|
HC STAPLER 60 MM ECHELON 280MM
|
Facility
OP
|
$2,420.10
|
|
| Hospital Charge Code |
41607898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,250.69 |
| Rate for Payer: Aetna Commercial |
$2,042.56
|
| Rate for Payer: Aetna Medicare |
$798.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$798.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,389.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,512.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$918.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$878.50
|
| Rate for Payer: Cash Price |
$1,500.46
|
| Rate for Payer: Cash Price |
$1,500.46
|
| Rate for Payer: Centivo All Commercial |
$1,234.25
|
| Rate for Payer: Cigna All Commercial |
$2,088.55
|
| Rate for Payer: CORVEL All Commercial |
$2,250.69
|
| Rate for Payer: Coventry All Commercial |
$2,129.69
|
| Rate for Payer: Encore All Commercial |
$2,227.70
|
| Rate for Payer: Frontpath All Commercial |
$2,226.49
|
| Rate for Payer: Humana ChoiceCare |
$2,090.24
|
| Rate for Payer: Humana Medicare |
$1,234.25
|
| Rate for Payer: Lucent All Commercial |
$1,234.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,178.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,815.08
|
| Rate for Payer: PHP All Commercial |
$1,835.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$943.84
|
| Rate for Payer: Sagamore Health Network All Products |
$1,868.32
|
| Rate for Payer: Signature Care EPO |
$2,008.68
|
| Rate for Payer: Signature Care PPO |
$2,129.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,057.08
|
| Rate for Payer: United Healthcare Commercial |
$1,907.04
|
| Rate for Payer: United Healthcare Medicare |
$798.63
|
|
|
HC STAPLER 60 MM ECHELON 280MM
|
Facility
IP
|
$2,420.10
|
|
| Hospital Charge Code |
41607898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,815.08 |
| Max. Negotiated Rate |
$2,250.69 |
| Rate for Payer: Aetna Commercial |
$2,090.97
|
| Rate for Payer: Cash Price |
$1,500.46
|
| Rate for Payer: Cigna All Commercial |
$2,088.55
|
| Rate for Payer: CORVEL All Commercial |
$2,250.69
|
| Rate for Payer: Coventry All Commercial |
$2,129.69
|
| Rate for Payer: Encore All Commercial |
$2,227.70
|
| Rate for Payer: Frontpath All Commercial |
$2,226.49
|
| Rate for Payer: Humana ChoiceCare |
$2,090.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,178.09
|
| Rate for Payer: PHCS All Commercial |
$1,815.08
|
| Rate for Payer: PHP All Commercial |
$1,835.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,868.32
|
| Rate for Payer: Signature Care EPO |
$2,008.68
|
| Rate for Payer: Signature Care PPO |
$2,129.69
|
| Rate for Payer: United Healthcare Commercial |
$1,907.04
|
|
|
HC STAPLER 60MM ECHELON 340MM
|
Facility
OP
|
$1,870.76
|
|
| Hospital Charge Code |
41607897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,739.81 |
| Rate for Payer: Aetna Commercial |
$1,578.92
|
| Rate for Payer: Aetna Medicare |
$617.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$617.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,074.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,169.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$709.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$679.09
|
| Rate for Payer: Cash Price |
$1,159.87
|
| Rate for Payer: Cash Price |
$1,159.87
|
| Rate for Payer: Centivo All Commercial |
$954.09
|
| Rate for Payer: Cigna All Commercial |
$1,614.47
|
| Rate for Payer: CORVEL All Commercial |
$1,739.81
|
| Rate for Payer: Coventry All Commercial |
$1,646.27
|
| Rate for Payer: Encore All Commercial |
$1,722.03
|
| Rate for Payer: Frontpath All Commercial |
$1,721.10
|
| Rate for Payer: Humana ChoiceCare |
$1,615.78
|
| Rate for Payer: Humana Medicare |
$954.09
|
| Rate for Payer: Lucent All Commercial |
$954.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,683.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,403.07
|
| Rate for Payer: PHP All Commercial |
