|
HC STRESS ECHO
|
Facility
OP
|
$2,145.57
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
00863350
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$648.65 |
| Max. Negotiated Rate |
$1,995.38 |
| Rate for Payer: Aetna Commercial |
$1,810.86
|
| Rate for Payer: Aetna Medicare |
$708.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$708.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,232.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,341.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$648.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.84
|
| Rate for Payer: Cash Price |
$1,330.25
|
| Rate for Payer: Cash Price |
$1,330.25
|
| Rate for Payer: Centivo All Commercial |
$1,094.24
|
| Rate for Payer: Cigna All Commercial |
$1,851.63
|
| Rate for Payer: CORVEL All Commercial |
$1,995.38
|
| Rate for Payer: Coventry All Commercial |
$1,888.10
|
| Rate for Payer: Encore All Commercial |
$1,975.00
|
| Rate for Payer: Frontpath All Commercial |
$1,973.92
|
| Rate for Payer: Humana ChoiceCare |
$1,853.13
|
| Rate for Payer: Humana Medicare |
$1,094.24
|
| Rate for Payer: Lucent All Commercial |
$1,094.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,931.01
|
| Rate for Payer: Managed Health Services Medicaid |
$648.65
|
| Rate for Payer: MDWise Medicaid |
$648.65
|
| Rate for Payer: PHCS All Commercial |
$1,609.18
|
| Rate for Payer: PHP All Commercial |
$1,627.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,656.38
|
| Rate for Payer: Signature Care EPO |
$1,780.82
|
| Rate for Payer: Signature Care PPO |
$1,888.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.73
|
| Rate for Payer: United Healthcare Commercial |
$1,690.71
|
| Rate for Payer: United Healthcare Medicare |
$708.04
|
|
|
HC STRESS ECHO
|
Facility
IP
|
$2,145.57
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
00863350
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,609.18 |
| Max. Negotiated Rate |
$1,995.38 |
| Rate for Payer: Aetna Commercial |
$1,853.77
|
| Rate for Payer: Cash Price |
$1,330.25
|
| Rate for Payer: Cigna All Commercial |
$1,851.63
|
| Rate for Payer: CORVEL All Commercial |
$1,995.38
|
| Rate for Payer: Coventry All Commercial |
$1,888.10
|
| Rate for Payer: Encore All Commercial |
$1,975.00
|
| Rate for Payer: Frontpath All Commercial |
$1,973.92
|
| Rate for Payer: Humana ChoiceCare |
$1,853.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,931.01
|
| Rate for Payer: PHCS All Commercial |
$1,609.18
|
| Rate for Payer: PHP All Commercial |
$1,627.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,656.38
|
| Rate for Payer: Signature Care EPO |
$1,780.82
|
| Rate for Payer: Signature Care PPO |
$1,888.10
|
| Rate for Payer: United Healthcare Commercial |
$1,690.71
|
|
|
HC S TRI FEM RET RIGHT 6 CR
|
Facility
IP
|
$10,703.99
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,027.99 |
| Max. Negotiated Rate |
$9,954.71 |
| Rate for Payer: Aetna Commercial |
$9,248.25
|
| Rate for Payer: Cash Price |
$6,636.47
|
| Rate for Payer: Cigna All Commercial |
$9,237.54
|
| Rate for Payer: CORVEL All Commercial |
$9,954.71
|
| Rate for Payer: Coventry All Commercial |
$9,419.51
|
| Rate for Payer: Encore All Commercial |
$9,853.02
|
| Rate for Payer: Frontpath All Commercial |
$9,847.67
|
| Rate for Payer: Humana ChoiceCare |
$9,245.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,633.59
|
| Rate for Payer: PHCS All Commercial |
$8,027.99
|
| Rate for Payer: PHP All Commercial |
$8,117.91
|
| Rate for Payer: Sagamore Health Network All Products |
$8,263.48
|
| Rate for Payer: Signature Care EPO |
$8,884.31
|
| Rate for Payer: Signature Care PPO |
$9,419.51
|
| Rate for Payer: United Healthcare Commercial |
$8,434.74
|
|
|
HC S TRI FEM RET RIGHT 6 CR
|
Facility
OP
|
$10,703.99
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,954.71 |
| Rate for Payer: Aetna Commercial |
$9,034.17
|
| Rate for Payer: Aetna Medicare |
$3,532.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,532.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,147.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,691.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,062.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,885.55
|
| Rate for Payer: Cash Price |
$6,636.47
|
| Rate for Payer: Cash Price |
$6,636.47
|
| Rate for Payer: Centivo All Commercial |
$5,459.03
|
| Rate for Payer: Cigna All Commercial |
$9,237.54
|
| Rate for Payer: CORVEL All Commercial |
$9,954.71
|
| Rate for Payer: Coventry All Commercial |
$9,419.51
|
| Rate for Payer: Encore All Commercial |
$9,853.02
|
| Rate for Payer: Frontpath All Commercial |
$9,847.67
|
| Rate for Payer: Humana ChoiceCare |
$9,245.04
|
| Rate for Payer: Humana Medicare |
$5,459.03
|
| Rate for Payer: Lucent All Commercial |
$5,459.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,633.59
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,027.99
|
| Rate for Payer: PHP All Commercial |
$8,117.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,174.56
|
| Rate for Payer: Sagamore Health Network All Products |
$8,263.48
|
| Rate for Payer: Signature Care EPO |
$8,884.31
|
| Rate for Payer: Signature Care PPO |
$9,419.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,098.39
|
| Rate for Payer: United Healthcare Commercial |
$8,434.74
|
| Rate for Payer: United Healthcare Medicare |
$3,532.32
|
|
|
HC S TRI PAT S33X9
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
|
HC S TRI PAT S33X9
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S TRI STEM 12X50
|
Facility
OP
|
$3,931.81
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,656.58 |
| Rate for Payer: Aetna Commercial |
$3,318.45
|
| Rate for Payer: Aetna Medicare |
