|
HC ENDO HEMOSPRAY
|
Facility
IP
|
$9,000.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
41608192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,750.00 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,776.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| 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: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| 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: United Healthcare Commercial |
$7,092.00
|
|
|
HC ENDO JAW WITH NEEDLE
|
Facility
OP
|
$58.07
|
|
| Hospital Charge Code |
41607496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$49.01
|
| Rate for Payer: Aetna Medicare |
$19.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.08
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Centivo All Commercial |
$29.62
|
| Rate for Payer: Cigna All Commercial |
$50.11
|
| Rate for Payer: CORVEL All Commercial |
$54.01
|
| Rate for Payer: Coventry All Commercial |
$51.10
|
| Rate for Payer: Encore All Commercial |
$53.45
|
| Rate for Payer: Frontpath All Commercial |
$53.42
|
| Rate for Payer: Humana ChoiceCare |
$50.16
|
| Rate for Payer: Humana Medicare |
$29.62
|
| Rate for Payer: Lucent All Commercial |
$29.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$43.55
|
| Rate for Payer: PHP All Commercial |
$44.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.65
|
| Rate for Payer: Sagamore Health Network All Products |
$44.83
|
| Rate for Payer: Signature Care EPO |
$48.20
|
| Rate for Payer: Signature Care PPO |
$51.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.36
|
| Rate for Payer: United Healthcare Commercial |
$45.76
|
| Rate for Payer: United Healthcare Medicare |
$19.16
|
|
|
HC ENDO JAW WITH NEEDLE
|
Facility
IP
|
$58.07
|
|
| Hospital Charge Code |
41607496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$54.01 |
| Rate for Payer: Aetna Commercial |
$50.17
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna All Commercial |
$50.11
|
| Rate for Payer: CORVEL All Commercial |
$54.01
|
| Rate for Payer: Coventry All Commercial |
$51.10
|
| Rate for Payer: Encore All Commercial |
$53.45
|
| Rate for Payer: Frontpath All Commercial |
$53.42
|
| Rate for Payer: Humana ChoiceCare |
$50.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.26
|
| Rate for Payer: PHCS All Commercial |
$43.55
|
| Rate for Payer: PHP All Commercial |
$44.04
|
| Rate for Payer: Sagamore Health Network All Products |
$44.83
|
| Rate for Payer: Signature Care EPO |
$48.20
|
| Rate for Payer: Signature Care PPO |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$45.76
|
|
|
HC ENDO LIGACLIP MCA 10MM
|
Facility
OP
|
$551.34
|
|
| Hospital Charge Code |
41607941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$512.75 |
| Rate for Payer: Aetna Commercial |
$465.33
|
| Rate for Payer: Aetna Medicare |
$181.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$181.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$316.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$344.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$209.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$200.14
|
| Rate for Payer: Cash Price |
$341.83
|
| Rate for Payer: Cash Price |
$341.83
|
| Rate for Payer: Centivo All Commercial |
$281.18
|
| Rate for Payer: Cigna All Commercial |
$475.81
|
| Rate for Payer: CORVEL All Commercial |
$512.75
|
| Rate for Payer: Coventry All Commercial |
$485.18
|
| Rate for Payer: Encore All Commercial |
$507.51
|
| Rate for Payer: Frontpath All Commercial |
$507.23
|
| Rate for Payer: Humana ChoiceCare |
$476.19
|
| Rate for Payer: Humana Medicare |
$281.18
|
| Rate for Payer: Lucent All Commercial |
$281.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$496.21
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$413.50
|
