,400.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41603379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Aetna Commercial |
$1,181.60
|
| Rate for Payer: Aetna Medicare |
$462.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$462.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$804.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$875.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$531.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$508.20
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Centivo All Commercial |
$714.00
|
| Rate for Payer: Cigna All Commercial |
$1,208.20
|
| Rate for Payer: CORVEL All Commercial |
$1,302.00
|
| Rate for Payer: Coventry All Commercial |
$1,232.00
|
| Rate for Payer: Encore All Commercial |
$1,288.70
|
| Rate for Payer: Frontpath All Commercial |
$1,288.00
|
| Rate for Payer: Humana ChoiceCare |
$1,209.18
|
| Rate for Payer: Humana Medicare |
$714.00
|
| Rate for Payer: Lucent All Commercial |
$714.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,260.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,050.00
|
| Rate for Payer: PHP All Commercial |
$1,061.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$546.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,080.80
|
| Rate for Payer: Signature Care EPO |
$1,162.00
|
| Rate for Payer: Signature Care PPO |
$1,232.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,190.00
|
| Rate for Payer: United Healthcare Commercial |
$1,103.20
|
| Rate for Payer: United Healthcare Medicare |
$462.00
|
|
|
HC INTERSTIM PERIPH ACCESS 355018
|
Facility
IP
|
$1,400.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41603379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Aetna Commercial |
$1,209.60
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cigna All Commercial |
$1,208.20
|
| Rate for Payer: CORVEL All Commercial |
$1,302.00
|
| Rate for Payer: Coventry All Commercial |
$1,232.00
|
| Rate for Payer: Encore All Commercial |
$1,288.70
|
| Rate for Payer: Frontpath All Commercial |
$1,288.00
|
| Rate for Payer: Humana ChoiceCare |
$1,209.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,260.00
|
| Rate for Payer: PHCS All Commercial |
$1,050.00
|
| Rate for Payer: PHP All Commercial |
$1,061.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,080.80
|
| Rate for Payer: Signature Care EPO |
$1,162.00
|
| Rate for Payer: Signature Care PPO |
$1,232.00
|
| Rate for Payer: United Healthcare Commercial |
$1,103.20
|
|
|
HC INTERSTIM PRG PATIENT 3037
|
Facility
OP
|
$991.67
|
|
|
Service Code
|
CPT C1787
|
| Hospital Charge Code |
41603383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$922.25 |
| Rate for Payer: Aetna Commercial |
$836.97
|
| Rate for Payer: Aetna Medicare |
$327.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$327.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$569.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$619.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$376.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.98
|
| Rate for Payer: Cash Price |
$614.84
|
| Rate for Payer: Cash Price |
$614.84
|
| Rate for Payer: Centivo All Commercial |
$505.75
|
| Rate for Payer: Cigna All Commercial |
$855.81
|
| Rate for Payer: CORVEL All Commercial |
$922.25
|
| Rate for Payer: Coventry All Commercial |
$872.67
|
| Rate for Payer: Encore All Commercial |
$912.83
|
| Rate for Payer: Frontpath All Commercial |
$912.34
|
| Rate for Payer: Humana ChoiceCare |
$856.51
|
| Rate for Payer: Humana Medicare |
$505.75
|
| Rate for Payer: Lucent All Commercial |
$505.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$892.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$743.75
|
| Rate for Payer: PHP All Commercial |
$752.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.75
|
| Rate for Payer: Sagamore Health Network All Products |
$765.57
|
| Rate for Payer: Signature Care EPO |
$823.09
|
| Rate for Payer: Signature Care PPO |
$872.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$842.92
|
| Rate for Payer: United Healthcare Commercial |
$781.44
|
| Rate for Payer: United Healthcare Medicare |
$327.25
|
|
|
HC INTERSTIM PRG PATIENT 3037
|
Facility
IP
|
$991.67
|
|
|
Service Code
|
CPT C1787
|
| Hospital Charge Code |
41603383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$743.75 |
| Max. Negotiated Rate |
$922.25 |
| Rate for Payer: Aetna Commercial |
$856.80
|
| Rate for Payer: Cash Price |
$614.84
|
| Rate for Payer: Cigna All Commercial |
$855.81
|
| Rate for Payer: CORVEL All Commercial |
$922.25
|
| Rate for Payer: Coventry All Commercial |
$872.67
|
| Rate for Payer: Encore All Commercial |
$912.83
|
| Rate for Payer: Frontpath All Commercial |
$912.34
|
| Rate for Payer: Humana ChoiceCare |
$856.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$892.50
|
| Rate for Payer: PHCS All Commercial |
$743.75
|
| Rate for Payer: PHP All Commercial |
$752.08
|
| Rate for Payer: Sagamore Health Network All Products |
$765.57
|
| Rate for Payer: Signature Care EPO |
$823.09
|
| Rate for Payer: Signature Care PPO |
$872.67
|
| Rate for Payer: United Healthcare Commercial |
$781.44
|
|
|
HC INTERSTIM PRG TEST STIM 3531
|
Facility
IP
|
$77.78
|
|
| Hospital Charge Code |
41603382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$72.34 |
| Rate for Payer: Aetna Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Cigna All Commercial |
$67.12
|
| Rate for Payer: CORVEL All Commercial |
$72.34
|
| Rate for Payer: Coventry All Commercial |
$68.45
|
| Rate for Payer: Encore All Commercial |
$71.60
|
| Rate for Payer: Frontpath All Commercial |
$71.56
|
