|
HC INTRAOP-FLUORO >1 HR W/O IMAGE
|
Facility
IP
|
$1,672.55
|
|
| Hospital Charge Code |
01610007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,254.41 |
| Max. Negotiated Rate |
$1,555.47 |
| Rate for Payer: Aetna Commercial |
$1,445.08
|
| Rate for Payer: Cash Price |
$1,036.98
|
| Rate for Payer: Cigna All Commercial |
$1,443.41
|
| Rate for Payer: CORVEL All Commercial |
$1,555.47
|
| Rate for Payer: Coventry All Commercial |
$1,471.84
|
| Rate for Payer: Encore All Commercial |
$1,539.58
|
| Rate for Payer: Frontpath All Commercial |
$1,538.74
|
| Rate for Payer: Humana ChoiceCare |
$1,444.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,505.29
|
| Rate for Payer: PHCS All Commercial |
$1,254.41
|
| Rate for Payer: PHP All Commercial |
$1,268.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,291.20
|
| Rate for Payer: Signature Care EPO |
$1,388.21
|
| Rate for Payer: Signature Care PPO |
$1,471.84
|
| Rate for Payer: United Healthcare Commercial |
$1,317.97
|
|
|
HC INTRAVENOUS INFUSION BAMLAN AND ETESEV
|
Facility
IP
|
$583.44
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
00520245
|
|
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 INTRAVENOUS INFUSION BAMLAN AND ETESEV
|
Facility
OP
|
$583.44
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
00520245
|
|
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 INTRIN FACT BLOCK AB
|
Facility
IP
|
$178.78
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
63001907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.08 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Aetna Commercial |
$154.46
|
| Rate for Payer: Cash Price |
$110.84
|
| Rate for Payer: Cigna All Commercial |
$154.28
|
| Rate for Payer: CORVEL All Commercial |
$166.26
|
| Rate for Payer: Coventry All Commercial |
$157.32
|
| Rate for Payer: Encore All Commercial |
$164.56
|
| Rate for Payer: Frontpath All Commercial |
$164.47
|
| Rate for Payer: Humana ChoiceCare |
$154.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.90
|
| Rate for Payer: PHCS All Commercial |
$134.08
|
| Rate for Payer: PHP All Commercial |
$135.58
|
| Rate for Payer: Sagamore Health Network All Products |
$138.01
|
| Rate for Payer: Signature Care EPO |
$148.38
|
| Rate for Payer: Signature Care PPO |
$157.32
|
| Rate for Payer: United Healthcare Commercial |
$140.88
|
|
|
HC INTRIN FACT BLOCK AB
|
Facility
OP
|
$178.78
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
63001907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Aetna Commercial |
$150.89
|
| Rate for Payer: Aetna Medicare |
$59.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.90
|
| Rate for Payer: Cash Price |
$110.84
|
| Rate for Payer: Cash Price |
$110.84
|
| Rate for Payer: Centivo All Commercial |
$91.18
|
| Rate for Payer: Cigna All Commercial |
$154.28
|
| Rate for Payer: CORVEL All Commercial |
$166.26
|
| Rate for Payer: Coventry All Commercial |
$157.32
|
| Rate for Payer: Encore All Commercial |
$164.56
|
| Rate for Payer: Frontpath All Commercial |
$164.47
|
| Rate for Payer: Humana ChoiceCare |
$154.41
|
| Rate for Payer: Humana Medicare |
$91.18
|
| Rate for Payer: Lucent All Commercial |
$91.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.90
|
| Rate for Payer: Managed Health Services Medicaid |
$15.08
|
| Rate for Payer: MDWise Medicaid |
$15.08
|
| Rate for Payer: PHCS All Commercial |
$134.08
|
| Rate for Payer: PHP All Commercial |
$135.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.72
|
| Rate for Payer: Sagamore Health Network All Products |
$138.01
|
| Rate for Payer: Signature Care EPO |
$148.38
|
| Rate for Payer: Signature Care PPO |
$157.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.96
|
| Rate for Payer: United Healthcare Commercial |
$140.88
|
| Rate for Payer: United Healthcare Medicare |
$59.00
|
|
|
HC INTRODUCER ET TUBE ADULT 15FRX70CM
|
Facility
IP
|
$54.87
|
|
| Hospital Charge Code |
