|
HC STAPLER ENDO GIA SHORT
|
Facility
OP
|
$622.79
|
|
| Hospital Charge Code |
41602050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$579.19 |
| Rate for Payer: Aetna Commercial |
$525.63
|
| Rate for Payer: Aetna Medicare |
$205.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$357.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$389.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$236.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$226.07
|
| Rate for Payer: Cash Price |
$386.13
|
| Rate for Payer: Cash Price |
$386.13
|
| Rate for Payer: Centivo All Commercial |
$317.62
|
| 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: Humana Medicare |
$317.62
|
| Rate for Payer: Lucent All Commercial |
$317.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$560.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$467.09
|
| Rate for Payer: PHP All Commercial |
$472.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.89
|
| 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: Three Rivers Preferred All Commercial |
$529.37
|
| Rate for Payer: United Healthcare Commercial |
$490.76
|
| Rate for Payer: United Healthcare Medicare |
$205.52
|
|
|
HC STAPLER GIA 60 3.8
|
Facility
IP
|
$782.67
|
|
| Hospital Charge Code |
41602051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$587.00 |
| Max. Negotiated Rate |
$727.88 |
| Rate for Payer: Aetna Commercial |
$676.23
|
| Rate for Payer: Cash Price |
$485.26
|
| Rate for Payer: Cigna All Commercial |
$675.44
|
| Rate for Payer: CORVEL All Commercial |
$727.88
|
| Rate for Payer: Coventry All Commercial |
$688.75
|
| Rate for Payer: Encore All Commercial |
$720.45
|
| Rate for Payer: Frontpath All Commercial |
$720.06
|
| Rate for Payer: Humana ChoiceCare |
$675.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.40
|
| Rate for Payer: PHCS All Commercial |
$587.00
|
| Rate for Payer: PHP All Commercial |
$593.58
|
| Rate for Payer: Sagamore Health Network All Products |
$604.22
|
| Rate for Payer: Signature Care EPO |
$649.62
|
| Rate for Payer: Signature Care PPO |
$688.75
|
| Rate for Payer: United Healthcare Commercial |
$616.74
|
|
|
HC STAPLER GIA 60 3.8
|
Facility
OP
|
$782.67
|
|
| Hospital Charge Code |
41602051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$727.88 |
| Rate for Payer: Aetna Commercial |
$660.57
|
| Rate for Payer: Aetna Medicare |
$258.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$258.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$449.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$297.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$284.11
|
| Rate for Payer: Cash Price |
$485.26
|
| Rate for Payer: Cash Price |
$485.26
|
| Rate for Payer: Centivo All Commercial |
$399.16
|
| Rate for Payer: Cigna All Commercial |
$675.44
|
| Rate for Payer: CORVEL All Commercial |
$727.88
|
| Rate for Payer: Coventry All Commercial |
$688.75
|
| Rate for Payer: Encore All Commercial |
$720.45
|
| Rate for Payer: Frontpath All Commercial |
$720.06
|
| Rate for Payer: Humana ChoiceCare |
$675.99
|
| Rate for Payer: Humana Medicare |
$399.16
|
| Rate for Payer: Lucent All Commercial |
$399.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$587.00
|
| Rate for Payer: PHP All Commercial |
$593.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$305.24
|
| Rate for Payer: Sagamore Health Network All Products |
$604.22
|
| Rate for Payer: Signature Care EPO |
$649.62
|
| Rate for Payer: Signature Care PPO |
$688.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$665.27
|
| Rate for Payer: United Healthcare Commercial |
$616.74
|
| Rate for Payer: United Healthcare Medicare |
$258.28
|
|
|
HC STAPLER GIA 80 3.8
|
Facility
OP
|
$823.83
|
|
| Hospital Charge Code |
41602052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$766.16 |
| Rate for Payer: Aetna Commercial |
