|
HC SNARE ACUSNARE DUCK BILL
|
Facility
OP
|
$262.50
|
|
| Hospital Charge Code |
41602390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.62 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna Commercial |
$221.55
|
| Rate for Payer: Aetna Medicare |
$86.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$86.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$150.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.29
|
| Rate for Payer: Cash Price |
$162.75
|
| Rate for Payer: Cash Price |
$162.75
|
| Rate for Payer: Centivo All Commercial |
$133.88
|
| Rate for Payer: Cigna All Commercial |
$226.54
|
| Rate for Payer: CORVEL All Commercial |
$244.12
|
| Rate for Payer: Coventry All Commercial |
$231.00
|
| Rate for Payer: Encore All Commercial |
$241.63
|
| Rate for Payer: Frontpath All Commercial |
$241.50
|
| Rate for Payer: Humana ChoiceCare |
$226.72
|
| Rate for Payer: Humana Medicare |
$133.88
|
| Rate for Payer: Lucent All Commercial |
$133.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$236.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$196.88
|
| Rate for Payer: PHP All Commercial |
$199.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.38
|
| Rate for Payer: Sagamore Health Network All Products |
$202.65
|
| Rate for Payer: Signature Care EPO |
$217.88
|
| Rate for Payer: Signature Care PPO |
$231.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$223.12
|
| Rate for Payer: United Healthcare Commercial |
$206.85
|
| Rate for Payer: United Healthcare Medicare |
$86.62
|
|
|
HC SNARE ACUSNARE DUCK BILL
|
Facility
IP
|
$262.50
|
|
| Hospital Charge Code |
41602390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.88 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Cash Price |
$162.75
|
| Rate for Payer: Cigna All Commercial |
$226.54
|
| Rate for Payer: CORVEL All Commercial |
$244.12
|
| Rate for Payer: Coventry All Commercial |
$231.00
|
| Rate for Payer: Encore All Commercial |
$241.63
|
| Rate for Payer: Frontpath All Commercial |
$241.50
|
| Rate for Payer: Humana ChoiceCare |
$226.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$236.25
|
| Rate for Payer: PHCS All Commercial |
$196.88
|
| Rate for Payer: PHP All Commercial |
$199.08
|
| Rate for Payer: Sagamore Health Network All Products |
$202.65
|
| Rate for Payer: Signature Care EPO |
$217.88
|
| Rate for Payer: Signature Care PPO |
$231.00
|
| Rate for Payer: United Healthcare Commercial |
$206.85
|
|
|
HC SNARE CONLD EXACTO
|
Facility
OP
|
$71.40
|
|
| Hospital Charge Code |
41608232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$60.26
|
| Rate for Payer: Aetna Medicare |
$23.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.92
|
| Rate for Payer: Cash Price |
$44.27
|
| Rate for Payer: Cash Price |
$44.27
|
| Rate for Payer: Centivo All Commercial |
$36.41
|
| Rate for Payer: Cigna All Commercial |
$61.62
|
| Rate for Payer: CORVEL All Commercial |
$66.40
|
| Rate for Payer: Coventry All Commercial |
$62.83
|
| Rate for Payer: Encore All Commercial |
$65.72
|
| Rate for Payer: Frontpath All Commercial |
$65.69
|
| Rate for Payer: Humana ChoiceCare |
$61.67
|
| Rate for Payer: Humana Medicare |
$36.41
|
| Rate for Payer: Lucent All Commercial |
$36.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$53.55
|
| Rate for Payer: PHP All Commercial |
$54.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.85
|
| Rate for Payer: Sagamore Health Network All Products |
$55.12
|
| Rate for Payer: Signature Care EPO |
$59.26
|
| Rate for Payer: Signature Care PPO |
$62.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.69
|
| Rate for Payer: United Healthcare Commercial |
$56.26
|
| Rate for Payer: United Healthcare Medicare |
$23.56
|
|
|
HC SNARE CONLD EXACTO
|
Facility
IP
|
$71.40
|
|
| Hospital Charge Code |
41608232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$66.40 |
| Rate for Payer: Aetna Commercial |
$61.69
|
| Rate for Payer: Cash Price |
$44.27
|
| Rate for Payer: Cigna All Commercial |
$61.62
|
| Rate for Payer: CORVEL All Commercial |
$66.40
|
| Rate for Payer: Coventry All Commercial |
$62.83
|
| Rate for Payer: Encore All Commercial |
$65.72
|
