|
HC KIT CHOLANGIOGRAM
|
Facility
IP
|
$531.86
|
|
| Hospital Charge Code |
41601926
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.90 |
| Max. Negotiated Rate |
$494.63 |
| Rate for Payer: Aetna Commercial |
$459.53
|
| Rate for Payer: Cash Price |
$329.75
|
| Rate for Payer: Cigna All Commercial |
$459.00
|
| Rate for Payer: CORVEL All Commercial |
$494.63
|
| Rate for Payer: Coventry All Commercial |
$468.04
|
| Rate for Payer: Encore All Commercial |
$489.58
|
| Rate for Payer: Frontpath All Commercial |
$489.31
|
| Rate for Payer: Humana ChoiceCare |
$459.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.67
|
| Rate for Payer: PHCS All Commercial |
$398.90
|
| Rate for Payer: PHP All Commercial |
$403.36
|
| Rate for Payer: Sagamore Health Network All Products |
$410.60
|
| Rate for Payer: Signature Care EPO |
$441.44
|
| Rate for Payer: Signature Care PPO |
$468.04
|
| Rate for Payer: United Healthcare Commercial |
$419.11
|
|
|
HC KIT CHOLANGIOGRAM
|
Facility
OP
|
$531.86
|
|
| Hospital Charge Code |
41601926
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$494.63 |
| Rate for Payer: Aetna Commercial |
$448.89
|
| Rate for Payer: Aetna Medicare |
$175.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$305.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$332.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.07
|
| Rate for Payer: Cash Price |
$329.75
|
| Rate for Payer: Cash Price |
$329.75
|
| Rate for Payer: Centivo All Commercial |
$271.25
|
| Rate for Payer: Cigna All Commercial |
$459.00
|
| Rate for Payer: CORVEL All Commercial |
$494.63
|
| Rate for Payer: Coventry All Commercial |
$468.04
|
| Rate for Payer: Encore All Commercial |
$489.58
|
| Rate for Payer: Frontpath All Commercial |
$489.31
|
| Rate for Payer: Humana ChoiceCare |
$459.37
|
| Rate for Payer: Humana Medicare |
$271.25
|
| Rate for Payer: Lucent All Commercial |
$271.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.67
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$398.90
|
| Rate for Payer: PHP All Commercial |
$403.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$207.43
|
| Rate for Payer: Sagamore Health Network All Products |
$410.60
|
| Rate for Payer: Signature Care EPO |
$441.44
|
| Rate for Payer: Signature Care PPO |
$468.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$452.08
|
| Rate for Payer: United Healthcare Commercial |
$419.11
|
| Rate for Payer: United Healthcare Medicare |
$175.51
|
|
|
HC KIT CHOLANGIOGRAM 4 F ARROW
|
Facility
OP
|
$996.44
|
|
| Hospital Charge Code |
41602619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$926.69 |
| Rate for Payer: Aetna Commercial |
$841.00
|
| Rate for Payer: Aetna Medicare |
$328.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$572.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$622.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$378.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$361.71
|
| Rate for Payer: Cash Price |
$617.79
|
| Rate for Payer: Cash Price |
$617.79
|
| Rate for Payer: Centivo All Commercial |
$508.18
|
| Rate for Payer: Cigna All Commercial |
$859.93
|
| Rate for Payer: CORVEL All Commercial |
$926.69
|
| Rate for Payer: Coventry All Commercial |
$876.87
|
| Rate for Payer: Encore All Commercial |
$917.22
|
| Rate for Payer: Frontpath All Commercial |
$916.72
|
| Rate for Payer: Humana ChoiceCare |
$860.63
|
| Rate for Payer: Humana Medicare |
$508.18
|
| Rate for Payer: Lucent All Commercial |
$508.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$896.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$747.33
|
| Rate for Payer: PHP All Commercial |
$755.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$388.61
|
| Rate for Payer: Sagamore Health Network All Products |
$769.25
|
| Rate for Payer: Signature Care EPO |
$827.05
|
| Rate for Payer: Signature Care PPO |
$876.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$846.97
|
| Rate for Payer: United Healthcare Commercial |
$785.19
|
| Rate for Payer: United Healthcare Medicare |
$328.83
|
|
|
HC KIT CHOLANGIOGRAM 4 F ARROW
|
Facility
IP
|
$996.44
|
|
