|
HC ENDO CLIP APPLIER 5MM
|
Facility
|
IP
|
$832.50
|
|
| Hospital Charge Code |
41601914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.38 |
| Max. Negotiated Rate |
$774.23 |
| Rate for Payer: Aetna Commercial |
$719.28
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cigna All Commercial |
$718.45
|
| Rate for Payer: CORVEL All Commercial |
$774.23
|
| Rate for Payer: Coventry All Commercial |
$732.60
|
| Rate for Payer: Encore All Commercial |
$766.32
|
| Rate for Payer: Frontpath All Commercial |
$765.90
|
| Rate for Payer: Humana ChoiceCare |
$719.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$749.25
|
| Rate for Payer: PHCS All Commercial |
$624.38
|
| Rate for Payer: PHP All Commercial |
$631.37
|
| Rate for Payer: Sagamore Health Network All Products |
$642.69
|
| Rate for Payer: Signature Care EPO |
$690.98
|
| Rate for Payer: Signature Care PPO |
$732.60
|
| Rate for Payer: United Healthcare Commercial |
$656.01
|
|
|
HC ENDO CLIP APPLIER 5MM
|
Facility
|
OP
|
$832.50
|
|
| Hospital Charge Code |
41601914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$774.23 |
| Rate for Payer: Aetna Commercial |
$702.63
|
| Rate for Payer: Aetna Medicare |
$266.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$258.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$478.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$520.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$306.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$293.04
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Centivo All Commercial |
$452.88
|
| Rate for Payer: Cigna All Commercial |
$718.45
|
| Rate for Payer: CORVEL All Commercial |
$774.23
|
| Rate for Payer: Coventry All Commercial |
$732.60
|
| Rate for Payer: Encore All Commercial |
$766.32
|
| Rate for Payer: Frontpath All Commercial |
$765.90
|
| Rate for Payer: Humana ChoiceCare |
$719.03
|
| Rate for Payer: Humana Medicare |
$266.40
|
| Rate for Payer: Lucent All Commercial |
$452.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$749.25
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$624.38
|
| Rate for Payer: PHP All Commercial |
$631.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$324.68
|
| Rate for Payer: Sagamore Health Network All Products |
$642.69
|
| Rate for Payer: Signature Care EPO |
$690.98
|
| Rate for Payer: Signature Care PPO |
$732.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$707.62
|
| Rate for Payer: United Healthcare Commercial |
$656.01
|
| Rate for Payer: United Healthcare Medicare |
$266.40
|
|
|
HC ENDOCUFF VISION LG
|
Facility
|
OP
|
$187.25
|
|
| Hospital Charge Code |
41607442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$158.04
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.91
|
| Rate for Payer: Cash Price |
$112.35
|
| Rate for Payer: Cash Price |
$112.35
|
| Rate for Payer: Centivo All Commercial |
$101.86
|
| 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 |
$59.92
|
| Rate for Payer: Lucent All Commercial |
$101.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.53
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$59.92
|
|
|
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 |
$112.35
|
| 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 |
$168.53
|
| 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 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 |
$34.84
|
| 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 JAW WITH NEEDLE
|
Facility
|
OP
|
$58.07
|
|
| Hospital Charge Code |
41607496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$54.01 |
| Rate for Payer: Aetna Commercial |
$49.01
|
| Rate for Payer: Aetna Medicare |
$18.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.44
|
| Rate for Payer: Cash Price |
$34.84
|
| Rate for Payer: Cash Price |
$34.84
|
| Rate for Payer: Centivo All Commercial |
$31.59
|
| 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 |
$18.58
|
| Rate for Payer: Lucent All Commercial |
$31.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.26
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$18.58
|
|
|
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 |
$330.80
|
| 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 ENDO LIGACLIP MCA 10MM
|
Facility
|
OP
|
$551.34
|
|
| Hospital Charge Code |
41607941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$512.75 |
| Rate for Payer: Aetna Commercial |
$465.33
|
| Rate for Payer: Aetna Medicare |