| Rate for Payer: Frontpath All Commercial |
$65.69
|
| Rate for Payer: Humana ChoiceCare |
$61.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.26
|
| Rate for Payer: PHCS All Commercial |
$53.55
|
| Rate for Payer: PHP All Commercial |
$54.15
|
| Rate for Payer: Sagamore Health Network All Products |
$55.12
|
| Rate for Payer: Signature Care EPO |
$59.26
|
| Rate for Payer: Signature Care PPO |
$62.83
|
| Rate for Payer: United Healthcare Commercial |
$56.26
|
|
|
HC SNARE CRESCENT DUCKBILL
|
Facility
IP
|
$165.35
|
|
| Hospital Charge Code |
41601333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.01 |
| Max. Negotiated Rate |
$153.78 |
| Rate for Payer: Aetna Commercial |
$142.86
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Cigna All Commercial |
$142.70
|
| Rate for Payer: CORVEL All Commercial |
$153.78
|
| Rate for Payer: Coventry All Commercial |
$145.51
|
| Rate for Payer: Encore All Commercial |
$152.20
|
| Rate for Payer: Frontpath All Commercial |
$152.12
|
| Rate for Payer: Humana ChoiceCare |
$142.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.82
|
| Rate for Payer: PHCS All Commercial |
$124.01
|
| Rate for Payer: PHP All Commercial |
$125.40
|
| Rate for Payer: Sagamore Health Network All Products |
$127.65
|
| Rate for Payer: Signature Care EPO |
$137.24
|
| Rate for Payer: Signature Care PPO |
$145.51
|
| Rate for Payer: United Healthcare Commercial |
$130.30
|
|
|
HC SNARE CRESCENT DUCKBILL
|
Facility
OP
|
$165.35
|
|
| Hospital Charge Code |
41601333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$153.78 |
| Rate for Payer: Aetna Commercial |
$139.56
|
| Rate for Payer: Aetna Medicare |
$54.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.02
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Centivo All Commercial |
$84.33
|
| Rate for Payer: Cigna All Commercial |
$142.70
|
| Rate for Payer: CORVEL All Commercial |
$153.78
|
| Rate for Payer: Coventry All Commercial |
$145.51
|
| Rate for Payer: Encore All Commercial |
$152.20
|
| Rate for Payer: Frontpath All Commercial |
$152.12
|
| Rate for Payer: Humana ChoiceCare |
$142.81
|
| Rate for Payer: Humana Medicare |
$84.33
|
| Rate for Payer: Lucent All Commercial |
$84.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$124.01
|
| Rate for Payer: PHP All Commercial |
$125.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.49
|
| Rate for Payer: Sagamore Health Network All Products |
$127.65
|
| Rate for Payer: Signature Care EPO |
$137.24
|
| Rate for Payer: Signature Care PPO |
$145.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.55
|
| Rate for Payer: United Healthcare Commercial |
$130.30
|
| Rate for Payer: United Healthcare Medicare |
$54.57
|
|
|
HC SNARE I INJ NEEDLE
|
Facility
OP
|
$548.80
|
|
| Hospital Charge Code |
41601789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$510.38 |
| Rate for Payer: Aetna Commercial |
$463.19
|
| Rate for Payer: Aetna Medicare |
$181.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$181.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$315.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$343.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$208.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$199.21
|
| Rate for Payer: Cash Price |
$340.26
|
| Rate for Payer: Cash Price |
$340.26
|
| Rate for Payer: Centivo All Commercial |
$279.89
|
| Rate for Payer: Cigna All Commercial |
$473.61
|
| Rate for Payer: CORVEL All Commercial |
$510.38
|
| Rate for Payer: Coventry All Commercial |
$482.94
|
| Rate for Payer: Encore All Commercial |
$505.17
|
| Rate for Payer: Frontpath All Commercial |
$504.90
|
| Rate for Payer: Humana ChoiceCare |
$474.00
|
| Rate for Payer: Humana Medicare |
$279.89
|
| Rate for Payer: Lucent All Commercial |
$279.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$493.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$411.60
|
| Rate for Payer: PHP All Commercial |
$416.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$214.03
|
| Rate for Payer: Sagamore Health Network All Products |
$423.67
|
| Rate for Payer: Signature Care EPO |
$455.50
|
| Rate for Payer: Signature Care PPO |
$482.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$466.48