$695.31
|
| Rate for Payer: Aetna Medicare |
$271.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$271.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$514.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.05
|
| Rate for Payer: Cash Price |
$510.78
|
| Rate for Payer: Cash Price |
$510.78
|
| Rate for Payer: Centivo All Commercial |
$420.15
|
| Rate for Payer: Cigna All Commercial |
$710.97
|
| Rate for Payer: CORVEL All Commercial |
$766.16
|
| Rate for Payer: Coventry All Commercial |
$724.97
|
| Rate for Payer: Encore All Commercial |
$758.34
|
| Rate for Payer: Frontpath All Commercial |
$757.92
|
| Rate for Payer: Humana ChoiceCare |
$711.54
|
| Rate for Payer: Humana Medicare |
$420.15
|
| Rate for Payer: Lucent All Commercial |
$420.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$741.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$617.87
|
| Rate for Payer: PHP All Commercial |
$624.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.29
|
| Rate for Payer: Sagamore Health Network All Products |
$636.00
|
| Rate for Payer: Signature Care EPO |
$683.78
|
| Rate for Payer: Signature Care PPO |
$724.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$700.26
|
| Rate for Payer: United Healthcare Commercial |
$649.18
|
| Rate for Payer: United Healthcare Medicare |
$271.86
|
|
|
HC STAPLER GIA 80 3.8
|
Facility
IP
|
$823.83
|
|
| Hospital Charge Code |
41602052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$617.87 |
| Max. Negotiated Rate |
$766.16 |
| Rate for Payer: Aetna Commercial |
$711.79
|
| Rate for Payer: Cash Price |
$510.78
|
| Rate for Payer: Cigna All Commercial |
$710.97
|
| Rate for Payer: CORVEL All Commercial |
$766.16
|
| Rate for Payer: Coventry All Commercial |
$724.97
|
| Rate for Payer: Encore All Commercial |
$758.34
|
| Rate for Payer: Frontpath All Commercial |
$757.92
|
| Rate for Payer: Humana ChoiceCare |
$711.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$741.45
|
| Rate for Payer: PHCS All Commercial |
$617.87
|
| Rate for Payer: PHP All Commercial |
$624.79
|
| Rate for Payer: Sagamore Health Network All Products |
$636.00
|
| Rate for Payer: Signature Care EPO |
$683.78
|
| Rate for Payer: Signature Care PPO |
$724.97
|
| Rate for Payer: United Healthcare Commercial |
$649.18
|
|
|
HC STAPLER INSORB
|
Facility
OP
|
$338.33
|
|
| Hospital Charge Code |
41601401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$314.65 |
| Rate for Payer: Aetna Commercial |
$285.55
|
| Rate for Payer: Aetna Medicare |
$111.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$194.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.81
|
| Rate for Payer: Cash Price |
$209.77
|
| Rate for Payer: Cash Price |
$209.77
|
| Rate for Payer: Centivo All Commercial |
$172.55
|
| Rate for Payer: Cigna All Commercial |
$291.98
|
| Rate for Payer: CORVEL All Commercial |
$314.65
|
| Rate for Payer: Coventry All Commercial |
$297.73
|
| Rate for Payer: Encore All Commercial |
$311.43
|
| Rate for Payer: Frontpath All Commercial |
$311.26
|
| Rate for Payer: Humana ChoiceCare |
$292.22
|
| Rate for Payer: Humana Medicare |
$172.55
|
| Rate for Payer: Lucent All Commercial |
$172.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$304.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$253.75
|
| Rate for Payer: PHP All Commercial |
$256.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.95
|
| Rate for Payer: Sagamore Health Network All Products |
$261.19
|
| Rate for Payer: Signature Care EPO |
$280.81
|
| Rate for Payer: Signature Care PPO |
$297.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.58
|
| Rate for Payer: United Healthcare Commercial |
$266.60
|
| Rate for Payer: United Healthcare Medicare |
$111.65
|
|
|
HC STAPLER INSORB
|
Facility
IP
|
$338.33
|
|
| Hospital Charge Code |
