|
HC STAPLER TA 60 3.5
|
Facility
OP
|
$744.50
|
|
| Hospital Charge Code |
41602057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$692.38 |
| Rate for Payer: Aetna Commercial |
$628.36
|
| Rate for Payer: Aetna Medicare |
$245.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$245.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$427.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$465.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$282.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$270.25
|
| Rate for Payer: Cash Price |
$461.59
|
| Rate for Payer: Cash Price |
$461.59
|
| Rate for Payer: Centivo All Commercial |
$379.70
|
| Rate for Payer: Cigna All Commercial |
$642.50
|
| Rate for Payer: CORVEL All Commercial |
$692.38
|
| Rate for Payer: Coventry All Commercial |
$655.16
|
| Rate for Payer: Encore All Commercial |
$685.31
|
| Rate for Payer: Frontpath All Commercial |
$684.94
|
| Rate for Payer: Humana ChoiceCare |
$643.02
|
| Rate for Payer: Humana Medicare |
$379.70
|
| Rate for Payer: Lucent All Commercial |
$379.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$670.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$558.38
|
| Rate for Payer: PHP All Commercial |
$564.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$290.36
|
| Rate for Payer: Sagamore Health Network All Products |
$574.75
|
| Rate for Payer: Signature Care EPO |
$617.94
|
| Rate for Payer: Signature Care PPO |
$655.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$632.82
|
| Rate for Payer: United Healthcare Commercial |
$586.67
|
| Rate for Payer: United Healthcare Medicare |
$245.68
|
|
|
HC STAPLER TA 60 3.5
|
Facility
IP
|
$744.50
|
|
| Hospital Charge Code |
41602057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$558.38 |
| Max. Negotiated Rate |
$692.38 |
| Rate for Payer: Aetna Commercial |
$643.25
|
| Rate for Payer: Cash Price |
$461.59
|
| Rate for Payer: Cigna All Commercial |
$642.50
|
| Rate for Payer: CORVEL All Commercial |
$692.38
|
| Rate for Payer: Coventry All Commercial |
$655.16
|
| Rate for Payer: Encore All Commercial |
$685.31
|
| Rate for Payer: Frontpath All Commercial |
$684.94
|
| Rate for Payer: Humana ChoiceCare |
$643.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$670.05
|
| Rate for Payer: PHCS All Commercial |
$558.38
|
| Rate for Payer: PHP All Commercial |
$564.63
|
| Rate for Payer: Sagamore Health Network All Products |
$574.75
|
| Rate for Payer: Signature Care EPO |
$617.94
|
| Rate for Payer: Signature Care PPO |
$655.16
|
| Rate for Payer: United Healthcare Commercial |
$586.67
|
|
|
HC STAPLER VERSATAC 4.8
|
Facility
OP
|
$990.38
|
|
| Hospital Charge Code |
41602058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$921.05 |
| Rate for Payer: Aetna Commercial |
$835.88
|
| Rate for Payer: Aetna Medicare |
$326.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$326.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$568.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$619.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.51
|
| Rate for Payer: Cash Price |
$614.04
|
| Rate for Payer: Cash Price |
$614.04
|
| Rate for Payer: Centivo All Commercial |
$505.09
|
| Rate for Payer: Cigna All Commercial |
$854.70
|
| Rate for Payer: CORVEL All Commercial |
$921.05
|
| Rate for Payer: Coventry All Commercial |
$871.53
|
| Rate for Payer: Encore All Commercial |
$911.64
|
| Rate for Payer: Frontpath All Commercial |
$911.15
|
| Rate for Payer: Humana ChoiceCare |
$855.39
|
| Rate for Payer: Humana Medicare |
$505.09
|
| Rate for Payer: Lucent All Commercial |
$505.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.34
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$742.78