| Hospital Charge Code |
41602619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.33 |
| Max. Negotiated Rate |
$926.69 |
| Rate for Payer: Aetna Commercial |
$860.92
|
| Rate for Payer: Cash Price |
$617.79
|
| Rate for Payer: Cigna All Commercial |
$859.93
|
| Rate for Payer: CORVEL All Commercial |
$926.69
|
| Rate for Payer: Coventry All Commercial |
$876.87
|
| Rate for Payer: Encore All Commercial |
$917.22
|
| Rate for Payer: Frontpath All Commercial |
$916.72
|
| Rate for Payer: Humana ChoiceCare |
$860.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$896.80
|
| Rate for Payer: PHCS All Commercial |
$747.33
|
| Rate for Payer: PHP All Commercial |
$755.70
|
| Rate for Payer: Sagamore Health Network All Products |
$769.25
|
| Rate for Payer: Signature Care EPO |
$827.05
|
| Rate for Payer: Signature Care PPO |
$876.87
|
| Rate for Payer: United Healthcare Commercial |
$785.19
|
|
|
HC KIT COLLECTION FEE
|
Facility
OP
|
$27.29
|
|
| Hospital Charge Code |
63002224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.90
|
| Rate for Payer: Cash Price |
$16.92
|
| Rate for Payer: Centivo All Commercial |
$13.92
|
| Rate for Payer: Cigna All Commercial |
$23.55
|
| Rate for Payer: CORVEL All Commercial |
$25.38
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$25.12
|
| Rate for Payer: Frontpath All Commercial |
$25.10
|
| Rate for Payer: Humana ChoiceCare |
$23.57
|
| Rate for Payer: Humana Medicare |
$13.92
|
| Rate for Payer: Lucent All Commercial |
$13.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.56
|
| Rate for Payer: PHCS All Commercial |
$20.46
|
| Rate for Payer: PHP All Commercial |
$20.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.64
|
| Rate for Payer: Sagamore Health Network All Products |
$21.06
|
| Rate for Payer: Signature Care EPO |
$22.65
|
| Rate for Payer: Signature Care PPO |
$24.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.19
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
| Rate for Payer: United Healthcare Medicare |
$9.00
|
|
|
HC KIT COLLECTION FEE
|
Facility
IP
|
$27.29
|
|
| Hospital Charge Code |
63002224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Cash Price |
$16.92
|
| Rate for Payer: Cigna All Commercial |
$23.55
|
| Rate for Payer: CORVEL All Commercial |
$25.38
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$25.12
|
| Rate for Payer: Frontpath All Commercial |
$25.10
|
| Rate for Payer: Humana ChoiceCare |
$23.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.56
|
| Rate for Payer: PHCS All Commercial |
$20.46
|
| Rate for Payer: PHP All Commercial |
$20.69
|
| Rate for Payer: Sagamore Health Network All Products |
$21.06
|
| Rate for Payer: Signature Care EPO |
$22.65
|
| Rate for Payer: Signature Care PPO |
$24.01
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
|
|
HC KIT ENDOVIVE RA REPLACE 20 FR
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$230.41
|
| Rate for Payer: Aetna Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.10
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Centivo All Commercial |
$139.23
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Humana Medicare |
$139.23
|
| Rate for Payer: Lucent All Commercial |
$139.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.47
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.05
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
| Rate for Payer: United Healthcare Medicare |
$90.09
|
|
|
HC KIT ENDOVIVE RA REPLACE 20 FR
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
|
|
HC KIT ENDOVIVE RA REPLACE 22 FR
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
|
|
HC KIT ENDOVIVE RA REPLACE 22 FR
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$230.41
|
| Rate for Payer: Aetna Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.10
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Centivo All Commercial |
$139.23
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Humana Medicare |
$139.23
|
| Rate for Payer: Lucent All Commercial |
$139.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.47
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.05
