|
HC RELOAD ENDO GIA 60-2.5
|
Facility
OP
|
$1,390.11
|
|
| Hospital Charge Code |
41601976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,292.80 |
| Rate for Payer: Aetna Commercial |
$1,173.25
|
| Rate for Payer: Aetna Medicare |
$458.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$458.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$798.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$868.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$527.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$504.61
|
| Rate for Payer: Cash Price |
$861.87
|
| Rate for Payer: Cash Price |
$861.87
|
| Rate for Payer: Centivo All Commercial |
$708.96
|
| Rate for Payer: Cigna All Commercial |
$1,199.66
|
| Rate for Payer: CORVEL All Commercial |
$1,292.80
|
| Rate for Payer: Coventry All Commercial |
$1,223.30
|
| Rate for Payer: Encore All Commercial |
$1,279.60
|
| Rate for Payer: Frontpath All Commercial |
$1,278.90
|
| Rate for Payer: Humana ChoiceCare |
$1,200.64
|
| Rate for Payer: Humana Medicare |
$708.96
|
| Rate for Payer: Lucent All Commercial |
$708.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,251.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,042.58
|
| Rate for Payer: PHP All Commercial |
$1,054.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$542.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,073.16
|
| Rate for Payer: Signature Care EPO |
$1,153.79
|
| Rate for Payer: Signature Care PPO |
$1,223.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,181.59
|
| Rate for Payer: United Healthcare Commercial |
$1,095.41
|
| Rate for Payer: United Healthcare Medicare |
$458.74
|
|
|
HC RELOAD ENDO GIA 60-2.5
|
Facility
IP
|
$1,390.11
|
|
| Hospital Charge Code |
41601976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,042.58 |
| Max. Negotiated Rate |
$1,292.80 |
| Rate for Payer: Aetna Commercial |
$1,201.06
|
| Rate for Payer: Cash Price |
$861.87
|
| Rate for Payer: Cigna All Commercial |
$1,199.66
|
| Rate for Payer: CORVEL All Commercial |
$1,292.80
|
| Rate for Payer: Coventry All Commercial |
$1,223.30
|
| Rate for Payer: Encore All Commercial |
$1,279.60
|
| Rate for Payer: Frontpath All Commercial |
$1,278.90
|
| Rate for Payer: Humana ChoiceCare |
$1,200.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,251.10
|
| Rate for Payer: PHCS All Commercial |
$1,042.58
|
| Rate for Payer: PHP All Commercial |
$1,054.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,073.16
|
| Rate for Payer: Signature Care EPO |
$1,153.79
|
| Rate for Payer: Signature Care PPO |
$1,223.30
|
| Rate for Payer: United Healthcare Commercial |
$1,095.41
|
|
|
HC RELOAD ENDO GIA 60-3.5
|
Facility
OP
|
$1,451.80
|
|
| Hospital Charge Code |
41601977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,350.17 |
| Rate for Payer: Aetna Commercial |
$1,225.32
|
| Rate for Payer: Aetna Medicare |
$479.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$479.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$833.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$907.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$550.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$527.00
|
| Rate for Payer: Cash Price |
$900.12
|
| Rate for Payer: Cash Price |
$900.12
|
| Rate for Payer: Centivo All Commercial |
$740.42
|
| Rate for Payer: Cigna All Commercial |
$1,252.90
|
| Rate for Payer: CORVEL All Commercial |
$1,350.17
|
| Rate for Payer: Coventry All Commercial |
$1,277.58
|
| Rate for Payer: Encore All Commercial |
$1,336.38
|
| Rate for Payer: Frontpath All Commercial |
$1,335.66
|
| Rate for Payer: Humana ChoiceCare |
$1,253.92
|
| Rate for Payer: Humana Medicare |
$740.42
|
| Rate for Payer: Lucent All Commercial |
$740.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,306.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,088.85
|
| Rate for Payer: PHP All Commercial |
$1,101.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$566.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,120.79
|
