|
HC ENDO BABCOCK 10MM
|
Facility
IP
|
$526.12
|
|
| Hospital Charge Code |
41602270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$394.59 |
| Max. Negotiated Rate |
$489.29 |
| Rate for Payer: Aetna Commercial |
$454.57
|
| Rate for Payer: Cash Price |
$326.19
|
| Rate for Payer: Cigna All Commercial |
$454.04
|
| Rate for Payer: CORVEL All Commercial |
$489.29
|
| Rate for Payer: Coventry All Commercial |
$462.99
|
| Rate for Payer: Encore All Commercial |
$484.29
|
| Rate for Payer: Frontpath All Commercial |
$484.03
|
| Rate for Payer: Humana ChoiceCare |
$454.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$473.51
|
| Rate for Payer: PHCS All Commercial |
$394.59
|
| Rate for Payer: PHP All Commercial |
$399.01
|
| Rate for Payer: Sagamore Health Network All Products |
$406.16
|
| Rate for Payer: Signature Care EPO |
$436.68
|
| Rate for Payer: Signature Care PPO |
$462.99
|
| Rate for Payer: United Healthcare Commercial |
$414.58
|
|
|
HC ENDO BABCOCK 10MM
|
Facility
OP
|
$526.12
|
|
| Hospital Charge Code |
41602270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$489.29 |
| Rate for Payer: Aetna Commercial |
$444.05
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$173.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$302.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$328.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.98
|
| Rate for Payer: Cash Price |
$326.19
|
| Rate for Payer: Cash Price |
$326.19
|
| Rate for Payer: Centivo All Commercial |
$268.32
|
| Rate for Payer: Cigna All Commercial |
$454.04
|
| Rate for Payer: CORVEL All Commercial |
$489.29
|
| Rate for Payer: Coventry All Commercial |
$462.99
|
| Rate for Payer: Encore All Commercial |
$484.29
|
| Rate for Payer: Frontpath All Commercial |
$484.03
|
| Rate for Payer: Humana ChoiceCare |
$454.41
|
| Rate for Payer: Humana Medicare |
$268.32
|
| Rate for Payer: Lucent All Commercial |
$268.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$473.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$394.59
|
| Rate for Payer: PHP All Commercial |
$399.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$205.19
|
| Rate for Payer: Sagamore Health Network All Products |
$406.16
|
| Rate for Payer: Signature Care EPO |
$436.68
|
| Rate for Payer: Signature Care PPO |
$462.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$447.20
|
| Rate for Payer: United Healthcare Commercial |
$414.58
|
| Rate for Payer: United Healthcare Medicare |
$173.62
|
|
|
HC ENDO BRONCHIAL DBLE LUMEN LEFT 35 FR
|
Facility
IP
|
$361.20
|
|
| Hospital Charge Code |
41601044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$335.92 |
| Rate for Payer: Aetna Commercial |
$312.08
|
| Rate for Payer: Cash Price |
$223.94
|
| Rate for Payer: Cigna All Commercial |
$311.72
|
| Rate for Payer: CORVEL All Commercial |
$335.92
|
| Rate for Payer: Coventry All Commercial |
$317.86
|
| Rate for Payer: Encore All Commercial |
$332.48
|
| Rate for Payer: Frontpath All Commercial |
$332.30
|
| Rate for Payer: Humana ChoiceCare |
$311.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.08
|
| Rate for Payer: PHCS All Commercial |
$270.90
|
| Rate for Payer: PHP All Commercial |
$273.93
|
| Rate for Payer: Sagamore Health Network All Products |
$278.85
|
| Rate for Payer: Signature Care EPO |
$299.80
|
| Rate for Payer: Signature Care PPO |
$317.86
|
| Rate for Payer: United Healthcare Commercial |
$284.63
|
|
|
HC ENDO BRONCHIAL DBLE LUMEN LEFT 35 FR
|
Facility
OP
|
$361.20
|
|
| Hospital Charge Code |
41601044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.20 |
| Max. Negotiated Rate |
$335.92 |
| Rate for Payer: Aetna Commercial |
$304.85
|
| Rate for Payer: Aetna Medicare |
$119.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$207.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.12
|
| Rate for Payer: Cash Price |
$223.94
|
| Rate for Payer: Cash Price |
