|
HC PH STOOL
|
Facility
IP
|
$60.18
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
63001222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.14 |
| Max. Negotiated Rate |
$55.97 |
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: Cash Price |
$37.31
|
| Rate for Payer: Cigna All Commercial |
$51.94
|
| Rate for Payer: CORVEL All Commercial |
$55.97
|
| Rate for Payer: Coventry All Commercial |
$52.96
|
| Rate for Payer: Encore All Commercial |
$55.40
|
| Rate for Payer: Frontpath All Commercial |
$55.37
|
| Rate for Payer: Humana ChoiceCare |
$51.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.16
|
| Rate for Payer: PHCS All Commercial |
$45.14
|
| Rate for Payer: PHP All Commercial |
$45.64
|
| Rate for Payer: Sagamore Health Network All Products |
$46.46
|
| Rate for Payer: Signature Care EPO |
$49.95
|
| Rate for Payer: Signature Care PPO |
$52.96
|
| Rate for Payer: United Healthcare Commercial |
$47.42
|
|
|
HC PHYS PERF TEST W/RPT-15 MIN-OT
|
Facility
IP
|
$143.02
|
|
|
Service Code
|
CPT 97750 GO
|
| Hospital Charge Code |
01738062
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.27 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$123.57
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
|
|
HC PHYS PERF TEST W/RPT-15 MIN-OT
|
Facility
OP
|
$143.02
|
|
|
Service Code
|
CPT 97750 GO
|
| Hospital Charge Code |
01738062
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna Commercial |
$120.71
|
| Rate for Payer: Aetna Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.92
|
| Rate for Payer: Cash Price |
$88.68
|
| Rate for Payer: Centivo All Commercial |
$72.94
|
| Rate for Payer: Cigna All Commercial |
$123.43
|
| Rate for Payer: CORVEL All Commercial |
$133.01
|
| Rate for Payer: Coventry All Commercial |
$125.86
|
| Rate for Payer: Encore All Commercial |
$131.65
|
| Rate for Payer: Frontpath All Commercial |
$131.58
|
| Rate for Payer: Humana ChoiceCare |
$123.53
|
| Rate for Payer: Humana Medicare |
$72.94
|
| Rate for Payer: Lucent All Commercial |
$72.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.72
|
| Rate for Payer: PHCS All Commercial |
$107.27
|
| Rate for Payer: PHP All Commercial |
$108.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.41
|
| Rate for Payer: Signature Care EPO |
$118.71
|
| Rate for Payer: Signature Care PPO |
$125.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.57
|
| Rate for Payer: United Healthcare Commercial |
$112.70
|
| Rate for Payer: United Healthcare Medicare |
$47.20
|
|
|
HC PHYS PERF TEST W/RPT-15 MIN-PT
|
Facility
IP
|
$137.53
|
|
|
Service Code
|
CPT 97750 GP
|
| Hospital Charge Code |
01728064
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC PHYS PERF TEST W/RPT-15 MIN-PT
|
Facility
OP
|
$137.53
|
|
|
Service Code
|
CPT 97750 GP
|
| Hospital Charge Code |
01728064
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.07
|
| Rate for Payer: Aetna Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Centivo All Commercial |
$70.14
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.02
|
| Rate for Payer: Encore All Commercial |
$126.59
|
| Rate for Payer: Frontpath All Commercial |
$126.52
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Lucent All Commercial |
$70.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.77
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$45.38
|
|
|
HC PICC DOUBLE LUMEN POWER 4FR
|
Facility
IP
|
$1,452.75
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,089.56 |
| Max. Negotiated Rate |
$1,351.06 |
| Rate for Payer: Aetna Commercial |
$1,255.18
|
| Rate for Payer: Cash Price |
$900.71
|
| Rate for Payer: Cigna All Commercial |
$1,253.72
|
| Rate for Payer: CORVEL All Commercial |
$1,351.06
|
| Rate for Payer: Coventry All Commercial |
$1,278.42
|
| Rate for Payer: Encore All Commercial |
$1,337.26
|
| Rate for Payer: Frontpath All Commercial |
$1,336.53
|
| Rate for Payer: Humana ChoiceCare |
$1,254.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,307.48
|
| Rate for Payer: PHCS All Commercial |
$1,089.56
|
| Rate for Payer: PHP All Commercial |
$1,101.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,121.52
|
| Rate for Payer: Signature Care EPO |
$1,205.78
|
| Rate for Payer: Signature Care PPO |
$1,278.42
|
| Rate for Payer: United Healthcare Commercial |