| Rate for Payer: Signature Care EPO |
$1,204.99
|
| Rate for Payer: Signature Care PPO |
$1,277.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,234.03
|
| Rate for Payer: United Healthcare Commercial |
$1,144.02
|
| Rate for Payer: United Healthcare Medicare |
$479.09
|
|
|
HC RELOAD ENDO GIA 60-3.5
|
Facility
IP
|
$1,451.80
|
|
| Hospital Charge Code |
41601977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,088.85 |
| Max. Negotiated Rate |
$1,350.17 |
| Rate for Payer: Aetna Commercial |
$1,254.36
|
| Rate for Payer: Cash Price |
$900.12
|
| Rate for Payer: Cigna All Commercial |
$1,252.90
|
| Rate for Payer: CORVEL All Commercial |
$1,350.17
|
| Rate for Payer: Coventry All Commercial |
$1,277.58
|
| Rate for Payer: Encore All Commercial |
$1,336.38
|
| Rate for Payer: Frontpath All Commercial |
$1,335.66
|
| Rate for Payer: Humana ChoiceCare |
$1,253.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,306.62
|
| Rate for Payer: PHCS All Commercial |
$1,088.85
|
| Rate for Payer: PHP All Commercial |
$1,101.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,120.79
|
| Rate for Payer: Signature Care EPO |
$1,204.99
|
| Rate for Payer: Signature Care PPO |
$1,277.58
|
| Rate for Payer: United Healthcare Commercial |
$1,144.02
|
|
|
HC RELOAD ENDOHERNIA 4.8
|
Facility
IP
|
$316.13
|
|
| Hospital Charge Code |
41601978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.10 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna Commercial |
$273.14
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cigna All Commercial |
$272.82
|
| Rate for Payer: CORVEL All Commercial |
$294.00
|
| Rate for Payer: Coventry All Commercial |
$278.19
|
| Rate for Payer: Encore All Commercial |
$291.00
|
| Rate for Payer: Frontpath All Commercial |
$290.84
|
| Rate for Payer: Humana ChoiceCare |
$273.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.52
|
| Rate for Payer: PHCS All Commercial |
$237.10
|
| Rate for Payer: PHP All Commercial |
$239.75
|
| Rate for Payer: Sagamore Health Network All Products |
$244.05
|
| Rate for Payer: Signature Care EPO |
$262.39
|
| Rate for Payer: Signature Care PPO |
$278.19
|
| Rate for Payer: United Healthcare Commercial |
$249.11
|
|
|
HC RELOAD ENDOHERNIA 4.8
|
Facility
OP
|
$316.13
|
|
| Hospital Charge Code |
41601978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna Commercial |
$266.81
|
| Rate for Payer: Aetna Medicare |
$104.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$181.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.76
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Centivo All Commercial |
$161.23
|
| Rate for Payer: Cigna All Commercial |
$272.82
|
| Rate for Payer: CORVEL All Commercial |
$294.00
|
| Rate for Payer: Coventry All Commercial |
$278.19
|
| Rate for Payer: Encore All Commercial |
$291.00
|
| Rate for Payer: Frontpath All Commercial |
$290.84
|
| Rate for Payer: Humana ChoiceCare |
$273.04
|
| Rate for Payer: Humana Medicare |
$161.23
|
| Rate for Payer: Lucent All Commercial |
$161.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$284.52
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$237.10
|
| Rate for Payer: PHP All Commercial |
$239.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.29
|
| Rate for Payer: Sagamore Health Network All Products |
$244.05
|
| Rate for Payer: Signature Care EPO |
$262.39
|
| Rate for Payer: Signature Care PPO |
$278.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$268.71
|
| Rate for Payer: United Healthcare Commercial |
$249.11
|
| Rate for Payer: United Healthcare Medicare |
$104.32
|
|
|
HC RELOAD GIA 60 3.8
|
Facility
OP
|
$411.39
|
|
| Hospital Charge Code |
41601979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$382.59 |
| Rate for Payer: Aetna Commercial |
$347.21
|
| Rate for Payer: Aetna Medicare |
$135.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$236.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$257.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.33
|
| Rate for Payer: Cash Price |