$1,418.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$729.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,444.23
|
| Rate for Payer: Signature Care EPO |
$1,552.73
|
| Rate for Payer: Signature Care PPO |
$1,646.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,590.15
|
| Rate for Payer: United Healthcare Commercial |
$1,474.16
|
| Rate for Payer: United Healthcare Medicare |
$617.35
|
|
|
HC STAPLER 60MM ECHELON 340MM
|
Facility
IP
|
$1,870.76
|
|
| Hospital Charge Code |
41607897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,403.07 |
| Max. Negotiated Rate |
$1,739.81 |
| Rate for Payer: Aetna Commercial |
$1,616.34
|
| Rate for Payer: Cash Price |
$1,159.87
|
| Rate for Payer: Cigna All Commercial |
$1,614.47
|
| Rate for Payer: CORVEL All Commercial |
$1,739.81
|
| Rate for Payer: Coventry All Commercial |
$1,646.27
|
| Rate for Payer: Encore All Commercial |
$1,722.03
|
| Rate for Payer: Frontpath All Commercial |
$1,721.10
|
| Rate for Payer: Humana ChoiceCare |
$1,615.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,683.68
|
| Rate for Payer: PHCS All Commercial |
$1,403.07
|
| Rate for Payer: PHP All Commercial |
$1,418.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,444.23
|
| Rate for Payer: Signature Care EPO |
$1,552.73
|
| Rate for Payer: Signature Care PPO |
$1,646.27
|
| Rate for Payer: United Healthcare Commercial |
$1,474.16
|
|
|
HC STAPLER CEEA 25
|
Facility
OP
|
$1,359.55
|
|
| Hospital Charge Code |
41602046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,264.38 |
| Rate for Payer: Aetna Commercial |
$1,147.46
|
| Rate for Payer: Aetna Medicare |
$448.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$448.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$780.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$849.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$515.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$493.52
|
| Rate for Payer: Cash Price |
$842.92
|
| Rate for Payer: Cash Price |
$842.92
|
| Rate for Payer: Centivo All Commercial |
$693.37
|
| Rate for Payer: Cigna All Commercial |
$1,173.29
|
| Rate for Payer: CORVEL All Commercial |
$1,264.38
|
| Rate for Payer: Coventry All Commercial |
$1,196.40
|
| Rate for Payer: Encore All Commercial |
$1,251.47
|
| Rate for Payer: Frontpath All Commercial |
$1,250.79
|
| Rate for Payer: Humana ChoiceCare |
$1,174.24
|
| Rate for Payer: Humana Medicare |
$693.37
|
| Rate for Payer: Lucent All Commercial |
$693.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,223.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,019.66
|
| Rate for Payer: PHP All Commercial |
$1,031.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$530.22
|
| Rate for Payer: Sagamore Health Network All Products |
$1,049.57
|
| Rate for Payer: Signature Care EPO |
$1,128.43
|
| Rate for Payer: Signature Care PPO |
$1,196.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,155.62
|
| Rate for Payer: United Healthcare Commercial |
$1,071.33
|
| Rate for Payer: United Healthcare Medicare |
$448.65
|
|
|
HC STAPLER CEEA 25
|
Facility
IP
|
$1,359.55
|
|
| Hospital Charge Code |
41602046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,019.66 |
| Max. Negotiated Rate |
$1,264.38 |
| Rate for Payer: Aetna Commercial |
$1,174.65
|
| Rate for Payer: Cash Price |
$842.92
|
| Rate for Payer: Cigna All Commercial |
$1,173.29
|
| Rate for Payer: CORVEL All Commercial |
$1,264.38
|
| Rate for Payer: Coventry All Commercial |
$1,196.40
|
| Rate for Payer: Encore All Commercial |
$1,251.47
|
| Rate for Payer: Frontpath All Commercial |
$1,250.79
|
| Rate for Payer: Humana ChoiceCare |
$1,174.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,223.60
|
| Rate for Payer: PHCS All Commercial |
$1,019.66
|
| Rate for Payer: PHP All Commercial |
$1,031.08
|
| Rate for Payer: Sagamore Health Network All Products |
$1,049.57
|
| Rate for Payer: Signature Care EPO |
$1,128.43
|
| Rate for Payer: Signature Care PPO |
$1,196.40
|
| Rate for Payer: United Healthcare Commercial |