$223.94
|
| Rate for Payer: Centivo All Commercial |
$184.21
|
| Rate for Payer: Cigna All Commercial |
$311.72
|
| Rate for Payer: CORVEL All Commercial |
$335.92
|
| Rate for Payer: Coventry All Commercial |
$317.86
|
| Rate for Payer: Encore All Commercial |
$332.48
|
| Rate for Payer: Frontpath All Commercial |
$332.30
|
| Rate for Payer: Humana ChoiceCare |
$311.97
|
| Rate for Payer: Humana Medicare |
$184.21
|
| Rate for Payer: Lucent All Commercial |
$184.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$270.90
|
| Rate for Payer: PHP All Commercial |
$273.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.87
|
| Rate for Payer: Sagamore Health Network All Products |
$278.85
|
| Rate for Payer: Signature Care EPO |
$299.80
|
| Rate for Payer: Signature Care PPO |
$317.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.02
|
| Rate for Payer: United Healthcare Commercial |
$284.63
|
| Rate for Payer: United Healthcare Medicare |
$119.20
|
|
|
HC ENDO BRONCHIAL DBLE LUMEN LEFT 37 FR
|
Facility
IP
|
$361.20
|
|
| Hospital Charge Code |
41601045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$335.92 |
| Rate for Payer: Aetna Commercial |
$312.08
|
| Rate for Payer: Cash Price |
$223.94
|
| Rate for Payer: Cigna All Commercial |
$311.72
|
| Rate for Payer: CORVEL All Commercial |
$335.92
|
| Rate for Payer: Coventry All Commercial |
$317.86
|
| Rate for Payer: Encore All Commercial |
$332.48
|
| Rate for Payer: Frontpath All Commercial |
$332.30
|
| Rate for Payer: Humana ChoiceCare |
$311.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.08
|
| Rate for Payer: PHCS All Commercial |
$270.90
|
| Rate for Payer: PHP All Commercial |
$273.93
|
| Rate for Payer: Sagamore Health Network All Products |
$278.85
|
| Rate for Payer: Signature Care EPO |
$299.80
|
| Rate for Payer: Signature Care PPO |
$317.86
|
| Rate for Payer: United Healthcare Commercial |
$284.63
|
|
|
HC ENDO BRONCHIAL DBLE LUMEN LEFT 37 FR
|
Facility
OP
|
$361.20
|
|
| Hospital Charge Code |
41601045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.20 |
| Max. Negotiated Rate |
$335.92 |
| Rate for Payer: Aetna Commercial |
$304.85
|
| Rate for Payer: Aetna Medicare |
$119.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$207.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.12
|
| Rate for Payer: Cash Price |
$223.94
|
| Rate for Payer: Cash Price |
$223.94
|
| Rate for Payer: Centivo All Commercial |
$184.21
|
| Rate for Payer: Cigna All Commercial |
$311.72
|
| Rate for Payer: CORVEL All Commercial |
$335.92
|
| Rate for Payer: Coventry All Commercial |
$317.86
|
| Rate for Payer: Encore All Commercial |
$332.48
|
| Rate for Payer: Frontpath All Commercial |
$332.30
|
| Rate for Payer: Humana ChoiceCare |
$311.97
|
| Rate for Payer: Humana Medicare |
$184.21
|
| Rate for Payer: Lucent All Commercial |
$184.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$270.90
|
| Rate for Payer: PHP All Commercial |
$273.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.87
|
| Rate for Payer: Sagamore Health Network All Products |
$278.85
|
| Rate for Payer: Signature Care EPO |
$299.80
|
| Rate for Payer: Signature Care PPO |
$317.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.02
|
| Rate for Payer: United Healthcare Commercial |
$284.63
|
| Rate for Payer: United Healthcare Medicare |
$119.20
|
|
|
HC ENDOCATCH
|
Facility
OP
|
$492.49
|
|
| Hospital Charge Code |
41601057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$458.02 |
| Rate for Payer: Aetna Commercial |
$415.66
|
| Rate for Payer: Aetna Medicare |
$162.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$162.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$282.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$307.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$186.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$178.77
|
| Rate for Payer: Cash Price |