|
| Rate for Payer: PHP All Commercial |
$751.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.25
|
| Rate for Payer: Sagamore Health Network All Products |
$764.57
|
| Rate for Payer: Signature Care EPO |
$822.02
|
| Rate for Payer: Signature Care PPO |
$871.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$841.82
|
| Rate for Payer: United Healthcare Commercial |
$780.42
|
| Rate for Payer: United Healthcare Medicare |
$326.83
|
|
|
HC STAPLER VERSATAC 4.8
|
Facility
IP
|
$990.38
|
|
| Hospital Charge Code |
41602058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$742.78 |
| Max. Negotiated Rate |
$921.05 |
| Rate for Payer: Aetna Commercial |
$855.69
|
| Rate for Payer: Cash Price |
$614.04
|
| Rate for Payer: Cigna All Commercial |
$854.70
|
| Rate for Payer: CORVEL All Commercial |
$921.05
|
| Rate for Payer: Coventry All Commercial |
$871.53
|
| Rate for Payer: Encore All Commercial |
$911.64
|
| Rate for Payer: Frontpath All Commercial |
$911.15
|
| Rate for Payer: Humana ChoiceCare |
$855.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.34
|
| Rate for Payer: PHCS All Commercial |
$742.78
|
| Rate for Payer: PHP All Commercial |
$751.10
|
| Rate for Payer: Sagamore Health Network All Products |
$764.57
|
| Rate for Payer: Signature Care EPO |
$822.02
|
| Rate for Payer: Signature Care PPO |
$871.53
|
| Rate for Payer: United Healthcare Commercial |
$780.42
|
|
|
HC STENT PERCUFLEX PLUS 6X24
|
Facility
OP
|
$790.00
|
|
| Hospital Charge Code |
41602282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.70 |
| Max. Negotiated Rate |
$734.70 |
| Rate for Payer: Aetna Commercial |
$666.76
|
| Rate for Payer: Aetna Medicare |
$260.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$260.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$453.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$493.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$299.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$286.77
|
| Rate for Payer: Cash Price |
$489.80
|
| Rate for Payer: Cash Price |
$489.80
|
| Rate for Payer: Centivo All Commercial |
$402.90
|
| Rate for Payer: Cigna All Commercial |
$681.77
|
| Rate for Payer: CORVEL All Commercial |
$734.70
|
| Rate for Payer: Coventry All Commercial |
$695.20
|
| Rate for Payer: Encore All Commercial |
$727.20
|
| Rate for Payer: Frontpath All Commercial |
$726.80
|
| Rate for Payer: Humana ChoiceCare |
$682.32
|
| Rate for Payer: Humana Medicare |
$402.90
|
| Rate for Payer: Lucent All Commercial |
$402.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$711.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$592.50
|
| Rate for Payer: PHP All Commercial |
$599.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$308.10
|
| Rate for Payer: Sagamore Health Network All Products |
$609.88
|
| Rate for Payer: Signature Care EPO |
$655.70
|
| Rate for Payer: Signature Care PPO |
$695.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$671.50
|
| Rate for Payer: United Healthcare Commercial |
$622.52
|
| Rate for Payer: United Healthcare Medicare |
$260.70
|
|
|
HC STENT PERCUFLEX PLUS 6X24
|
Facility
IP
|
$790.00
|
|
| Hospital Charge Code |
41602282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.50 |
| Max. Negotiated Rate |
$734.70 |
| Rate for Payer: Aetna Commercial |
$682.56
|
| Rate for Payer: Cash Price |
$489.80
|
| Rate for Payer: Cigna All Commercial |
$681.77
|
| Rate for Payer: CORVEL All Commercial |
$734.70
|
| Rate for Payer: Coventry All Commercial |
$695.20
|
| Rate for Payer: Encore All Commercial |
$727.20
|
| Rate for Payer: Frontpath All Commercial |
$726.80
|
| Rate for Payer: Humana ChoiceCare |