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
| Rate for Payer: United Healthcare Medicare |
$90.09
|
|
|
HC KIT ENDOVIVE RA REPLACE 24 FR
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$230.41
|
| Rate for Payer: Aetna Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.10
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Centivo All Commercial |
$139.23
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Humana Medicare |
$139.23
|
| Rate for Payer: Lucent All Commercial |
$139.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.47
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.05
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
| Rate for Payer: United Healthcare Medicare |
$90.09
|
|
|
HC KIT ENDOVIVE RA REPLACE 24 FR
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
|
|
HC KIT ENDOVIVE REPLACEMENT 20 FR
|
Facility
IP
|
$273.00
|
|
| Hospital Charge Code |
41602092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
|
|
HC KIT ENDOVIVE REPLACEMENT 20 FR
|
Facility
OP
|
$273.00
|
|
| Hospital Charge Code |
41602092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$230.41
|
| Rate for Payer: Aetna Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.10
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Centivo All Commercial |
$139.23
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Humana Medicare |
$139.23
|
| Rate for Payer: Lucent All Commercial |
$139.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.47
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.05
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
| Rate for Payer: United Healthcare Medicare |
$90.09
|
|
|
HC KIT ENDOVIVE REPLACEMENT 22 FR
|
Facility
OP
|
$273.00
|
|
| Hospital Charge Code |
41602094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$230.41
|
| Rate for Payer: Aetna Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.10
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Centivo All Commercial |
$139.23
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Humana Medicare |
$139.23
|
| Rate for Payer: Lucent All Commercial |
$139.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.47
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.05
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
| Rate for Payer: United Healthcare Medicare |
$90.09
|
|
|
HC KIT ENDOVIVE REPLACEMENT 22 FR
|
Facility
IP
|
$273.00
|
|
| Hospital Charge Code |
41602094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
|
|
HC KIT ENDOVIVE REPLACEMENT 24 FR
|
Facility
IP
|
$273.00
|
|
| Hospital Charge Code |
41602095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
|
|
HC KIT ENDOVIVE REPLACEMENT 24 FR
|
Facility
OP
|
$273.00
|
|
| Hospital Charge Code |
41602095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$230.41
|
| Rate for Payer: Aetna Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.10
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Cash Price |
$169.26
|
| Rate for Payer: Centivo All Commercial |
$139.23
|
| Rate for Payer: Cigna All Commercial |
$235.60
|
| Rate for Payer: CORVEL All Commercial |
$253.89
|
| Rate for Payer: Coventry All Commercial |
$240.24
|
| Rate for Payer: Encore All Commercial |
$251.30
|
| Rate for Payer: Frontpath All Commercial |
$251.16
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Humana Medicare |
$139.23
|
| Rate for Payer: Lucent All Commercial |
$139.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$204.75
|
| Rate for Payer: PHP All Commercial |
$207.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.47
|
| Rate for Payer: Sagamore Health Network All Products |
$210.76
|
| Rate for Payer: Signature Care EPO |
$226.59
|
| Rate for Payer: Signature Care PPO |
$240.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.05
|
| Rate for Payer: United Healthcare Commercial |
$215.12
|
| Rate for Payer: United Healthcare Medicare |
$90.09
|
|
|
HC KIT ENDOVIVE STANDARD 1/2 PEG
|
Facility
OP
|
$490.00
|
|
| Hospital Charge Code |
41602165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$413.56
|
| Rate for Payer: Aetna Medicare |