41601401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$314.65 |
| Rate for Payer: Aetna Commercial |
$292.32
|
| Rate for Payer: Cash Price |
$209.77
|
| Rate for Payer: Cigna All Commercial |
$291.98
|
| Rate for Payer: CORVEL All Commercial |
$314.65
|
| Rate for Payer: Coventry All Commercial |
$297.73
|
| Rate for Payer: Encore All Commercial |
$311.43
|
| Rate for Payer: Frontpath All Commercial |
$311.26
|
| Rate for Payer: Humana ChoiceCare |
$292.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$304.50
|
| Rate for Payer: PHCS All Commercial |
$253.75
|
| Rate for Payer: PHP All Commercial |
$256.59
|
| Rate for Payer: Sagamore Health Network All Products |
$261.19
|
| Rate for Payer: Signature Care EPO |
$280.81
|
| Rate for Payer: Signature Care PPO |
$297.73
|
| Rate for Payer: United Healthcare Commercial |
$266.60
|
|
|
HC STAPLER LDS
|
Facility
IP
|
$905.68
|
|
| Hospital Charge Code |
41602053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$679.26 |
| Max. Negotiated Rate |
$842.28 |
| Rate for Payer: Aetna Commercial |
$782.51
|
| Rate for Payer: Cash Price |
$561.52
|
| Rate for Payer: Cigna All Commercial |
$781.60
|
| Rate for Payer: CORVEL All Commercial |
$842.28
|
| Rate for Payer: Coventry All Commercial |
$797.00
|
| Rate for Payer: Encore All Commercial |
$833.68
|
| Rate for Payer: Frontpath All Commercial |
$833.23
|
| Rate for Payer: Humana ChoiceCare |
$782.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$815.11
|
| Rate for Payer: PHCS All Commercial |
$679.26
|
| Rate for Payer: PHP All Commercial |
$686.87
|
| Rate for Payer: Sagamore Health Network All Products |
$699.18
|
| Rate for Payer: Signature Care EPO |
$751.71
|
| Rate for Payer: Signature Care PPO |
$797.00
|
| Rate for Payer: United Healthcare Commercial |
$713.68
|
|
|
HC STAPLER LDS
|
Facility
OP
|
$905.68
|
|
| Hospital Charge Code |
41602053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$842.28 |
| Rate for Payer: Aetna Commercial |
$764.39
|
| Rate for Payer: Aetna Medicare |
$298.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$298.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$520.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$566.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$343.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$328.76
|
| Rate for Payer: Cash Price |
$561.52
|
| Rate for Payer: Cash Price |
$561.52
|
| Rate for Payer: Centivo All Commercial |
$461.90
|
| Rate for Payer: Cigna All Commercial |
$781.60
|
| Rate for Payer: CORVEL All Commercial |
$842.28
|
| Rate for Payer: Coventry All Commercial |
$797.00
|
| Rate for Payer: Encore All Commercial |
$833.68
|
| Rate for Payer: Frontpath All Commercial |
$833.23
|
| Rate for Payer: Humana ChoiceCare |
$782.24
|
| Rate for Payer: Humana Medicare |
$461.90
|
| Rate for Payer: Lucent All Commercial |
$461.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$815.11
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$679.26
|
| Rate for Payer: PHP All Commercial |
$686.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$353.22
|
| Rate for Payer: Sagamore Health Network All Products |
$699.18
|
| Rate for Payer: Signature Care EPO |
$751.71
|
| Rate for Payer: Signature Care PPO |
$797.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$769.83
|
| Rate for Payer: United Healthcare Commercial |
$713.68
|
| Rate for Payer: United Healthcare Medicare |
$298.87
|
|
|
HC STAPLER PROXIMATE 25
|
Facility
IP
|
$4,004.95
|
|
| Hospital Charge Code |
41602280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,003.71 |
| Max. Negotiated Rate |
$3,724.60 |
| Rate for Payer: Aetna Commercial |
$3,460.28
|
| Rate for Payer: Cash Price |
$2,483.07
|
| Rate for Payer: Cigna All Commercial |
$3,456.27
|
| Rate for Payer: CORVEL All Commercial |
$3,724.60
|
| Rate for Payer: Coventry All Commercial |