| Rate for Payer: PHP All Commercial |
$418.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$215.02
|
| Rate for Payer: Sagamore Health Network All Products |
$425.63
|
| Rate for Payer: Signature Care EPO |
$457.61
|
| Rate for Payer: Signature Care PPO |
$485.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$468.64
|
| Rate for Payer: United Healthcare Commercial |
$434.46
|
| Rate for Payer: United Healthcare Medicare |
$181.94
|
|
|
HC ENDO LIGACLIP MCA 10MM
|
Facility
IP
|
$551.34
|
|
| Hospital Charge Code |
41607941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$413.50 |
| Max. Negotiated Rate |
$512.75 |
| Rate for Payer: Aetna Commercial |
$476.36
|
| Rate for Payer: Cash Price |
$341.83
|
| Rate for Payer: Cigna All Commercial |
$475.81
|
| Rate for Payer: CORVEL All Commercial |
$512.75
|
| Rate for Payer: Coventry All Commercial |
$485.18
|
| Rate for Payer: Encore All Commercial |
$507.51
|
| Rate for Payer: Frontpath All Commercial |
$507.23
|
| Rate for Payer: Humana ChoiceCare |
$476.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$496.21
|
| Rate for Payer: PHCS All Commercial |
$413.50
|
| Rate for Payer: PHP All Commercial |
$418.14
|
| Rate for Payer: Sagamore Health Network All Products |
$425.63
|
| Rate for Payer: Signature Care EPO |
$457.61
|
| Rate for Payer: Signature Care PPO |
$485.18
|
| Rate for Payer: United Healthcare Commercial |
$434.46
|
|
|
HC ENDOLOOP O PDS EZ10G
|
Facility
OP
|
$275.53
|
|
| Hospital Charge Code |
41602078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$256.24 |
| Rate for Payer: Aetna Commercial |
$232.55
|
| Rate for Payer: Aetna Medicare |
$90.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$158.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$104.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.02
|
| Rate for Payer: Cash Price |
$170.83
|
| Rate for Payer: Cash Price |
$170.83
|
| Rate for Payer: Centivo All Commercial |
$140.52
|
| Rate for Payer: Cigna All Commercial |
$237.78
|
| Rate for Payer: CORVEL All Commercial |
$256.24
|
| Rate for Payer: Coventry All Commercial |
$242.47
|
| Rate for Payer: Encore All Commercial |
$253.63
|
| Rate for Payer: Frontpath All Commercial |
$253.49
|
| Rate for Payer: Humana ChoiceCare |
$237.98
|
| Rate for Payer: Humana Medicare |
$140.52
|
| Rate for Payer: Lucent All Commercial |
$140.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$247.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$206.65
|
| Rate for Payer: PHP All Commercial |
$208.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.46
|
| Rate for Payer: Sagamore Health Network All Products |
$212.71
|
| Rate for Payer: Signature Care EPO |
$228.69
|
| Rate for Payer: Signature Care PPO |
$242.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$234.20
|
| Rate for Payer: United Healthcare Commercial |
$217.12
|
| Rate for Payer: United Healthcare Medicare |
$90.92
|
|
|
HC ENDOLOOP O PDS EZ10G
|
Facility
IP
|
$275.53
|
|
| Hospital Charge Code |
41602078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.65 |
| Max. Negotiated Rate |
$256.24 |
| Rate for Payer: Aetna Commercial |
$238.06
|
| Rate for Payer: Cash Price |
$170.83
|
| Rate for Payer: Cigna All Commercial |
$237.78
|
| Rate for Payer: CORVEL All Commercial |
$256.24
|
| Rate for Payer: Coventry All Commercial |
$242.47
|
| Rate for Payer: Encore All Commercial |
$253.63
|
| Rate for Payer: Frontpath All Commercial |
$253.49
|
| Rate for Payer: Humana ChoiceCare |
$237.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$247.98
|
| Rate for Payer: PHCS All Commercial |
$206.65
|
| Rate for Payer: PHP All Commercial |
$208.96
|
| Rate for Payer: Sagamore Health Network All Products |
$212.71
|
| Rate for Payer: Signature Care EPO |
$228.69
|
| Rate for Payer: Signature Care PPO |
