|
HC INTERPULSE HANDPIECE W/COAXIAL TIP
|
Facility
|
OP
|
$265.63
|
|
| Hospital Charge Code |
41601243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Aetna Commercial |
$224.19
|
| Rate for Payer: Aetna Medicare |
$85.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$152.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.50
|
| Rate for Payer: Cash Price |
$159.38
|
| Rate for Payer: Cash Price |
$159.38
|
| Rate for Payer: Centivo All Commercial |
$144.50
|
| 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 |
$85.00
|
| Rate for Payer: Lucent All Commercial |
$144.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.07
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$85.00
|
|
|
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 |
$159.38
|
| 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 INTRADERMAL TB TEST-ED
|
Facility
|
OP
|
$56.01
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
1296580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$52.09 |
| Rate for Payer: Aetna Commercial |
$47.27
|
| Rate for Payer: Aetna Medicare |
$17.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.72
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Centivo All Commercial |
$30.47
|
| 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 |
$48.38
|
| Rate for Payer: Humana Medicare |
$17.92
|
| Rate for Payer: Lucent All Commercial |
$30.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.41
|
| Rate for Payer: Managed Health Services Medicaid |
$3.89
|
| Rate for Payer: MDWise Medicaid |
$3.89
|
| 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 |
$44.14
|
| Rate for Payer: United Healthcare Medicare |
$17.92
|
|
|
HC INTRADERMAL TB TEST-ED
|
Facility
|
IP
|
$56.01
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
1296580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$52.09 |
| Rate for Payer: Aetna Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$33.61
|
| 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 |
$48.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.41
|
| Rate for Payer: PHCS All Commercial |
$42.01
|
| Rate for Payer: PHP All Commercial |
$42.48
|
| 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: United Healthcare Commercial |
$44.14
|
|
|
HC INTRADUCER TAUT 7.5 FR X 3.5 IN
|
Facility
|
OP
|
$469.30
|
|
| Hospital Charge Code |
41601923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$436.45 |
| Rate for Payer: Aetna Commercial |
$396.09
|
| Rate for Payer: Aetna Medicare |
$150.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$269.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$293.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.19
|
| Rate for Payer: Cash Price |
$281.58
|
| Rate for Payer: Cash Price |
$281.58
|
| Rate for Payer: Centivo All Commercial |
$255.30
|
| Rate for Payer: Cigna All Commercial |
$405.01
|
| Rate for Payer: CORVEL All Commercial |
$436.45
|
| Rate for Payer: Coventry All Commercial |
$412.98
|
| Rate for Payer: Encore All Commercial |
$431.99
|
| Rate for Payer: Frontpath All Commercial |
$431.76
|
| Rate for Payer: Humana ChoiceCare |
$405.33
|
| Rate for Payer: Humana Medicare |
$150.18
|
| Rate for Payer: Lucent All Commercial |
$255.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$422.37
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$351.98
|
| Rate for Payer: PHP All Commercial |
$355.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$183.03
|
| Rate for Payer: Sagamore Health Network All Products |
$362.30
|
| Rate for Payer: Signature Care EPO |
$389.52
|
| Rate for Payer: Signature Care PPO |
$412.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$398.90
|
| Rate for Payer: United Healthcare Commercial |
$369.81
|
| Rate for Payer: United Healthcare Medicare |
$150.18
|
|
|
HC INTRADUCER TAUT 7.5 FR X 3.5 IN
|
Facility
|
IP
|
$469.30
|
|
| Hospital Charge Code |
41601923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.98 |
| Max. Negotiated Rate |
$436.45 |
| Rate for Payer: Aetna Commercial |
$405.48
|
| Rate for Payer: Cash Price |
$281.58
|
| Rate for Payer: Cigna All Commercial |
$405.01
|
| Rate for Payer: CORVEL All Commercial |
$436.45
|
| Rate for Payer: Coventry All Commercial |
$412.98
|
| Rate for Payer: Encore All Commercial |
$431.99
|
| Rate for Payer: Frontpath All Commercial |
$431.76
|
| Rate for Payer: Humana ChoiceCare |
$405.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$422.37
|
| Rate for Payer: PHCS All Commercial |
$351.98
|
| Rate for Payer: PHP All Commercial |
$355.92
|
| Rate for Payer: Sagamore Health Network All Products |
$362.30
|
| Rate for Payer: Signature Care EPO |
$389.52
|
| Rate for Payer: Signature Care PPO |
$412.98
|
| Rate for Payer: United Healthcare Commercial |
$369.81
|
|
|
HC INTRAOCULAR LENS AU00T0
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602546
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC INTRAOCULAR LENS AU00T0
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602546