$1,071.33
|
|
|
HC STAPLER CEEA 28
|
Facility
OP
|
$1,359.55
|
|
| Hospital Charge Code |
41602047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,264.38 |
| Rate for Payer: Aetna Commercial |
$1,147.46
|
| Rate for Payer: Aetna Medicare |
$448.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$448.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$780.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$849.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$515.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$493.52
|
| Rate for Payer: Cash Price |
$842.92
|
| Rate for Payer: Cash Price |
$842.92
|
| Rate for Payer: Centivo All Commercial |
$693.37
|
| Rate for Payer: Cigna All Commercial |
$1,173.29
|
| Rate for Payer: CORVEL All Commercial |
$1,264.38
|
| Rate for Payer: Coventry All Commercial |
$1,196.40
|
| Rate for Payer: Encore All Commercial |
$1,251.47
|
| Rate for Payer: Frontpath All Commercial |
$1,250.79
|
| Rate for Payer: Humana ChoiceCare |
$1,174.24
|
| Rate for Payer: Humana Medicare |
$693.37
|
| Rate for Payer: Lucent All Commercial |
$693.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,223.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,019.66
|
| Rate for Payer: PHP All Commercial |
$1,031.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$530.22
|
| Rate for Payer: Sagamore Health Network All Products |
$1,049.57
|
| Rate for Payer: Signature Care EPO |
$1,128.43
|
| Rate for Payer: Signature Care PPO |
$1,196.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,155.62
|
| Rate for Payer: United Healthcare Commercial |
$1,071.33
|
| Rate for Payer: United Healthcare Medicare |
$448.65
|
|
|
HC STAPLER CEEA 28
|
Facility
IP
|
$1,359.55
|
|
| Hospital Charge Code |
41602047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,019.66 |
| Max. Negotiated Rate |
$1,264.38 |
| Rate for Payer: Aetna Commercial |
$1,174.65
|
| Rate for Payer: Cash Price |
$842.92
|
| Rate for Payer: Cigna All Commercial |
$1,173.29
|
| Rate for Payer: CORVEL All Commercial |
$1,264.38
|
| Rate for Payer: Coventry All Commercial |
$1,196.40
|
| Rate for Payer: Encore All Commercial |
$1,251.47
|
| Rate for Payer: Frontpath All Commercial |
$1,250.79
|
| Rate for Payer: Humana ChoiceCare |
$1,174.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,223.60
|
| Rate for Payer: PHCS All Commercial |
$1,019.66
|
| Rate for Payer: PHP All Commercial |
$1,031.08
|
| Rate for Payer: Sagamore Health Network All Products |
$1,049.57
|
| Rate for Payer: Signature Care EPO |
$1,128.43
|
| Rate for Payer: Signature Care PPO |
$1,196.40
|
| Rate for Payer: United Healthcare Commercial |
$1,071.33
|
|
|
HC STAPLER CEEA 31
|
Facility
IP
|
$1,451.60
|
|
| Hospital Charge Code |
41602048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,088.70 |
| Max. Negotiated Rate |
$1,349.99 |
| Rate for Payer: Aetna Commercial |
$1,254.18
|
| Rate for Payer: Cash Price |
$899.99
|
| Rate for Payer: Cigna All Commercial |
$1,252.73
|
| Rate for Payer: CORVEL All Commercial |
$1,349.99
|
| Rate for Payer: Coventry All Commercial |
$1,277.41
|
| Rate for Payer: Encore All Commercial |
$1,336.20
|
| Rate for Payer: Frontpath All Commercial |
$1,335.47
|
| Rate for Payer: Humana ChoiceCare |
$1,253.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,306.44
|
| Rate for Payer: PHCS All Commercial |
$1,088.70
|
| Rate for Payer: PHP All Commercial |
$1,100.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,120.64
|
| Rate for Payer: Signature Care EPO |
$1,204.83
|
| Rate for Payer: Signature Care PPO |
$1,277.41
|
| Rate for Payer: United Healthcare Commercial |
$1,143.86
|
|
|
HC STAPLER CEEA 31
|
Facility
OP
|
$1,451.60
|
|
| Hospital Charge Code |
41602048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,349.99 |
| Rate for Payer: Aetna Commercial |
$1,225.15
|
| Rate for Payer: Aetna Medicare |