$161.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$281.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$306.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$185.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$177.87
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Centivo All Commercial |
$249.90
|
| Rate for Payer: Cigna All Commercial |
$422.87
|
| Rate for Payer: CORVEL All Commercial |
$455.70
|
| Rate for Payer: Coventry All Commercial |
$431.20
|
| Rate for Payer: Encore All Commercial |
$451.04
|
| Rate for Payer: Frontpath All Commercial |
$450.80
|
| Rate for Payer: Humana ChoiceCare |
$423.21
|
| Rate for Payer: Humana Medicare |
$249.90
|
| Rate for Payer: Lucent All Commercial |
$249.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$367.50
|
| Rate for Payer: PHP All Commercial |
$371.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.10
|
| Rate for Payer: Sagamore Health Network All Products |
$378.28
|
| Rate for Payer: Signature Care EPO |
$406.70
|
| Rate for Payer: Signature Care PPO |
$431.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$416.50
|
| Rate for Payer: United Healthcare Commercial |
$386.12
|
| Rate for Payer: United Healthcare Medicare |
$161.70
|
|
|
HC KIT ENDOVIVE STANDARD 1/2 PEG
|
Facility
IP
|
$490.00
|
|
| Hospital Charge Code |
41602165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$423.36
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cigna All Commercial |
$422.87
|
| Rate for Payer: CORVEL All Commercial |
$455.70
|
| Rate for Payer: Coventry All Commercial |
$431.20
|
| Rate for Payer: Encore All Commercial |
$451.04
|
| Rate for Payer: Frontpath All Commercial |
$450.80
|
| Rate for Payer: Humana ChoiceCare |
$423.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.00
|
| Rate for Payer: PHCS All Commercial |
$367.50
|
| Rate for Payer: PHP All Commercial |
$371.62
|
| Rate for Payer: Sagamore Health Network All Products |
$378.28
|
| Rate for Payer: Signature Care EPO |
$406.70
|
| Rate for Payer: Signature Care PPO |
$431.20
|
| Rate for Payer: United Healthcare Commercial |
$386.12
|
|
|
HC KIT EPIDURAL COMBINED
|
Facility
IP
|
$273.87
|
|
| Hospital Charge Code |
41602147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$254.70 |
| Rate for Payer: Aetna Commercial |
$236.62
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna All Commercial |
$236.35
|
| Rate for Payer: CORVEL All Commercial |
$254.70
|
| Rate for Payer: Coventry All Commercial |
$241.01
|
| Rate for Payer: Encore All Commercial |
$252.10
|
| Rate for Payer: Frontpath All Commercial |
$251.96
|
| Rate for Payer: Humana ChoiceCare |
$236.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.48
|
| Rate for Payer: PHCS All Commercial |
$205.40
|
| Rate for Payer: PHP All Commercial |
$207.70
|
| Rate for Payer: Sagamore Health Network All Products |
$211.43
|
| Rate for Payer: Signature Care EPO |
$227.31
|
| Rate for Payer: Signature Care PPO |
$241.01
|
| Rate for Payer: United Healthcare Commercial |
$215.81
|
|
|
HC KIT EPIDURAL COMBINED
|
Facility
OP
|
$273.87
|
|
| Hospital Charge Code |
41602147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$254.70 |
| Rate for Payer: Aetna Commercial |
$231.15
|
| Rate for Payer: Aetna Medicare |
$90.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$157.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.41
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Centivo All Commercial |
$139.67
|
| Rate for Payer: Cigna All Commercial |
$236.35
|
| Rate for Payer: CORVEL All Commercial |
$254.70
|
| Rate for Payer: Coventry All Commercial |
$241.01
|
| Rate for Payer: Encore All Commercial |
$252.10
|
| Rate for Payer: Frontpath All Commercial |
$251.96
|
| Rate for Payer: Humana ChoiceCare |
$236.54
|
| Rate for Payer: Humana Medicare |
$139.67
|
| Rate for Payer: Lucent All Commercial |
$139.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$205.40
|
| Rate for Payer: PHP All Commercial |
$207.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.81
|
| Rate for Payer: Sagamore Health Network All Products |
$211.43
|
| Rate for Payer: Signature Care EPO |
$227.31
|
| Rate for Payer: Signature Care PPO |