$1,144.77
|
|
|
HC PICC DOUBLE LUMEN POWER 4FR
|
Facility
OP
|
$1,452.75
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,351.06 |
| Rate for Payer: Aetna Commercial |
$1,226.12
|
| Rate for Payer: Aetna Medicare |
$479.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$479.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$834.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$908.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$551.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$527.35
|
| Rate for Payer: Cash Price |
$900.71
|
| Rate for Payer: Cash Price |
$900.71
|
| Rate for Payer: Centivo All Commercial |
$740.90
|
| Rate for Payer: Cigna All Commercial |
$1,253.72
|
| Rate for Payer: CORVEL All Commercial |
$1,351.06
|
| Rate for Payer: Coventry All Commercial |
$1,278.42
|
| Rate for Payer: Encore All Commercial |
$1,337.26
|
| Rate for Payer: Frontpath All Commercial |
$1,336.53
|
| Rate for Payer: Humana ChoiceCare |
$1,254.74
|
| Rate for Payer: Humana Medicare |
$740.90
|
| Rate for Payer: Lucent All Commercial |
$740.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,307.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,089.56
|
| Rate for Payer: PHP All Commercial |
$1,101.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$566.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,121.52
|
| Rate for Payer: Signature Care EPO |
$1,205.78
|
| Rate for Payer: Signature Care PPO |
$1,278.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,234.84
|
| Rate for Payer: United Healthcare Commercial |
$1,144.77
|
| Rate for Payer: United Healthcare Medicare |
$479.41
|
|
|
HC PICC LINE INSERTION <5 YR W/IMAGING GUIDANCE
|
Facility
OP
|
$2,057.95
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
00950572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$2,273.62 |
| Rate for Payer: Aetna Commercial |
$1,736.91
|
| Rate for Payer: Aetna Medicare |
$679.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$679.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,181.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,286.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,273.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$780.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$747.04
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Centivo All Commercial |
$1,049.56
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.90
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.32
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Humana Medicare |
$1,049.56
|
| Rate for Payer: Lucent All Commercial |
$1,049.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.16
|
| Rate for Payer: Managed Health Services Medicaid |
$2,273.62
|
| Rate for Payer: MDWise Medicaid |
$2,273.62
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$802.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,749.26
|
| Rate for Payer: United Healthcare Commercial |
$1,621.67
|
| Rate for Payer: United Healthcare Medicare |
$679.12
|
|
|
HC PICC LINE INSERTION <5 YR W/IMAGING GUIDANCE
|
Facility
IP
|
$2,057.95
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
00950572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,543.46 |
| Max. Negotiated Rate |
$1,913.90 |
| Rate for Payer: Aetna Commercial |
$1,778.07
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.90
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.32
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.16
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: United Healthcare Commercial |
$1,621.67
|
|
|
HC PICC LINE INSERTION 5+ YR W/IMAGING GUIDANCE
|
Facility
OP
|
$2,057.95
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
00950573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$4,211.34 |
| Rate for Payer: Aetna Commercial |
$1,736.91
|
| Rate for Payer: Aetna Medicare |
$679.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$679.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,181.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,286.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4,211.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$780.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$747.04
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Centivo All Commercial |
$1,049.56