$255.06
|
| Rate for Payer: Cash Price |
$255.06
|
| Rate for Payer: Centivo All Commercial |
$209.81
|
| Rate for Payer: Cigna All Commercial |
$355.03
|
| Rate for Payer: CORVEL All Commercial |
$382.59
|
| Rate for Payer: Coventry All Commercial |
$362.02
|
| Rate for Payer: Encore All Commercial |
$378.68
|
| Rate for Payer: Frontpath All Commercial |
$378.48
|
| Rate for Payer: Humana ChoiceCare |
$355.32
|
| Rate for Payer: Humana Medicare |
$209.81
|
| Rate for Payer: Lucent All Commercial |
$209.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$370.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$308.54
|
| Rate for Payer: PHP All Commercial |
$312.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$160.44
|
| Rate for Payer: Sagamore Health Network All Products |
$317.59
|
| Rate for Payer: Signature Care EPO |
$341.45
|
| Rate for Payer: Signature Care PPO |
$362.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$349.68
|
| Rate for Payer: United Healthcare Commercial |
$324.18
|
| Rate for Payer: United Healthcare Medicare |
$135.76
|
|
|
HC RELOAD GIA 60 3.8
|
Facility
IP
|
$411.39
|
|
| Hospital Charge Code |
41601979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$308.54 |
| Max. Negotiated Rate |
$382.59 |
| Rate for Payer: Aetna Commercial |
$355.44
|
| Rate for Payer: Cash Price |
$255.06
|
| Rate for Payer: Cigna All Commercial |
$355.03
|
| Rate for Payer: CORVEL All Commercial |
$382.59
|
| Rate for Payer: Coventry All Commercial |
$362.02
|
| Rate for Payer: Encore All Commercial |
$378.68
|
| Rate for Payer: Frontpath All Commercial |
$378.48
|
| Rate for Payer: Humana ChoiceCare |
$355.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$370.25
|
| Rate for Payer: PHCS All Commercial |
$308.54
|
| Rate for Payer: PHP All Commercial |
$312.00
|
| Rate for Payer: Sagamore Health Network All Products |
$317.59
|
| Rate for Payer: Signature Care EPO |
$341.45
|
| Rate for Payer: Signature Care PPO |
$362.02
|
| Rate for Payer: United Healthcare Commercial |
$324.18
|
|
|
HC RELOAD GIA 80 3.8
|
Facility
OP
|
$601.32
|
|
| Hospital Charge Code |
41601980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$559.23 |
| Rate for Payer: Aetna Commercial |
$507.51
|
| Rate for Payer: Aetna Medicare |
$198.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$198.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$345.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$375.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$228.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$218.28
|
| Rate for Payer: Cash Price |
$372.82
|
| Rate for Payer: Cash Price |
$372.82
|
| Rate for Payer: Centivo All Commercial |
$306.67
|
| Rate for Payer: Cigna All Commercial |
$518.94
|
| Rate for Payer: CORVEL All Commercial |
$559.23
|
| Rate for Payer: Coventry All Commercial |
$529.16
|
| Rate for Payer: Encore All Commercial |
$553.52
|
| Rate for Payer: Frontpath All Commercial |
$553.21
|
| Rate for Payer: Humana ChoiceCare |
$519.36
|
| Rate for Payer: Humana Medicare |
$306.67
|
| Rate for Payer: Lucent All Commercial |
$306.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$541.19
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$450.99
|
| Rate for Payer: PHP All Commercial |
$456.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$234.51
|
| Rate for Payer: Sagamore Health Network All Products |
$464.22
|
| Rate for Payer: Signature Care EPO |
$499.10
|
| Rate for Payer: Signature Care PPO |
$529.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$511.12
|
| Rate for Payer: United Healthcare Commercial |
$473.84
|
| Rate for Payer: United Healthcare Medicare |
$198.44
|
|
|
HC RELOAD GIA 80 3.8
|
Facility
IP
|
$601.32
|
|
| Hospital Charge Code |
41601980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.99 |
| Max. Negotiated Rate |
$559.23 |
| Rate for Payer: Aetna Commercial |
$519.54
|
| Rate for Payer: Cash Price |
$372.82
|
| Rate for Payer: Cigna All Commercial |
$518.94
|
| Rate for Payer: CORVEL All Commercial |