$3,524.36
|
| Rate for Payer: Encore All Commercial |
$3,686.56
|
| Rate for Payer: Frontpath All Commercial |
$3,684.55
|
| Rate for Payer: Humana ChoiceCare |
$3,459.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,604.46
|
| Rate for Payer: PHCS All Commercial |
$3,003.71
|
| Rate for Payer: PHP All Commercial |
$3,037.35
|
| Rate for Payer: Sagamore Health Network All Products |
$3,091.82
|
| Rate for Payer: Signature Care EPO |
$3,324.11
|
| Rate for Payer: Signature Care PPO |
$3,524.36
|
| Rate for Payer: United Healthcare Commercial |
$3,155.90
|
|
|
HC STAPLER PROXIMATE 25
|
Facility
OP
|
$4,004.95
|
|
| Hospital Charge Code |
41602280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$3,724.60 |
| Rate for Payer: Aetna Commercial |
$3,380.18
|
| Rate for Payer: Aetna Medicare |
$1,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,321.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,300.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,503.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,519.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,453.80
|
| Rate for Payer: Cash Price |
$2,483.07
|
| Rate for Payer: Cash Price |
$2,483.07
|
| Rate for Payer: Centivo All Commercial |
$2,042.52
|
| Rate for Payer: Cigna All Commercial |
$3,456.27
|
| Rate for Payer: CORVEL All Commercial |
$3,724.60
|
| Rate for Payer: Coventry All Commercial |
$3,524.36
|
| Rate for Payer: Encore All Commercial |
$3,686.56
|
| Rate for Payer: Frontpath All Commercial |
$3,684.55
|
| Rate for Payer: Humana ChoiceCare |
$3,459.08
|
| Rate for Payer: Humana Medicare |
$2,042.52
|
| Rate for Payer: Lucent All Commercial |
$2,042.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,604.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,003.71
|
| Rate for Payer: PHP All Commercial |
$3,037.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,561.93
|
| Rate for Payer: Sagamore Health Network All Products |
$3,091.82
|
| Rate for Payer: Signature Care EPO |
$3,324.11
|
| Rate for Payer: Signature Care PPO |
$3,524.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,404.21
|
| Rate for Payer: United Healthcare Commercial |
$3,155.90
|
| Rate for Payer: United Healthcare Medicare |
$1,321.63
|
|
|
HC STAPLER PROXIMATE 29
|
Facility
OP
|
$4,004.95
|
|
| Hospital Charge Code |
41602054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$3,724.60 |
| Rate for Payer: Aetna Commercial |
$3,380.18
|
| Rate for Payer: Aetna Medicare |
$1,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,321.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,300.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,503.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,519.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,453.80
|
| Rate for Payer: Cash Price |
$2,483.07
|
| Rate for Payer: Cash Price |
$2,483.07
|
| Rate for Payer: Centivo All Commercial |
$2,042.52
|
| Rate for Payer: Cigna All Commercial |
$3,456.27
|
| Rate for Payer: CORVEL All Commercial |
$3,724.60
|
| Rate for Payer: Coventry All Commercial |
$3,524.36
|
| Rate for Payer: Encore All Commercial |
$3,686.56
|
| Rate for Payer: Frontpath All Commercial |
$3,684.55
|
| Rate for Payer: Humana ChoiceCare |
$3,459.08
|
| Rate for Payer: Humana Medicare |
$2,042.52
|
| Rate for Payer: Lucent All Commercial |
$2,042.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,604.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,003.71
|
| Rate for Payer: PHP All Commercial |
$3,037.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,561.93
|
| Rate for Payer: Sagamore Health Network All Products |
$3,091.82
|
| Rate for Payer: Signature Care EPO |
$3,324.11
|
| Rate for Payer: Signature Care PPO |
$3,524.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,404.21
|
| Rate for Payer: United Healthcare Commercial |