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.90
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.32
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Humana Medicare |
$1,049.56
|
| Rate for Payer: Lucent All Commercial |
$1,049.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.16
|
| Rate for Payer: Managed Health Services Medicaid |
$4,211.34
|
| Rate for Payer: MDWise Medicaid |
$4,211.34
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$802.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,749.26
|
| Rate for Payer: United Healthcare Commercial |
$1,621.67
|
| Rate for Payer: United Healthcare Medicare |
$679.12
|
|
|
HC PICC LINE INSERTION 5+ YR W/IMAGING GUIDANCE
|
Facility
IP
|
$2,057.95
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
00950573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,543.46 |
| Max. Negotiated Rate |
$1,913.90 |
| Rate for Payer: Aetna Commercial |
$1,778.07
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.90
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.32
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.16
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: United Healthcare Commercial |
$1,621.67
|
|
|
HC PICC LINE INSERTION <5 YR W/O IMAGING
|
Facility
IP
|
$2,057.95
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
00950568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,543.46 |
| Max. Negotiated Rate |
$1,913.90 |
| Rate for Payer: Aetna Commercial |
$1,778.07
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.90
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.32
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.16
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: United Healthcare Commercial |
$1,621.67
|
|
|
HC PICC LINE INSERTION <5 YR W/O IMAGING
|
Facility
OP
|
$2,057.95
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
00950568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$2,273.62 |
| Rate for Payer: Aetna Commercial |
$1,736.91
|
| Rate for Payer: Aetna Medicare |
$679.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$679.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,181.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,286.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,273.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$780.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$747.04
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Centivo All Commercial |
$1,049.56
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.90
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.32
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Humana Medicare |
$1,049.56
|
| Rate for Payer: Lucent All Commercial |
$1,049.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.16
|
| Rate for Payer: Managed Health Services Medicaid |
$2,273.62
|
| Rate for Payer: MDWise Medicaid |
$2,273.62
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$802.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,749.26
|
| Rate for Payer: United Healthcare Commercial |
$1,621.67
|
| Rate for Payer: United Healthcare Medicare |
$679.12
|
|
|
HC PICC LINE INSERTION 5 YR+ W/O IMAGING
|
Facility
IP
|
$2,057.95
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
00950569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,543.46 |
| Max. Negotiated Rate |
$1,913.90 |
| Rate for Payer: Aetna Commercial |
$1,778.07
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.90
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.32
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.16
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: United Healthcare Commercial |
$1,621.67
|
|
|
HC PICC LINE INSERTION 5 YR+ W/O IMAGING
|
Facility
OP
|
$2,057.95
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
00950569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$1,913.90 |
| Rate for Payer: Aetna Commercial |
$1,736.91
|
| Rate for Payer: Aetna Medicare |
$679.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$679.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,181.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,286.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,242.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$780.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$747.04