$559.23
|
| Rate for Payer: Coventry All Commercial |
$529.16
|
| Rate for Payer: Encore All Commercial |
$553.52
|
| Rate for Payer: Frontpath All Commercial |
$553.21
|
| Rate for Payer: Humana ChoiceCare |
$519.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$541.19
|
| Rate for Payer: PHCS All Commercial |
$450.99
|
| Rate for Payer: PHP All Commercial |
$456.04
|
| Rate for Payer: Sagamore Health Network All Products |
$464.22
|
| Rate for Payer: Signature Care EPO |
$499.10
|
| Rate for Payer: Signature Care PPO |
$529.16
|
| Rate for Payer: United Healthcare Commercial |
$473.84
|
|
|
HC RELOAD GRIP 45MM BLUE
|
Facility
IP
|
$953.54
|
|
| Hospital Charge Code |
41607900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$715.16 |
| Max. Negotiated Rate |
$886.79 |
| Rate for Payer: Aetna Commercial |
$823.86
|
| Rate for Payer: Cash Price |
$591.20
|
| Rate for Payer: Cigna All Commercial |
$822.91
|
| Rate for Payer: CORVEL All Commercial |
$886.79
|
| Rate for Payer: Coventry All Commercial |
$839.12
|
| Rate for Payer: Encore All Commercial |
$877.73
|
| Rate for Payer: Frontpath All Commercial |
$877.26
|
| Rate for Payer: Humana ChoiceCare |
$823.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$858.19
|
| Rate for Payer: PHCS All Commercial |
$715.16
|
| Rate for Payer: PHP All Commercial |
$723.16
|
| Rate for Payer: Sagamore Health Network All Products |
$736.13
|
| Rate for Payer: Signature Care EPO |
$791.44
|
| Rate for Payer: Signature Care PPO |
$839.12
|
| Rate for Payer: United Healthcare Commercial |
$751.39
|
|
|
HC RELOAD GRIP 45MM BLUE
|
Facility
OP
|
$953.54
|
|
| Hospital Charge Code |
41607900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$886.79 |
| Rate for Payer: Aetna Commercial |
$804.79
|
| Rate for Payer: Aetna Medicare |
$314.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$314.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$547.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$596.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$361.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$346.14
|
| Rate for Payer: Cash Price |
$591.20
|
| Rate for Payer: Cash Price |
$591.20
|
| Rate for Payer: Centivo All Commercial |
$486.31
|
| Rate for Payer: Cigna All Commercial |
$822.91
|
| Rate for Payer: CORVEL All Commercial |
$886.79
|
| Rate for Payer: Coventry All Commercial |
$839.12
|
| Rate for Payer: Encore All Commercial |
$877.73
|
| Rate for Payer: Frontpath All Commercial |
$877.26
|
| Rate for Payer: Humana ChoiceCare |
$823.57
|
| Rate for Payer: Humana Medicare |
$486.31
|
| Rate for Payer: Lucent All Commercial |
$486.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$858.19
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$715.16
|
| Rate for Payer: PHP All Commercial |
$723.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$371.88
|
| Rate for Payer: Sagamore Health Network All Products |
$736.13
|
| Rate for Payer: Signature Care EPO |
$791.44
|
| Rate for Payer: Signature Care PPO |
$839.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$810.51
|
| Rate for Payer: United Healthcare Commercial |
$751.39
|
| Rate for Payer: United Healthcare Medicare |
$314.67
|
|
|
HC RELOAD GRIP 60MM BLUE
|
Facility
OP
|
$960.35
|
|
| Hospital Charge Code |
41607902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$893.13 |
| Rate for Payer: Aetna Commercial |
$810.54
|
| Rate for Payer: Aetna Medicare |
$316.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$316.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$551.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$600.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$364.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$348.61
|
| Rate for Payer: Cash Price |
$595.42
|
| Rate for Payer: Cash Price |
$595.42
|
| Rate for Payer: Centivo All Commercial |
$489.78
|
| Rate for Payer: Cigna All Commercial |
$828.78
|
| Rate for Payer: CORVEL All Commercial |
$893.13
|
| Rate for Payer: Coventry All Commercial |
