|
HC WIRE ACUITY WHISPER VIEW EDS
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
|
|
HC WIRE ACUITY WHISPER VIEW EDS
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$443.10
|
| Rate for Payer: Aetna Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$301.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$328.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.58
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Centivo All Commercial |
$267.75
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Humana Medicare |
$267.75
|
| Rate for Payer: Lucent All Commercial |
$267.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$204.75
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$446.25
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
| Rate for Payer: United Healthcare Medicare |
$173.25
|
|
|
HC WIRE ACUITY WHISPER VIEW ES
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
|
|
HC WIRE ACUITY WHISPER VIEW ES
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$443.10
|
| Rate for Payer: Aetna Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$301.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$328.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.58
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Centivo All Commercial |
$267.75
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Humana Medicare |
$267.75
|
| Rate for Payer: Lucent All Commercial |
$267.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$204.75
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$446.25
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
| Rate for Payer: United Healthcare Medicare |
$173.25
|
|
|
HC WIRE ACUITY WHISP. VIEW DS CSJ
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
|
|
HC WIRE ACUITY WHISP. VIEW DS CSJ
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$443.10
|
| Rate for Payer: Aetna Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$301.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$328.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.58
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Centivo All Commercial |
$267.75
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Humana Medicare |
$267.75
|
| Rate for Payer: Lucent All Commercial |
$267.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$204.75
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$446.25
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
| Rate for Payer: United Healthcare Medicare |
$173.25
|
|
|
HC WIRE ACUITY WHISP VIEW EDS CSJ
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
|
|
HC WIRE ACUITY WHISP VIEW EDS CSJ
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$443.10
|
| Rate for Payer: Aetna Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$301.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$328.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.58
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Centivo All Commercial |
$267.75
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Humana Medicare |
$267.75
|
| Rate for Payer: Lucent All Commercial |
$267.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$204.75
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$446.25
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
| Rate for Payer: United Healthcare Medicare |
$173.25
|
|
|
HC WIRE ACUITY WHISP. VIEW ES CSJ
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
|
|
HC WIRE ACUITY WHISP. VIEW ES CSJ
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$443.10
|
| Rate for Payer: Aetna Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$301.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$328.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.58
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Centivo All Commercial |
$267.75
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Humana Medicare |
$267.75
|
| Rate for Payer: Lucent All Commercial |
$267.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$204.75
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$446.25
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
| Rate for Payer: United Healthcare Medicare |
$173.25
|
|
|
HC WIRE ACUITY X4 CONNECTOR TOOL
|
Facility
IP
|
$112.50
|
|
| Hospital Charge Code |
41607278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cigna All Commercial |
$97.09
|
| Rate for Payer: CORVEL All Commercial |
$104.62
|
| Rate for Payer: Coventry All Commercial |
$99.00
|
| Rate for Payer: Encore All Commercial |
$103.56
|
| Rate for Payer: Frontpath All Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$97.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.25
|
| Rate for Payer: PHCS All Commercial |
$84.38
|
| Rate for Payer: PHP All Commercial |
$85.32
|
| Rate for Payer: Sagamore Health Network All Products |
$86.85
|
| Rate for Payer: Signature Care EPO |
$93.38
|
| Rate for Payer: Signature Care PPO |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$88.65
|
|
|