$3,155.90
|
| Rate for Payer: United Healthcare Medicare |
$1,321.63
|
|
|
HC STAPLER PROXIMATE 29
|
Facility
IP
|
$4,004.95
|
|
| Hospital Charge Code |
41602054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,003.71 |
| Max. Negotiated Rate |
$3,724.60 |
| Rate for Payer: Aetna Commercial |
$3,460.28
|
| Rate for Payer: Cash Price |
$2,483.07
|
| Rate for Payer: Cigna All Commercial |
$3,456.27
|
| Rate for Payer: CORVEL All Commercial |
$3,724.60
|
| Rate for Payer: Coventry All Commercial |
$3,524.36
|
| Rate for Payer: Encore All Commercial |
$3,686.56
|
| Rate for Payer: Frontpath All Commercial |
$3,684.55
|
| Rate for Payer: Humana ChoiceCare |
$3,459.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,604.46
|
| Rate for Payer: PHCS All Commercial |
$3,003.71
|
| Rate for Payer: PHP All Commercial |
$3,037.35
|
| Rate for Payer: Sagamore Health Network All Products |
$3,091.82
|
| Rate for Payer: Signature Care EPO |
$3,324.11
|
| Rate for Payer: Signature Care PPO |
$3,524.36
|
| Rate for Payer: United Healthcare Commercial |
$3,155.90
|
|
|
HC STAPLER PROXIMATE 33
|
Facility
IP
|
$4,004.95
|
|
| Hospital Charge Code |
41602281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,003.71 |
| Max. Negotiated Rate |
$3,724.60 |
| Rate for Payer: Aetna Commercial |
$3,460.28
|
| Rate for Payer: Cash Price |
$2,483.07
|
| Rate for Payer: Cigna All Commercial |
$3,456.27
|
| Rate for Payer: CORVEL All Commercial |
$3,724.60
|
| Rate for Payer: Coventry All Commercial |
$3,524.36
|
| Rate for Payer: Encore All Commercial |
$3,686.56
|
| Rate for Payer: Frontpath All Commercial |
$3,684.55
|
| Rate for Payer: Humana ChoiceCare |
$3,459.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,604.46
|
| Rate for Payer: PHCS All Commercial |
$3,003.71
|
| Rate for Payer: PHP All Commercial |
$3,037.35
|
| Rate for Payer: Sagamore Health Network All Products |
$3,091.82
|
| Rate for Payer: Signature Care EPO |
$3,324.11
|
| Rate for Payer: Signature Care PPO |
$3,524.36
|
| Rate for Payer: United Healthcare Commercial |
$3,155.90
|
|
|
HC STAPLER PROXIMATE 33
|
Facility
OP
|
$4,004.95
|
|
| Hospital Charge Code |
41602281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$3,724.60 |
| Rate for Payer: Aetna Commercial |
$3,380.18
|
| Rate for Payer: Aetna Medicare |
$1,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,321.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,300.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,503.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,519.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,453.80
|
| Rate for Payer: Cash Price |
$2,483.07
|
| Rate for Payer: Cash Price |
$2,483.07
|
| Rate for Payer: Centivo All Commercial |
$2,042.52
|
| Rate for Payer: Cigna All Commercial |
$3,456.27
|
| Rate for Payer: CORVEL All Commercial |
$3,724.60
|
| Rate for Payer: Coventry All Commercial |
$3,524.36
|
| Rate for Payer: Encore All Commercial |
$3,686.56
|
| Rate for Payer: Frontpath All Commercial |
$3,684.55
|
| Rate for Payer: Humana ChoiceCare |
$3,459.08
|
| Rate for Payer: Humana Medicare |
$2,042.52
|
| Rate for Payer: Lucent All Commercial |
$2,042.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,604.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,003.71
|
| Rate for Payer: PHP All Commercial |
$3,037.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,561.93
|
| Rate for Payer: Sagamore Health Network All Products |
$3,091.82
|
| Rate for Payer: Signature Care EPO |
$3,324.11
|
| Rate for Payer: Signature Care PPO |
$3,524.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,404.21
|
| Rate for Payer: United Healthcare Commercial |
$3,155.90
|
| Rate for Payer: United Healthcare Medicare |
$1,321.63
|
|
|
HC STAPLER PROX SKIN WIDE
|
Facility
IP
|
$55.03
|
|
| Hospital Charge Code |