$682.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$711.00
|
| Rate for Payer: PHCS All Commercial |
$592.50
|
| Rate for Payer: PHP All Commercial |
$599.14
|
| Rate for Payer: Sagamore Health Network All Products |
$609.88
|
| Rate for Payer: Signature Care EPO |
$655.70
|
| Rate for Payer: Signature Care PPO |
$695.20
|
| Rate for Payer: United Healthcare Commercial |
$622.52
|
|
|
HC STENT URETER 4.7 FR 22CM
|
Facility
OP
|
$848.75
|
|
| Hospital Charge Code |
41602283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.09 |
| Max. Negotiated Rate |
$789.34 |
| Rate for Payer: Aetna Commercial |
$716.34
|
| Rate for Payer: Aetna Medicare |
$280.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$280.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$487.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$322.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$308.10
|
| Rate for Payer: Cash Price |
$526.23
|
| Rate for Payer: Cash Price |
$526.23
|
| Rate for Payer: Centivo All Commercial |
$432.86
|
| Rate for Payer: Cigna All Commercial |
$732.47
|
| Rate for Payer: CORVEL All Commercial |
$789.34
|
| Rate for Payer: Coventry All Commercial |
$746.90
|
| Rate for Payer: Encore All Commercial |
$781.27
|
| Rate for Payer: Frontpath All Commercial |
$780.85
|
| Rate for Payer: Humana ChoiceCare |
$733.07
|
| Rate for Payer: Humana Medicare |
$432.86
|
| Rate for Payer: Lucent All Commercial |
$432.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.88
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$636.56
|
| Rate for Payer: PHP All Commercial |
$643.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$331.01
|
| Rate for Payer: Sagamore Health Network All Products |
$655.24
|
| Rate for Payer: Signature Care EPO |
$704.46
|
| Rate for Payer: Signature Care PPO |
$746.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$721.44
|
| Rate for Payer: United Healthcare Commercial |
$668.82
|
| Rate for Payer: United Healthcare Medicare |
$280.09
|
|
|
HC STENT URETER 4.7 FR 22CM
|
Facility
IP
|
$848.75
|
|
| Hospital Charge Code |
41602283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.56 |
| Max. Negotiated Rate |
$789.34 |
| Rate for Payer: Aetna Commercial |
$733.32
|
| Rate for Payer: Cash Price |
$526.23
|
| Rate for Payer: Cigna All Commercial |
$732.47
|
| Rate for Payer: CORVEL All Commercial |
$789.34
|
| Rate for Payer: Coventry All Commercial |
$746.90
|
| Rate for Payer: Encore All Commercial |
$781.27
|
| Rate for Payer: Frontpath All Commercial |
$780.85
|
| Rate for Payer: Humana ChoiceCare |
$733.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.88
|
| Rate for Payer: PHCS All Commercial |
$636.56
|
| Rate for Payer: PHP All Commercial |
$643.69
|
| Rate for Payer: Sagamore Health Network All Products |
$655.24
|
| Rate for Payer: Signature Care EPO |
$704.46
|
| Rate for Payer: Signature Care PPO |
$746.90
|
| Rate for Payer: United Healthcare Commercial |
$668.82
|
|
|
HC STENT URETER 6.0 FR 22CM
|
Facility
OP
|
$831.25
|
|
| Hospital Charge Code |
41602059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.31 |
| Max. Negotiated Rate |
$773.06 |
| Rate for Payer: Aetna Commercial |
$701.58
|
| Rate for Payer: Aetna Medicare |
$274.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$274.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$477.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$519.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$315.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.74
|
| Rate for Payer: Cash Price |
$515.38
|
| Rate for Payer: Cash Price |
$515.38
|
| Rate for Payer: Centivo All Commercial |
$423.94
|
| Rate for Payer: Cigna All Commercial |
$717.37
|