HC WIRE ACUITY X4 CONNECTOR TOOL
|
Facility
OP
|
$112.50
|
|
| Hospital Charge Code |
41607278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$94.95
|
| Rate for Payer: Aetna Medicare |
$37.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.84
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Centivo All Commercial |
$57.38
|
| Rate for Payer: Cigna All Commercial |
$97.09
|
| Rate for Payer: CORVEL All Commercial |
$104.62
|
| Rate for Payer: Coventry All Commercial |
$99.00
|
| Rate for Payer: Encore All Commercial |
$103.56
|
| Rate for Payer: Frontpath All Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$97.17
|
| Rate for Payer: Humana Medicare |
$57.38
|
| Rate for Payer: Lucent All Commercial |
$57.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$84.38
|
| Rate for Payer: PHP All Commercial |
$85.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.88
|
| Rate for Payer: Sagamore Health Network All Products |
$86.85
|
| Rate for Payer: Signature Care EPO |
$93.38
|
| Rate for Payer: Signature Care PPO |
$99.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.62
|
| Rate for Payer: United Healthcare Commercial |
$88.65
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
|
|
HC WIRE GUIDE BS .035
|
Facility
IP
|
$133.00
|
|
| Hospital Charge Code |
41602291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$123.69 |
| Rate for Payer: Aetna Commercial |
$114.91
|
| Rate for Payer: Cash Price |
$82.46
|
| Rate for Payer: Cigna All Commercial |
$114.78
|
| Rate for Payer: CORVEL All Commercial |
$123.69
|
| Rate for Payer: Coventry All Commercial |
$117.04
|
| Rate for Payer: Encore All Commercial |
$122.43
|
| Rate for Payer: Frontpath All Commercial |
$122.36
|
| Rate for Payer: Humana ChoiceCare |
$114.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.70
|
| Rate for Payer: PHCS All Commercial |
$99.75
|
| Rate for Payer: PHP All Commercial |
$100.87
|
| Rate for Payer: Sagamore Health Network All Products |
$102.68
|
| Rate for Payer: Signature Care EPO |
$110.39
|
| Rate for Payer: Signature Care PPO |
$117.04
|
| Rate for Payer: United Healthcare Commercial |
$104.80
|
|
|
HC WIRE GUIDE BS .035
|
Facility
OP
|
$133.00
|
|
| Hospital Charge Code |
41602291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$123.69 |
| Rate for Payer: Aetna Commercial |
$112.25
|
| Rate for Payer: Aetna Medicare |
$43.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.28
|
| Rate for Payer: Cash Price |
$82.46
|
| Rate for Payer: Cash Price |
$82.46
|
| Rate for Payer: Centivo All Commercial |
$67.83
|
| Rate for Payer: Cigna All Commercial |
$114.78
|
| Rate for Payer: CORVEL All Commercial |
$123.69
|
| Rate for Payer: Coventry All Commercial |
$117.04
|
| Rate for Payer: Encore All Commercial |
$122.43
|
| Rate for Payer: Frontpath All Commercial |
$122.36
|
| Rate for Payer: Humana ChoiceCare |
$114.87
|
| Rate for Payer: Humana Medicare |
$67.83
|
| Rate for Payer: Lucent All Commercial |
$67.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$99.75
|
| Rate for Payer: PHP All Commercial |
$100.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.87
|
| Rate for Payer: Sagamore Health Network All Products |
$102.68
|
| Rate for Payer: Signature Care EPO |
$110.39
|
| Rate for Payer: Signature Care PPO |
$117.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$113.05
|
| Rate for Payer: United Healthcare Commercial |
$104.80
|
| Rate for Payer: United Healthcare Medicare |
$43.89
|
|
|
HC WIRE GUIDE BS .038
|
Facility
OP
|
$324.80
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41602290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.18 |
| Max. Negotiated Rate |
$302.06 |
| Rate for Payer: Aetna Commercial |
$274.13
|
| Rate for Payer: Aetna Medicare |
$107.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$186.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$203.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$117.90
|
| Rate for Payer: Cash Price |
$201.38
|
| Rate for Payer: Cash Price |
$201.38
|
| Rate for Payer: Centivo All Commercial |
$165.65
|
| Rate for Payer: Cigna All Commercial |
$280.30
|
| Rate for Payer: CORVEL All Commercial |
$302.06
|
| Rate for Payer: Coventry All Commercial |
$285.82
|
| Rate for Payer: Encore All Commercial |
$298.98
|
| Rate for Payer: Frontpath All Commercial |
$298.82
|
| Rate for Payer: Humana ChoiceCare |
$280.53
|
| Rate for Payer: Humana Medicare |
$165.65
|
| Rate for Payer: Lucent All Commercial |
$165.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$292.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$243.60
|
| Rate for Payer: PHP All Commercial |
$246.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.67
|
| Rate for Payer: Sagamore Health Network All Products |
$250.75
|
| Rate for Payer: Signature Care EPO |
$269.58
|
| Rate for Payer: Signature Care PPO |
$285.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$276.08
|
| Rate for Payer: United Healthcare Commercial |