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Cash Price |
$1,275.93
|
| Rate for Payer: Centivo All Commercial |
$1,049.56
|
| Rate for Payer: Cigna All Commercial |
$1,776.01
|
| Rate for Payer: CORVEL All Commercial |
$1,913.90
|
| Rate for Payer: Coventry All Commercial |
$1,811.00
|
| Rate for Payer: Encore All Commercial |
$1,894.34
|
| Rate for Payer: Frontpath All Commercial |
$1,893.32
|
| Rate for Payer: Humana ChoiceCare |
$1,777.45
|
| Rate for Payer: Humana Medicare |
$1,049.56
|
| Rate for Payer: Lucent All Commercial |
$1,049.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,852.16
|
| Rate for Payer: Managed Health Services Medicaid |
$1,242.31
|
| Rate for Payer: MDWise Medicaid |
$1,242.31
|
| Rate for Payer: PHCS All Commercial |
$1,543.46
|
| Rate for Payer: PHP All Commercial |
$1,560.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$802.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,588.74
|
| Rate for Payer: Signature Care EPO |
$1,708.10
|
| Rate for Payer: Signature Care PPO |
$1,811.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,749.26
|
| Rate for Payer: United Healthcare Commercial |
$1,621.67
|
| Rate for Payer: United Healthcare Medicare |
$679.12
|
|
|
HC PICC SINGLE LUMEN POWER 4FR
|
Facility
IP
|
$1,363.25
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,022.44 |
| Max. Negotiated Rate |
$1,267.82 |
| Rate for Payer: Aetna Commercial |
$1,177.85
|
| Rate for Payer: Cash Price |
$845.22
|
| Rate for Payer: Cigna All Commercial |
$1,176.48
|
| Rate for Payer: CORVEL All Commercial |
$1,267.82
|
| Rate for Payer: Coventry All Commercial |
$1,199.66
|
| Rate for Payer: Encore All Commercial |
$1,254.87
|
| Rate for Payer: Frontpath All Commercial |
$1,254.19
|
| Rate for Payer: Humana ChoiceCare |
$1,177.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,226.92
|
| Rate for Payer: PHCS All Commercial |
$1,022.44
|
| Rate for Payer: PHP All Commercial |
$1,033.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,052.43
|
| Rate for Payer: Signature Care EPO |
$1,131.50
|
| Rate for Payer: Signature Care PPO |
$1,199.66
|
| Rate for Payer: United Healthcare Commercial |
$1,074.24
|
|
|
HC PICC SINGLE LUMEN POWER 4FR
|
Facility
OP
|
$1,363.25
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,267.82 |
| Rate for Payer: Aetna Commercial |
$1,150.58
|
| Rate for Payer: Aetna Medicare |
$449.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$449.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$782.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$852.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$517.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$494.86
|
| Rate for Payer: Cash Price |
$845.22
|
| Rate for Payer: Cash Price |
$845.22
|
| Rate for Payer: Centivo All Commercial |
$695.26
|
| Rate for Payer: Cigna All Commercial |
$1,176.48
|
| Rate for Payer: CORVEL All Commercial |
$1,267.82
|
| Rate for Payer: Coventry All Commercial |
$1,199.66
|
| Rate for Payer: Encore All Commercial |
$1,254.87
|
| Rate for Payer: Frontpath All Commercial |
$1,254.19
|
| Rate for Payer: Humana ChoiceCare |
$1,177.44
|
| Rate for Payer: Humana Medicare |
$695.26
|
| Rate for Payer: Lucent All Commercial |
$695.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,226.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,022.44
|
| Rate for Payer: PHP All Commercial |
$1,033.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$531.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,052.43
|
| Rate for Payer: Signature Care EPO |
$1,131.50
|
| Rate for Payer: Signature Care PPO |
$1,199.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,158.76
|
| Rate for Payer: United Healthcare Commercial |
$1,074.24
|
| Rate for Payer: United Healthcare Medicare |
$449.87
|
|
|
HC PICC TRIPLE LUMEN POWER 5FR
|
Facility
IP
|
$1,545.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,158.75 |
| Max. Negotiated Rate |
$1,436.85 |
| Rate for Payer: Aetna Commercial |
$1,334.88
|
| Rate for Payer: Cash Price |
$957.90
|
| Rate for Payer: Cigna All Commercial |
$1,333.34
|
| Rate for Payer: CORVEL All Commercial |
$1,436.85
|
| Rate for Payer: Coventry All Commercial |
$1,359.60
|
| Rate for Payer: Encore All Commercial |
$1,422.17
|