$305.34
|
| Rate for Payer: Cash Price |
$305.34
|
| Rate for Payer: Centivo All Commercial |
$251.17
|
| Rate for Payer: Cigna All Commercial |
$425.02
|
| Rate for Payer: CORVEL All Commercial |
$458.02
|
| Rate for Payer: Coventry All Commercial |
$433.39
|
| Rate for Payer: Encore All Commercial |
$453.34
|
| Rate for Payer: Frontpath All Commercial |
$453.09
|
| Rate for Payer: Humana ChoiceCare |
$425.36
|
| Rate for Payer: Humana Medicare |
$251.17
|
| Rate for Payer: Lucent All Commercial |
$251.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$443.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$369.37
|
| Rate for Payer: PHP All Commercial |
$373.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$192.07
|
| Rate for Payer: Sagamore Health Network All Products |
$380.20
|
| Rate for Payer: Signature Care EPO |
$408.77
|
| Rate for Payer: Signature Care PPO |
$433.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$418.62
|
| Rate for Payer: United Healthcare Commercial |
$388.08
|
| Rate for Payer: United Healthcare Medicare |
$162.52
|
|
|
HC ENDOCATCH
|
Facility
IP
|
$492.49
|
|
| Hospital Charge Code |
41601057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.37 |
| Max. Negotiated Rate |
$458.02 |
| Rate for Payer: Aetna Commercial |
$425.51
|
| Rate for Payer: Cash Price |
$305.34
|
| Rate for Payer: Cigna All Commercial |
$425.02
|
| Rate for Payer: CORVEL All Commercial |
$458.02
|
| Rate for Payer: Coventry All Commercial |
$433.39
|
| Rate for Payer: Encore All Commercial |
$453.34
|
| Rate for Payer: Frontpath All Commercial |
$453.09
|
| Rate for Payer: Humana ChoiceCare |
$425.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$443.24
|
| Rate for Payer: PHCS All Commercial |
$369.37
|
| Rate for Payer: PHP All Commercial |
$373.50
|
| Rate for Payer: Sagamore Health Network All Products |
$380.20
|
| Rate for Payer: Signature Care EPO |
$408.77
|
| Rate for Payer: Signature Care PPO |
$433.39
|
| Rate for Payer: United Healthcare Commercial |
$388.08
|
|
|
HC ENDOCATCH II 15MM
|
Facility
OP
|
$906.17
|
|
| Hospital Charge Code |
41602486
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$842.74 |
| Rate for Payer: Aetna Commercial |
$764.81
|
| Rate for Payer: Aetna Medicare |
$299.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$299.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$520.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$566.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$343.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$328.94
|
| Rate for Payer: Cash Price |
$561.83
|
| Rate for Payer: Cash Price |
$561.83
|
| Rate for Payer: Centivo All Commercial |
$462.15
|
| Rate for Payer: Cigna All Commercial |
$782.02
|
| Rate for Payer: CORVEL All Commercial |
$842.74
|
| Rate for Payer: Coventry All Commercial |
$797.43
|
| Rate for Payer: Encore All Commercial |
$834.13
|
| Rate for Payer: Frontpath All Commercial |
$833.68
|
| Rate for Payer: Humana ChoiceCare |
$782.66
|
| Rate for Payer: Humana Medicare |
$462.15
|
| Rate for Payer: Lucent All Commercial |
$462.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$815.55
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$679.63
|
| Rate for Payer: PHP All Commercial |
$687.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$353.41
|
| Rate for Payer: Sagamore Health Network All Products |
$699.56
|
| Rate for Payer: Signature Care EPO |
$752.12
|
| Rate for Payer: Signature Care PPO |
$797.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$770.24
|
| Rate for Payer: United Healthcare Commercial |
$714.06
|
| Rate for Payer: United Healthcare Medicare |
$299.04
|
|
|
HC ENDOCATCH II 15MM
|
Facility
IP
|
$906.17
|
|
| Hospital Charge Code |
41602486
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$679.63 |
| Max. Negotiated Rate |
$842.74 |
| Rate for Payer: Aetna Commercial |
$782.93