41601188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.15 |
| Max. Negotiated Rate |
$51.03 |
| Rate for Payer: Aetna Commercial |
$47.41
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cigna All Commercial |
$47.35
|
| Rate for Payer: CORVEL All Commercial |
$51.03
|
| Rate for Payer: Coventry All Commercial |
$48.29
|
| Rate for Payer: Encore All Commercial |
$50.51
|
| Rate for Payer: Frontpath All Commercial |
$50.48
|
| Rate for Payer: Humana ChoiceCare |
$47.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.38
|
| Rate for Payer: PHCS All Commercial |
$41.15
|
| Rate for Payer: PHP All Commercial |
$41.61
|
| Rate for Payer: Sagamore Health Network All Products |
$42.36
|
| Rate for Payer: Signature Care EPO |
$45.54
|
| Rate for Payer: Signature Care PPO |
$48.29
|
| Rate for Payer: United Healthcare Commercial |
$43.24
|
|
|
HC INTRODUCER ET TUBE ADULT 15FRX70CM
|
Facility
OP
|
$54.87
|
|
| Hospital Charge Code |
41601188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$46.31
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.92
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Centivo All Commercial |
$27.98
|
| Rate for Payer: Cigna All Commercial |
$47.35
|
| Rate for Payer: CORVEL All Commercial |
$51.03
|
| Rate for Payer: Coventry All Commercial |
$48.29
|
| Rate for Payer: Encore All Commercial |
$50.51
|
| Rate for Payer: Frontpath All Commercial |
$50.48
|
| Rate for Payer: Humana ChoiceCare |
$47.39
|
| Rate for Payer: Humana Medicare |
$27.98
|
| Rate for Payer: Lucent All Commercial |
$27.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.38
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$41.15
|
| Rate for Payer: PHP All Commercial |
$41.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.40
|
| Rate for Payer: Sagamore Health Network All Products |
$42.36
|
| Rate for Payer: Signature Care EPO |
$45.54
|
| Rate for Payer: Signature Care PPO |
$48.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.64
|
| Rate for Payer: United Healthcare Commercial |
$43.24
|
| Rate for Payer: United Healthcare Medicare |
$18.11
|
|
|
HC INTRODUCER SHEATH 10FR 13CM
|
Facility
OP
|
$131.25
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.31 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$110.78
|
| Rate for Payer: Aetna Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.64
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Centivo All Commercial |
$66.94
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Humana Medicare |
$66.94
|
| Rate for Payer: Lucent All Commercial |
$66.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.19
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.56
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
|
|
HC INTRODUCER SHEATH 10FR 13CM
|
Facility
IP
|
$131.25
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.44 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
|
|
HC INTRODUCER SHEATH 11FR 13CM
|
Facility
OP
|
$136.50
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$126.94 |
| Rate for Payer: Aetna Commercial |
$115.21
|
| Rate for Payer: Aetna Medicare |
$45.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.55
|
| Rate for Payer: Cash Price |
$84.63
|
| Rate for Payer: Cash Price |
$84.63
|
| Rate for Payer: Centivo All Commercial |
$69.62
|
| Rate for Payer: Cigna All Commercial |
$117.80
|
| Rate for Payer: CORVEL All Commercial |
$126.94
|
| Rate for Payer: Coventry All Commercial |
$120.12
|
| Rate for Payer: Encore All Commercial |
$125.65
|
| Rate for Payer: Frontpath All Commercial |
$125.58
|
| Rate for Payer: Humana ChoiceCare |
$117.90
|
| Rate for Payer: Humana Medicare |
$69.62
|
| Rate for Payer: Lucent All Commercial |
$69.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$102.38
|
| Rate for Payer: PHP All Commercial |
$103.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.24
|
| Rate for Payer: Sagamore Health Network All Products |