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$336.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$523.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$603.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$523.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$386.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$369.60
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Centivo All Commercial |
$571.20
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$336.00
|
| Rate for Payer: Lucent All Commercial |
$571.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$523.53
|
| Rate for Payer: MDWise Medicaid |
$523.53
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$336.00
|
|
|
HC INTRAOCULAR LENS MTA4U0
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41604352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC INTRAOCULAR LENS MTA4U0
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41604352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$336.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$603.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$386.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$369.60
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Centivo All Commercial |
$571.20
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$336.00
|
| Rate for Payer: Lucent All Commercial |
$571.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$336.00
|
|
|
HC INTRAOCULAR LENS PCB00
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602547
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$336.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$523.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$603.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$523.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$386.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$369.60
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Centivo All Commercial |
$571.20
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$336.00
|
| Rate for Payer: Lucent All Commercial |
$571.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$523.53
|
| Rate for Payer: MDWise Medicaid |
$523.53
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$336.00
|
|
|
HC INTRAOCULAR LENS PCB00
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602547
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC INTRAOP-FLUORO > 1 HR W/IMAGE
|
Facility
|
IP
|
$2,038.98
|
|
| Hospital Charge Code |
1610008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,529.23 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC INTRAOP-FLUORO > 1 HR W/IMAGE
|
Facility
|
OP
|
$2,038.98
|
|
| Hospital Charge Code |
1610008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.08 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$652.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,170.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,274.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$750.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$717.72
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Centivo All Commercial |
$1,109.21
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$652.47
|
| Rate for Payer: Lucent All Commercial |
$1,109.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$652.47
|
|
|
HC INTRAOP-FLUORO < 1 HR W/IMAGE
|
Facility
|
IP
|
$1,796.56
|
|
| Hospital Charge Code |
1610006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,347.42 |
| Max. Negotiated Rate |
$1,670.80 |
| Rate for Payer: Aetna Commercial |
$1,552.23
|
| Rate for Payer: Cash Price |
$1,077.94
|
| Rate for Payer: Cigna All Commercial |
$1,550.43
|
| Rate for Payer: CORVEL All Commercial |
$1,670.80
|
| Rate for Payer: Coventry All Commercial |
$1,580.97
|
| Rate for Payer: Encore All Commercial |
$1,653.73
|
| Rate for Payer: Frontpath All Commercial |
$1,652.84
|
| Rate for Payer: Humana ChoiceCare |
$1,551.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,616.90
|
| Rate for Payer: PHCS All Commercial |
$1,347.42
|
| Rate for Payer: PHP All Commercial |
$1,362.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,386.94
|
| Rate for Payer: Signature Care EPO |
$1,491.14
|
| Rate for Payer: Signature Care PPO |
$1,580.97
|
| Rate for Payer: United Healthcare Commercial |
$1,415.69
|
|
|
HC INTRAOP-FLUORO < 1 HR W/IMAGE
|
Facility
|
OP
|
$1,796.56
|
|
| Hospital Charge Code |
1610006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$556.93 |
| Max. Negotiated Rate |
$1,670.80 |
| Rate for Payer: Aetna Commercial |
$1,516.30
|
| Rate for Payer: Aetna Medicare |
$574.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$556.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,031.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,123.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$661.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$632.39
|
| Rate for Payer: Cash Price |
$1,077.94
|
| Rate for Payer: Centivo All Commercial |
$977.33
|
| Rate for Payer: Cigna All Commercial |
$1,550.43
|
| Rate for Payer: CORVEL All Commercial |
$1,670.80
|
| Rate for Payer: Coventry All Commercial |
$1,580.97