| Rate for Payer: CORVEL All Commercial |
$773.06
|
| Rate for Payer: Coventry All Commercial |
$731.50
|
| Rate for Payer: Encore All Commercial |
$765.17
|
| Rate for Payer: Frontpath All Commercial |
$764.75
|
| Rate for Payer: Humana ChoiceCare |
$717.95
|
| Rate for Payer: Humana Medicare |
$423.94
|
| Rate for Payer: Lucent All Commercial |
$423.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$748.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$623.44
|
| Rate for Payer: PHP All Commercial |
$630.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$324.19
|
| Rate for Payer: Sagamore Health Network All Products |
$641.72
|
| Rate for Payer: Signature Care EPO |
$689.94
|
| Rate for Payer: Signature Care PPO |
$731.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$706.56
|
| Rate for Payer: United Healthcare Commercial |
$655.02
|
| Rate for Payer: United Healthcare Medicare |
$274.31
|
|
|
HC STENT URETER 6.0 FR 22CM
|
Facility
IP
|
$831.25
|
|
| Hospital Charge Code |
41602059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.44 |
| Max. Negotiated Rate |
$773.06 |
| Rate for Payer: Aetna Commercial |
$718.20
|
| Rate for Payer: Cash Price |
$515.38
|
| Rate for Payer: Cigna All Commercial |
$717.37
|
| Rate for Payer: CORVEL All Commercial |
$773.06
|
| Rate for Payer: Coventry All Commercial |
$731.50
|
| Rate for Payer: Encore All Commercial |
$765.17
|
| Rate for Payer: Frontpath All Commercial |
$764.75
|
| Rate for Payer: Humana ChoiceCare |
$717.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$748.12
|
| Rate for Payer: PHCS All Commercial |
$623.44
|
| Rate for Payer: PHP All Commercial |
$630.42
|
| Rate for Payer: Sagamore Health Network All Products |
$641.72
|
| Rate for Payer: Signature Care EPO |
$689.94
|
| Rate for Payer: Signature Care PPO |
$731.50
|
| Rate for Payer: United Healthcare Commercial |
$655.02
|
|
|
HC STENT URETER UNIVERSA FIRM 5 FR ML
|
Facility
OP
|
$626.50
|
|
| Hospital Charge Code |
41601360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$582.64 |
| Rate for Payer: Aetna Commercial |
$528.77
|
| Rate for Payer: Aetna Medicare |
$206.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$206.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$359.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$391.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.42
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Centivo All Commercial |
$319.52
|
| Rate for Payer: Cigna All Commercial |
$540.67
|
| Rate for Payer: CORVEL All Commercial |
$582.64
|
| Rate for Payer: Coventry All Commercial |
$551.32
|
| Rate for Payer: Encore All Commercial |
$576.69
|
| Rate for Payer: Frontpath All Commercial |
$576.38
|
| Rate for Payer: Humana ChoiceCare |
$541.11
|
| Rate for Payer: Humana Medicare |
$319.52
|
| Rate for Payer: Lucent All Commercial |
$319.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.85
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$469.88
|
| Rate for Payer: PHP All Commercial |
$475.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$244.34
|
| Rate for Payer: Sagamore Health Network All Products |
$483.66
|
| Rate for Payer: Signature Care EPO |
$520.00
|
| Rate for Payer: Signature Care PPO |
$551.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$532.52
|
| Rate for Payer: United Healthcare Commercial |
$493.68
|
| Rate for Payer: United Healthcare Medicare |
$206.74
|
|
|
HC STENT URETER UNIVERSA FIRM 5 FR ML
|
Facility
IP
|
$626.50
|
|
| Hospital Charge Code |
41601360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.88 |
| Max. Negotiated Rate |
$582.64 |
| Rate for Payer: Aetna Commercial |
$541.30
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Cigna All Commercial |