$845.11
|
| Rate for Payer: Encore All Commercial |
$884.00
|
| Rate for Payer: Frontpath All Commercial |
$883.52
|
| Rate for Payer: Humana ChoiceCare |
$829.45
|
| Rate for Payer: Humana Medicare |
$489.78
|
| Rate for Payer: Lucent All Commercial |
$489.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$864.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$720.26
|
| Rate for Payer: PHP All Commercial |
$728.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$374.54
|
| Rate for Payer: Sagamore Health Network All Products |
$741.39
|
| Rate for Payer: Signature Care EPO |
$797.09
|
| Rate for Payer: Signature Care PPO |
$845.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$816.30
|
| Rate for Payer: United Healthcare Commercial |
$756.76
|
| Rate for Payer: United Healthcare Medicare |
$316.92
|
|
|
HC RELOAD GRIP 60MM BLUE
|
Facility
IP
|
$960.35
|
|
| Hospital Charge Code |
41607902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$720.26 |
| Max. Negotiated Rate |
$893.13 |
| Rate for Payer: Aetna Commercial |
$829.74
|
| Rate for Payer: Cash Price |
$595.42
|
| Rate for Payer: Cigna All Commercial |
$828.78
|
| Rate for Payer: CORVEL All Commercial |
$893.13
|
| Rate for Payer: Coventry All Commercial |
$845.11
|
| Rate for Payer: Encore All Commercial |
$884.00
|
| Rate for Payer: Frontpath All Commercial |
$883.52
|
| Rate for Payer: Humana ChoiceCare |
$829.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$864.32
|
| Rate for Payer: PHCS All Commercial |
$720.26
|
| Rate for Payer: PHP All Commercial |
$728.33
|
| Rate for Payer: Sagamore Health Network All Products |
$741.39
|
| Rate for Payer: Signature Care EPO |
$797.09
|
| Rate for Payer: Signature Care PPO |
$845.11
|
| Rate for Payer: United Healthcare Commercial |
$756.76
|
|
|
HC RELOAD GRIP 60MM GREEN
|
Facility
OP
|
$1,031.07
|
|
| Hospital Charge Code |
41607903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$958.90 |
| Rate for Payer: Aetna Commercial |
$870.22
|
| Rate for Payer: Aetna Medicare |
$340.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$340.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$592.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$644.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$391.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$374.28
|
| Rate for Payer: Cash Price |
$639.26
|
| Rate for Payer: Cash Price |
$639.26
|
| Rate for Payer: Centivo All Commercial |
$525.85
|
| Rate for Payer: Cigna All Commercial |
$889.81
|
| Rate for Payer: CORVEL All Commercial |
$958.90
|
| Rate for Payer: Coventry All Commercial |
$907.34
|
| Rate for Payer: Encore All Commercial |
$949.10
|
| Rate for Payer: Frontpath All Commercial |
$948.58
|
| Rate for Payer: Humana ChoiceCare |
$890.54
|
| Rate for Payer: Humana Medicare |
$525.85
|
| Rate for Payer: Lucent All Commercial |
$525.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$927.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$773.30
|
| Rate for Payer: PHP All Commercial |
$781.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$402.12
|
| Rate for Payer: Sagamore Health Network All Products |
$795.99
|
| Rate for Payer: Signature Care EPO |
$855.79
|
| Rate for Payer: Signature Care PPO |
$907.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$876.41
|
| Rate for Payer: United Healthcare Commercial |
$812.48
|
| Rate for Payer: United Healthcare Medicare |
$340.25
|
|
|
HC RELOAD GRIP 60MM GREEN
|
Facility
IP
|
$1,031.07
|
|
| Hospital Charge Code |
41607903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.30 |
| Max. Negotiated Rate |
$958.90 |
| Rate for Payer: Aetna Commercial |
$890.84
|
| Rate for Payer: Cash Price |
$639.26
|
| Rate for Payer: Cigna All Commercial |
$889.81
|
| Rate for Payer: CORVEL All Commercial |
$958.90
|
| Rate for Payer: Coventry All Commercial |
$907.34
|
| Rate for Payer: Encore All Commercial |
$949.10
|
| Rate for Payer: Frontpath All Commercial |
$948.58
|
| Rate for Payer: Humana ChoiceCare |