$1,297.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,297.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,258.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,457.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,492.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,427.25
|
| Rate for Payer: Cash Price |
$2,437.72
|
| Rate for Payer: Cash Price |
$2,437.72
|
| Rate for Payer: Centivo All Commercial |
$2,005.22
|
| Rate for Payer: Cigna All Commercial |
$3,393.15
|
| Rate for Payer: CORVEL All Commercial |
$3,656.58
|
| Rate for Payer: Coventry All Commercial |
$3,459.99
|
| Rate for Payer: Encore All Commercial |
$3,619.23
|
| Rate for Payer: Frontpath All Commercial |
$3,617.27
|
| Rate for Payer: Humana ChoiceCare |
$3,395.90
|
| Rate for Payer: Humana Medicare |
$2,005.22
|
| Rate for Payer: Lucent All Commercial |
$2,005.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,538.63
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,948.86
|
| Rate for Payer: PHP All Commercial |
$2,981.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,533.41
|
| Rate for Payer: Sagamore Health Network All Products |
$3,035.36
|
| Rate for Payer: Signature Care EPO |
$3,263.40
|
| Rate for Payer: Signature Care PPO |
$3,459.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,342.04
|
| Rate for Payer: United Healthcare Commercial |
$3,098.27
|
| Rate for Payer: United Healthcare Medicare |
$1,297.50
|
|
|
HC S TRI STEM 12X50
|
Facility
IP
|
$3,931.81
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,948.86 |
| Max. Negotiated Rate |
$3,656.58 |
| Rate for Payer: Aetna Commercial |
$3,397.08
|
| Rate for Payer: Cash Price |
$2,437.72
|
| Rate for Payer: Cigna All Commercial |
$3,393.15
|
| Rate for Payer: CORVEL All Commercial |
$3,656.58
|
| Rate for Payer: Coventry All Commercial |
$3,459.99
|
| Rate for Payer: Encore All Commercial |
$3,619.23
|
| Rate for Payer: Frontpath All Commercial |
$3,617.27
|
| Rate for Payer: Humana ChoiceCare |
$3,395.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,538.63
|
| Rate for Payer: PHCS All Commercial |
$2,948.86
|
| Rate for Payer: PHP All Commercial |
$2,981.88
|
| Rate for Payer: Sagamore Health Network All Products |
$3,035.36
|
| Rate for Payer: Signature Care EPO |
$3,263.40
|
| Rate for Payer: Signature Care PPO |
$3,459.99
|
| Rate for Payer: United Healthcare Commercial |
$3,098.27
|
|
|
HC S TUBING INFLOW/OUTFLOW
|
Facility
OP
|
$755.09
|
|
| Hospital Charge Code |
41607425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$702.23 |
| Rate for Payer: Aetna Commercial |
$637.30
|
| Rate for Payer: Aetna Medicare |
$249.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$249.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$433.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$472.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$286.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$274.10
|
| Rate for Payer: Cash Price |
$468.16
|
| Rate for Payer: Cash Price |
$468.16
|
| Rate for Payer: Centivo All Commercial |
$385.10
|
| Rate for Payer: Cigna All Commercial |
$651.64
|
| Rate for Payer: CORVEL All Commercial |
$702.23
|
| Rate for Payer: Coventry All Commercial |
$664.48
|
| Rate for Payer: Encore All Commercial |
$695.06
|
| Rate for Payer: Frontpath All Commercial |
$694.68
|
| Rate for Payer: Humana ChoiceCare |
$652.17
|
| Rate for Payer: Humana Medicare |
$385.10
|
| Rate for Payer: Lucent All Commercial |
$385.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$566.32
|
| Rate for Payer: PHP All Commercial |
$572.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$294.49
|
| Rate for Payer: Sagamore Health Network All Products |
$582.93
|
| Rate for Payer: Signature Care EPO |
$626.72
|
| Rate for Payer: Signature Care PPO |
$664.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$641.83
|
| Rate for Payer: United Healthcare Commercial |
$595.01
|
| Rate for Payer: United Healthcare Medicare |
$249.18
|
|
|
HC S TUBING INFLOW/OUTFLOW
|
Facility
IP
|
$755.09
|
|
| Hospital Charge Code |
41607425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$566.32 |
| Max. Negotiated Rate |
$702.23 |
| Rate for Payer: Aetna Commercial |
$652.40
|
| Rate for Payer: Cash Price |
$468.16
|
| Rate for Payer: Cigna All Commercial |
$651.64
|
| Rate for Payer: CORVEL All Commercial |
$702.23
|
| Rate for Payer: Coventry All Commercial |
$664.48
|
| Rate for Payer: Encore All Commercial |
$695.06
|
| Rate for Payer: Frontpath All Commercial |
$694.68
|
| Rate for Payer: Humana ChoiceCare |
$652.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.58
|
| Rate for Payer: PHCS All Commercial |
$566.32
|
| Rate for Payer: PHP All Commercial |
$572.66
|
| Rate for Payer: Sagamore Health Network All Products |
$582.93
|
| Rate for Payer: Signature Care EPO |
$626.72
|
| Rate for Payer: Signature Care PPO |
$664.48
|
| Rate for Payer: United Healthcare Commercial |
$595.01
|
|
|
HC STYLET J 0.014 59CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET J 0.014 59CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET J 0.016 59CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET J 0.016 59CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET J .014 45CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET J .014 45CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET J .014 52CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET J .014 52CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET J .016 45CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET J .016 45CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET J .016 52CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET J .016 52CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET STR 0.014 59CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET STR 0.014 59CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET STR 0.016 59CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