|
| Rate for Payer: United Healthcare Commercial |
$432.45
|
| Rate for Payer: United Healthcare Medicare |
$181.10
|
|
|
HC SNARE I INJ NEEDLE
|
Facility
IP
|
$548.80
|
|
| Hospital Charge Code |
41601789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.60 |
| Max. Negotiated Rate |
$510.38 |
| Rate for Payer: Aetna Commercial |
$474.16
|
| Rate for Payer: Cash Price |
$340.26
|
| Rate for Payer: Cigna All Commercial |
$473.61
|
| Rate for Payer: CORVEL All Commercial |
$510.38
|
| Rate for Payer: Coventry All Commercial |
$482.94
|
| Rate for Payer: Encore All Commercial |
$505.17
|
| Rate for Payer: Frontpath All Commercial |
$504.90
|
| Rate for Payer: Humana ChoiceCare |
$474.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$493.92
|
| Rate for Payer: PHCS All Commercial |
$411.60
|
| Rate for Payer: PHP All Commercial |
$416.21
|
| Rate for Payer: Sagamore Health Network All Products |
$423.67
|
| Rate for Payer: Signature Care EPO |
$455.50
|
| Rate for Payer: Signature Care PPO |
$482.94
|
| Rate for Payer: United Healthcare Commercial |
$432.45
|
|
|
HC SNARE LARIAT INJ
|
Facility
OP
|
$882.00
|
|
| Hospital Charge Code |
41608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$820.26 |
| Rate for Payer: Aetna Commercial |
$744.41
|
| Rate for Payer: Aetna Medicare |
$291.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$291.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$506.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$551.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$334.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$320.17
|
| Rate for Payer: Cash Price |
$546.84
|
| Rate for Payer: Cash Price |
$546.84
|
| Rate for Payer: Centivo All Commercial |
$449.82
|
| Rate for Payer: Cigna All Commercial |
$761.17
|
| Rate for Payer: CORVEL All Commercial |
$820.26
|
| Rate for Payer: Coventry All Commercial |
$776.16
|
| Rate for Payer: Encore All Commercial |
$811.88
|
| Rate for Payer: Frontpath All Commercial |
$811.44
|
| Rate for Payer: Humana ChoiceCare |
$761.78
|
| Rate for Payer: Humana Medicare |
$449.82
|
| Rate for Payer: Lucent All Commercial |
$449.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$793.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$661.50
|
| Rate for Payer: PHP All Commercial |
$668.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$343.98
|
| Rate for Payer: Sagamore Health Network All Products |
$680.90
|
| Rate for Payer: Signature Care EPO |
$732.06
|
| Rate for Payer: Signature Care PPO |
$776.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$749.70
|
| Rate for Payer: United Healthcare Commercial |
$695.02
|
| Rate for Payer: United Healthcare Medicare |
$291.06
|
|
|
HC SNARE LARIAT INJ
|
Facility
IP
|
$882.00
|
|
| Hospital Charge Code |
41608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.50 |
| Max. Negotiated Rate |
$820.26 |
| Rate for Payer: Aetna Commercial |
$762.05
|
| Rate for Payer: Cash Price |
$546.84
|
| Rate for Payer: Cigna All Commercial |
$761.17
|
| Rate for Payer: CORVEL All Commercial |
$820.26
|
| Rate for Payer: Coventry All Commercial |
$776.16
|
| Rate for Payer: Encore All Commercial |
$811.88
|
| Rate for Payer: Frontpath All Commercial |
$811.44
|
| Rate for Payer: Humana ChoiceCare |
$761.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$793.80
|
| Rate for Payer: PHCS All Commercial |
$661.50
|
| Rate for Payer: PHP All Commercial |
$668.91
|
| Rate for Payer: Sagamore Health Network All Products |
$680.90
|
| Rate for Payer: Signature Care EPO |
$732.06
|
| Rate for Payer: Signature Care PPO |
$776.16
|
| Rate for Payer: United Healthcare Commercial |
$695.02
|
|
|
HC SNARE SPIRAL BARBED
|
Facility
IP
|
$170.10
|
|
| Hospital Charge Code |
41601334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.58 |
| Max. Negotiated Rate |
$158.19 |
| Rate for Payer: Aetna Commercial |
$146.97
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cigna All Commercial |
$146.80
|
| Rate for Payer: CORVEL All Commercial |
$158.19
|
| Rate for Payer: Coventry All Commercial |
$149.69
|
| Rate for Payer: Encore All Commercial |
$156.58
|