41607917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$51.18 |
| Rate for Payer: Aetna Commercial |
$47.55
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Cigna All Commercial |
$47.49
|
| Rate for Payer: CORVEL All Commercial |
$51.18
|
| Rate for Payer: Coventry All Commercial |
$48.43
|
| Rate for Payer: Encore All Commercial |
$50.66
|
| Rate for Payer: Frontpath All Commercial |
$50.63
|
| Rate for Payer: Humana ChoiceCare |
$47.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.53
|
| Rate for Payer: PHCS All Commercial |
$41.27
|
| Rate for Payer: PHP All Commercial |
$41.73
|
| Rate for Payer: Sagamore Health Network All Products |
$42.48
|
| Rate for Payer: Signature Care EPO |
$45.67
|
| Rate for Payer: Signature Care PPO |
$48.43
|
| Rate for Payer: United Healthcare Commercial |
$43.36
|
|
|
HC STAPLER PROX SKIN WIDE
|
Facility
OP
|
$55.03
|
|
| Hospital Charge Code |
41607917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.16 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$46.45
|
| Rate for Payer: Aetna Medicare |
$18.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.98
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Centivo All Commercial |
$28.07
|
| Rate for Payer: Cigna All Commercial |
$47.49
|
| Rate for Payer: CORVEL All Commercial |
$51.18
|
| Rate for Payer: Coventry All Commercial |
$48.43
|
| Rate for Payer: Encore All Commercial |
$50.66
|
| Rate for Payer: Frontpath All Commercial |
$50.63
|
| Rate for Payer: Humana ChoiceCare |
$47.53
|
| Rate for Payer: Humana Medicare |
$28.07
|
| Rate for Payer: Lucent All Commercial |
$28.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$41.27
|
| Rate for Payer: PHP All Commercial |
$41.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.46
|
| Rate for Payer: Sagamore Health Network All Products |
$42.48
|
| Rate for Payer: Signature Care EPO |
$45.67
|
| Rate for Payer: Signature Care PPO |
$48.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.78
|
| Rate for Payer: United Healthcare Commercial |
$43.36
|
| Rate for Payer: United Healthcare Medicare |
$18.16
|
|
|
HC STAPLER PURSE STRING
|
Facility
IP
|
$596.82
|
|
| Hospital Charge Code |
41602055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.62 |
| Max. Negotiated Rate |
$555.04 |
| Rate for Payer: Aetna Commercial |
$515.65
|
| Rate for Payer: Cash Price |
$370.03
|
| Rate for Payer: Cigna All Commercial |
$515.06
|
| Rate for Payer: CORVEL All Commercial |
$555.04
|
| Rate for Payer: Coventry All Commercial |
$525.20
|
| Rate for Payer: Encore All Commercial |
$549.37
|
| Rate for Payer: Frontpath All Commercial |
$549.07
|
| Rate for Payer: Humana ChoiceCare |
$515.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$537.14
|
| Rate for Payer: PHCS All Commercial |
$447.62
|
| Rate for Payer: PHP All Commercial |
$452.63
|
| Rate for Payer: Sagamore Health Network All Products |
$460.75
|
| Rate for Payer: Signature Care EPO |
$495.36
|
| Rate for Payer: Signature Care PPO |
$525.20
|
| Rate for Payer: United Healthcare Commercial |
$470.29
|
|
|
HC STAPLER PURSE STRING
|
Facility
OP
|
$596.82
|
|
| Hospital Charge Code |
41602055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$555.04 |
| Rate for Payer: Aetna Commercial |
$503.72
|
| Rate for Payer: Aetna Medicare |
$196.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$196.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$342.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$226.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$216.65
|
| Rate for Payer: Cash Price |
$370.03
|
| Rate for Payer: Cash Price |
$370.03
|
| Rate for Payer: Centivo All Commercial |
$304.38
|
| Rate for Payer: Cigna All Commercial |
$515.06
|
| Rate for Payer: CORVEL All Commercial |
$555.04
|
| Rate for Payer: Coventry All Commercial |
$525.20
|