$242.47
|
| Rate for Payer: United Healthcare Commercial |
$217.12
|
|
|
HC ENDO MINI LAP GRASPER
|
Facility
IP
|
$1,325.00
|
|
| Hospital Charge Code |
41602150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$1,232.25 |
| Rate for Payer: Aetna Commercial |
$1,144.80
|
| Rate for Payer: Cash Price |
$821.50
|
| Rate for Payer: Cigna All Commercial |
$1,143.48
|
| Rate for Payer: CORVEL All Commercial |
$1,232.25
|
| Rate for Payer: Coventry All Commercial |
$1,166.00
|
| Rate for Payer: Encore All Commercial |
$1,219.66
|
| Rate for Payer: Frontpath All Commercial |
$1,219.00
|
| Rate for Payer: Humana ChoiceCare |
$1,144.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,192.50
|
| Rate for Payer: PHCS All Commercial |
$993.75
|
| Rate for Payer: PHP All Commercial |
$1,004.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,022.90
|
| Rate for Payer: Signature Care EPO |
$1,099.75
|
| Rate for Payer: Signature Care PPO |
$1,166.00
|
| Rate for Payer: United Healthcare Commercial |
$1,044.10
|
|
|
HC ENDO MINI LAP GRASPER
|
Facility
OP
|
$1,325.00
|
|
| Hospital Charge Code |
41602150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,232.25 |
| Rate for Payer: Aetna Commercial |
$1,118.30
|
| Rate for Payer: Aetna Medicare |
$437.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$437.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$760.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$828.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$502.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$480.98
|
| Rate for Payer: Cash Price |
$821.50
|
| Rate for Payer: Cash Price |
$821.50
|
| Rate for Payer: Centivo All Commercial |
$675.75
|
| Rate for Payer: Cigna All Commercial |
$1,143.48
|
| Rate for Payer: CORVEL All Commercial |
$1,232.25
|
| Rate for Payer: Coventry All Commercial |
$1,166.00
|
| Rate for Payer: Encore All Commercial |
$1,219.66
|
| Rate for Payer: Frontpath All Commercial |
$1,219.00
|
| Rate for Payer: Humana ChoiceCare |
$1,144.40
|
| Rate for Payer: Humana Medicare |
$675.75
|
| Rate for Payer: Lucent All Commercial |
$675.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,192.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$993.75
|
| Rate for Payer: PHP All Commercial |
$1,004.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$516.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,022.90
|
| Rate for Payer: Signature Care EPO |
$1,099.75
|
| Rate for Payer: Signature Care PPO |
$1,166.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,126.25
|
| Rate for Payer: United Healthcare Commercial |
$1,044.10
|
| Rate for Payer: United Healthcare Medicare |
$437.25
|
|
|
HC ENDOPATH 5MM CURVED
|
Facility
OP
|
$387.63
|
|
| Hospital Charge Code |
41608027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$360.50 |
| Rate for Payer: Aetna Commercial |
$327.16
|
| Rate for Payer: Aetna Medicare |
$127.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$127.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$222.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$242.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.71
|
| Rate for Payer: Cash Price |
$240.33
|
| Rate for Payer: Cash Price |
$240.33
|
| Rate for Payer: Centivo All Commercial |
$197.69
|
| Rate for Payer: Cigna All Commercial |
$334.52
|
| Rate for Payer: CORVEL All Commercial |
$360.50
|
| Rate for Payer: Coventry All Commercial |
$341.11
|
| Rate for Payer: Encore All Commercial |
$356.81
|
| Rate for Payer: Frontpath All Commercial |
$356.62
|
| Rate for Payer: Humana ChoiceCare |
$334.80
|
| Rate for Payer: Humana Medicare |
$197.69
|
| Rate for Payer: Lucent All Commercial |
$197.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$348.87
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$290.72