$890.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$927.96
|
| Rate for Payer: PHCS All Commercial |
$773.30
|
| Rate for Payer: PHP All Commercial |
$781.96
|
| Rate for Payer: Sagamore Health Network All Products |
$795.99
|
| Rate for Payer: Signature Care EPO |
$855.79
|
| Rate for Payer: Signature Care PPO |
$907.34
|
| Rate for Payer: United Healthcare Commercial |
$812.48
|
|
|
HC RELOAD GRIP VASC 45MM WHITE
|
Facility
OP
|
$953.54
|
|
| Hospital Charge Code |
41607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$886.79 |
| Rate for Payer: Aetna Commercial |
$804.79
|
| Rate for Payer: Aetna Medicare |
$314.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$314.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$547.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$596.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$361.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$346.14
|
| Rate for Payer: Cash Price |
$591.20
|
| Rate for Payer: Cash Price |
$591.20
|
| Rate for Payer: Centivo All Commercial |
$486.31
|
| Rate for Payer: Cigna All Commercial |
$822.91
|
| Rate for Payer: CORVEL All Commercial |
$886.79
|
| Rate for Payer: Coventry All Commercial |
$839.12
|
| Rate for Payer: Encore All Commercial |
$877.73
|
| Rate for Payer: Frontpath All Commercial |
$877.26
|
| Rate for Payer: Humana ChoiceCare |
$823.57
|
| Rate for Payer: Humana Medicare |
$486.31
|
| Rate for Payer: Lucent All Commercial |
$486.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$858.19
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$715.16
|
| Rate for Payer: PHP All Commercial |
$723.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$371.88
|
| Rate for Payer: Sagamore Health Network All Products |
$736.13
|
| Rate for Payer: Signature Care EPO |
$791.44
|
| Rate for Payer: Signature Care PPO |
$839.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$810.51
|
| Rate for Payer: United Healthcare Commercial |
$751.39
|
| Rate for Payer: United Healthcare Medicare |
$314.67
|
|
|
HC RELOAD GRIP VASC 45MM WHITE
|
Facility
IP
|
$953.54
|
|
| Hospital Charge Code |
41607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$715.16 |
| Max. Negotiated Rate |
$886.79 |
| Rate for Payer: Aetna Commercial |
$823.86
|
| Rate for Payer: Cash Price |
$591.20
|
| Rate for Payer: Cigna All Commercial |
$822.91
|
| Rate for Payer: CORVEL All Commercial |
$886.79
|
| Rate for Payer: Coventry All Commercial |
$839.12
|
| Rate for Payer: Encore All Commercial |
$877.73
|
| Rate for Payer: Frontpath All Commercial |
$877.26
|
| Rate for Payer: Humana ChoiceCare |
$823.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$858.19
|
| Rate for Payer: PHCS All Commercial |
$715.16
|
| Rate for Payer: PHP All Commercial |
$723.16
|
| Rate for Payer: Sagamore Health Network All Products |
$736.13
|
| Rate for Payer: Signature Care EPO |
$791.44
|
| Rate for Payer: Signature Care PPO |
$839.12
|
| Rate for Payer: United Healthcare Commercial |
$751.39
|
|
|
HC RELOAD GRIP VASC 60MM WHITE
|
Facility
IP
|
$1,031.07
|
|
| Hospital Charge Code |
41607901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.30 |
| Max. Negotiated Rate |
$958.90 |
| Rate for Payer: Aetna Commercial |
$890.84
|
| Rate for Payer: Cash Price |
$639.26
|
| Rate for Payer: Cigna All Commercial |
$889.81
|
| Rate for Payer: CORVEL All Commercial |
$958.90
|
| Rate for Payer: Coventry All Commercial |
$907.34
|
| Rate for Payer: Encore All Commercial |
$949.10
|
| Rate for Payer: Frontpath All Commercial |
$948.58
|
| Rate for Payer: Humana ChoiceCare |
$890.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$927.96
|
| Rate for Payer: PHCS All Commercial |
$773.30
|
| Rate for Payer: PHP All Commercial |
$781.96
|
| Rate for Payer: Sagamore Health Network All Products |
$795.99
|
| Rate for Payer: Signature Care EPO |
$855.79
|
| Rate for Payer: Signature Care PPO |
$907.34
|
| Rate for Payer: United Healthcare Commercial |
$812.48
|
|
|
HC RELOAD GRIP VASC 60MM WHITE
|
Facility
OP