| Rate for Payer: Encore All Commercial |
$549.37
|
| Rate for Payer: Frontpath All Commercial |
$549.07
|
| Rate for Payer: Humana ChoiceCare |
$515.47
|
| Rate for Payer: Humana Medicare |
$304.38
|
| Rate for Payer: Lucent All Commercial |
$304.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$537.14
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$447.62
|
| Rate for Payer: PHP All Commercial |
$452.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$232.76
|
| Rate for Payer: Sagamore Health Network All Products |
$460.75
|
| Rate for Payer: Signature Care EPO |
$495.36
|
| Rate for Payer: Signature Care PPO |
$525.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$507.30
|
| Rate for Payer: United Healthcare Commercial |
$470.29
|
| Rate for Payer: United Healthcare Medicare |
$196.95
|
|
|
HC STAPLER SKIN 5-SHOT
|
Facility
OP
|
$26.02
|
|
| Hospital Charge Code |
41601100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$21.96
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.45
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Centivo All Commercial |
$13.27
|
| Rate for Payer: Cigna All Commercial |
$22.46
|
| Rate for Payer: CORVEL All Commercial |
$24.20
|
| Rate for Payer: Coventry All Commercial |
$22.90
|
| Rate for Payer: Encore All Commercial |
$23.95
|
| Rate for Payer: Frontpath All Commercial |
$23.94
|
| Rate for Payer: Humana ChoiceCare |
$22.47
|
| Rate for Payer: Humana Medicare |
$13.27
|
| Rate for Payer: Lucent All Commercial |
$13.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.42
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$19.52
|
| Rate for Payer: PHP All Commercial |
$19.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.15
|
| Rate for Payer: Sagamore Health Network All Products |
$20.09
|
| Rate for Payer: Signature Care EPO |
$21.60
|
| Rate for Payer: Signature Care PPO |
$22.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.12
|
| Rate for Payer: United Healthcare Commercial |
$20.50
|
| Rate for Payer: United Healthcare Medicare |
$8.59
|
|
|
HC STAPLER SKIN 5-SHOT
|
Facility
IP
|
$26.02
|
|
| Hospital Charge Code |
41601100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$24.20 |
| Rate for Payer: Aetna Commercial |
$22.48
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cigna All Commercial |
$22.46
|
| Rate for Payer: CORVEL All Commercial |
$24.20
|
| Rate for Payer: Coventry All Commercial |
$22.90
|
| Rate for Payer: Encore All Commercial |
$23.95
|
| Rate for Payer: Frontpath All Commercial |
$23.94
|
| Rate for Payer: Humana ChoiceCare |
$22.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.42
|
| Rate for Payer: PHCS All Commercial |
$19.52
|
| Rate for Payer: PHP All Commercial |
$19.73
|
| Rate for Payer: Sagamore Health Network All Products |
$20.09
|
| Rate for Payer: Signature Care EPO |
$21.60
|
| Rate for Payer: Signature Care PPO |
$22.90
|
| Rate for Payer: United Healthcare Commercial |
$20.50
|
|
|
HC STAPLER SKIN VISTA PRECISE 35W
|
Facility
IP
|
$73.12
|
|
| Hospital Charge Code |
41605569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$63.18
|
| Rate for Payer: Cash Price |
$45.33
|
| Rate for Payer: Cigna All Commercial |
$63.10
|
| Rate for Payer: CORVEL All Commercial |
$68.00
|
| Rate for Payer: Coventry All Commercial |
$64.35
|
| Rate for Payer: Encore All Commercial |
$67.31
|
| Rate for Payer: Frontpath All Commercial |
$67.27
|
| Rate for Payer: Humana ChoiceCare |
$63.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.81
|
| Rate for Payer: PHCS All Commercial |
$54.84
|
| Rate for Payer: PHP All Commercial |
$55.45
|
| Rate for Payer: Sagamore Health Network All Products |
$56.45
|
| Rate for Payer: Signature Care EPO |
$60.69
|
| Rate for Payer: Signature Care PPO |
$64.35
|
| Rate for Payer: United Healthcare Commercial |
$57.62
|
|
|
HC STAPLER SKIN VISTA PRECISE 35W