|
| Rate for Payer: PHP All Commercial |
$293.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.18
|
| Rate for Payer: Sagamore Health Network All Products |
$299.25
|
| Rate for Payer: Signature Care EPO |
$321.73
|
| Rate for Payer: Signature Care PPO |
$341.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$329.49
|
| Rate for Payer: United Healthcare Commercial |
$305.45
|
| Rate for Payer: United Healthcare Medicare |
$127.92
|
|
|
HC ENDOPATH 5MM CURVED
|
Facility
IP
|
$387.63
|
|
| Hospital Charge Code |
41608027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$290.72 |
| Max. Negotiated Rate |
$360.50 |
| Rate for Payer: Aetna Commercial |
$334.91
|
| Rate for Payer: Cash Price |
$240.33
|
| Rate for Payer: Cigna All Commercial |
$334.52
|
| Rate for Payer: CORVEL All Commercial |
$360.50
|
| Rate for Payer: Coventry All Commercial |
$341.11
|
| Rate for Payer: Encore All Commercial |
$356.81
|
| Rate for Payer: Frontpath All Commercial |
$356.62
|
| Rate for Payer: Humana ChoiceCare |
$334.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$348.87
|
| Rate for Payer: PHCS All Commercial |
$290.72
|
| Rate for Payer: PHP All Commercial |
$293.98
|
| Rate for Payer: Sagamore Health Network All Products |
$299.25
|
| Rate for Payer: Signature Care EPO |
$321.73
|
| Rate for Payer: Signature Care PPO |
$341.11
|
| Rate for Payer: United Healthcare Commercial |
$305.45
|
|
|
HC ENDO PEANUT 5MM
|
Facility
IP
|
$173.53
|
|
| Hospital Charge Code |
41601915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.15 |
| Max. Negotiated Rate |
$161.38 |
| Rate for Payer: Aetna Commercial |
$149.93
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Cigna All Commercial |
$149.76
|
| Rate for Payer: CORVEL All Commercial |
$161.38
|
| Rate for Payer: Coventry All Commercial |
$152.71
|
| Rate for Payer: Encore All Commercial |
$159.73
|
| Rate for Payer: Frontpath All Commercial |
$159.65
|
| Rate for Payer: Humana ChoiceCare |
$149.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.18
|
| Rate for Payer: PHCS All Commercial |
$130.15
|
| Rate for Payer: PHP All Commercial |
$131.61
|
| Rate for Payer: Sagamore Health Network All Products |
$133.97
|
| Rate for Payer: Signature Care EPO |
$144.03
|
| Rate for Payer: Signature Care PPO |
$152.71
|
| Rate for Payer: United Healthcare Commercial |
$136.74
|
|
|
HC ENDO PEANUT 5MM
|
Facility
OP
|
$173.53
|
|
| Hospital Charge Code |
41601915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.26 |
| Max. Negotiated Rate |
$161.38 |
| Rate for Payer: Aetna Commercial |
$146.46
|
| Rate for Payer: Aetna Medicare |
$57.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.99
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Centivo All Commercial |
$88.50
|
| Rate for Payer: Cigna All Commercial |
$149.76
|
| Rate for Payer: CORVEL All Commercial |
$161.38
|
| Rate for Payer: Coventry All Commercial |
$152.71
|
| Rate for Payer: Encore All Commercial |
$159.73
|
| Rate for Payer: Frontpath All Commercial |
$159.65
|
| Rate for Payer: Humana ChoiceCare |
$149.88
|
| Rate for Payer: Humana Medicare |
$88.50
|
| Rate for Payer: Lucent All Commercial |
$88.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$130.15
|
| Rate for Payer: PHP All Commercial |
$131.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.68
|
| Rate for Payer: Sagamore Health Network All Products |
$133.97
|
| Rate for Payer: Signature Care EPO |
$144.03
|
| Rate for Payer: Signature Care PPO |
$152.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.50
|
| Rate for Payer: United Healthcare Commercial |
$136.74
|
| Rate for Payer: United Healthcare Medicare |
$57.26
|
|
|
HC ENDOPOUCH RETRIEVER BAG
|
Facility
OP
|
$362.08
|
|
| Hospital Charge Code |
41608026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.49 |