$176.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$316.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$344.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$202.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$194.07
|
| Rate for Payer: Cash Price |
$330.80
|
| Rate for Payer: Cash Price |
$330.80
|
| Rate for Payer: Centivo All Commercial |
$299.93
|
| 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 |
$176.43
|
| Rate for Payer: Lucent All Commercial |
$299.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$496.21
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$176.43
|
|
|
HC ENDOLOOP O PDS EZ10G
|
Facility
|
IP
|
$206.96
|
|
| Hospital Charge Code |
41602078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.22 |
| Max. Negotiated Rate |
$192.47 |
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cigna All Commercial |
$178.61
|
| Rate for Payer: CORVEL All Commercial |
$192.47
|
| Rate for Payer: Coventry All Commercial |
$182.12
|
| Rate for Payer: Encore All Commercial |
$190.51
|
| Rate for Payer: Frontpath All Commercial |
$190.40
|
| Rate for Payer: Humana ChoiceCare |
$178.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.26
|
| Rate for Payer: PHCS All Commercial |
$155.22
|
| Rate for Payer: PHP All Commercial |
$156.96
|
| Rate for Payer: Sagamore Health Network All Products |
$159.77
|
| Rate for Payer: Signature Care EPO |
$171.78
|
| Rate for Payer: Signature Care PPO |
$182.12
|
| Rate for Payer: United Healthcare Commercial |
$163.08
|
|
|
HC ENDOLOOP O PDS EZ10G
|
Facility
|
OP
|
$206.96
|
|
| Hospital Charge Code |
41602078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$192.47 |
| Rate for Payer: Aetna Commercial |
$174.67
|
| Rate for Payer: Aetna Medicare |
$66.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$118.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.85
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Centivo All Commercial |
$112.59
|
| Rate for Payer: Cigna All Commercial |
$178.61
|
| Rate for Payer: CORVEL All Commercial |
$192.47
|
| Rate for Payer: Coventry All Commercial |
$182.12
|
| Rate for Payer: Encore All Commercial |
$190.51
|
| Rate for Payer: Frontpath All Commercial |
$190.40
|
| Rate for Payer: Humana ChoiceCare |
$178.75
|
| Rate for Payer: Humana Medicare |
$66.23
|
| Rate for Payer: Lucent All Commercial |
$112.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.26
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$155.22
|
| Rate for Payer: PHP All Commercial |
$156.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.71
|
| Rate for Payer: Sagamore Health Network All Products |
$159.77
|
| Rate for Payer: Signature Care EPO |
$171.78
|
| Rate for Payer: Signature Care PPO |
$182.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.92
|
| Rate for Payer: United Healthcare Commercial |
$163.08
|
| Rate for Payer: United Healthcare Medicare |
$66.23
|
|
|
HC ENDOPATH 5MM CURVED
|
Facility
|
IP
|
$199.35
|
|
| Hospital Charge Code |
41608027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna Commercial |
$172.24
|
| Rate for Payer: Cash Price |
$119.61
|
| Rate for Payer: Cigna All Commercial |
$172.04
|
| Rate for Payer: CORVEL All Commercial |
$185.40
|
| Rate for Payer: Coventry All Commercial |
$175.43
|
| Rate for Payer: Encore All Commercial |
$183.50
|
| Rate for Payer: Frontpath All Commercial |
$183.40
|
| Rate for Payer: Humana ChoiceCare |
$172.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.41
|
| Rate for Payer: PHCS All Commercial |
$149.51
|
| Rate for Payer: PHP All Commercial |
$151.19
|
| Rate for Payer: Sagamore Health Network All Products |
$153.90
|
| Rate for Payer: Signature Care EPO |
$165.46
|
| Rate for Payer: Signature Care PPO |
$175.43
|
| Rate for Payer: United Healthcare Commercial |
$157.09
|
|
|
HC ENDOPATH 5MM CURVED
|
Facility
|
OP
|
$199.35
|
|
| Hospital Charge Code |
41608027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna Commercial |
$168.25
|
| Rate for Payer: Aetna Medicare |
$63.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$114.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.17
|
| Rate for Payer: Cash Price |
$119.61
|
| Rate for Payer: Cash Price |
$119.61
|
| Rate for Payer: Centivo All Commercial |
$108.45
|
| Rate for Payer: Cigna All Commercial |
$172.04
|
| Rate for Payer: CORVEL All Commercial |
$185.40
|
| Rate for Payer: Coventry All Commercial |
$175.43
|