$105.38
|
| Rate for Payer: Signature Care EPO |
$113.30
|
| Rate for Payer: Signature Care PPO |
$120.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.02
|
| Rate for Payer: United Healthcare Commercial |
$107.56
|
| Rate for Payer: United Healthcare Medicare |
$45.04
|
|
|
HC INTRODUCER SHEATH 11FR 13CM
|
Facility
IP
|
$136.50
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$126.94 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Cash Price |
$84.63
|
| Rate for Payer: Cigna All Commercial |
$117.80
|
| Rate for Payer: CORVEL All Commercial |
$126.94
|
| Rate for Payer: Coventry All Commercial |
$120.12
|
| Rate for Payer: Encore All Commercial |
$125.65
|
| Rate for Payer: Frontpath All Commercial |
$125.58
|
| Rate for Payer: Humana ChoiceCare |
$117.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.85
|
| Rate for Payer: PHCS All Commercial |
$102.38
|
| Rate for Payer: PHP All Commercial |
$103.52
|
| Rate for Payer: Sagamore Health Network All Products |
$105.38
|
| Rate for Payer: Signature Care EPO |
$113.30
|
| Rate for Payer: Signature Care PPO |
$120.12
|
| Rate for Payer: United Healthcare Commercial |
$107.56
|
|
|
HC INTRODUCER SHEATH 11FR 25CM
|
Facility
OP
|
$166.09
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$154.46 |
| Rate for Payer: Aetna Commercial |
$140.18
|
| Rate for Payer: Aetna Medicare |
$54.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.29
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Centivo All Commercial |
$84.71
|
| Rate for Payer: Cigna All Commercial |
$143.34
|
| Rate for Payer: CORVEL All Commercial |
$154.46
|
| Rate for Payer: Coventry All Commercial |
$146.16
|
| Rate for Payer: Encore All Commercial |
$152.89
|
| Rate for Payer: Frontpath All Commercial |
$152.80
|
| Rate for Payer: Humana ChoiceCare |
$143.45
|
| Rate for Payer: Humana Medicare |
$84.71
|
| Rate for Payer: Lucent All Commercial |
$84.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$124.57
|
| Rate for Payer: PHP All Commercial |
$125.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.78
|
| Rate for Payer: Sagamore Health Network All Products |
$128.22
|
| Rate for Payer: Signature Care EPO |
$137.85
|
| Rate for Payer: Signature Care PPO |
$146.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.18
|
| Rate for Payer: United Healthcare Commercial |
$130.88
|
| Rate for Payer: United Healthcare Medicare |
$54.81
|
|
|
HC INTRODUCER SHEATH 11FR 25CM
|
Facility
IP
|
$166.09
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$154.46 |
| Rate for Payer: Aetna Commercial |
$143.50
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cigna All Commercial |
$143.34
|
| Rate for Payer: CORVEL All Commercial |
$154.46
|
| Rate for Payer: Coventry All Commercial |
$146.16
|
| Rate for Payer: Encore All Commercial |
$152.89
|
| Rate for Payer: Frontpath All Commercial |
$152.80
|
| Rate for Payer: Humana ChoiceCare |
$143.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.48
|
| Rate for Payer: PHCS All Commercial |
$124.57
|
| Rate for Payer: PHP All Commercial |
$125.96
|
| Rate for Payer: Sagamore Health Network All Products |
$128.22
|
| Rate for Payer: Signature Care EPO |
$137.85
|
| Rate for Payer: Signature Care PPO |
$146.16
|
| Rate for Payer: United Healthcare Commercial |
$130.88
|
|
|
HC INTRODUCER SHEATH 5FR 11CM
|
Facility
OP
|
$97.50
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.18 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$82.29
|
| Rate for Payer: Aetna Medicare |
$32.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.39
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Centivo All Commercial |
$49.72
|
| Rate for Payer: Cigna All Commercial |
$84.14
|
| Rate for Payer: CORVEL All Commercial |
$90.68
|
| Rate for Payer: Coventry All Commercial |
$85.80
|
| Rate for Payer: Encore All Commercial |
$89.75
|
| Rate for Payer: Frontpath All Commercial |
$89.70