$241.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.79
|
| Rate for Payer: United Healthcare Commercial |
$215.81
|
| Rate for Payer: United Healthcare Medicare |
$90.38
|
|
|
HC KIT EPIDURAL SINGLE DOSE
|
Facility
IP
|
$107.18
|
|
| Hospital Charge Code |
41602146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.38 |
| Max. Negotiated Rate |
$99.68 |
| Rate for Payer: Aetna Commercial |
$92.60
|
| Rate for Payer: Cash Price |
$66.45
|
| Rate for Payer: Cigna All Commercial |
$92.50
|
| Rate for Payer: CORVEL All Commercial |
$99.68
|
| Rate for Payer: Coventry All Commercial |
$94.32
|
| Rate for Payer: Encore All Commercial |
$98.66
|
| Rate for Payer: Frontpath All Commercial |
$98.61
|
| Rate for Payer: Humana ChoiceCare |
$92.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.46
|
| Rate for Payer: PHCS All Commercial |
$80.38
|
| Rate for Payer: PHP All Commercial |
$81.29
|
| Rate for Payer: Sagamore Health Network All Products |
$82.74
|
| Rate for Payer: Signature Care EPO |
$88.96
|
| Rate for Payer: Signature Care PPO |
$94.32
|
| Rate for Payer: United Healthcare Commercial |
$84.46
|
|
|
HC KIT EPIDURAL SINGLE DOSE
|
Facility
OP
|
$107.18
|
|
| Hospital Charge Code |
41602146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.37 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$90.46
|
| Rate for Payer: Aetna Medicare |
$35.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.91
|
| Rate for Payer: Cash Price |
$66.45
|
| Rate for Payer: Cash Price |
$66.45
|
| Rate for Payer: Centivo All Commercial |
$54.66
|
| Rate for Payer: Cigna All Commercial |
$92.50
|
| Rate for Payer: CORVEL All Commercial |
$99.68
|
| Rate for Payer: Coventry All Commercial |
$94.32
|
| Rate for Payer: Encore All Commercial |
$98.66
|
| Rate for Payer: Frontpath All Commercial |
$98.61
|
| Rate for Payer: Humana ChoiceCare |
$92.57
|
| Rate for Payer: Humana Medicare |
$54.66
|
| Rate for Payer: Lucent All Commercial |
$54.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$80.38
|
| Rate for Payer: PHP All Commercial |
$81.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.80
|
| Rate for Payer: Sagamore Health Network All Products |
$82.74
|
| Rate for Payer: Signature Care EPO |
$88.96
|
| Rate for Payer: Signature Care PPO |
$94.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.10
|
| Rate for Payer: United Healthcare Commercial |
$84.46
|
| Rate for Payer: United Healthcare Medicare |
$35.37
|
|
|
HC KIT EVICEL 5ML
|
Facility
OP
|
$1,842.98
|
|
| Hospital Charge Code |
41603434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,713.97 |
| Rate for Payer: Aetna Commercial |
$1,555.48
|
| Rate for Payer: Aetna Medicare |
$608.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$608.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,058.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,152.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$699.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$669.00
|
| Rate for Payer: Cash Price |
$1,142.65
|
| Rate for Payer: Cash Price |
$1,142.65
|
| Rate for Payer: Centivo All Commercial |
$939.92
|
| Rate for Payer: Cigna All Commercial |
$1,590.49
|
| Rate for Payer: CORVEL All Commercial |
$1,713.97
|
| Rate for Payer: Coventry All Commercial |
$1,621.82
|
| Rate for Payer: Encore All Commercial |
$1,696.46
|
| Rate for Payer: Frontpath All Commercial |
$1,695.54
|
| Rate for Payer: Humana ChoiceCare |
$1,591.78
|
| Rate for Payer: Humana Medicare |
$939.92
|
| Rate for Payer: Lucent All Commercial |
$939.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,658.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,382.24
|
| Rate for Payer: PHP All Commercial |
$1,397.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$718.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,422.78
|
| Rate for Payer: Signature Care EPO |
$1,529.67
|
| Rate for Payer: Signature Care PPO |
$1,621.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,566.53
|
| Rate for Payer: United Healthcare Commercial |
$1,452.27
|
| Rate for Payer: United Healthcare Medicare |
$608.18
|
|