|
| Rate for Payer: Cash Price |
$561.83
|
| Rate for Payer: Cigna All Commercial |
$782.02
|
| Rate for Payer: CORVEL All Commercial |
$842.74
|
| Rate for Payer: Coventry All Commercial |
$797.43
|
| Rate for Payer: Encore All Commercial |
$834.13
|
| Rate for Payer: Frontpath All Commercial |
$833.68
|
| Rate for Payer: Humana ChoiceCare |
$782.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$815.55
|
| Rate for Payer: PHCS All Commercial |
$679.63
|
| Rate for Payer: PHP All Commercial |
$687.24
|
| Rate for Payer: Sagamore Health Network All Products |
$699.56
|
| Rate for Payer: Signature Care EPO |
$752.12
|
| Rate for Payer: Signature Care PPO |
$797.43
|
| Rate for Payer: United Healthcare Commercial |
$714.06
|
|
|
HC ENDO CLIP APPLIER 10MM COVIDIEN
|
Facility
IP
|
$709.09
|
|
| Hospital Charge Code |
41601006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.82 |
| Max. Negotiated Rate |
$659.45 |
| Rate for Payer: Aetna Commercial |
$612.65
|
| Rate for Payer: Cash Price |
$439.64
|
| Rate for Payer: Cigna All Commercial |
$611.94
|
| Rate for Payer: CORVEL All Commercial |
$659.45
|
| Rate for Payer: Coventry All Commercial |
$624.00
|
| Rate for Payer: Encore All Commercial |
$652.72
|
| Rate for Payer: Frontpath All Commercial |
$652.36
|
| Rate for Payer: Humana ChoiceCare |
$612.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$638.18
|
| Rate for Payer: PHCS All Commercial |
$531.82
|
| Rate for Payer: PHP All Commercial |
$537.77
|
| Rate for Payer: Sagamore Health Network All Products |
$547.42
|
| Rate for Payer: Signature Care EPO |
$588.54
|
| Rate for Payer: Signature Care PPO |
$624.00
|
| Rate for Payer: United Healthcare Commercial |
$558.76
|
|
|
HC ENDO CLIP APPLIER 10MM COVIDIEN
|
Facility
OP
|
$709.09
|
|
| Hospital Charge Code |
41601006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$659.45 |
| Rate for Payer: Aetna Commercial |
$598.47
|
| Rate for Payer: Aetna Medicare |
$234.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$234.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$407.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$443.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$269.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$257.40
|
| Rate for Payer: Cash Price |
$439.64
|
| Rate for Payer: Cash Price |
$439.64
|
| Rate for Payer: Centivo All Commercial |
$361.64
|
| Rate for Payer: Cigna All Commercial |
$611.94
|
| Rate for Payer: CORVEL All Commercial |
$659.45
|
| Rate for Payer: Coventry All Commercial |
$624.00
|
| Rate for Payer: Encore All Commercial |
$652.72
|
| Rate for Payer: Frontpath All Commercial |
$652.36
|
| Rate for Payer: Humana ChoiceCare |
$612.44
|
| Rate for Payer: Humana Medicare |
$361.64
|
| Rate for Payer: Lucent All Commercial |
$361.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$638.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$531.82
|
| Rate for Payer: PHP All Commercial |
$537.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$276.55
|
| Rate for Payer: Sagamore Health Network All Products |
$547.42
|
| Rate for Payer: Signature Care EPO |
$588.54
|
| Rate for Payer: Signature Care PPO |
$624.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$602.73
|
| Rate for Payer: United Healthcare Commercial |
$558.76
|
| Rate for Payer: United Healthcare Medicare |
$234.00
|
|
|
HC ENDO CLIP APPLIER 5MM
|
Facility
IP
|
$851.05
|
|
| Hospital Charge Code |
41601914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.29 |
| Max. Negotiated Rate |
$791.48 |
| Rate for Payer: Aetna Commercial |
$735.31
|
| Rate for Payer: Cash Price |
$527.65
|
| Rate for Payer: Cigna All Commercial |
$734.46
|
| Rate for Payer: CORVEL All Commercial |
$791.48
|
| Rate for Payer: Coventry All Commercial |
$748.92
|
| Rate for Payer: Encore All Commercial |
$783.39
|
| Rate for Payer: Frontpath All Commercial |
$782.97
|