| Rate for Payer: Encore All Commercial |
$183.50
|
| Rate for Payer: Frontpath All Commercial |
$183.40
|
| Rate for Payer: Humana ChoiceCare |
$172.18
|
| Rate for Payer: Humana Medicare |
$63.79
|
| Rate for Payer: Lucent All Commercial |
$108.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.41
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$149.51
|
| Rate for Payer: PHP All Commercial |
$151.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.75
|
| Rate for Payer: Sagamore Health Network All Products |
$153.90
|
| Rate for Payer: Signature Care EPO |
$165.46
|
| Rate for Payer: Signature Care PPO |
$175.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$169.45
|
| Rate for Payer: United Healthcare Commercial |
$157.09
|
| Rate for Payer: United Healthcare Medicare |
$63.79
|
|
|
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 |
$104.12
|
| 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 |
$31.20 |
| Max. Negotiated Rate |
$161.38 |
| Rate for Payer: Aetna Commercial |
$146.46
|
| Rate for Payer: Aetna Medicare |
$55.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$99.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.08
|
| Rate for Payer: Cash Price |
$104.12
|
| Rate for Payer: Cash Price |
$104.12
|
| Rate for Payer: Centivo All Commercial |
$94.40
|
| 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 |
$55.53
|
| Rate for Payer: Lucent All Commercial |
$94.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.18
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$55.53
|
|
|
HC ENDOPOUCH RETRIEVER BAG
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
41608026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$295.40
|
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$201.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.20
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Centivo All Commercial |
$190.40
|
| Rate for Payer: Cigna All Commercial |
$302.05
|
| Rate for Payer: CORVEL All Commercial |
$325.50
|
| Rate for Payer: Coventry All Commercial |
$308.00
|
| Rate for Payer: Encore All Commercial |
$322.18
|
| Rate for Payer: Frontpath All Commercial |
$322.00
|
| Rate for Payer: Humana ChoiceCare |
$302.30
|
| Rate for Payer: Humana Medicare |
$112.00
|
| Rate for Payer: Lucent All Commercial |
$190.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: PHP All Commercial |
$265.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.50
|
| Rate for Payer: Sagamore Health Network All Products |
$270.20
|
| Rate for Payer: Signature Care EPO |
$290.50
|
| Rate for Payer: Signature Care PPO |
$308.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.50
|
| Rate for Payer: United Healthcare Commercial |
$275.80
|
| Rate for Payer: United Healthcare Medicare |
$112.00
|
|
|
HC ENDOPOUCH RETRIEVER BAG
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
41608026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna All Commercial |
$302.05
|
| Rate for Payer: CORVEL All Commercial |
$325.50
|
| Rate for Payer: Coventry All Commercial |
$308.00
|
| Rate for Payer: Encore All Commercial |
$322.18
|
| Rate for Payer: Frontpath All Commercial |
$322.00
|
| Rate for Payer: Humana ChoiceCare |
$302.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: PHP All Commercial |
$265.44
|
| Rate for Payer: Sagamore Health Network All Products |
$270.20
|
| Rate for Payer: Signature Care EPO |
$290.50
|
| Rate for Payer: Signature Care PPO |
$308.00
|
| Rate for Payer: United Healthcare Commercial |
$275.80
|
|
|
HC ENDOSHEARS 5MM
|
Facility
|
IP
|
$503.58
|
|
| Hospital Charge Code |
41601058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.69 |
| Max. Negotiated Rate |
$468.33 |
| Rate for Payer: Aetna Commercial |
$435.09
|
| Rate for Payer: Cash Price |
$302.15
|
| Rate for Payer: Cigna All Commercial |
$434.59
|
| Rate for Payer: CORVEL All Commercial |
$468.33
|
| Rate for Payer: Coventry All Commercial |
$443.15
|
| Rate for Payer: Encore All Commercial |
$463.55
|
| Rate for Payer: Frontpath All Commercial |
$463.29
|
| Rate for Payer: Humana ChoiceCare |
$434.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.22
|
| Rate for Payer: PHCS All Commercial |
$377.69
|
| Rate for Payer: PHP All Commercial |
$381.92
|
| Rate for Payer: Sagamore Health Network All Products |
$388.76
|
| Rate for Payer: Signature Care EPO |
$417.97
|
| Rate for Payer: Signature Care PPO |
$443.15
|
| Rate for Payer: United Healthcare Commercial |