|
$1,031.07
|
|
| Hospital Charge Code |
41607901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$958.90 |
| Rate for Payer: Aetna Commercial |
$870.22
|
| Rate for Payer: Aetna Medicare |
$340.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$340.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$592.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$644.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$391.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$374.28
|
| Rate for Payer: Cash Price |
$639.26
|
| Rate for Payer: Cash Price |
$639.26
|
| Rate for Payer: Centivo All Commercial |
$525.85
|
| Rate for Payer: Cigna All Commercial |
$889.81
|
| Rate for Payer: CORVEL All Commercial |
$958.90
|
| Rate for Payer: Coventry All Commercial |
$907.34
|
| Rate for Payer: Encore All Commercial |
$949.10
|
| Rate for Payer: Frontpath All Commercial |
$948.58
|
| Rate for Payer: Humana ChoiceCare |
$890.54
|
| Rate for Payer: Humana Medicare |
$525.85
|
| Rate for Payer: Lucent All Commercial |
$525.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$927.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$773.30
|
| Rate for Payer: PHP All Commercial |
$781.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$402.12
|
| Rate for Payer: Sagamore Health Network All Products |
$795.99
|
| Rate for Payer: Signature Care EPO |
$855.79
|
| Rate for Payer: Signature Care PPO |
$907.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$876.41
|
| Rate for Payer: United Healthcare Commercial |
$812.48
|
| Rate for Payer: United Healthcare Medicare |
$340.25
|
|
|
HC RELOAD PROX 30MM BLUE
|
Facility
OP
|
$276.38
|
|
| Hospital Charge Code |
41607895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.21 |
| Max. Negotiated Rate |
$257.03 |
| Rate for Payer: Aetna Commercial |
$233.26
|
| Rate for Payer: Aetna Medicare |
$91.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$158.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$104.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.33
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Centivo All Commercial |
$140.95
|
| Rate for Payer: Cigna All Commercial |
$238.52
|
| Rate for Payer: CORVEL All Commercial |
$257.03
|
| Rate for Payer: Coventry All Commercial |
$243.21
|
| Rate for Payer: Encore All Commercial |
$254.41
|
| Rate for Payer: Frontpath All Commercial |
$254.27
|
| Rate for Payer: Humana ChoiceCare |
$238.71
|
| Rate for Payer: Humana Medicare |
$140.95
|
| Rate for Payer: Lucent All Commercial |
$140.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$248.74
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$207.28
|
| Rate for Payer: PHP All Commercial |
$209.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.79
|
| Rate for Payer: Sagamore Health Network All Products |
$213.37
|
| Rate for Payer: Signature Care EPO |
$229.40
|
| Rate for Payer: Signature Care PPO |
$243.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$234.92
|
| Rate for Payer: United Healthcare Commercial |
$217.79
|
| Rate for Payer: United Healthcare Medicare |
$91.21
|
|
|
HC RELOAD PROX 30MM BLUE
|
Facility
IP
|
$276.38
|
|
| Hospital Charge Code |
41607895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.28 |
| Max. Negotiated Rate |
$257.03 |
| Rate for Payer: Aetna Commercial |
$238.79
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cigna All Commercial |
$238.52
|
| Rate for Payer: CORVEL All Commercial |
$257.03
|
| Rate for Payer: Coventry All Commercial |
$243.21
|
| Rate for Payer: Encore All Commercial |
$254.41
|
| Rate for Payer: Frontpath All Commercial |
$254.27
|
| Rate for Payer: Humana ChoiceCare |
$238.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$248.74
|
| Rate for Payer: PHCS All Commercial |
$207.28
|
| Rate for Payer: PHP All Commercial |
$209.61
|
| Rate for Payer: Sagamore Health Network All Products |
$213.37
|
| Rate for Payer: Signature Care EPO |
$229.40
|
| Rate for Payer: Signature Care PPO |
$243.21
|
| Rate for Payer: United Healthcare Commercial |