|
| Rate for Payer: Encore All Commercial |
$1,653.73
|
| Rate for Payer: Frontpath All Commercial |
$1,652.84
|
| Rate for Payer: Humana ChoiceCare |
$1,551.69
|
| Rate for Payer: Humana Medicare |
$574.90
|
| Rate for Payer: Lucent All Commercial |
$977.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,616.90
|
| Rate for Payer: PHCS All Commercial |
$1,347.42
|
| Rate for Payer: PHP All Commercial |
$1,362.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$700.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,386.94
|
| Rate for Payer: Signature Care EPO |
$1,491.14
|
| Rate for Payer: Signature Care PPO |
$1,580.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,527.08
|
| Rate for Payer: United Healthcare Commercial |
$1,415.69
|
| Rate for Payer: United Healthcare Medicare |
$574.90
|
|
|
HC INTRAOP-FLUORO <1 HR W/O IMAGE
|
Facility
|
IP
|
$1,254.41
|
|
| Hospital Charge Code |
1610005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$940.81 |
| Max. Negotiated Rate |
$1,166.60 |
| Rate for Payer: Aetna Commercial |
$1,083.81
|
| Rate for Payer: Cash Price |
$752.65
|
| Rate for Payer: Cigna All Commercial |
$1,082.56
|
| Rate for Payer: CORVEL All Commercial |
$1,166.60
|
| Rate for Payer: Coventry All Commercial |
$1,103.88
|
| Rate for Payer: Encore All Commercial |
$1,154.68
|
| Rate for Payer: Frontpath All Commercial |
$1,154.06
|
| Rate for Payer: Humana ChoiceCare |
$1,083.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,128.97
|
| Rate for Payer: PHCS All Commercial |
$940.81
|
| Rate for Payer: PHP All Commercial |
$951.34
|
| Rate for Payer: Sagamore Health Network All Products |
$968.40
|
| Rate for Payer: Signature Care EPO |
$1,041.16
|
| Rate for Payer: Signature Care PPO |
$1,103.88
|
| Rate for Payer: United Healthcare Commercial |
$988.48
|
|
|
HC INTRAOP-FLUORO <1 HR W/O IMAGE
|
Facility
|
OP
|
$1,254.41
|
|
| Hospital Charge Code |
1610005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.87 |
| Max. Negotiated Rate |
$1,166.60 |
| Rate for Payer: Aetna Commercial |
$1,058.72
|
| Rate for Payer: Aetna Medicare |
$401.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$388.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$720.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$784.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$461.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.55
|
| Rate for Payer: Cash Price |
$752.65
|
| Rate for Payer: Centivo All Commercial |
$682.40
|
| Rate for Payer: Cigna All Commercial |
$1,082.56
|
| Rate for Payer: CORVEL All Commercial |
$1,166.60
|
| Rate for Payer: Coventry All Commercial |
$1,103.88
|
| Rate for Payer: Encore All Commercial |
$1,154.68
|
| Rate for Payer: Frontpath All Commercial |
$1,154.06
|
| Rate for Payer: Humana ChoiceCare |
$1,083.43
|
| Rate for Payer: Humana Medicare |
$401.41
|
| Rate for Payer: Lucent All Commercial |
$682.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,128.97
|
| Rate for Payer: PHCS All Commercial |
$940.81
|
| Rate for Payer: PHP All Commercial |
$951.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$489.22
|
| Rate for Payer: Sagamore Health Network All Products |
$968.40
|
| Rate for Payer: Signature Care EPO |
$1,041.16
|
| Rate for Payer: Signature Care PPO |
$1,103.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,066.25
|
| Rate for Payer: United Healthcare Commercial |
$988.48
|
| Rate for Payer: United Healthcare Medicare |
$401.41
|
|
|
HC INTRAOP-FLUORO >1 HR W/O IMAGE
|
Facility
|
OP
|
$1,672.55
|
|
| Hospital Charge Code |
1610007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$518.49 |
| Max. Negotiated Rate |
$1,555.47 |
| Rate for Payer: Aetna Commercial |
$1,411.63
|
| Rate for Payer: Aetna Medicare |
$535.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$518.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$960.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,045.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$615.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$588.74
|
| Rate for Payer: Cash Price |
$1,003.53
|
| Rate for Payer: Centivo All Commercial |
$909.87
|
| 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 |
$1,538.75
|
| Rate for Payer: Humana ChoiceCare |
$1,444.58
|
| Rate for Payer: Humana Medicare |
$535.22
|
| Rate for Payer: Lucent All Commercial |
$909.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,505.30
|
| Rate for Payer: PHCS All Commercial |
$1,254.41
|
| Rate for Payer: PHP All Commercial |
$1,268.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$652.29
|
| Rate for Payer: Sagamore Health Network All Products |
$1,291.21
|
| Rate for Payer: Signature Care EPO |
$1,388.22
|
| Rate for Payer: Signature Care PPO |
$1,471.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,421.67
|
| Rate for Payer: United Healthcare Commercial |
$1,317.97
|
| Rate for Payer: United Healthcare Medicare |
$535.22
|
|
|
HC INTRAOP-FLUORO >1 HR W/O IMAGE
|
Facility
|
IP
|
$1,672.55
|
|
| Hospital Charge Code |
1610007
|
|
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 |