|
| Rate for Payer: Humana ChoiceCare |
$84.21
|
| Rate for Payer: Humana Medicare |
$49.72
|
| Rate for Payer: Lucent All Commercial |
$49.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$73.12
|
| Rate for Payer: PHP All Commercial |
$73.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.02
|
| Rate for Payer: Sagamore Health Network All Products |
$75.27
|
| Rate for Payer: Signature Care EPO |
$80.92
|
| Rate for Payer: Signature Care PPO |
$85.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.88
|
| Rate for Payer: United Healthcare Commercial |
$76.83
|
| Rate for Payer: United Healthcare Medicare |
$32.18
|
|
|
HC INTRODUCER SHEATH 5FR 11CM
|
Facility
IP
|
$97.50
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.12 |
| Max. Negotiated Rate |
$90.68 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Cigna All Commercial |
$84.14
|
| Rate for Payer: CORVEL All Commercial |
$90.68
|
| Rate for Payer: Coventry All Commercial |
$85.80
|
| Rate for Payer: Encore All Commercial |
$89.75
|
| Rate for Payer: Frontpath All Commercial |
$89.70
|
| Rate for Payer: Humana ChoiceCare |
$84.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.75
|
| Rate for Payer: PHCS All Commercial |
$73.12
|
| Rate for Payer: PHP All Commercial |
$73.94
|
| Rate for Payer: Sagamore Health Network All Products |
$75.27
|
| Rate for Payer: Signature Care EPO |
$80.92
|
| Rate for Payer: Signature Care PPO |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$76.83
|
|
|
HC INTRODUCER SHEATH 6FR 11CM
|
Facility
IP
|
$177.47
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.10 |
| Max. Negotiated Rate |
$165.05 |
| Rate for Payer: Aetna Commercial |
$153.33
|
| Rate for Payer: Cash Price |
$110.03
|
| Rate for Payer: Cigna All Commercial |
$153.16
|
| Rate for Payer: CORVEL All Commercial |
$165.05
|
| Rate for Payer: Coventry All Commercial |
$156.17
|
| Rate for Payer: Encore All Commercial |
$163.36
|
| Rate for Payer: Frontpath All Commercial |
$163.27
|
| Rate for Payer: Humana ChoiceCare |
$153.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.72
|
| Rate for Payer: PHCS All Commercial |
$133.10
|
| Rate for Payer: PHP All Commercial |
$134.59
|
| Rate for Payer: Sagamore Health Network All Products |
$137.01
|
| Rate for Payer: Signature Care EPO |
$147.30
|
| Rate for Payer: Signature Care PPO |
$156.17
|
| Rate for Payer: United Healthcare Commercial |
$139.85
|
|
|
HC INTRODUCER SHEATH 6FR 11CM
|
Facility
OP
|
$177.47
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
41607158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.57 |
| Max. Negotiated Rate |
$165.05 |
| Rate for Payer: Aetna Commercial |
$149.78
|
| Rate for Payer: Aetna Medicare |
$58.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$101.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.42
|
| Rate for Payer: Cash Price |
$110.03
|
| Rate for Payer: Cash Price |
$110.03
|
| Rate for Payer: Centivo All Commercial |
$90.51
|
| Rate for Payer: Cigna All Commercial |
$153.16
|
| Rate for Payer: CORVEL All Commercial |
$165.05
|
| Rate for Payer: Coventry All Commercial |
$156.17
|
| Rate for Payer: Encore All Commercial |
$163.36
|
| Rate for Payer: Frontpath All Commercial |
$163.27
|
| Rate for Payer: Humana ChoiceCare |
$153.28
|
| Rate for Payer: Humana Medicare |
$90.51
|
| Rate for Payer: Lucent All Commercial |
$90.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.72
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$133.10
|
| Rate for Payer: PHP All Commercial |
$134.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.21
|
| Rate for Payer: Sagamore Health Network All Products |
$137.01
|
| Rate for Payer: Signature Care EPO |
$147.30
|
| Rate for Payer: Signature Care PPO |
$156.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$150.85
|
| Rate for Payer: United Healthcare Commercial |
$139.85
|
| Rate for Payer: United Healthcare Medicare |
$58.57