| Max. Negotiated Rate |
$336.73 |
| Rate for Payer: Aetna Commercial |
$305.60
|
| Rate for Payer: Aetna Medicare |
$119.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$207.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.44
|
| Rate for Payer: Cash Price |
$224.49
|
| Rate for Payer: Cash Price |
$224.49
|
| Rate for Payer: Centivo All Commercial |
$184.66
|
| Rate for Payer: Cigna All Commercial |
$312.48
|
| Rate for Payer: CORVEL All Commercial |
$336.73
|
| Rate for Payer: Coventry All Commercial |
$318.63
|
| Rate for Payer: Encore All Commercial |
$333.29
|
| Rate for Payer: Frontpath All Commercial |
$333.11
|
| Rate for Payer: Humana ChoiceCare |
$312.73
|
| Rate for Payer: Humana Medicare |
$184.66
|
| Rate for Payer: Lucent All Commercial |
$184.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.87
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$271.56
|
| Rate for Payer: PHP All Commercial |
$274.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.21
|
| Rate for Payer: Sagamore Health Network All Products |
$279.53
|
| Rate for Payer: Signature Care EPO |
$300.53
|
| Rate for Payer: Signature Care PPO |
$318.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.77
|
| Rate for Payer: United Healthcare Commercial |
$285.32
|
| Rate for Payer: United Healthcare Medicare |
$119.49
|
|
|
HC ENDOPOUCH RETRIEVER BAG
|
Facility
IP
|
$362.08
|
|
| Hospital Charge Code |
41608026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.56 |
| Max. Negotiated Rate |
$336.73 |
| Rate for Payer: Aetna Commercial |
$312.84
|
| Rate for Payer: Cash Price |
$224.49
|
| Rate for Payer: Cigna All Commercial |
$312.48
|
| Rate for Payer: CORVEL All Commercial |
$336.73
|
| Rate for Payer: Coventry All Commercial |
$318.63
|
| Rate for Payer: Encore All Commercial |
$333.29
|
| Rate for Payer: Frontpath All Commercial |
$333.11
|
| Rate for Payer: Humana ChoiceCare |
$312.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.87
|
| Rate for Payer: PHCS All Commercial |
$271.56
|
| Rate for Payer: PHP All Commercial |
$274.60
|
| Rate for Payer: Sagamore Health Network All Products |
$279.53
|
| Rate for Payer: Signature Care EPO |
$300.53
|
| Rate for Payer: Signature Care PPO |
$318.63
|
| Rate for Payer: United Healthcare Commercial |
$285.32
|
|
|
HC ENDOSCOPIC CANN DRILL BIT 4.5
|
Facility
IP
|
$938.49
|
|
| Hospital Charge Code |
41603281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.87 |
| Max. Negotiated Rate |
$872.80 |
| Rate for Payer: Aetna Commercial |
$810.86
|
| Rate for Payer: Cash Price |
$581.86
|
| Rate for Payer: Cigna All Commercial |
$809.92
|
| Rate for Payer: CORVEL All Commercial |
$872.80
|
| Rate for Payer: Coventry All Commercial |
$825.87
|
| Rate for Payer: Encore All Commercial |
$863.88
|
| Rate for Payer: Frontpath All Commercial |
$863.41
|
| Rate for Payer: Humana ChoiceCare |
$810.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$844.64
|
| Rate for Payer: PHCS All Commercial |
$703.87
|
| Rate for Payer: PHP All Commercial |
$711.75
|
| Rate for Payer: Sagamore Health Network All Products |
$724.51
|
| Rate for Payer: Signature Care EPO |
$778.95
|
| Rate for Payer: Signature Care PPO |
$825.87
|
| Rate for Payer: United Healthcare Commercial |
$739.53
|
|
|
HC ENDOSCOPIC CANN DRILL BIT 4.5
|
Facility
OP
|
$938.49
|
|
| Hospital Charge Code |
41603281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$872.80 |
| Rate for Payer: Aetna Commercial |
$792.09
|
| Rate for Payer: Aetna Medicare |
$309.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$309.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$538.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$586.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$356.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$340.67