| Rate for Payer: Frontpath All Commercial |
$156.49
|
| Rate for Payer: Humana ChoiceCare |
$146.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.09
|
| Rate for Payer: PHCS All Commercial |
$127.58
|
| Rate for Payer: PHP All Commercial |
$129.00
|
| Rate for Payer: Sagamore Health Network All Products |
$131.32
|
| Rate for Payer: Signature Care EPO |
$141.18
|
| Rate for Payer: Signature Care PPO |
$149.69
|
| Rate for Payer: United Healthcare Commercial |
$134.04
|
|
|
HC SNARE SPIRAL BARBED
|
Facility
OP
|
$170.10
|
|
| Hospital Charge Code |
41601334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$158.19 |
| Rate for Payer: Aetna Commercial |
$143.56
|
| Rate for Payer: Aetna Medicare |
$56.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.75
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Centivo All Commercial |
$86.75
|
| Rate for Payer: Cigna All Commercial |
$146.80
|
| Rate for Payer: CORVEL All Commercial |
$158.19
|
| Rate for Payer: Coventry All Commercial |
$149.69
|
| Rate for Payer: Encore All Commercial |
$156.58
|
| Rate for Payer: Frontpath All Commercial |
$156.49
|
| Rate for Payer: Humana ChoiceCare |
$146.92
|
| Rate for Payer: Humana Medicare |
$86.75
|
| Rate for Payer: Lucent All Commercial |
$86.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$127.58
|
| Rate for Payer: PHP All Commercial |
$129.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.34
|
| Rate for Payer: Sagamore Health Network All Products |
$131.32
|
| Rate for Payer: Signature Care EPO |
$141.18
|
| Rate for Payer: Signature Care PPO |
$149.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144.58
|
| Rate for Payer: United Healthcare Commercial |
$134.04
|
| Rate for Payer: United Healthcare Medicare |
$56.13
|
|
|
HC SNARE STD OVAL
|
Facility
OP
|
$62.30
|
|
| Hospital Charge Code |
41602044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna Medicare |
$20.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.61
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Centivo All Commercial |
$31.77
|
| Rate for Payer: Cigna All Commercial |
$53.76
|
| Rate for Payer: CORVEL All Commercial |
$57.94
|
| Rate for Payer: Coventry All Commercial |
$54.82
|
| Rate for Payer: Encore All Commercial |
$57.35
|
| Rate for Payer: Frontpath All Commercial |
$57.32
|
| Rate for Payer: Humana ChoiceCare |
$53.81
|
| Rate for Payer: Humana Medicare |
$31.77
|
| Rate for Payer: Lucent All Commercial |
$31.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.07
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$46.72
|
| Rate for Payer: PHP All Commercial |
$47.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.30
|
| Rate for Payer: Sagamore Health Network All Products |
$48.10
|
| Rate for Payer: Signature Care EPO |
$51.71
|
| Rate for Payer: Signature Care PPO |
$54.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.96
|
| Rate for Payer: United Healthcare Commercial |
$49.09
|
| Rate for Payer: United Healthcare Medicare |
$20.56
|
|
|
HC SNARE STD OVAL
|
Facility
IP
|
$62.30
|
|
| Hospital Charge Code |
41602044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$57.94 |
| Rate for Payer: Aetna Commercial |
$53.83
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Cigna All Commercial |
$53.76
|
| Rate for Payer: CORVEL All Commercial |
$57.94
|
| Rate for Payer: Coventry All Commercial |
$54.82
|
| Rate for Payer: Encore All Commercial |
$57.35
|
| Rate for Payer: Frontpath All Commercial |
$57.32
|
| Rate for Payer: Humana ChoiceCare |
$53.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.07
|
| Rate for Payer: PHCS All Commercial |
$46.72
|
| Rate for Payer: PHP All Commercial |
$47.25
|
| Rate for Payer: Sagamore Health Network All Products |
$48.10
|
| Rate for Payer: Signature Care EPO |
$51.71
|
| Rate for Payer: Signature Care PPO |
$54.82
|
| Rate for Payer: United Healthcare Commercial |
$49.09
|
|
|
HC SNARE STD OVAL ROTATOR
|
Facility
IP
|
$252.00
|
|
| Hospital Charge Code |
41602045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$234.36 |
| Rate for Payer: Aetna Commercial |
$217.73
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cigna All Commercial |
$217.48
|