$540.67
|
| Rate for Payer: CORVEL All Commercial |
$582.64
|
| Rate for Payer: Coventry All Commercial |
$551.32
|
| Rate for Payer: Encore All Commercial |
$576.69
|
| Rate for Payer: Frontpath All Commercial |
$576.38
|
| Rate for Payer: Humana ChoiceCare |
$541.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.85
|
| Rate for Payer: PHCS All Commercial |
$469.88
|
| Rate for Payer: PHP All Commercial |
$475.14
|
| Rate for Payer: Sagamore Health Network All Products |
$483.66
|
| Rate for Payer: Signature Care EPO |
$520.00
|
| Rate for Payer: Signature Care PPO |
$551.32
|
| Rate for Payer: United Healthcare Commercial |
$493.68
|
|
|
HC STENT URETER UNIVERSA FIRM 6.0 FR 24CM
|
Facility
OP
|
$626.50
|
|
| Hospital Charge Code |
41601361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$582.64 |
| Rate for Payer: Aetna Commercial |
$528.77
|
| Rate for Payer: Aetna Medicare |
$206.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$206.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$359.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$391.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.42
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Centivo All Commercial |
$319.52
|
| Rate for Payer: Cigna All Commercial |
$540.67
|
| Rate for Payer: CORVEL All Commercial |
$582.64
|
| Rate for Payer: Coventry All Commercial |
$551.32
|
| Rate for Payer: Encore All Commercial |
$576.69
|
| Rate for Payer: Frontpath All Commercial |
$576.38
|
| Rate for Payer: Humana ChoiceCare |
$541.11
|
| Rate for Payer: Humana Medicare |
$319.52
|
| Rate for Payer: Lucent All Commercial |
$319.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.85
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$469.88
|
| Rate for Payer: PHP All Commercial |
$475.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$244.34
|
| Rate for Payer: Sagamore Health Network All Products |
$483.66
|
| Rate for Payer: Signature Care EPO |
$520.00
|
| Rate for Payer: Signature Care PPO |
$551.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$532.52
|
| Rate for Payer: United Healthcare Commercial |
$493.68
|
| Rate for Payer: United Healthcare Medicare |
$206.74
|
|
|
HC STENT URETER UNIVERSA FIRM 6.0 FR 24CM
|
Facility
IP
|
$626.50
|
|
| Hospital Charge Code |
41601361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.88 |
| Max. Negotiated Rate |
$582.64 |
| Rate for Payer: Aetna Commercial |
$541.30
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Cigna All Commercial |
$540.67
|
| Rate for Payer: CORVEL All Commercial |
$582.64
|
| Rate for Payer: Coventry All Commercial |
$551.32
|
| Rate for Payer: Encore All Commercial |
$576.69
|
| Rate for Payer: Frontpath All Commercial |
$576.38
|
| Rate for Payer: Humana ChoiceCare |
$541.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.85
|
| Rate for Payer: PHCS All Commercial |
$469.88
|
| Rate for Payer: PHP All Commercial |
$475.14
|
| Rate for Payer: Sagamore Health Network All Products |
$483.66
|
| Rate for Payer: Signature Care EPO |
$520.00
|
| Rate for Payer: Signature Care PPO |
$551.32
|
| Rate for Payer: United Healthcare Commercial |
$493.68
|
|
|
HC STENT URETER UNIVERSA FIRM 6.0 FR 26CM
|
Facility
IP
|
$626.50
|
|
| Hospital Charge Code |
41601362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.88 |
| Max. Negotiated Rate |
$582.64 |
| Rate for Payer: Aetna Commercial |
$541.30
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Cigna All Commercial |
$540.67
|
| Rate for Payer: CORVEL All Commercial |
$582.64
|
| Rate for Payer: Coventry All Commercial |
$551.32
|
| Rate for Payer: Encore All Commercial |
$576.69
|
| Rate for Payer: Frontpath All Commercial |