|
|
|
HC INTRODUCER SHEATH 6FR 13CM
|
Facility
IP
|
$131.25
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.44 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
|
|
HC INTRODUCER SHEATH 6FR 13CM
|
Facility
OP
|
$131.25
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.31 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$110.78
|
| Rate for Payer: Aetna Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.64
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Cash Price |
$81.38
|
| Rate for Payer: Centivo All Commercial |
$66.94
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$122.06
|
| Rate for Payer: Coventry All Commercial |
$115.50
|
| Rate for Payer: Encore All Commercial |
$120.82
|
| Rate for Payer: Frontpath All Commercial |
$120.75
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Humana Medicare |
$66.94
|
| Rate for Payer: Lucent All Commercial |
$66.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$98.44
|
| Rate for Payer: PHP All Commercial |
$99.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.19
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.94
|
| Rate for Payer: Signature Care PPO |
$115.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.56
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
|
|
HC INTRODUCER SHEATH 6FR 25CM
|
Facility
IP
|
$175.50
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.62 |
| Max. Negotiated Rate |
$163.22 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Cash Price |
$108.81
|
| Rate for Payer: Cigna All Commercial |
$151.46
|
| Rate for Payer: CORVEL All Commercial |
$163.22
|
| Rate for Payer: Coventry All Commercial |
$154.44
|
| Rate for Payer: Encore All Commercial |
$161.55
|
| Rate for Payer: Frontpath All Commercial |
$161.46
|
| Rate for Payer: Humana ChoiceCare |
$151.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.95
|
| Rate for Payer: PHCS All Commercial |
$131.62
|
| Rate for Payer: PHP All Commercial |
$133.10
|
| Rate for Payer: Sagamore Health Network All Products |
$135.49
|
| Rate for Payer: Signature Care EPO |
$145.66
|
| Rate for Payer: Signature Care PPO |
$154.44
|
| Rate for Payer: United Healthcare Commercial |
$138.29
|
|
|
HC INTRODUCER SHEATH 6FR 25CM
|
Facility
OP
|
$175.50
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.92 |
| Max. Negotiated Rate |
$163.22 |
| Rate for Payer: Aetna Commercial |
$148.12
|
| Rate for Payer: Aetna Medicare |
$57.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.71
|
| Rate for Payer: Cash Price |
$108.81
|
| Rate for Payer: Cash Price |
$108.81
|
| Rate for Payer: Centivo All Commercial |
$89.50
|
| Rate for Payer: Cigna All Commercial |
$151.46
|
| Rate for Payer: CORVEL All Commercial |
$163.22
|
| Rate for Payer: Coventry All Commercial |
$154.44
|
| Rate for Payer: Encore All Commercial |
$161.55
|
| Rate for Payer: Frontpath All Commercial |
$161.46
|
| Rate for Payer: Humana ChoiceCare |
$151.58
|
| Rate for Payer: Humana Medicare |
$89.50
|
| Rate for Payer: Lucent All Commercial |
$89.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$131.62
|
| Rate for Payer: PHP All Commercial |
$133.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.44
|
| Rate for Payer: Sagamore Health Network All Products |
$135.49
|
| Rate for Payer: Signature Care EPO |
$145.66
|
| Rate for Payer: Signature Care PPO |
$154.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$149.18
|
| Rate for Payer: United Healthcare Commercial |
$138.29
|
| Rate for Payer: United Healthcare Medicare |
$57.92
|
|
|
HC INTRODUCER SHEATH 7FR 13CM
|
Facility
OP
|
$136.50
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$126.94 |
| Rate for Payer: Aetna Commercial |
$115.21
|
| Rate for Payer: Aetna Medicare |
$45.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.55
|
| Rate for Payer: Cash Price |
$84.63
|
| Rate for Payer: Cash Price |
$84.63
|
| Rate for Payer: Centivo All Commercial |
$69.62
|