|
| Rate for Payer: Cash Price |
$581.86
|
| Rate for Payer: Cash Price |
$581.86
|
| Rate for Payer: Centivo All Commercial |
$478.63
|
| Rate for Payer: Cigna All Commercial |
$809.92
|
| Rate for Payer: CORVEL All Commercial |
$872.80
|
| Rate for Payer: Coventry All Commercial |
$825.87
|
| Rate for Payer: Encore All Commercial |
$863.88
|
| Rate for Payer: Frontpath All Commercial |
$863.41
|
| Rate for Payer: Humana ChoiceCare |
$810.57
|
| Rate for Payer: Humana Medicare |
$478.63
|
| Rate for Payer: Lucent All Commercial |
$478.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$844.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$703.87
|
| Rate for Payer: PHP All Commercial |
$711.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$366.01
|
| Rate for Payer: Sagamore Health Network All Products |
$724.51
|
| Rate for Payer: Signature Care EPO |
$778.95
|
| Rate for Payer: Signature Care PPO |
$825.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$797.72
|
| Rate for Payer: United Healthcare Commercial |
$739.53
|
| Rate for Payer: United Healthcare Medicare |
$309.70
|
|
|
HC ENDO SEAL CAP
|
Facility
IP
|
$2,025.00
|
|
| Hospital Charge Code |
41602304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,518.75 |
| Max. Negotiated Rate |
$1,883.25 |
| Rate for Payer: Aetna Commercial |
$1,749.60
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cigna All Commercial |
$1,747.58
|
| Rate for Payer: CORVEL All Commercial |
$1,883.25
|
| Rate for Payer: Coventry All Commercial |
$1,782.00
|
| Rate for Payer: Encore All Commercial |
$1,864.01
|
| Rate for Payer: Frontpath All Commercial |
$1,863.00
|
| Rate for Payer: Humana ChoiceCare |
$1,748.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,822.50
|
| Rate for Payer: PHCS All Commercial |
$1,518.75
|
| Rate for Payer: PHP All Commercial |
$1,535.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,563.30
|
| Rate for Payer: Signature Care EPO |
$1,680.75
|
| Rate for Payer: Signature Care PPO |
$1,782.00
|
| Rate for Payer: United Healthcare Commercial |
$1,595.70
|
|
|
HC ENDO SEAL CAP
|
Facility
OP
|
$2,025.00
|
|
| Hospital Charge Code |
41602304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,883.25 |
| Rate for Payer: Aetna Commercial |
$1,709.10
|
| Rate for Payer: Aetna Medicare |
$668.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$668.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,162.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,265.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$768.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$735.08
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Centivo All Commercial |
$1,032.75
|
| Rate for Payer: Cigna All Commercial |
$1,747.58
|
| Rate for Payer: CORVEL All Commercial |
$1,883.25
|
| Rate for Payer: Coventry All Commercial |
$1,782.00
|
| Rate for Payer: Encore All Commercial |
$1,864.01
|
| Rate for Payer: Frontpath All Commercial |
$1,863.00
|
| Rate for Payer: Humana ChoiceCare |
$1,748.99
|
| Rate for Payer: Humana Medicare |
$1,032.75
|
| Rate for Payer: Lucent All Commercial |
$1,032.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,822.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,518.75
|
| Rate for Payer: PHP All Commercial |
$1,535.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$789.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,563.30
|
| Rate for Payer: Signature Care EPO |
$1,680.75
|
| Rate for Payer: Signature Care PPO |
$1,782.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare Commercial |
$1,595.70
|
| Rate for Payer: United Healthcare Medicare |
$668.25
|
|
|
HC ENDOSHEARS 5MM
|
Facility
OP
|
$519.95
|
|
| Hospital Charge Code |
41601058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Aetna Commercial |