| Rate for Payer: Humana ChoiceCare |
$735.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$765.94
|
| Rate for Payer: PHCS All Commercial |
$638.29
|
| Rate for Payer: PHP All Commercial |
$645.44
|
| Rate for Payer: Sagamore Health Network All Products |
$657.01
|
| Rate for Payer: Signature Care EPO |
$706.37
|
| Rate for Payer: Signature Care PPO |
$748.92
|
| Rate for Payer: United Healthcare Commercial |
$670.63
|
|
|
HC ENDO CLIP APPLIER 5MM
|
Facility
OP
|
$851.05
|
|
| Hospital Charge Code |
41601914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$791.48 |
| Rate for Payer: Aetna Commercial |
$718.29
|
| Rate for Payer: Aetna Medicare |
$280.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$280.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$488.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$531.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$322.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$308.93
|
| Rate for Payer: Cash Price |
$527.65
|
| Rate for Payer: Cash Price |
$527.65
|
| Rate for Payer: Centivo All Commercial |
$434.04
|
| Rate for Payer: Cigna All Commercial |
$734.46
|
| Rate for Payer: CORVEL All Commercial |
$791.48
|
| Rate for Payer: Coventry All Commercial |
$748.92
|
| Rate for Payer: Encore All Commercial |
$783.39
|
| Rate for Payer: Frontpath All Commercial |
$782.97
|
| Rate for Payer: Humana ChoiceCare |
$735.05
|
| Rate for Payer: Humana Medicare |
$434.04
|
| Rate for Payer: Lucent All Commercial |
$434.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$765.94
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$638.29
|
| Rate for Payer: PHP All Commercial |
$645.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$331.91
|
| Rate for Payer: Sagamore Health Network All Products |
$657.01
|
| Rate for Payer: Signature Care EPO |
$706.37
|
| Rate for Payer: Signature Care PPO |
$748.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$723.39
|
| Rate for Payer: United Healthcare Commercial |
$670.63
|
| Rate for Payer: United Healthcare Medicare |
$280.85
|
|
|
HC ENDO CLIP APPLIER 6MM (ETHICON
|
Facility
IP
|
$1,036.61
|
|
| Hospital Charge Code |
41602271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.46 |
| Max. Negotiated Rate |
$964.05 |
| Rate for Payer: Aetna Commercial |
$895.63
|
| Rate for Payer: Cash Price |
$642.70
|
| Rate for Payer: Cigna All Commercial |
$894.59
|
| Rate for Payer: CORVEL All Commercial |
$964.05
|
| Rate for Payer: Coventry All Commercial |
$912.22
|
| Rate for Payer: Encore All Commercial |
$954.20
|
| Rate for Payer: Frontpath All Commercial |
$953.68
|
| Rate for Payer: Humana ChoiceCare |
$895.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$932.95
|
| Rate for Payer: PHCS All Commercial |
$777.46
|
| Rate for Payer: PHP All Commercial |
$786.17
|
| Rate for Payer: Sagamore Health Network All Products |
$800.26
|
| Rate for Payer: Signature Care EPO |
$860.39
|
| Rate for Payer: Signature Care PPO |
$912.22
|
| Rate for Payer: United Healthcare Commercial |
$816.85
|
|
|
HC ENDO CLIP APPLIER 6MM (ETHICON
|
Facility
OP
|
$1,036.61
|
|
| Hospital Charge Code |
41602271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$964.05 |
| Rate for Payer: Aetna Commercial |
$874.90
|
| Rate for Payer: Aetna Medicare |
$342.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$342.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$595.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$647.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$393.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$376.29
|
| Rate for Payer: Cash Price |
$642.70
|
| Rate for Payer: Cash Price |
$642.70
|
| Rate for Payer: Centivo All Commercial |
$528.67
|
| Rate for Payer: Cigna All Commercial |
$894.59
|
| Rate for Payer: CORVEL All Commercial |
$964.05
|
| Rate for Payer: Coventry All Commercial |
$912.22
|
| Rate for Payer: Encore All Commercial |