| Rate for Payer: Cigna All Commercial |
$117.80
|
| Rate for Payer: CORVEL All Commercial |
$126.94
|
| Rate for Payer: Coventry All Commercial |
$120.12
|
| Rate for Payer: Encore All Commercial |
$125.65
|
| Rate for Payer: Frontpath All Commercial |
$125.58
|
| Rate for Payer: Humana ChoiceCare |
$117.90
|
| Rate for Payer: Humana Medicare |
$69.62
|
| Rate for Payer: Lucent All Commercial |
$69.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$102.38
|
| Rate for Payer: PHP All Commercial |
$103.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.24
|
| Rate for Payer: Sagamore Health Network All Products |
$105.38
|
| Rate for Payer: Signature Care EPO |
$113.30
|
| Rate for Payer: Signature Care PPO |
$120.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.02
|
| Rate for Payer: United Healthcare Commercial |
$107.56
|
| Rate for Payer: United Healthcare Medicare |
$45.04
|
|
|
HC INTRODUCER SHEATH 7FR 13CM
|
Facility
IP
|
$136.50
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$126.94 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Cash Price |
$84.63
|
| Rate for Payer: Cigna All Commercial |
$117.80
|
| Rate for Payer: CORVEL All Commercial |
$126.94
|
| Rate for Payer: Coventry All Commercial |
$120.12
|
| Rate for Payer: Encore All Commercial |
$125.65
|
| Rate for Payer: Frontpath All Commercial |
$125.58
|
| Rate for Payer: Humana ChoiceCare |
$117.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.85
|
| Rate for Payer: PHCS All Commercial |
$102.38
|
| Rate for Payer: PHP All Commercial |
$103.52
|
| Rate for Payer: Sagamore Health Network All Products |
$105.38
|
| Rate for Payer: Signature Care EPO |
$113.30
|
| Rate for Payer: Signature Care PPO |
$120.12
|
| Rate for Payer: United Healthcare Commercial |
$107.56
|
|
|
HC INTRODUCER SHEATH 7FR 25CM
|
Facility
OP
|
$166.09
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$154.46 |
| Rate for Payer: Aetna Commercial |
$140.18
|
| Rate for Payer: Aetna Medicare |
$54.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.29
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Centivo All Commercial |
$84.71
|
| Rate for Payer: Cigna All Commercial |
$143.34
|
| Rate for Payer: CORVEL All Commercial |
$154.46
|
| Rate for Payer: Coventry All Commercial |
$146.16
|
| Rate for Payer: Encore All Commercial |
$152.89
|
| Rate for Payer: Frontpath All Commercial |
$152.80
|
| Rate for Payer: Humana ChoiceCare |
$143.45
|
| Rate for Payer: Humana Medicare |
$84.71
|
| Rate for Payer: Lucent All Commercial |
$84.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$124.57
|
| Rate for Payer: PHP All Commercial |
$125.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.78
|
| Rate for Payer: Sagamore Health Network All Products |
$128.22
|
| Rate for Payer: Signature Care EPO |
$137.85
|
| Rate for Payer: Signature Care PPO |
$146.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.18
|
| Rate for Payer: United Healthcare Commercial |
$130.88
|
| Rate for Payer: United Healthcare Medicare |
$54.81
|
|
|
HC INTRODUCER SHEATH 7FR 25CM
|
Facility
IP
|
$166.09
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$154.46 |
| Rate for Payer: Aetna Commercial |
$143.50
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cigna All Commercial |
$143.34
|
| Rate for Payer: CORVEL All Commercial |
$154.46
|
| Rate for Payer: Coventry All Commercial |
$146.16
|
| Rate for Payer: Encore All Commercial |
$152.89
|
| Rate for Payer: Frontpath All Commercial |
$152.80
|
| Rate for Payer: Humana ChoiceCare |
$143.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.48
|
| Rate for Payer: PHCS All Commercial |
$124.57
|
| Rate for Payer: PHP All Commercial |
$125.96
|
| Rate for Payer: Sagamore Health Network All Products |
$128.22
|
| Rate for Payer: Signature Care EPO |
$137.85
|
| Rate for Payer: Signature Care PPO |
$146.16
|
| Rate for Payer: United Healthcare Commercial |
$130.88
|
|