| Rate for Payer: Frontpath All Commercial |
$1,421.40
|
| Rate for Payer: Humana ChoiceCare |
$1,334.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,390.50
|
| Rate for Payer: PHCS All Commercial |
$1,158.75
|
| Rate for Payer: PHP All Commercial |
$1,171.73
|
| Rate for Payer: Sagamore Health Network All Products |
$1,192.74
|
| Rate for Payer: Signature Care EPO |
$1,282.35
|
| Rate for Payer: Signature Care PPO |
$1,359.60
|
| Rate for Payer: United Healthcare Commercial |
$1,217.46
|
|
|
HC PICC TRIPLE LUMEN POWER 5FR
|
Facility
OP
|
$1,545.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41606593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,436.85 |
| Rate for Payer: Aetna Commercial |
$1,303.98
|
| Rate for Payer: Aetna Medicare |
$509.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$509.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$887.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$965.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$586.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$560.84
|
| Rate for Payer: Cash Price |
$957.90
|
| Rate for Payer: Cash Price |
$957.90
|
| Rate for Payer: Centivo All Commercial |
$787.95
|
| Rate for Payer: Cigna All Commercial |
$1,333.34
|
| Rate for Payer: CORVEL All Commercial |
$1,436.85
|
| Rate for Payer: Coventry All Commercial |
$1,359.60
|
| Rate for Payer: Encore All Commercial |
$1,422.17
|
| Rate for Payer: Frontpath All Commercial |
$1,421.40
|
| Rate for Payer: Humana ChoiceCare |
$1,334.42
|
| Rate for Payer: Humana Medicare |
$787.95
|
| Rate for Payer: Lucent All Commercial |
$787.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,390.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,158.75
|
| Rate for Payer: PHP All Commercial |
$1,171.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$602.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,192.74
|
| Rate for Payer: Signature Care EPO |
$1,282.35
|
| Rate for Payer: Signature Care PPO |
$1,359.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,313.25
|
| Rate for Payer: United Healthcare Commercial |
$1,217.46
|
| Rate for Payer: United Healthcare Medicare |
$509.85
|
|
|
HC PIN/PLUG KIT 6717
|
Facility
OP
|
$168.75
|
|
| Hospital Charge Code |
41607371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$156.94 |
| Rate for Payer: Aetna Commercial |
$142.42
|
| Rate for Payer: Aetna Medicare |
$55.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.26
|
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Centivo All Commercial |
$86.06
|
| Rate for Payer: Cigna All Commercial |
$145.63
|
| Rate for Payer: CORVEL All Commercial |
$156.94
|
| Rate for Payer: Coventry All Commercial |
$148.50
|
| Rate for Payer: Encore All Commercial |
$155.33
|
| Rate for Payer: Frontpath All Commercial |
$155.25
|
| Rate for Payer: Humana ChoiceCare |
$145.75
|
| Rate for Payer: Humana Medicare |
$86.06
|
| Rate for Payer: Lucent All Commercial |
$86.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$126.56
|
| Rate for Payer: PHP All Commercial |
$127.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.81
|
| Rate for Payer: Sagamore Health Network All Products |
$130.28
|
| Rate for Payer: Signature Care EPO |
$140.06
|
| Rate for Payer: Signature Care PPO |
$148.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.44
|
| Rate for Payer: United Healthcare Commercial |
$132.98
|
| Rate for Payer: United Healthcare Medicare |
$55.69
|
|
|
HC PIN/PLUG KIT 6717
|
Facility
IP
|
$168.75
|
|
| Hospital Charge Code |
41607371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$156.94 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Cigna All Commercial |
$145.63
|
| Rate for Payer: CORVEL All Commercial |
$156.94
|
| Rate for Payer: Coventry All Commercial |
$148.50
|
| Rate for Payer: Encore All Commercial |
$155.33
|
| Rate for Payer: Frontpath All Commercial |
$155.25
|
| Rate for Payer: Humana ChoiceCare |
$145.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.88
|
| Rate for Payer: PHCS All Commercial |
$126.56
|
| Rate for Payer: PHP All Commercial |
$127.98
|
| Rate for Payer: Sagamore Health Network All Products |
$130.28
|
| Rate for Payer: Signature Care EPO |
$140.06
|
| Rate for Payer: Signature Care PPO |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$132.98