$479.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$479.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$833.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$907.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$550.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$526.93
|
| Rate for Payer: Cash Price |
$899.99
|
| Rate for Payer: Cash Price |
$899.99
|
| Rate for Payer: Centivo All Commercial |
$740.32
|
| Rate for Payer: Cigna All Commercial |
$1,252.73
|
| Rate for Payer: CORVEL All Commercial |
$1,349.99
|
| Rate for Payer: Coventry All Commercial |
$1,277.41
|
| Rate for Payer: Encore All Commercial |
$1,336.20
|
| Rate for Payer: Frontpath All Commercial |
$1,335.47
|
| Rate for Payer: Humana ChoiceCare |
$1,253.75
|
| Rate for Payer: Humana Medicare |
$740.32
|
| Rate for Payer: Lucent All Commercial |
$740.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,306.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,088.70
|
| Rate for Payer: PHP All Commercial |
$1,100.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$566.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,120.64
|
| Rate for Payer: Signature Care EPO |
$1,204.83
|
| Rate for Payer: Signature Care PPO |
$1,277.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,233.86
|
| Rate for Payer: United Healthcare Commercial |
$1,143.86
|
| Rate for Payer: United Healthcare Medicare |
$479.03
|
|
|
HC STAPLER CIRCULAR 25 CM
|
Facility
OP
|
$2,327.63
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,164.70 |
| Rate for Payer: Aetna Commercial |
$1,964.52
|
| Rate for Payer: Aetna Medicare |
$768.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$768.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,336.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,455.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$883.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$844.93
|
| Rate for Payer: Cash Price |
$1,443.13
|
| Rate for Payer: Cash Price |
$1,443.13
|
| Rate for Payer: Centivo All Commercial |
$1,187.09
|
| Rate for Payer: Cigna All Commercial |
$2,008.74
|
| Rate for Payer: CORVEL All Commercial |
$2,164.70
|
| Rate for Payer: Coventry All Commercial |
$2,048.31
|
| Rate for Payer: Encore All Commercial |
$2,142.58
|
| Rate for Payer: Frontpath All Commercial |
$2,141.42
|
| Rate for Payer: Humana ChoiceCare |
$2,010.37
|
| Rate for Payer: Humana Medicare |
$1,187.09
|
| Rate for Payer: Lucent All Commercial |
$1,187.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,094.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,745.72
|
| Rate for Payer: PHP All Commercial |
$1,765.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$907.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,796.93
|
| Rate for Payer: Signature Care EPO |
$1,931.93
|
| Rate for Payer: Signature Care PPO |
$2,048.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,978.49
|
| Rate for Payer: United Healthcare Commercial |
$1,834.17
|
| Rate for Payer: United Healthcare Medicare |
$768.12
|
|
|
HC STAPLER CIRCULAR 25 CM
|
Facility
IP
|
$2,327.63
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,745.72 |
| Max. Negotiated Rate |
$2,164.70 |
| Rate for Payer: Aetna Commercial |
$2,011.07
|
| Rate for Payer: Cash Price |
$1,443.13
|
| Rate for Payer: Cigna All Commercial |
$2,008.74
|
| Rate for Payer: CORVEL All Commercial |
$2,164.70
|
| Rate for Payer: Coventry All Commercial |
$2,048.31
|
| Rate for Payer: Encore All Commercial |
$2,142.58
|
| Rate for Payer: Frontpath All Commercial |
$2,141.42
|
| Rate for Payer: Humana ChoiceCare |
$2,010.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,094.87
|
| Rate for Payer: PHCS All Commercial |
$1,745.72
|
| Rate for Payer: PHP All Commercial |
$1,765.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,796.93
|
| Rate for Payer: Signature Care EPO |
$1,931.93
|
| Rate for Payer: Signature Care PPO |
$2,048.31
|
| Rate for Payer: United Healthcare Commercial |
$1,834.17
|
|
|
HC STAPLER CIRCULAR 29 CM
|
Facility
OP
|
$2,327.63