$255.94
|
| Rate for Payer: United Healthcare Medicare |
$107.18
|
|
|
HC WIRE GUIDE BS .038
|
Facility
IP
|
$324.80
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41602290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$302.06 |
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Cash Price |
$201.38
|
| Rate for Payer: Cigna All Commercial |
$280.30
|
| Rate for Payer: CORVEL All Commercial |
$302.06
|
| Rate for Payer: Coventry All Commercial |
$285.82
|
| Rate for Payer: Encore All Commercial |
$298.98
|
| Rate for Payer: Frontpath All Commercial |
$298.82
|
| Rate for Payer: Humana ChoiceCare |
$280.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$292.32
|
| Rate for Payer: PHCS All Commercial |
$243.60
|
| Rate for Payer: PHP All Commercial |
$246.33
|
| Rate for Payer: Sagamore Health Network All Products |
$250.75
|
| Rate for Payer: Signature Care EPO |
$269.58
|
| Rate for Payer: Signature Care PPO |
$285.82
|
| Rate for Payer: United Healthcare Commercial |
$255.94
|
|
|
HC WIRE GUIDE HIWIRE .035
|
Facility
OP
|
$246.05
|
|
| Hospital Charge Code |
41602065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$228.83 |
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.32
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Centivo All Commercial |
$125.49
|
| Rate for Payer: Cigna All Commercial |
$212.34
|
| Rate for Payer: CORVEL All Commercial |
$228.83
|
| Rate for Payer: Coventry All Commercial |
$216.52
|
| Rate for Payer: Encore All Commercial |
$226.49
|
| Rate for Payer: Frontpath All Commercial |
$226.37
|
| Rate for Payer: Humana ChoiceCare |
$212.51
|
| Rate for Payer: Humana Medicare |
$125.49
|
| Rate for Payer: Lucent All Commercial |
$125.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.54
|
| Rate for Payer: PHP All Commercial |
$186.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.96
|
| Rate for Payer: Sagamore Health Network All Products |
$189.95
|
| Rate for Payer: Signature Care EPO |
$204.22
|
| Rate for Payer: Signature Care PPO |
$216.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.14
|
| Rate for Payer: United Healthcare Commercial |
$193.89
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
|
|
HC WIRE GUIDE HIWIRE .035
|
Facility
IP
|
$246.05
|
|
| Hospital Charge Code |
41602065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.54 |
| Max. Negotiated Rate |
$228.83 |
| Rate for Payer: Aetna Commercial |
$212.59
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cigna All Commercial |
$212.34
|
| Rate for Payer: CORVEL All Commercial |
$228.83
|
| Rate for Payer: Coventry All Commercial |
$216.52
|
| Rate for Payer: Encore All Commercial |
$226.49
|
| Rate for Payer: Frontpath All Commercial |
$226.37
|
| Rate for Payer: Humana ChoiceCare |
$212.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.44
|
| Rate for Payer: PHCS All Commercial |
$184.54
|
| Rate for Payer: PHP All Commercial |
$186.60
|
| Rate for Payer: Sagamore Health Network All Products |
$189.95
|
| Rate for Payer: Signature Care EPO |
$204.22
|
| Rate for Payer: Signature Care PPO |
$216.52
|
| Rate for Payer: United Healthcare Commercial |
$193.89
|
|
|
HC WIRE GUIDE HIWIRE .038
|
Facility
OP
|
$231.78
|
|
| Hospital Charge Code |
41601365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.49 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna Commercial |
$195.62
|
| Rate for Payer: Aetna Medicare |
$76.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$133.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.14
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Centivo All Commercial |
$118.21
|
| Rate for Payer: Cigna All Commercial |
$200.03
|
| Rate for Payer: CORVEL All Commercial |
$215.56
|
| Rate for Payer: Coventry All Commercial |
$203.97
|
| Rate for Payer: Encore All Commercial |
$213.35
|
| Rate for Payer: Frontpath All Commercial |
$213.24
|
| Rate for Payer: Humana ChoiceCare |
$200.19
|
| Rate for Payer: Humana Medicare |
$118.21
|
| Rate for Payer: Lucent All Commercial |
$118.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$173.84
|
| Rate for Payer: PHP All Commercial |
$175.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.39
|
| Rate for Payer: Sagamore Health Network All Products |
$178.93
|
| Rate for Payer: Signature Care EPO |
$192.38
|
| Rate for Payer: Signature Care PPO |
$203.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$197.01
|
| Rate for Payer: United Healthcare Commercial |
$182.64
|
| Rate for Payer: United Healthcare Medicare |
$76.49
|
|
|
HC WIRE GUIDE HIWIRE .038
|
Facility
IP
|
$231.78
|
|
| Hospital Charge Code |
41601365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.84 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna All Commercial |
$200.03
|
| Rate for Payer: CORVEL All Commercial |
$215.56
|
| Rate for Payer: Coventry All Commercial |
$203.97
|
| Rate for Payer: Encore All Commercial |
$213.35
|
| Rate for Payer: Frontpath All Commercial |