$396.82
|
|
|
HC ENDOSHEARS 5MM
|
Facility
|
OP
|
$503.58
|
|
| Hospital Charge Code |
41601058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$468.33 |
| Rate for Payer: Aetna Commercial |
$425.02
|
| Rate for Payer: Aetna Medicare |
$161.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$156.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$289.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$314.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$185.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$177.26
|
| Rate for Payer: Cash Price |
$302.15
|
| Rate for Payer: Cash Price |
$302.15
|
| Rate for Payer: Centivo All Commercial |
$273.95
|
| Rate for Payer: Cigna All Commercial |
$434.59
|
| Rate for Payer: CORVEL All Commercial |
$468.33
|
| Rate for Payer: Coventry All Commercial |
$443.15
|
| Rate for Payer: Encore All Commercial |
$463.55
|
| Rate for Payer: Frontpath All Commercial |
$463.29
|
| Rate for Payer: Humana ChoiceCare |
$434.94
|
| Rate for Payer: Humana Medicare |
$161.15
|
| Rate for Payer: Lucent All Commercial |
$273.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.22
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$377.69
|
| Rate for Payer: PHP All Commercial |
$381.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$196.40
|
| Rate for Payer: Sagamore Health Network All Products |
$388.76
|
| Rate for Payer: Signature Care EPO |
$417.97
|
| Rate for Payer: Signature Care PPO |
$443.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$428.04
|
| Rate for Payer: United Healthcare Commercial |
$396.82
|
| Rate for Payer: United Healthcare Medicare |
$161.15
|
|
|
HC ENDO TUBE PORT CUFF 5.0
|
Facility
|
IP
|
$16.87
|
|
| Hospital Charge Code |
41601414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$15.69 |
| Rate for Payer: Aetna Commercial |
$14.58
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cigna All Commercial |
$14.56
|
| Rate for Payer: CORVEL All Commercial |
$15.69
|
| Rate for Payer: Coventry All Commercial |
$14.85
|
| Rate for Payer: Encore All Commercial |
$15.53
|
| Rate for Payer: Frontpath All Commercial |
$15.52
|
| Rate for Payer: Humana ChoiceCare |
$14.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.18
|
| Rate for Payer: PHCS All Commercial |
$12.65
|
| Rate for Payer: PHP All Commercial |
$12.79
|
| Rate for Payer: Sagamore Health Network All Products |
$13.02
|
| Rate for Payer: Signature Care EPO |
$14.00
|
| Rate for Payer: Signature Care PPO |
$14.85
|
| Rate for Payer: United Healthcare Commercial |
$13.29
|
|
|
HC ENDO TUBE PORT CUFF 5.0
|
Facility
|
OP
|
$16.87
|
|
| Hospital Charge Code |
41601414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna Medicare |
$5.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.94
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$14.56
|
| Rate for Payer: CORVEL All Commercial |
$15.69
|
| Rate for Payer: Coventry All Commercial |
$14.85
|
| Rate for Payer: Encore All Commercial |
$15.53
|
| Rate for Payer: Frontpath All Commercial |
$15.52
|
| Rate for Payer: Humana ChoiceCare |
$14.57
|
| Rate for Payer: Humana Medicare |
$5.40
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.18
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.65
|
| Rate for Payer: PHP All Commercial |
$12.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.58
|
| Rate for Payer: Sagamore Health Network All Products |
$13.02
|
| Rate for Payer: Signature Care EPO |
$14.00
|
| Rate for Payer: Signature Care PPO |
$14.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.34
|
| Rate for Payer: United Healthcare Commercial |
$13.29
|
| Rate for Payer: United Healthcare Medicare |
$5.40
|
|
|
HC ENDO TUBE PORT CUFF 5.5
|
Facility
|
IP
|
$16.94
|
|
| Hospital Charge Code |
41601415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$14.64
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Cigna All Commercial |
$14.62
|
| Rate for Payer: CORVEL All Commercial |
$15.75
|
| Rate for Payer: Coventry All Commercial |
$14.91
|
| Rate for Payer: Encore All Commercial |
$15.59
|
| Rate for Payer: Frontpath All Commercial |
$15.58
|
| Rate for Payer: Humana ChoiceCare |
$14.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.25
|
| Rate for Payer: PHCS All Commercial |
$12.71
|
| Rate for Payer: PHP All Commercial |
$12.85
|
| Rate for Payer: Sagamore Health Network All Products |
$13.08
|
| Rate for Payer: Signature Care EPO |
$14.06
|