$576.38
|
| Rate for Payer: Humana ChoiceCare |
$541.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.85
|
| Rate for Payer: PHCS All Commercial |
$469.88
|
| Rate for Payer: PHP All Commercial |
$475.14
|
| Rate for Payer: Sagamore Health Network All Products |
$483.66
|
| Rate for Payer: Signature Care EPO |
$520.00
|
| Rate for Payer: Signature Care PPO |
$551.32
|
| Rate for Payer: United Healthcare Commercial |
$493.68
|
|
|
HC STENT URETER UNIVERSA FIRM 6.0 FR 26CM
|
Facility
OP
|
$626.50
|
|
| Hospital Charge Code |
41601362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$582.64 |
| Rate for Payer: Aetna Commercial |
$528.77
|
| Rate for Payer: Aetna Medicare |
$206.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$206.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$359.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$391.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.42
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Centivo All Commercial |
$319.52
|
| Rate for Payer: Cigna All Commercial |
$540.67
|
| Rate for Payer: CORVEL All Commercial |
$582.64
|
| Rate for Payer: Coventry All Commercial |
$551.32
|
| Rate for Payer: Encore All Commercial |
$576.69
|
| Rate for Payer: Frontpath All Commercial |
$576.38
|
| Rate for Payer: Humana ChoiceCare |
$541.11
|
| Rate for Payer: Humana Medicare |
$319.52
|
| Rate for Payer: Lucent All Commercial |
$319.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.85
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$469.88
|
| Rate for Payer: PHP All Commercial |
$475.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$244.34
|
| Rate for Payer: Sagamore Health Network All Products |
$483.66
|
| Rate for Payer: Signature Care EPO |
$520.00
|
| Rate for Payer: Signature Care PPO |
$551.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$532.52
|
| Rate for Payer: United Healthcare Commercial |
$493.68
|
| Rate for Payer: United Healthcare Medicare |
$206.74
|
|
|
HC STENT URETER UNIVERSA FIRM 6.0 FR 28CM
|
Facility
IP
|
$421.12
|
|
| Hospital Charge Code |
41601363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.84 |
| Max. Negotiated Rate |
$391.64 |
| Rate for Payer: Aetna Commercial |
$363.85
|
| Rate for Payer: Cash Price |
$261.09
|
| Rate for Payer: Cigna All Commercial |
$363.43
|
| Rate for Payer: CORVEL All Commercial |
$391.64
|
| Rate for Payer: Coventry All Commercial |
$370.59
|
| Rate for Payer: Encore All Commercial |
$387.64
|
| Rate for Payer: Frontpath All Commercial |
$387.43
|
| Rate for Payer: Humana ChoiceCare |
$363.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.01
|
| Rate for Payer: PHCS All Commercial |
$315.84
|
| Rate for Payer: PHP All Commercial |
$319.38
|
| Rate for Payer: Sagamore Health Network All Products |
$325.10
|
| Rate for Payer: Signature Care EPO |
$349.53
|
| Rate for Payer: Signature Care PPO |
$370.59
|
| Rate for Payer: United Healthcare Commercial |
$331.84
|
|
|
HC STENT URETER UNIVERSA FIRM 6.0 FR 28CM
|
Facility
OP
|
$421.12
|
|
| Hospital Charge Code |
41601363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.97 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$355.43
|
| Rate for Payer: Aetna Medicare |
$138.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.87
|
| Rate for Payer: Cash Price |
$261.09
|
| Rate for Payer: Cash Price |
$261.09
|
| Rate for Payer: Centivo All Commercial |
$214.77
|
| Rate for Payer: Cigna All Commercial |
$363.43
|
| Rate for Payer: CORVEL All Commercial |
$391.64
|
| Rate for Payer: Coventry All Commercial |
$370.59
|
| Rate for Payer: Encore All Commercial |
$387.64
|
| Rate for Payer: Frontpath All Commercial |
$387.43
|