$954.20
|
| Rate for Payer: Frontpath All Commercial |
$953.68
|
| Rate for Payer: Humana ChoiceCare |
$895.32
|
| Rate for Payer: Humana Medicare |
$528.67
|
| Rate for Payer: Lucent All Commercial |
$528.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$932.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$777.46
|
| Rate for Payer: PHP All Commercial |
$786.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$404.28
|
| Rate for Payer: Sagamore Health Network All Products |
$800.26
|
| Rate for Payer: Signature Care EPO |
$860.39
|
| Rate for Payer: Signature Care PPO |
$912.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$881.12
|
| Rate for Payer: United Healthcare Commercial |
$816.85
|
| Rate for Payer: United Healthcare Medicare |
$342.08
|
|
|
HC ENDO CLOSE
|
Facility
IP
|
$167.24
|
|
| Hospital Charge Code |
41602096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.43 |
| Max. Negotiated Rate |
$155.53 |
| Rate for Payer: Aetna Commercial |
$144.50
|
| Rate for Payer: Cash Price |
$103.69
|
| Rate for Payer: Cigna All Commercial |
$144.33
|
| Rate for Payer: CORVEL All Commercial |
$155.53
|
| Rate for Payer: Coventry All Commercial |
$147.17
|
| Rate for Payer: Encore All Commercial |
$153.94
|
| Rate for Payer: Frontpath All Commercial |
$153.86
|
| Rate for Payer: Humana ChoiceCare |
$144.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.52
|
| Rate for Payer: PHCS All Commercial |
$125.43
|
| Rate for Payer: PHP All Commercial |
$126.83
|
| Rate for Payer: Sagamore Health Network All Products |
$129.11
|
| Rate for Payer: Signature Care EPO |
$138.81
|
| Rate for Payer: Signature Care PPO |
$147.17
|
| Rate for Payer: United Healthcare Commercial |
$131.79
|
|
|
HC ENDO CLOSE
|
Facility
OP
|
$167.24
|
|
| Hospital Charge Code |
41602096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.19 |
| Max. Negotiated Rate |
$155.53 |
| Rate for Payer: Aetna Commercial |
$141.15
|
| Rate for Payer: Aetna Medicare |
$55.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.71
|
| Rate for Payer: Cash Price |
$103.69
|
| Rate for Payer: Cash Price |
$103.69
|
| Rate for Payer: Centivo All Commercial |
$85.29
|
| Rate for Payer: Cigna All Commercial |
$144.33
|
| Rate for Payer: CORVEL All Commercial |
$155.53
|
| Rate for Payer: Coventry All Commercial |
$147.17
|
| Rate for Payer: Encore All Commercial |
$153.94
|
| Rate for Payer: Frontpath All Commercial |
$153.86
|
| Rate for Payer: Humana ChoiceCare |
$144.45
|
| Rate for Payer: Humana Medicare |
$85.29
|
| Rate for Payer: Lucent All Commercial |
$85.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.52
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$125.43
|
| Rate for Payer: PHP All Commercial |
$126.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.22
|
| Rate for Payer: Sagamore Health Network All Products |
$129.11
|
| Rate for Payer: Signature Care EPO |
$138.81
|
| Rate for Payer: Signature Care PPO |
$147.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.15
|
| Rate for Payer: United Healthcare Commercial |
$131.79
|
| Rate for Payer: United Healthcare Medicare |
$55.19
|
|
|
HC ENDOCUFF VISION LG
|
Facility
OP
|
$187.25
|
|
| Hospital Charge Code |
41607442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.79 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$158.04
|
| Rate for Payer: Aetna Medicare |
$61.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.97
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Centivo All Commercial |
$95.50
|
| Rate for Payer: Cigna All Commercial |
$161.60
|
| Rate for Payer: CORVEL All Commercial |
$174.14
|
| Rate for Payer: Coventry All Commercial |
$164.78
|
| Rate for Payer: Encore All Commercial |
$172.36
|
| Rate for Payer: Frontpath All Commercial |
$172.27
|
| Rate for Payer: Humana ChoiceCare |
$161.73
|
| Rate for Payer: Humana Medicare |
$95.50
|