$438.84
|
| Rate for Payer: Aetna Medicare |
$171.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$171.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$298.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$325.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$197.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.74
|
| Rate for Payer: Cash Price |
$322.37
|
| Rate for Payer: Cash Price |
$322.37
|
| Rate for Payer: Centivo All Commercial |
$265.17
|
| Rate for Payer: Cigna All Commercial |
$448.72
|
| Rate for Payer: CORVEL All Commercial |
$483.55
|
| Rate for Payer: Coventry All Commercial |
$457.56
|
| Rate for Payer: Encore All Commercial |
$478.61
|
| Rate for Payer: Frontpath All Commercial |
$478.35
|
| Rate for Payer: Humana ChoiceCare |
$449.08
|
| Rate for Payer: Humana Medicare |
$265.17
|
| Rate for Payer: Lucent All Commercial |
$265.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$467.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$389.96
|
| Rate for Payer: PHP All Commercial |
$394.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.78
|
| Rate for Payer: Sagamore Health Network All Products |
$401.40
|
| Rate for Payer: Signature Care EPO |
$431.56
|
| Rate for Payer: Signature Care PPO |
$457.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.96
|
| Rate for Payer: United Healthcare Commercial |
$409.72
|
| Rate for Payer: United Healthcare Medicare |
$171.58
|
|
|
HC ENDOSHEARS 5MM
|
Facility
IP
|
$519.95
|
|
| Hospital Charge Code |
41601058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$389.96 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Aetna Commercial |
$449.24
|
| Rate for Payer: Cash Price |
$322.37
|
| Rate for Payer: Cigna All Commercial |
$448.72
|
| Rate for Payer: CORVEL All Commercial |
$483.55
|
| Rate for Payer: Coventry All Commercial |
$457.56
|
| Rate for Payer: Encore All Commercial |
$478.61
|
| Rate for Payer: Frontpath All Commercial |
$478.35
|
| Rate for Payer: Humana ChoiceCare |
$449.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$467.96
|
| Rate for Payer: PHCS All Commercial |
$389.96
|
| Rate for Payer: PHP All Commercial |
$394.33
|
| Rate for Payer: Sagamore Health Network All Products |
$401.40
|
| Rate for Payer: Signature Care EPO |
$431.56
|
| Rate for Payer: Signature Care PPO |
$457.56
|
| Rate for Payer: United Healthcare Commercial |
$409.72
|
|
|
HC ENDOSHEARS LONG W/MONOPOLAR CAUTERY
|
Facility
OP
|
$596.63
|
|
| Hospital Charge Code |
41601332
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$554.87 |
| Rate for Payer: Aetna Commercial |
$503.56
|
| Rate for Payer: Aetna Medicare |
$196.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$196.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$342.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$372.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$226.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$216.58
|
| Rate for Payer: Cash Price |
$369.91
|
| Rate for Payer: Cash Price |
$369.91
|
| Rate for Payer: Centivo All Commercial |
$304.28
|
| Rate for Payer: Cigna All Commercial |
$514.89
|
| Rate for Payer: CORVEL All Commercial |
$554.87
|
| Rate for Payer: Coventry All Commercial |
$525.03
|
| Rate for Payer: Encore All Commercial |
$549.20
|
| Rate for Payer: Frontpath All Commercial |
$548.90
|
| Rate for Payer: Humana ChoiceCare |
$515.31
|
| Rate for Payer: Humana Medicare |
$304.28
|
| Rate for Payer: Lucent All Commercial |
$304.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$536.97
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$447.47
|
| Rate for Payer: PHP All Commercial |
$452.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$232.69
|
| Rate for Payer: Sagamore Health Network All Products |
$460.60
|
| Rate for Payer: Signature Care EPO |