| Rate for Payer: CORVEL All Commercial |
$234.36
|
| Rate for Payer: Coventry All Commercial |
$221.76
|
| Rate for Payer: Encore All Commercial |
$231.97
|
| Rate for Payer: Frontpath All Commercial |
$231.84
|
| Rate for Payer: Humana ChoiceCare |
$217.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.80
|
| Rate for Payer: PHCS All Commercial |
$189.00
|
| Rate for Payer: PHP All Commercial |
$191.12
|
| Rate for Payer: Sagamore Health Network All Products |
$194.54
|
| Rate for Payer: Signature Care EPO |
$209.16
|
| Rate for Payer: Signature Care PPO |
$221.76
|
| Rate for Payer: United Healthcare Commercial |
$198.58
|
|
|
HC SNARE STD OVAL ROTATOR
|
Facility
OP
|
$252.00
|
|
| Hospital Charge Code |
41602045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$234.36 |
| Rate for Payer: Aetna Commercial |
$212.69
|
| Rate for Payer: Aetna Medicare |
$83.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$157.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.48
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Centivo All Commercial |
$128.52
|
| Rate for Payer: Cigna All Commercial |
$217.48
|
| Rate for Payer: CORVEL All Commercial |
$234.36
|
| Rate for Payer: Coventry All Commercial |
$221.76
|
| Rate for Payer: Encore All Commercial |
$231.97
|
| Rate for Payer: Frontpath All Commercial |
$231.84
|
| Rate for Payer: Humana ChoiceCare |
$217.65
|
| Rate for Payer: Humana Medicare |
$128.52
|
| Rate for Payer: Lucent All Commercial |
$128.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$189.00
|
| Rate for Payer: PHP All Commercial |
$191.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.28
|
| Rate for Payer: Sagamore Health Network All Products |
$194.54
|
| Rate for Payer: Signature Care EPO |
$209.16
|
| Rate for Payer: Signature Care PPO |
$221.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$214.20
|
| Rate for Payer: United Healthcare Commercial |
$198.58
|
| Rate for Payer: United Healthcare Medicare |
$83.16
|
|
|
HC SNARE TRAXTION HEXAGONAL
|
Facility
OP
|
$140.00
|
|
| Hospital Charge Code |
41601222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$118.16
|
| Rate for Payer: Aetna Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.82
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Centivo All Commercial |
$71.40
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.92
|
| Rate for Payer: Humana Medicare |
$71.40
|
| Rate for Payer: Lucent All Commercial |
$71.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.60
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
|
|
HC SNARE TRAXTION HEXAGONAL
|
Facility
IP
|
$140.00
|
|
| Hospital Charge Code |
41601222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$120.96
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Cigna All Commercial |
$120.82
|
| Rate for Payer: CORVEL All Commercial |
$130.20
|
| Rate for Payer: Coventry All Commercial |
$123.20
|
| Rate for Payer: Encore All Commercial |
$128.87
|
| Rate for Payer: Frontpath All Commercial |
$128.80
|
| Rate for Payer: Humana ChoiceCare |
$120.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$105.00
|
| Rate for Payer: PHP All Commercial |
$106.18
|
| Rate for Payer: Sagamore Health Network All Products |
$108.08
|
| Rate for Payer: Signature Care EPO |
$116.20
|
| Rate for Payer: Signature Care PPO |
$123.20
|
| Rate for Payer: United Healthcare Commercial |
$110.32
|
|
|
HC SN BIOSURE HA 10X20
|
Facility
OP
|
$1,630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,515.90 |
| Rate for Payer: Aetna Commercial |
$1,375.72
|
| Rate for Payer: Aetna Medicare |
$537.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$936.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,018.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$618.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$591.69
|
| Rate for Payer: Cash Price |
$1,010.60
|
| Rate for Payer: Cash Price |
$1,010.60
|
| Rate for Payer: Centivo All Commercial |
$831.30
|
| Rate for Payer: Cigna All Commercial |
$1,406.69
|
| Rate for Payer: CORVEL All Commercial |
$1,515.90
|
| Rate for Payer: Coventry All Commercial |
$1,434.40
|
| Rate for Payer: Encore All Commercial |