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,164.70 |
| Rate for Payer: Aetna Commercial |
$1,964.52
|
| Rate for Payer: Aetna Medicare |
$768.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$768.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,336.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,455.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$883.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$844.93
|
| Rate for Payer: Cash Price |
$1,443.13
|
| Rate for Payer: Cash Price |
$1,443.13
|
| Rate for Payer: Centivo All Commercial |
$1,187.09
|
| Rate for Payer: Cigna All Commercial |
$2,008.74
|
| Rate for Payer: CORVEL All Commercial |
$2,164.70
|
| Rate for Payer: Coventry All Commercial |
$2,048.31
|
| Rate for Payer: Encore All Commercial |
$2,142.58
|
| Rate for Payer: Frontpath All Commercial |
$2,141.42
|
| Rate for Payer: Humana ChoiceCare |
$2,010.37
|
| Rate for Payer: Humana Medicare |
$1,187.09
|
| Rate for Payer: Lucent All Commercial |
$1,187.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,094.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,745.72
|
| Rate for Payer: PHP All Commercial |
$1,765.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$907.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,796.93
|
| Rate for Payer: Signature Care EPO |
$1,931.93
|
| Rate for Payer: Signature Care PPO |
$2,048.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,978.49
|
| Rate for Payer: United Healthcare Commercial |
$1,834.17
|
| Rate for Payer: United Healthcare Medicare |
$768.12
|
|
|
HC STAPLER CIRCULAR 29 CM
|
Facility
IP
|
$2,327.63
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,745.72 |
| Max. Negotiated Rate |
$2,164.70 |
| Rate for Payer: Aetna Commercial |
$2,011.07
|
| Rate for Payer: Cash Price |
$1,443.13
|
| Rate for Payer: Cigna All Commercial |
$2,008.74
|
| Rate for Payer: CORVEL All Commercial |
$2,164.70
|
| Rate for Payer: Coventry All Commercial |
$2,048.31
|
| Rate for Payer: Encore All Commercial |
$2,142.58
|
| Rate for Payer: Frontpath All Commercial |
$2,141.42
|
| Rate for Payer: Humana ChoiceCare |
$2,010.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,094.87
|
| Rate for Payer: PHCS All Commercial |
$1,745.72
|
| Rate for Payer: PHP All Commercial |
$1,765.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,796.93
|
| Rate for Payer: Signature Care EPO |
$1,931.93
|
| Rate for Payer: Signature Care PPO |
$2,048.31
|
| Rate for Payer: United Healthcare Commercial |
$1,834.17
|
|
|
HC STAPLER CIRCULAR 31 CM
|
Facility
OP
|
$2,327.63
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,164.70 |
| Rate for Payer: Aetna Commercial |
$1,964.52
|
| Rate for Payer: Aetna Medicare |
$768.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$768.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,336.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,455.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$883.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$844.93
|
| Rate for Payer: Cash Price |
$1,443.13
|
| Rate for Payer: Cash Price |
$1,443.13
|
| Rate for Payer: Centivo All Commercial |
$1,187.09
|
| Rate for Payer: Cigna All Commercial |
$2,008.74
|
| Rate for Payer: CORVEL All Commercial |
$2,164.70
|
| Rate for Payer: Coventry All Commercial |
$2,048.31
|
| Rate for Payer: Encore All Commercial |
$2,142.58
|
| Rate for Payer: Frontpath All Commercial |
$2,141.42
|
| Rate for Payer: Humana ChoiceCare |
$2,010.37
|
| Rate for Payer: Humana Medicare |
$1,187.09
|
| Rate for Payer: Lucent All Commercial |
$1,187.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,094.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,745.72
|
| Rate for Payer: PHP All Commercial |
$1,765.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$907.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,796.93
|
| Rate for Payer: Signature Care EPO |
$1,931.93
|
| Rate for Payer: Signature Care PPO |