$495.20
|
| Rate for Payer: Signature Care PPO |
$525.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$507.14
|
| Rate for Payer: United Healthcare Commercial |
$470.14
|
| Rate for Payer: United Healthcare Medicare |
$196.89
|
|
|
HC ENDOSHEARS LONG W/MONOPOLAR CAUTERY
|
Facility
IP
|
$596.63
|
|
| Hospital Charge Code |
41601332
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$447.47 |
| Max. Negotiated Rate |
$554.87 |
| Rate for Payer: Aetna Commercial |
$515.49
|
| Rate for Payer: Cash Price |
$369.91
|
| Rate for Payer: Cigna All Commercial |
$514.89
|
| Rate for Payer: CORVEL All Commercial |
$554.87
|
| Rate for Payer: Coventry All Commercial |
$525.03
|
| Rate for Payer: Encore All Commercial |
$549.20
|
| Rate for Payer: Frontpath All Commercial |
$548.90
|
| Rate for Payer: Humana ChoiceCare |
$515.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$536.97
|
| Rate for Payer: PHCS All Commercial |
$447.47
|
| Rate for Payer: PHP All Commercial |
$452.48
|
| Rate for Payer: Sagamore Health Network All Products |
$460.60
|
| Rate for Payer: Signature Care EPO |
$495.20
|
| Rate for Payer: Signature Care PPO |
$525.03
|
| Rate for Payer: United Healthcare Commercial |
$470.14
|
|
|
HC ENDOSTITCH
|
Facility
OP
|
$814.03
|
|
| Hospital Charge Code |
41601865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$757.05 |
| Rate for Payer: Aetna Commercial |
$687.04
|
| Rate for Payer: Aetna Medicare |
$268.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$268.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$467.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$508.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$308.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$295.49
|
| Rate for Payer: Cash Price |
$504.70
|
| Rate for Payer: Cash Price |
$504.70
|
| Rate for Payer: Centivo All Commercial |
$415.16
|
| Rate for Payer: Cigna All Commercial |
$702.51
|
| Rate for Payer: CORVEL All Commercial |
$757.05
|
| Rate for Payer: Coventry All Commercial |
$716.35
|
| Rate for Payer: Encore All Commercial |
$749.31
|
| Rate for Payer: Frontpath All Commercial |
$748.91
|
| Rate for Payer: Humana ChoiceCare |
$703.08
|
| Rate for Payer: Humana Medicare |
$415.16
|
| Rate for Payer: Lucent All Commercial |
$415.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$732.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$610.52
|
| Rate for Payer: PHP All Commercial |
$617.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$317.47
|
| Rate for Payer: Sagamore Health Network All Products |
$628.43
|
| Rate for Payer: Signature Care EPO |
$675.64
|
| Rate for Payer: Signature Care PPO |
$716.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$691.93
|
| Rate for Payer: United Healthcare Commercial |
$641.46
|
| Rate for Payer: United Healthcare Medicare |
$268.63
|
|
|
HC ENDOSTITCH
|
Facility
IP
|
$814.03
|
|
| Hospital Charge Code |
41601865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.52 |
| Max. Negotiated Rate |
$757.05 |
| Rate for Payer: Aetna Commercial |
$703.32
|
| Rate for Payer: Cash Price |
$504.70
|
| Rate for Payer: Cigna All Commercial |
$702.51
|
| Rate for Payer: CORVEL All Commercial |
$757.05
|
| Rate for Payer: Coventry All Commercial |
$716.35
|
| Rate for Payer: Encore All Commercial |
$749.31
|
| Rate for Payer: Frontpath All Commercial |
$748.91
|
| Rate for Payer: Humana ChoiceCare |
$703.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$732.63
|
| Rate for Payer: PHCS All Commercial |
$610.52
|
| Rate for Payer: PHP All Commercial |
$617.36
|
| Rate for Payer: Sagamore Health Network All Products |
$628.43
|
| Rate for Payer: Signature Care EPO |
$675.64
|
| Rate for Payer: Signature Care PPO |
$716.35
|
| Rate for Payer: United Healthcare Commercial |
$641.46
|
|