| Rate for Payer: Signature Care PPO |
$14.91
|
| Rate for Payer: United Healthcare Commercial |
$13.35
|
|
|
HC ENDO TUBE PORT CUFF 5.5
|
Facility
|
OP
|
$16.94
|
|
| Hospital Charge Code |
41601415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Medicare |
$5.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.96
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Centivo All Commercial |
$9.22
|
| Rate for Payer: Cigna All Commercial |
$14.62
|
| Rate for Payer: CORVEL All Commercial |
$15.75
|
| Rate for Payer: Coventry All Commercial |
$14.91
|
| Rate for Payer: Encore All Commercial |
$15.59
|
| Rate for Payer: Frontpath All Commercial |
$15.58
|
| Rate for Payer: Humana ChoiceCare |
$14.63
|
| Rate for Payer: Humana Medicare |
$5.42
|
| Rate for Payer: Lucent All Commercial |
$9.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.25
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.71
|
| Rate for Payer: PHP All Commercial |
$12.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.61
|
| Rate for Payer: Sagamore Health Network All Products |
$13.08
|
| Rate for Payer: Signature Care EPO |
$14.06
|
| Rate for Payer: Signature Care PPO |
$14.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.40
|
| Rate for Payer: United Healthcare Commercial |
$13.35
|
| Rate for Payer: United Healthcare Medicare |
$5.42
|
|
|
HC ENDO TUBE PORT CUFF 6.0
|
Facility
|
IP
|
$17.29
|
|
| Hospital Charge Code |
41601416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$16.08 |
| Rate for Payer: Aetna Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$10.37
|
| Rate for Payer: Cigna All Commercial |
$14.92
|
| Rate for Payer: CORVEL All Commercial |
$16.08
|
| Rate for Payer: Coventry All Commercial |
$15.22
|
| Rate for Payer: Encore All Commercial |
$15.92
|
| Rate for Payer: Frontpath All Commercial |
$15.91
|
| Rate for Payer: Humana ChoiceCare |
$14.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.56
|
| Rate for Payer: PHCS All Commercial |
$12.97
|
| Rate for Payer: PHP All Commercial |
$13.11
|
| Rate for Payer: Sagamore Health Network All Products |
$13.35
|
| Rate for Payer: Signature Care EPO |
$14.35
|
| Rate for Payer: Signature Care PPO |
$15.22
|
| Rate for Payer: United Healthcare Commercial |
$13.62
|
|
|
HC ENDO TUBE PORT CUFF 6.0
|
Facility
|
OP
|
$17.29
|
|
| Hospital Charge Code |
41601416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.59
|
| Rate for Payer: Aetna Medicare |
$5.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.09
|
| Rate for Payer: Cash Price |
$10.37
|
| Rate for Payer: Cash Price |
$10.37
|
| Rate for Payer: Centivo All Commercial |
$9.41
|
| Rate for Payer: Cigna All Commercial |
$14.92
|
| Rate for Payer: CORVEL All Commercial |
$16.08
|
| Rate for Payer: Coventry All Commercial |
$15.22
|
| Rate for Payer: Encore All Commercial |
$15.92
|
| Rate for Payer: Frontpath All Commercial |
$15.91
|
| Rate for Payer: Humana ChoiceCare |
$14.93
|
| Rate for Payer: Humana Medicare |
$5.53
|
| Rate for Payer: Lucent All Commercial |
$9.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.56
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.97
|
| Rate for Payer: PHP All Commercial |
$13.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.74
|
| Rate for Payer: Sagamore Health Network All Products |
$13.35
|
| Rate for Payer: Signature Care EPO |
$14.35
|
| Rate for Payer: Signature Care PPO |
$15.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.70
|
| Rate for Payer: United Healthcare Commercial |
$13.62
|
| Rate for Payer: United Healthcare Medicare |
$5.53
|
|
|
HC ENDO TUBE PORT CUFF 6.5
|
Facility
|
IP
|
$17.01
|
|
| Hospital Charge Code |
41601046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Aetna Commercial |
$14.70
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cigna All Commercial |
$14.68
|
| Rate for Payer: CORVEL All Commercial |
$15.82
|
| Rate for Payer: Coventry All Commercial |
$14.97
|
| Rate for Payer: Encore All Commercial |
$15.66
|
| Rate for Payer: Frontpath All Commercial |
$15.65
|
| Rate for Payer: Humana ChoiceCare |
$14.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.31
|
| Rate for Payer: PHCS All Commercial |
$12.76
|
| Rate for Payer: PHP All Commercial |
$12.90
|
| Rate for Payer: Sagamore Health Network All Products |
$13.13
|
| Rate for Payer: Signature Care EPO |
$14.12
|
| Rate for Payer: Signature Care PPO |
$14.97
|
| Rate for Payer: United Healthcare Commercial |
$13.40
|
|