$217.79
|
|
|
HC RELOAD PROX 30MM BLUE
|
Facility
OP
|
$586.93
|
|
| Hospital Charge Code |
41607894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$545.84 |
| Rate for Payer: Aetna Commercial |
$495.37
|
| Rate for Payer: Aetna Medicare |
$193.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$337.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$366.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$222.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$213.06
|
| Rate for Payer: Cash Price |
$363.90
|
| Rate for Payer: Cash Price |
$363.90
|
| Rate for Payer: Centivo All Commercial |
$299.33
|
| Rate for Payer: Cigna All Commercial |
$506.52
|
| Rate for Payer: CORVEL All Commercial |
$545.84
|
| Rate for Payer: Coventry All Commercial |
$516.50
|
| Rate for Payer: Encore All Commercial |
$540.27
|
| Rate for Payer: Frontpath All Commercial |
$539.98
|
| Rate for Payer: Humana ChoiceCare |
$506.93
|
| Rate for Payer: Humana Medicare |
$299.33
|
| Rate for Payer: Lucent All Commercial |
$299.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$528.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$440.20
|
| Rate for Payer: PHP All Commercial |
$445.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.90
|
| Rate for Payer: Sagamore Health Network All Products |
$453.11
|
| Rate for Payer: Signature Care EPO |
$487.15
|
| Rate for Payer: Signature Care PPO |
$516.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$498.89
|
| Rate for Payer: United Healthcare Commercial |
$462.50
|
| Rate for Payer: United Healthcare Medicare |
$193.69
|
|
|
HC RELOAD PROX 30MM BLUE
|
Facility
IP
|
$586.93
|
|
| Hospital Charge Code |
41607894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$545.84 |
| Rate for Payer: Aetna Commercial |
$507.11
|
| Rate for Payer: Cash Price |
$363.90
|
| Rate for Payer: Cigna All Commercial |
$506.52
|
| Rate for Payer: CORVEL All Commercial |
$545.84
|
| Rate for Payer: Coventry All Commercial |
$516.50
|
| Rate for Payer: Encore All Commercial |
$540.27
|
| Rate for Payer: Frontpath All Commercial |
$539.98
|
| Rate for Payer: Humana ChoiceCare |
$506.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$528.24
|
| Rate for Payer: PHCS All Commercial |
$440.20
|
| Rate for Payer: PHP All Commercial |
$445.13
|
| Rate for Payer: Sagamore Health Network All Products |
$453.11
|
| Rate for Payer: Signature Care EPO |
$487.15
|
| Rate for Payer: Signature Care PPO |
$516.50
|
| Rate for Payer: United Healthcare Commercial |
$462.50
|
|
|
HC RELOAD PROX 60MM BLUE
|
Facility
OP
|
$297.69
|
|
| Hospital Charge Code |
41607893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.24 |
| Max. Negotiated Rate |
$276.85 |
| Rate for Payer: Aetna Commercial |
$251.25
|
| Rate for Payer: Aetna Medicare |
$98.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$170.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$186.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.06
|
| Rate for Payer: Cash Price |
$184.57
|
| Rate for Payer: Cash Price |
$184.57
|
| Rate for Payer: Centivo All Commercial |
$151.82
|
| Rate for Payer: Cigna All Commercial |
$256.91
|
| Rate for Payer: CORVEL All Commercial |
$276.85
|
| Rate for Payer: Coventry All Commercial |
$261.97
|
| Rate for Payer: Encore All Commercial |
$274.02
|
| Rate for Payer: Frontpath All Commercial |
$273.87
|
| Rate for Payer: Humana ChoiceCare |
$257.11
|
| Rate for Payer: Humana Medicare |
$151.82
|
| Rate for Payer: Lucent All Commercial |
$151.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$223.27
|
| Rate for Payer: PHP All Commercial |
$225.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.10
|
| Rate for Payer: Sagamore Health Network All Products |
$229.82
|
| Rate for Payer: Signature Care EPO |
$247.08
|
| Rate for Payer: Signature Care PPO |
$261.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$253.04
|
| Rate for Payer: United Healthcare Commercial |
$234.58
|
| Rate for Payer: United Healthcare Medicare |
$98.24
|
|