$213.24
|
| Rate for Payer: Humana ChoiceCare |
$200.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.60
|
| Rate for Payer: PHCS All Commercial |
$173.84
|
| Rate for Payer: PHP All Commercial |
$175.78
|
| Rate for Payer: Sagamore Health Network All Products |
$178.93
|
| Rate for Payer: Signature Care EPO |
$192.38
|
| Rate for Payer: Signature Care PPO |
$203.97
|
| Rate for Payer: United Healthcare Commercial |
$182.64
|
|
|
HC WIRE GUIDE PFTE .038
|
Facility
IP
|
$106.68
|
|
| Hospital Charge Code |
41602293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$99.21 |
| Rate for Payer: Aetna Commercial |
$92.17
|
| Rate for Payer: Cash Price |
$66.14
|
| Rate for Payer: Cigna All Commercial |
$92.06
|
| Rate for Payer: CORVEL All Commercial |
$99.21
|
| Rate for Payer: Coventry All Commercial |
$93.88
|
| Rate for Payer: Encore All Commercial |
$98.20
|
| Rate for Payer: Frontpath All Commercial |
$98.15
|
| Rate for Payer: Humana ChoiceCare |
$92.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.01
|
| Rate for Payer: PHCS All Commercial |
$80.01
|
| Rate for Payer: PHP All Commercial |
$80.91
|
| Rate for Payer: Sagamore Health Network All Products |
$82.36
|
| Rate for Payer: Signature Care EPO |
$88.54
|
| Rate for Payer: Signature Care PPO |
$93.88
|
| Rate for Payer: United Healthcare Commercial |
$84.06
|
|
|
HC WIRE GUIDE PFTE .038
|
Facility
OP
|
$106.68
|
|
| Hospital Charge Code |
41602293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$90.04
|
| Rate for Payer: Aetna Medicare |
$35.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.72
|
| Rate for Payer: Cash Price |
$66.14
|
| Rate for Payer: Cash Price |
$66.14
|
| Rate for Payer: Centivo All Commercial |
$54.41
|
| Rate for Payer: Cigna All Commercial |
$92.06
|
| Rate for Payer: CORVEL All Commercial |
$99.21
|
| Rate for Payer: Coventry All Commercial |
$93.88
|
| Rate for Payer: Encore All Commercial |
$98.20
|
| Rate for Payer: Frontpath All Commercial |
$98.15
|
| Rate for Payer: Humana ChoiceCare |
$92.14
|
| Rate for Payer: Humana Medicare |
$54.41
|
| Rate for Payer: Lucent All Commercial |
$54.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$80.01
|
| Rate for Payer: PHP All Commercial |
$80.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.61
|
| Rate for Payer: Sagamore Health Network All Products |
$82.36
|
| Rate for Payer: Signature Care EPO |
$88.54
|
| Rate for Payer: Signature Care PPO |
$93.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.68
|
| Rate for Payer: United Healthcare Commercial |
$84.06
|
| Rate for Payer: United Healthcare Medicare |
$35.20
|
|
|
HC WIRE GUIDE PTFE .035
|
Facility
OP
|
$106.68
|
|
| Hospital Charge Code |
41602292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$90.04
|
| Rate for Payer: Aetna Medicare |
$35.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.72
|
| Rate for Payer: Cash Price |
$66.14
|
| Rate for Payer: Cash Price |
$66.14
|
| Rate for Payer: Centivo All Commercial |
$54.41
|
| Rate for Payer: Cigna All Commercial |
$92.06
|
| Rate for Payer: CORVEL All Commercial |
$99.21
|
| Rate for Payer: Coventry All Commercial |
$93.88
|
| Rate for Payer: Encore All Commercial |
$98.20
|
| Rate for Payer: Frontpath All Commercial |
$98.15
|
| Rate for Payer: Humana ChoiceCare |
$92.14
|
| Rate for Payer: Humana Medicare |
$54.41
|
| Rate for Payer: Lucent All Commercial |
$54.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$80.01
|
| Rate for Payer: PHP All Commercial |
$80.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.61
|
| Rate for Payer: Sagamore Health Network All Products |
$82.36
|
| Rate for Payer: Signature Care EPO |
$88.54
|
| Rate for Payer: Signature Care PPO |
$93.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.68
|
| Rate for Payer: United Healthcare Commercial |
$84.06
|
| Rate for Payer: United Healthcare Medicare |
$35.20
|
|
|
HC WIRE GUIDE PTFE .035
|
Facility
IP
|
$106.68
|
|
| Hospital Charge Code |
41602292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$99.21 |
| Rate for Payer: Aetna Commercial |
$92.17
|
| Rate for Payer: Cash Price |
$66.14
|
| Rate for Payer: Cigna All Commercial |
$92.06
|
| Rate for Payer: CORVEL All Commercial |
$99.21
|
| Rate for Payer: Coventry All Commercial |
$93.88
|
| Rate for Payer: Encore All Commercial |
$98.20
|
| Rate for Payer: Frontpath All Commercial |
$98.15
|
| Rate for Payer: Humana ChoiceCare |
$92.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.01
|
| Rate for Payer: PHCS All Commercial |
$80.01
|
| Rate for Payer: PHP All Commercial |
$80.91
|
| Rate for Payer: Sagamore Health Network All Products |
$82.36
|
| Rate for Payer: Signature Care EPO |
$88.54
|
| Rate for Payer: Signature Care PPO |
$93.88
|
| Rate for Payer: United Healthcare Commercial |
$84.06
|
|
|
HC WIRE GW WHISPER VIEW DS
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$90.72
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
|