| Rate for Payer: Lucent All Commercial |
$95.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.52
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.44
|
| Rate for Payer: PHP All Commercial |
$142.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.03
|
| Rate for Payer: Sagamore Health Network All Products |
$144.56
|
| Rate for Payer: Signature Care EPO |
$155.42
|
| Rate for Payer: Signature Care PPO |
$164.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.16
|
| Rate for Payer: United Healthcare Commercial |
$147.55
|
| Rate for Payer: United Healthcare Medicare |
$61.79
|
|
|
HC ENDOCUFF VISION LG
|
Facility
IP
|
$187.25
|
|
| Hospital Charge Code |
41607442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$161.78
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna All Commercial |
$161.60
|
| Rate for Payer: CORVEL All Commercial |
$174.14
|
| Rate for Payer: Coventry All Commercial |
$164.78
|
| Rate for Payer: Encore All Commercial |
$172.36
|
| Rate for Payer: Frontpath All Commercial |
$172.27
|
| Rate for Payer: Humana ChoiceCare |
$161.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.52
|
| Rate for Payer: PHCS All Commercial |
$140.44
|
| Rate for Payer: PHP All Commercial |
$142.01
|
| Rate for Payer: Sagamore Health Network All Products |
$144.56
|
| Rate for Payer: Signature Care EPO |
$155.42
|
| Rate for Payer: Signature Care PPO |
$164.78
|
| Rate for Payer: United Healthcare Commercial |
$147.55
|
|
|
HC ENDO DISSECTOR
|
Facility
IP
|
$515.90
|
|
| Hospital Charge Code |
41602272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.92 |
| Max. Negotiated Rate |
$479.79 |
| Rate for Payer: Aetna Commercial |
$445.74
|
| Rate for Payer: Cash Price |
$319.86
|
| Rate for Payer: Cigna All Commercial |
$445.22
|
| Rate for Payer: CORVEL All Commercial |
$479.79
|
| Rate for Payer: Coventry All Commercial |
$453.99
|
| Rate for Payer: Encore All Commercial |
$474.89
|
| Rate for Payer: Frontpath All Commercial |
$474.63
|
| Rate for Payer: Humana ChoiceCare |
$445.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$464.31
|
| Rate for Payer: PHCS All Commercial |
$386.92
|
| Rate for Payer: PHP All Commercial |
$391.26
|
| Rate for Payer: Sagamore Health Network All Products |
$398.27
|
| Rate for Payer: Signature Care EPO |
$428.20
|
| Rate for Payer: Signature Care PPO |
$453.99
|
| Rate for Payer: United Healthcare Commercial |
$406.53
|
|
|
HC ENDO DISSECTOR
|
Facility
OP
|
$515.90
|
|
| Hospital Charge Code |
41602272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$479.79 |
| Rate for Payer: Aetna Commercial |
$435.42
|
| Rate for Payer: Aetna Medicare |
$170.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$296.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$322.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$195.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.27
|
| Rate for Payer: Cash Price |
$319.86
|
| Rate for Payer: Cash Price |
$319.86
|
| Rate for Payer: Centivo All Commercial |
$263.11
|
| Rate for Payer: Cigna All Commercial |
$445.22
|
| Rate for Payer: CORVEL All Commercial |
$479.79
|
| Rate for Payer: Coventry All Commercial |
$453.99
|
| Rate for Payer: Encore All Commercial |
$474.89
|
| Rate for Payer: Frontpath All Commercial |
$474.63
|
| Rate for Payer: Humana ChoiceCare |
$445.58
|
| Rate for Payer: Humana Medicare |
$263.11
|
| Rate for Payer: Lucent All Commercial |
$263.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$464.31
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$386.92
|
| Rate for Payer: PHP All Commercial |
$391.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$201.20
|
| Rate for Payer: Sagamore Health Network All Products |
$398.27
|
| Rate for Payer: Signature Care EPO |
$428.20
|
| Rate for Payer: Signature Care PPO |
$453.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$438.52
|
| Rate for Payer: United Healthcare Commercial |