$2,048.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,978.49
|
| Rate for Payer: United Healthcare Commercial |
$1,834.17
|
| Rate for Payer: United Healthcare Medicare |
$768.12
|
|
|
HC STAPLER CIRCULAR 31 CM
|
Facility
IP
|
$2,327.63
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,745.72 |
| Max. Negotiated Rate |
$2,164.70 |
| Rate for Payer: Aetna Commercial |
$2,011.07
|
| Rate for Payer: Cash Price |
$1,443.13
|
| Rate for Payer: Cigna All Commercial |
$2,008.74
|
| Rate for Payer: CORVEL All Commercial |
$2,164.70
|
| Rate for Payer: Coventry All Commercial |
$2,048.31
|
| Rate for Payer: Encore All Commercial |
$2,142.58
|
| Rate for Payer: Frontpath All Commercial |
$2,141.42
|
| Rate for Payer: Humana ChoiceCare |
$2,010.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,094.87
|
| Rate for Payer: PHCS All Commercial |
$1,745.72
|
| Rate for Payer: PHP All Commercial |
$1,765.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,796.93
|
| Rate for Payer: Signature Care EPO |
$1,931.93
|
| Rate for Payer: Signature Care PPO |
$2,048.31
|
| Rate for Payer: United Healthcare Commercial |
$1,834.17
|
|
|
HC STAPLE REMOVER SKIN
|
Facility
IP
|
$12.16
|
|
| Hospital Charge Code |
41601092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$11.31 |
| Rate for Payer: Aetna Commercial |
$10.51
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cigna All Commercial |
$10.49
|
| Rate for Payer: CORVEL All Commercial |
$11.31
|
| Rate for Payer: Coventry All Commercial |
$10.70
|
| Rate for Payer: Encore All Commercial |
$11.19
|
| Rate for Payer: Frontpath All Commercial |
$11.19
|
| Rate for Payer: Humana ChoiceCare |
$10.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.94
|
| Rate for Payer: PHCS All Commercial |
$9.12
|
| Rate for Payer: PHP All Commercial |
$9.22
|
| Rate for Payer: Sagamore Health Network All Products |
$9.39
|
| Rate for Payer: Signature Care EPO |
$10.09
|
| Rate for Payer: Signature Care PPO |
$10.70
|
| Rate for Payer: United Healthcare Commercial |
$9.58
|
|
|
HC STAPLE REMOVER SKIN
|
Facility
OP
|
$12.16
|
|
| Hospital Charge Code |
41601092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare |
$4.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.41
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Centivo All Commercial |
$6.20
|
| Rate for Payer: Cigna All Commercial |
$10.49
|
| Rate for Payer: CORVEL All Commercial |
$11.31
|
| Rate for Payer: Coventry All Commercial |
$10.70
|
| Rate for Payer: Encore All Commercial |
$11.19
|
| Rate for Payer: Frontpath All Commercial |
$11.19
|
| Rate for Payer: Humana ChoiceCare |
$10.50
|
| Rate for Payer: Humana Medicare |
$6.20
|
| Rate for Payer: Lucent All Commercial |
$6.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.94
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.12
|
| Rate for Payer: PHP All Commercial |
$9.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.74
|
| Rate for Payer: Sagamore Health Network All Products |
$9.39
|
| Rate for Payer: Signature Care EPO |
$10.09
|
| Rate for Payer: Signature Care PPO |
$10.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.34
|
| Rate for Payer: United Healthcare Commercial |
$9.58
|
| Rate for Payer: United Healthcare Medicare |
$4.01
|
|
|
HC STAPLER ENDO GIA
|
Facility
IP
|
$678.74
|
|
| Hospital Charge Code |
41602049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.06 |
| Max. Negotiated Rate |
$631.23 |
| Rate for Payer: Aetna Commercial |
$586.43
|
| Rate for Payer: Cash Price |
$420.82
|
| Rate for Payer: Cigna All Commercial |
$585.75
|
| Rate for Payer: CORVEL All Commercial |
$631.23
|
| Rate for Payer: Coventry All Commercial |
$597.29
|
| Rate for Payer: Encore All Commercial |
$624.78
|
| Rate for Payer: Frontpath All Commercial |
$624.44
|
| Rate for Payer: Humana ChoiceCare |
$586.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$610.87
|
| Rate for Payer: PHCS All Commercial |
$509.06
|
| Rate for Payer: PHP All Commercial |