$1,500.42
|
| Rate for Payer: Frontpath All Commercial |
$1,499.60
|
| Rate for Payer: Humana ChoiceCare |
$1,407.83
|
| Rate for Payer: Humana Medicare |
$831.30
|
| Rate for Payer: Lucent All Commercial |
$831.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,467.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,222.50
|
| Rate for Payer: PHP All Commercial |
$1,236.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$635.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,258.36
|
| Rate for Payer: Signature Care EPO |
$1,352.90
|
| Rate for Payer: Signature Care PPO |
$1,434.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,385.50
|
| Rate for Payer: United Healthcare Commercial |
$1,284.44
|
| Rate for Payer: United Healthcare Medicare |
$537.90
|
|
|
HC SN BIOSURE HA 10X20
|
Facility
IP
|
$1,630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.50 |
| Max. Negotiated Rate |
$1,515.90 |
| Rate for Payer: Aetna Commercial |
$1,408.32
|
| Rate for Payer: Cash Price |
$1,010.60
|
| Rate for Payer: Cigna All Commercial |
$1,406.69
|
| Rate for Payer: CORVEL All Commercial |
$1,515.90
|
| Rate for Payer: Coventry All Commercial |
$1,434.40
|
| Rate for Payer: Encore All Commercial |
$1,500.42
|
| Rate for Payer: Frontpath All Commercial |
$1,499.60
|
| Rate for Payer: Humana ChoiceCare |
$1,407.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,467.00
|
| Rate for Payer: PHCS All Commercial |
$1,222.50
|
| Rate for Payer: PHP All Commercial |
$1,236.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,258.36
|
| Rate for Payer: Signature Care EPO |
$1,352.90
|
| Rate for Payer: Signature Care PPO |
$1,434.40
|
| Rate for Payer: United Healthcare Commercial |
$1,284.44
|
|
|
HC SN BIOSURE HA 8X 25
|
Facility
OP
|
$1,630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,515.90 |
| Rate for Payer: Aetna Commercial |
$1,375.72
|
| Rate for Payer: Aetna Medicare |
$537.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$936.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,018.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$618.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$591.69
|
| Rate for Payer: Cash Price |
$1,010.60
|
| Rate for Payer: Cash Price |
$1,010.60
|
| Rate for Payer: Centivo All Commercial |
$831.30
|
| Rate for Payer: Cigna All Commercial |
$1,406.69
|
| Rate for Payer: CORVEL All Commercial |
$1,515.90
|
| Rate for Payer: Coventry All Commercial |
$1,434.40
|
| Rate for Payer: Encore All Commercial |
$1,500.42
|
| Rate for Payer: Frontpath All Commercial |
$1,499.60
|
| Rate for Payer: Humana ChoiceCare |
$1,407.83
|
| Rate for Payer: Humana Medicare |
$831.30
|
| Rate for Payer: Lucent All Commercial |
$831.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,467.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,222.50
|
| Rate for Payer: PHP All Commercial |
$1,236.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$635.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,258.36
|
| Rate for Payer: Signature Care EPO |
$1,352.90
|
| Rate for Payer: Signature Care PPO |
$1,434.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,385.50
|
| Rate for Payer: United Healthcare Commercial |
$1,284.44
|
| Rate for Payer: United Healthcare Medicare |
$537.90
|
|
|
HC SN BIOSURE HA 8X 25
|
Facility
IP
|
$1,630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.50 |
| Max. Negotiated Rate |
$1,515.90 |
| Rate for Payer: Aetna Commercial |
$1,408.32
|
| Rate for Payer: Cash Price |
$1,010.60
|
| Rate for Payer: Cigna All Commercial |
$1,406.69
|
| Rate for Payer: CORVEL All Commercial |
$1,515.90
|
| Rate for Payer: Coventry All Commercial |
$1,434.40
|
| Rate for Payer: Encore All Commercial |
$1,500.42
|
| Rate for Payer: Frontpath All Commercial |
$1,499.60
|
| Rate for Payer: Humana ChoiceCare |
$1,407.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,467.00
|
| Rate for Payer: PHCS All Commercial |
$1,222.50
|
| Rate for Payer: PHP All Commercial |
$1,236.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,258.36
|
| Rate for Payer: Signature Care EPO |
$1,352.90
|
| Rate for Payer: Signature Care PPO |
$1,434.40
|
| Rate for Payer: United Healthcare Commercial |