$406.53
|
| Rate for Payer: United Healthcare Medicare |
$170.25
|
|
|
HC ENDOGRASP 5 MM
|
Facility
IP
|
$531.37
|
|
| Hospital Charge Code |
41602273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.53 |
| Max. Negotiated Rate |
$494.17 |
| Rate for Payer: Aetna Commercial |
$459.10
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cigna All Commercial |
$458.57
|
| Rate for Payer: CORVEL All Commercial |
$494.17
|
| Rate for Payer: Coventry All Commercial |
$467.61
|
| Rate for Payer: Encore All Commercial |
$489.13
|
| Rate for Payer: Frontpath All Commercial |
$488.86
|
| Rate for Payer: Humana ChoiceCare |
$458.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.23
|
| Rate for Payer: PHCS All Commercial |
$398.53
|
| Rate for Payer: PHP All Commercial |
$402.99
|
| Rate for Payer: Sagamore Health Network All Products |
$410.22
|
| Rate for Payer: Signature Care EPO |
$441.04
|
| Rate for Payer: Signature Care PPO |
$467.61
|
| Rate for Payer: United Healthcare Commercial |
$418.72
|
|
|
HC ENDOGRASP 5 MM
|
Facility
OP
|
$531.37
|
|
| Hospital Charge Code |
41602273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$494.17 |
| Rate for Payer: Aetna Commercial |
$448.48
|
| Rate for Payer: Aetna Medicare |
$175.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$305.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$332.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.89
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Centivo All Commercial |
$271.00
|
| Rate for Payer: Cigna All Commercial |
$458.57
|
| Rate for Payer: CORVEL All Commercial |
$494.17
|
| Rate for Payer: Coventry All Commercial |
$467.61
|
| Rate for Payer: Encore All Commercial |
$489.13
|
| Rate for Payer: Frontpath All Commercial |
$488.86
|
| Rate for Payer: Humana ChoiceCare |
$458.94
|
| Rate for Payer: Humana Medicare |
$271.00
|
| Rate for Payer: Lucent All Commercial |
$271.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.23
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$398.53
|
| Rate for Payer: PHP All Commercial |
$402.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$207.23
|
| Rate for Payer: Sagamore Health Network All Products |
$410.22
|
| Rate for Payer: Signature Care EPO |
$441.04
|
| Rate for Payer: Signature Care PPO |
$467.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$451.66
|
| Rate for Payer: United Healthcare Commercial |
$418.72
|
| Rate for Payer: United Healthcare Medicare |
$175.35
|
|
|
HC ENDO HEMOSPRAY
|
Facility
OP
|
$9,000.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
41608192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,596.00
|
| Rate for Payer: Aetna Medicare |
$2,970.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,970.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,168.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,625.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,415.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,267.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Centivo All Commercial |
$4,590.00
|
| Rate for Payer: Cigna All Commercial |
$7,767.00
|
| Rate for Payer: CORVEL All Commercial |
$8,370.00
|
| Rate for Payer: Coventry All Commercial |
$7,920.00
|
| Rate for Payer: Encore All Commercial |
$8,284.50
|
| Rate for Payer: Frontpath All Commercial |
$8,280.00
|
| Rate for Payer: Humana ChoiceCare |
$7,773.30
|
| Rate for Payer: Humana Medicare |
$4,590.00
|
| Rate for Payer: Lucent All Commercial |
$4,590.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,510.00
|
| Rate for Payer: Sagamore Health Network All Products |
$6,948.00
|
| Rate for Payer: Signature Care EPO |
$7,470.00
|
| Rate for Payer: Signature Care PPO |
$7,920.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,650.00
|
| Rate for Payer: United Healthcare Commercial |
$7,092.00
|
| Rate for Payer: United Healthcare Medicare |
$2,970.00
|
|