$514.76
|
| Rate for Payer: Sagamore Health Network All Products |
$523.99
|
| Rate for Payer: Signature Care EPO |
$563.35
|
| Rate for Payer: Signature Care PPO |
$597.29
|
| Rate for Payer: United Healthcare Commercial |
$534.85
|
|
|
HC STAPLER ENDO GIA
|
Facility
OP
|
$678.74
|
|
| Hospital Charge Code |
41602049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$631.23 |
| Rate for Payer: Aetna Commercial |
$572.86
|
| Rate for Payer: Aetna Medicare |
$223.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$223.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$389.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$424.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$257.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$246.38
|
| Rate for Payer: Cash Price |
$420.82
|
| Rate for Payer: Cash Price |
$420.82
|
| Rate for Payer: Centivo All Commercial |
$346.16
|
| Rate for Payer: Cigna All Commercial |
$585.75
|
| Rate for Payer: CORVEL All Commercial |
$631.23
|
| Rate for Payer: Coventry All Commercial |
$597.29
|
| Rate for Payer: Encore All Commercial |
$624.78
|
| Rate for Payer: Frontpath All Commercial |
$624.44
|
| Rate for Payer: Humana ChoiceCare |
$586.23
|
| Rate for Payer: Humana Medicare |
$346.16
|
| Rate for Payer: Lucent All Commercial |
$346.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$610.87
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$509.06
|
| Rate for Payer: PHP All Commercial |
$514.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$264.71
|
| Rate for Payer: Sagamore Health Network All Products |
$523.99
|
| Rate for Payer: Signature Care EPO |
$563.35
|
| Rate for Payer: Signature Care PPO |
$597.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$576.93
|
| Rate for Payer: United Healthcare Commercial |
$534.85
|
| Rate for Payer: United Healthcare Medicare |
$223.98
|
|
|
HC STAPLER ENDO GIA
|
Facility
IP
|
$929.97
|
|
| Hospital Charge Code |
41604000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$697.48 |
| Max. Negotiated Rate |
$864.87 |
| Rate for Payer: Aetna Commercial |
$803.49
|
| Rate for Payer: Cash Price |
$576.58
|
| Rate for Payer: Cigna All Commercial |
$802.56
|
| Rate for Payer: CORVEL All Commercial |
$864.87
|
| Rate for Payer: Coventry All Commercial |
$818.37
|
| Rate for Payer: Encore All Commercial |
$856.04
|
| Rate for Payer: Frontpath All Commercial |
$855.57
|
| Rate for Payer: Humana ChoiceCare |
$803.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$836.97
|
| Rate for Payer: PHCS All Commercial |
$697.48
|
| Rate for Payer: PHP All Commercial |
$705.29
|
| Rate for Payer: Sagamore Health Network All Products |
$717.94
|
| Rate for Payer: Signature Care EPO |
$771.88
|
| Rate for Payer: Signature Care PPO |
$818.37
|
| Rate for Payer: United Healthcare Commercial |
$732.82
|
|
|
HC STAPLER ENDO GIA
|
Facility
OP
|
$929.97
|
|
| Hospital Charge Code |
41604000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$864.87 |
| Rate for Payer: Aetna Commercial |
$784.89
|
| Rate for Payer: Aetna Medicare |
$306.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$306.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$352.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.58
|
| Rate for Payer: Cash Price |
$576.58
|
| Rate for Payer: Cash Price |
$576.58
|
| Rate for Payer: Centivo All Commercial |
$474.28
|
| Rate for Payer: Cigna All Commercial |
$802.56
|
| Rate for Payer: CORVEL All Commercial |
$864.87
|
| Rate for Payer: Coventry All Commercial |
$818.37
|
| Rate for Payer: Encore All Commercial |
$856.04
|
| Rate for Payer: Frontpath All Commercial |
$855.57
|
| Rate for Payer: Humana ChoiceCare |
$803.22
|
| Rate for Payer: Humana Medicare |
$474.28
|
| Rate for Payer: Lucent All Commercial |
$474.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$836.97
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$697.48
|
| Rate for Payer: PHP All Commercial |