| Rate for Payer: Humana ChoiceCare |
$67.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.00
|
| Rate for Payer: PHCS All Commercial |
$58.34
|
| Rate for Payer: PHP All Commercial |
$58.99
|
| Rate for Payer: Sagamore Health Network All Products |
$60.05
|
| Rate for Payer: Signature Care EPO |
$64.56
|
| Rate for Payer: Signature Care PPO |
$68.45
|
| Rate for Payer: United Healthcare Commercial |
$61.29
|
|
|
HC INTERSTIM PRG TEST STIM 3531
|
Facility
OP
|
$77.78
|
|
| Hospital Charge Code |
41603382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$65.65
|
| Rate for Payer: Aetna Medicare |
$25.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.23
|
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Centivo All Commercial |
$39.67
|
| Rate for Payer: Cigna All Commercial |
$67.12
|
| Rate for Payer: CORVEL All Commercial |
$72.34
|
| Rate for Payer: Coventry All Commercial |
$68.45
|
| Rate for Payer: Encore All Commercial |
$71.60
|
| Rate for Payer: Frontpath All Commercial |
$71.56
|
| Rate for Payer: Humana ChoiceCare |
$67.18
|
| Rate for Payer: Humana Medicare |
$39.67
|
| Rate for Payer: Lucent All Commercial |
$39.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$58.34
|
| Rate for Payer: PHP All Commercial |
$58.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.33
|
| Rate for Payer: Sagamore Health Network All Products |
$60.05
|
| Rate for Payer: Signature Care EPO |
$64.56
|
| Rate for Payer: Signature Care PPO |
$68.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.11
|
| Rate for Payer: United Healthcare Commercial |
$61.29
|
| Rate for Payer: United Healthcare Medicare |
$25.67
|
|
|
HC INT INFUSION OR SQ INJECTIONS, CASIRIVIMAB & IMDEVIMAB
|
Facility
IP
|
$583.44
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
00520243
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$542.60 |
| Rate for Payer: Aetna Commercial |
$504.09
|
| Rate for Payer: Cash Price |
$361.73
|
| Rate for Payer: Cigna All Commercial |
$503.51
|
| Rate for Payer: CORVEL All Commercial |
$542.60
|
| Rate for Payer: Coventry All Commercial |
$513.43
|
| Rate for Payer: Encore All Commercial |
$537.06
|
| Rate for Payer: Frontpath All Commercial |
$536.76
|
| Rate for Payer: Humana ChoiceCare |
$503.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$525.10
|
| Rate for Payer: PHCS All Commercial |
$437.58
|
| Rate for Payer: PHP All Commercial |
$442.48
|
| Rate for Payer: Sagamore Health Network All Products |
$450.42
|
| Rate for Payer: Signature Care EPO |
$484.26
|
| Rate for Payer: Signature Care PPO |
$513.43
|
| Rate for Payer: United Healthcare Commercial |
$459.75
|
|
|
HC INT INFUSION OR SQ INJECTIONS, CASIRIVIMAB & IMDEVIMAB
|
Facility
OP
|
$583.44
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
00520243
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$192.54 |
| Max. Negotiated Rate |
$542.60 |
| Rate for Payer: Aetna Commercial |
$492.42
|
| Rate for Payer: Aetna Medicare |
$192.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$335.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$364.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.79
|
| Rate for Payer: Cash Price |
$361.73
|
| Rate for Payer: Centivo All Commercial |
$297.55
|
| Rate for Payer: Cigna All Commercial |
$503.51
|
| Rate for Payer: CORVEL All Commercial |
$542.60
|
| Rate for Payer: Coventry All Commercial |
$513.43
|
| Rate for Payer: Encore All Commercial |
$537.06
|
| Rate for Payer: Frontpath All Commercial |
$536.76
|
| Rate for Payer: Humana ChoiceCare |
$503.92
|
| Rate for Payer: Humana Medicare |
$297.55
|
| Rate for Payer: Lucent All Commercial |
$297.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$525.10
|
| Rate for Payer: PHCS All Commercial |
$437.58
|
| Rate for Payer: PHP All Commercial |
$442.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.54
|
| Rate for Payer: Sagamore Health Network All Products |
$450.42
|
| Rate for Payer: Signature Care EPO |
$484.26
|
| Rate for Payer: Signature Care PPO |
$513.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$495.92
|
| Rate for Payer: United Healthcare Commercial |
$459.75
|
| Rate for Payer: United Healthcare Medicare |
$192.54
|
|
|
HC INTRADERMAL TB TEST-ED
|
Facility
OP
|
$56.01
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
01296580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$52.09 |
| Rate for Payer: Aetna Commercial |
$47.27
|
| Rate for Payer: Aetna Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.33
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Centivo All Commercial |
$28.56
|
| Rate for Payer: Cigna All Commercial |
$48.34
|
| Rate for Payer: CORVEL All Commercial |
$52.09
|
| Rate for Payer: Coventry All Commercial |
$49.29
|
| Rate for Payer: Encore All Commercial |
$51.56
|
| Rate for Payer: Frontpath All Commercial |
$51.53
|
| Rate for Payer: Humana ChoiceCare |
$48.37
|
| Rate for Payer: Humana Medicare |
$28.56
|
| Rate for Payer: Lucent All Commercial |
$28.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.41
|
| Rate for Payer: Managed Health Services Medicaid |
$15.17
|
| Rate for Payer: MDWise Medicaid |
$15.17
|
| Rate for Payer: PHCS All Commercial |
$42.01
|
| Rate for Payer: PHP All Commercial |
$42.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.84
|
| Rate for Payer: Sagamore Health Network All Products |
$43.24
|
| Rate for Payer: Signature Care EPO |
$46.49
|
| Rate for Payer: Signature Care PPO |
$49.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.61
|
| Rate for Payer: United Healthcare Commercial |
$44.13
|
| Rate for Payer: United Healthcare Medicare |
$18.48
|
|