|
Facility
OP
|
$73.12
|
|
| Hospital Charge Code |
41605569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$61.71
|
| Rate for Payer: Aetna Medicare |
$24.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.54
|
| Rate for Payer: Cash Price |
$45.33
|
| Rate for Payer: Cash Price |
$45.33
|
| Rate for Payer: Centivo All Commercial |
$37.29
|
| Rate for Payer: Cigna All Commercial |
$63.10
|
| Rate for Payer: CORVEL All Commercial |
$68.00
|
| Rate for Payer: Coventry All Commercial |
$64.35
|
| Rate for Payer: Encore All Commercial |
$67.31
|
| Rate for Payer: Frontpath All Commercial |
$67.27
|
| Rate for Payer: Humana ChoiceCare |
$63.15
|
| Rate for Payer: Humana Medicare |
$37.29
|
| Rate for Payer: Lucent All Commercial |
$37.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.81
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$54.84
|
| Rate for Payer: PHP All Commercial |
$55.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.52
|
| Rate for Payer: Sagamore Health Network All Products |
$56.45
|
| Rate for Payer: Signature Care EPO |
$60.69
|
| Rate for Payer: Signature Care PPO |
$64.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.15
|
| Rate for Payer: United Healthcare Commercial |
$57.62
|
| Rate for Payer: United Healthcare Medicare |
$24.13
|
|
|
HC STAPLER TA 45 3.5
|
Facility
OP
|
$754.50
|
|
| Hospital Charge Code |
41602056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$701.68 |
| Rate for Payer: Aetna Commercial |
$636.80
|
| Rate for Payer: Aetna Medicare |
$248.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$248.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$433.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$471.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$286.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$273.88
|
| Rate for Payer: Cash Price |
$467.79
|
| Rate for Payer: Cash Price |
$467.79
|
| Rate for Payer: Centivo All Commercial |
$384.80
|
| Rate for Payer: Cigna All Commercial |
$651.13
|
| Rate for Payer: CORVEL All Commercial |
$701.68
|
| Rate for Payer: Coventry All Commercial |
$663.96
|
| Rate for Payer: Encore All Commercial |
$694.52
|
| Rate for Payer: Frontpath All Commercial |
$694.14
|
| Rate for Payer: Humana ChoiceCare |
$651.66
|
| Rate for Payer: Humana Medicare |
$384.80
|
| Rate for Payer: Lucent All Commercial |
$384.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$565.88
|
| Rate for Payer: PHP All Commercial |
$572.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$294.26
|
| Rate for Payer: Sagamore Health Network All Products |
$582.47
|
| Rate for Payer: Signature Care EPO |
$626.24
|
| Rate for Payer: Signature Care PPO |
$663.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$641.32
|
| Rate for Payer: United Healthcare Commercial |
$594.55
|
| Rate for Payer: United Healthcare Medicare |
$248.98
|
|
|
HC STAPLER TA 45 3.5
|
Facility
IP
|
$754.50
|
|
| Hospital Charge Code |
41602056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.88 |
| Max. Negotiated Rate |
$701.68 |
| Rate for Payer: Aetna Commercial |
$651.89
|
| Rate for Payer: Cash Price |
$467.79
|
| Rate for Payer: Cigna All Commercial |
$651.13
|
| Rate for Payer: CORVEL All Commercial |
$701.68
|
| Rate for Payer: Coventry All Commercial |
$663.96
|
| Rate for Payer: Encore All Commercial |
$694.52
|
| Rate for Payer: Frontpath All Commercial |
$694.14
|
| Rate for Payer: Humana ChoiceCare |
$651.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.05
|
| Rate for Payer: PHCS All Commercial |
$565.88
|
| Rate for Payer: PHP All Commercial |
$572.21
|
| Rate for Payer: Sagamore Health Network All Products |
$582.47
|
| Rate for Payer: Signature Care EPO |
$626.24
|
| Rate for Payer: Signature Care PPO |
$663.96
|
| Rate for Payer: United Healthcare Commercial |
$594.55
|
|