|
|
|
HC PIN/PLUG KIT 6719
|
Facility
OP
|
$168.75
|
|
| Hospital Charge Code |
41607372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$156.94 |
| Rate for Payer: Aetna Commercial |
$142.42
|
| Rate for Payer: Aetna Medicare |
$55.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.26
|
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Centivo All Commercial |
$86.06
|
| Rate for Payer: Cigna All Commercial |
$145.63
|
| Rate for Payer: CORVEL All Commercial |
$156.94
|
| Rate for Payer: Coventry All Commercial |
$148.50
|
| Rate for Payer: Encore All Commercial |
$155.33
|
| Rate for Payer: Frontpath All Commercial |
$155.25
|
| Rate for Payer: Humana ChoiceCare |
$145.75
|
| Rate for Payer: Humana Medicare |
$86.06
|
| Rate for Payer: Lucent All Commercial |
$86.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$126.56
|
| Rate for Payer: PHP All Commercial |
$127.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.81
|
| Rate for Payer: Sagamore Health Network All Products |
$130.28
|
| Rate for Payer: Signature Care EPO |
$140.06
|
| Rate for Payer: Signature Care PPO |
$148.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.44
|
| Rate for Payer: United Healthcare Commercial |
$132.98
|
| Rate for Payer: United Healthcare Medicare |
$55.69
|
|
|
HC PIN/PLUG KIT 6719
|
Facility
IP
|
$168.75
|
|
| Hospital Charge Code |
41607372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$156.94 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Cigna All Commercial |
$145.63
|
| Rate for Payer: CORVEL All Commercial |
$156.94
|
| Rate for Payer: Coventry All Commercial |
$148.50
|
| Rate for Payer: Encore All Commercial |
$155.33
|
| Rate for Payer: Frontpath All Commercial |
$155.25
|
| Rate for Payer: Humana ChoiceCare |
$145.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.88
|
| Rate for Payer: PHCS All Commercial |
$126.56
|
| Rate for Payer: PHP All Commercial |
$127.98
|
| Rate for Payer: Sagamore Health Network All Products |
$130.28
|
| Rate for Payer: Signature Care EPO |
$140.06
|
| Rate for Payer: Signature Care PPO |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$132.98
|
|
|
HC PIN/PLUG KIT 6920
|
Facility
IP
|
$168.75
|
|
| Hospital Charge Code |
41607373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$156.94 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Cigna All Commercial |
$145.63
|
| Rate for Payer: CORVEL All Commercial |
$156.94
|
| Rate for Payer: Coventry All Commercial |
$148.50
|
| Rate for Payer: Encore All Commercial |
$155.33
|
| Rate for Payer: Frontpath All Commercial |
$155.25
|
| Rate for Payer: Humana ChoiceCare |
$145.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.88
|
| Rate for Payer: PHCS All Commercial |
$126.56
|
| Rate for Payer: PHP All Commercial |
$127.98
|
| Rate for Payer: Sagamore Health Network All Products |
$130.28
|
| Rate for Payer: Signature Care EPO |
$140.06
|
| Rate for Payer: Signature Care PPO |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$132.98
|
|
|
HC PIN/PLUG KIT 6920
|
Facility
OP
|
$168.75
|
|
| Hospital Charge Code |
41607373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$156.94 |
| Rate for Payer: Aetna Commercial |
$142.42
|
| Rate for Payer: Aetna Medicare |
$55.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.26
|
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Centivo All Commercial |
$86.06
|
| Rate for Payer: Cigna All Commercial |
$145.63
|
| Rate for Payer: CORVEL All Commercial |
$156.94
|
| Rate for Payer: Coventry All Commercial |
$148.50
|
| Rate for Payer: Encore All Commercial |
$155.33
|
| Rate for Payer: Frontpath All Commercial |
$155.25
|
| Rate for Payer: Humana ChoiceCare |
$145.75
|
| Rate for Payer: Humana Medicare |
$86.06
|
| Rate for Payer: Lucent All Commercial |
$86.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$126.56
|
| Rate for Payer: PHP All Commercial |
$127.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.81
|
| Rate for Payer: Sagamore Health Network All Products |
$130.28
|
| Rate for Payer: Signature Care EPO |
$140.06
|
| Rate for Payer: Signature Care PPO |
$148.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.44
|
| Rate for Payer: United Healthcare Commercial |
$132.98
|
| Rate for Payer: United Healthcare Medicare |
$55.69
|
|