$705.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$362.69
|
| Rate for Payer: Sagamore Health Network All Products |
$717.94
|
| Rate for Payer: Signature Care EPO |
$771.88
|
| Rate for Payer: Signature Care PPO |
$818.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$790.47
|
| Rate for Payer: United Healthcare Commercial |
$732.82
|
| Rate for Payer: United Healthcare Medicare |
$306.89
|
|
|
HC STAPLER ENDO GIA SHORT
|
Facility
IP
|
$845.39
|
|
| Hospital Charge Code |
41604001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$634.04 |
| Max. Negotiated Rate |
$786.21 |
| Rate for Payer: Aetna Commercial |
$730.42
|
| Rate for Payer: Cash Price |
$524.14
|
| Rate for Payer: Cigna All Commercial |
$729.57
|
| Rate for Payer: CORVEL All Commercial |
$786.21
|
| Rate for Payer: Coventry All Commercial |
$743.94
|
| Rate for Payer: Encore All Commercial |
$778.18
|
| Rate for Payer: Frontpath All Commercial |
$777.76
|
| Rate for Payer: Humana ChoiceCare |
$730.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$760.85
|
| Rate for Payer: PHCS All Commercial |
$634.04
|
| Rate for Payer: PHP All Commercial |
$641.14
|
| Rate for Payer: Sagamore Health Network All Products |
$652.64
|
| Rate for Payer: Signature Care EPO |
$701.67
|
| Rate for Payer: Signature Care PPO |
$743.94
|
| Rate for Payer: United Healthcare Commercial |
$666.17
|
|
|
HC STAPLER ENDO GIA SHORT
|
Facility
OP
|
$845.39
|
|
| Hospital Charge Code |
41604001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$786.21 |
| Rate for Payer: Aetna Commercial |
$713.51
|
| Rate for Payer: Aetna Medicare |
$278.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$278.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$485.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$528.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$320.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$306.88
|
| Rate for Payer: Cash Price |
$524.14
|
| Rate for Payer: Cash Price |
$524.14
|
| Rate for Payer: Centivo All Commercial |
$431.15
|
| Rate for Payer: Cigna All Commercial |
$729.57
|
| Rate for Payer: CORVEL All Commercial |
$786.21
|
| Rate for Payer: Coventry All Commercial |
$743.94
|
| Rate for Payer: Encore All Commercial |
$778.18
|
| Rate for Payer: Frontpath All Commercial |
$777.76
|
| Rate for Payer: Humana ChoiceCare |
$730.16
|
| Rate for Payer: Humana Medicare |
$431.15
|
| Rate for Payer: Lucent All Commercial |
$431.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$760.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$634.04
|
| Rate for Payer: PHP All Commercial |
$641.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$329.70
|
| Rate for Payer: Sagamore Health Network All Products |
$652.64
|
| Rate for Payer: Signature Care EPO |
$701.67
|
| Rate for Payer: Signature Care PPO |
$743.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$718.58
|
| Rate for Payer: United Healthcare Commercial |
$666.17
|
| Rate for Payer: United Healthcare Medicare |
$278.98
|
|
|
HC STAPLER ENDO GIA SHORT
|
Facility
IP
|
$622.79
|
|
| Hospital Charge Code |
41602050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$467.09 |
| Max. Negotiated Rate |
$579.19 |
| Rate for Payer: Aetna Commercial |
$538.09
|
| Rate for Payer: Cash Price |
$386.13
|
| Rate for Payer: Cigna All Commercial |
$537.47
|
| Rate for Payer: CORVEL All Commercial |
$579.19
|
| Rate for Payer: Coventry All Commercial |
$548.06
|
| Rate for Payer: Encore All Commercial |
$573.28
|
| Rate for Payer: Frontpath All Commercial |
$572.97
|
| Rate for Payer: Humana ChoiceCare |
$537.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$560.51
|
| Rate for Payer: PHCS All Commercial |
$467.09
|
| Rate for Payer: PHP All Commercial |
$472.32
|
| Rate for Payer: Sagamore Health Network All Products |
$480.79
|
| Rate for Payer: Signature Care EPO |
$516.92
|
| Rate for Payer: Signature Care PPO |
$548.06
|
| Rate for Payer: United Healthcare Commercial |
$490.76
|
|