$1,284.44
|
|
|
HC SN BIOSURE HA 9X20
|
Facility
OP
|
$1,630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,515.90 |
| Rate for Payer: Aetna Commercial |
$1,375.72
|
| Rate for Payer: Aetna Medicare |
$537.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$936.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,018.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$618.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$591.69
|
| Rate for Payer: Cash Price |
$1,010.60
|
| Rate for Payer: Cash Price |
$1,010.60
|
| Rate for Payer: Centivo All Commercial |
$831.30
|
| Rate for Payer: Cigna All Commercial |
$1,406.69
|
| Rate for Payer: CORVEL All Commercial |
$1,515.90
|
| Rate for Payer: Coventry All Commercial |
$1,434.40
|
| Rate for Payer: Encore All Commercial |
$1,500.42
|
| Rate for Payer: Frontpath All Commercial |
$1,499.60
|
| Rate for Payer: Humana ChoiceCare |
$1,407.83
|
| Rate for Payer: Humana Medicare |
$831.30
|
| Rate for Payer: Lucent All Commercial |
$831.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,467.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,222.50
|
| Rate for Payer: PHP All Commercial |
$1,236.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$635.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,258.36
|
| Rate for Payer: Signature Care EPO |
$1,352.90
|
| Rate for Payer: Signature Care PPO |
$1,434.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,385.50
|
| Rate for Payer: United Healthcare Commercial |
$1,284.44
|
| Rate for Payer: United Healthcare Medicare |
$537.90
|
|
|
HC SN BIOSURE HA 9X20
|
Facility
IP
|
$1,630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.50 |
| Max. Negotiated Rate |
$1,515.90 |
| Rate for Payer: Aetna Commercial |
$1,408.32
|
| Rate for Payer: Cash Price |
$1,010.60
|
| Rate for Payer: Cigna All Commercial |
$1,406.69
|
| Rate for Payer: CORVEL All Commercial |
$1,515.90
|
| Rate for Payer: Coventry All Commercial |
$1,434.40
|
| Rate for Payer: Encore All Commercial |
$1,500.42
|
| Rate for Payer: Frontpath All Commercial |
$1,499.60
|
| Rate for Payer: Humana ChoiceCare |
$1,407.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,467.00
|
| Rate for Payer: PHCS All Commercial |
$1,222.50
|
| Rate for Payer: PHP All Commercial |
$1,236.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,258.36
|
| Rate for Payer: Signature Care EPO |
$1,352.90
|
| Rate for Payer: Signature Care PPO |
$1,434.40
|
| Rate for Payer: United Healthcare Commercial |
$1,284.44
|
|
|
HC SN CEMENT AB MV RALLY
|
Facility
OP
|
$1,302.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.82 |
| Max. Negotiated Rate |
$1,211.32 |
| Rate for Payer: Aetna Commercial |
$1,099.31
|
| Rate for Payer: Aetna Medicare |
$429.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$429.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$748.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$814.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$494.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$472.81
|
| Rate for Payer: Cash Price |
$807.55
|
| Rate for Payer: Cash Price |
$807.55
|
| Rate for Payer: Centivo All Commercial |
$664.28
|
| Rate for Payer: Cigna All Commercial |
$1,124.06
|
| Rate for Payer: CORVEL All Commercial |
$1,211.32
|
| Rate for Payer: Coventry All Commercial |
$1,146.20
|
| Rate for Payer: Encore All Commercial |
$1,198.95
|
| Rate for Payer: Frontpath All Commercial |
$1,198.30
|
| Rate for Payer: Humana ChoiceCare |
$1,124.97
|
| Rate for Payer: Humana Medicare |
$664.28
|
| Rate for Payer: Lucent All Commercial |
$664.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,172.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$976.88
|
| Rate for Payer: PHP All Commercial |
$987.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$507.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,005.53
|
| Rate for Payer: Signature Care EPO |
$1,081.08
|
| Rate for Payer: Signature Care PPO |
$1,146.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,107.12
|
| Rate for Payer: United Healthcare Commercial |
$1,026.37
|
| Rate for Payer: United Healthcare Medicare |
$429.82
|
|