$1,003.53
|
| 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 |
$1,538.75
|
| Rate for Payer: Humana ChoiceCare |
$1,444.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,505.30
|
| 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 |
$1,291.21
|
| Rate for Payer: Signature Care EPO |
$1,388.22
|
| Rate for Payer: Signature Care PPO |
$1,471.84
|
| Rate for Payer: United Healthcare Commercial |
$1,317.97
|
|
|
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 |
$166.27 |
| Rate for Payer: Aetna Commercial |
$150.89
|
| Rate for Payer: Aetna Medicare |
$57.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$82.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.93
|
| Rate for Payer: Cash Price |
$107.27
|
| Rate for Payer: Cash Price |
$107.27
|
| Rate for Payer: Centivo All Commercial |
$97.26
|
| Rate for Payer: Cigna All Commercial |
$154.29
|
| Rate for Payer: CORVEL All Commercial |
$166.27
|
| Rate for Payer: Coventry All Commercial |
$157.33
|
| Rate for Payer: Encore All Commercial |
$164.57
|
| Rate for Payer: Frontpath All Commercial |
$164.48
|
| Rate for Payer: Humana ChoiceCare |
$154.41
|
| Rate for Payer: Humana Medicare |
$57.21
|
| Rate for Payer: Lucent All Commercial |
$97.26
|
| 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 |
$134.09
|
| Rate for Payer: PHP All Commercial |
$135.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.72
|
| Rate for Payer: Sagamore Health Network All Products |
$138.02
|
| Rate for Payer: Signature Care EPO |
$148.39
|
| Rate for Payer: Signature Care PPO |
$157.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.96
|
| Rate for Payer: United Healthcare Commercial |
$140.88
|
| Rate for Payer: United Healthcare Medicare |
$57.21
|
|
|
HC INTRIN FACT BLOCK AB
|
Facility
|
IP
|
$178.78
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
63001907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.09 |
| Max. Negotiated Rate |
$166.27 |
| Rate for Payer: Aetna Commercial |
$154.47
|
| Rate for Payer: Cash Price |
$107.27
|
| Rate for Payer: Cigna All Commercial |
$154.29
|
| Rate for Payer: CORVEL All Commercial |
$166.27
|
| Rate for Payer: Coventry All Commercial |
$157.33
|
| Rate for Payer: Encore All Commercial |
$164.57
|
| Rate for Payer: Frontpath All Commercial |
$164.48
|
| Rate for Payer: Humana ChoiceCare |
$154.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.90
|
| Rate for Payer: PHCS All Commercial |
$134.09
|
| Rate for Payer: PHP All Commercial |
$135.59
|
| Rate for Payer: Sagamore Health Network All Products |
$138.02
|
| Rate for Payer: Signature Care EPO |
$148.39
|
| Rate for Payer: Signature Care PPO |
$157.33
|
| Rate for Payer: United Healthcare Commercial |
$140.88
|
|
|
HC INTRODUCER ET TUBE ADULT 15FRX70CM
|
Facility
|
OP
|
$54.87
|
|
| Hospital Charge Code |
41601188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$51.03 |
| Rate for Payer: Aetna Commercial |
$46.31
|
| Rate for Payer: Aetna Medicare |
$17.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.31
|
| Rate for Payer: Cash Price |
$32.92
|
| Rate for Payer: Cash Price |
$32.92
|
| Rate for Payer: Centivo All Commercial |
$29.85
|
| 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 |
$17.56
|
| Rate for Payer: Lucent All Commercial |
$29.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.38
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| 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 |
$17.56
|
|
|
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 |
$32.92
|
| 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 SHEATH 7FR 13CM
|
Facility
|
OP
|
$254.80
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
41607145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$236.96 |
| Rate for Payer: Aetna Commercial |
$215.05
|
| Rate for Payer: Aetna Medicare |
$81.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$146.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.69
|
| Rate for Payer: Cash Price |
$152.88
|
| Rate for Payer: Cash Price |
$152.88
|
| Rate for Payer: Centivo All Commercial |
$138.61
|
| Rate for Payer: Cigna All Commercial |
$219.89
|
| Rate for Payer: CORVEL All Commercial |
$236.96
|
| Rate for Payer: Coventry All Commercial |
$224.22
|
| Rate for Payer: Encore All Commercial |
$234.54
|
| Rate for Payer: Frontpath All Commercial |
$234.42
|
| Rate for Payer: Humana ChoiceCare |
$220.07
|
| Rate for Payer: Humana Medicare |
$81.54
|
| Rate for Payer: Lucent All Commercial |
$138.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.32
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$191.10
|
| Rate for Payer: PHP All Commercial |
$193.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.37
|
| Rate for Payer: Sagamore Health Network All Products |
$196.71
|
| Rate for Payer: Signature Care EPO |
$211.48
|
| Rate for Payer: Signature Care PPO |
$224.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$216.58
|
| Rate for Payer: United Healthcare Commercial |
$200.78
|
| Rate for Payer: United Healthcare Medicare |
$81.54
|
|