| Rate for Payer: Humana ChoiceCare |
$363.72
|
| Rate for Payer: Humana Medicare |
$214.77
|
| Rate for Payer: Lucent All Commercial |
$214.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.01
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$315.84
|
| Rate for Payer: PHP All Commercial |
$319.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.24
|
| Rate for Payer: Sagamore Health Network All Products |
$325.10
|
| Rate for Payer: Signature Care EPO |
$349.53
|
| Rate for Payer: Signature Care PPO |
$370.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.95
|
| Rate for Payer: United Healthcare Commercial |
$331.84
|
| Rate for Payer: United Healthcare Medicare |
$138.97
|
|
|
HC STEREOSCOPIC X-RAY GUIDANCE
|
Facility
IP
|
$848.64
|
|
|
Service Code
|
CPT G6002
|
| Hospital Charge Code |
01540421
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$636.48 |
| Max. Negotiated Rate |
$789.24 |
| Rate for Payer: Aetna Commercial |
$733.22
|
| Rate for Payer: Cash Price |
$526.16
|
| Rate for Payer: Cigna All Commercial |
$732.38
|
| Rate for Payer: CORVEL All Commercial |
$789.24
|
| Rate for Payer: Coventry All Commercial |
$746.80
|
| Rate for Payer: Encore All Commercial |
$781.17
|
| Rate for Payer: Frontpath All Commercial |
$780.75
|
| Rate for Payer: Humana ChoiceCare |
$732.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.78
|
| Rate for Payer: PHCS All Commercial |
$636.48
|
| Rate for Payer: PHP All Commercial |
$643.61
|
| Rate for Payer: Sagamore Health Network All Products |
$655.15
|
| Rate for Payer: Signature Care EPO |
$704.37
|
| Rate for Payer: Signature Care PPO |
$746.80
|
| Rate for Payer: United Healthcare Commercial |
$668.73
|
|
|
HC STEREOSCOPIC X-RAY GUIDANCE
|
Facility
OP
|
$848.64
|
|
|
Service Code
|
CPT G6002
|
| Hospital Charge Code |
01540421
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$280.05 |
| Max. Negotiated Rate |
$789.24 |
| Rate for Payer: Aetna Commercial |
$716.25
|
| Rate for Payer: Aetna Medicare |
$280.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$280.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$487.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$322.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$308.06
|
| Rate for Payer: Cash Price |
$526.16
|
| Rate for Payer: Centivo All Commercial |
$432.81
|
| Rate for Payer: Cigna All Commercial |
$732.38
|
| Rate for Payer: CORVEL All Commercial |
$789.24
|
| Rate for Payer: Coventry All Commercial |
$746.80
|
| Rate for Payer: Encore All Commercial |
$781.17
|
| Rate for Payer: Frontpath All Commercial |
$780.75
|
| Rate for Payer: Humana ChoiceCare |
$732.97
|
| Rate for Payer: Humana Medicare |
$432.81
|
| Rate for Payer: Lucent All Commercial |
$432.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.78
|
| Rate for Payer: PHCS All Commercial |
$636.48
|
| Rate for Payer: PHP All Commercial |
$643.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.97
|
| Rate for Payer: Sagamore Health Network All Products |
$655.15
|
| Rate for Payer: Signature Care EPO |
$704.37
|
| Rate for Payer: Signature Care PPO |
$746.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$721.34
|
| Rate for Payer: United Healthcare Commercial |
$668.73
|
| Rate for Payer: United Healthcare Medicare |
$280.05
|
|
|
HC STERIFLATE INFLATION DEVICE
|
Facility
IP
|
$273.98
|
|
| Hospital Charge Code |
41608202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.48 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$236.72
|
| Rate for Payer: Cash Price |
$169.87
|
| Rate for Payer: Cigna All Commercial |
$236.44
|
| Rate for Payer: CORVEL All Commercial |
$254.80
|
| Rate for Payer: Coventry All Commercial |
$241.10
|
| Rate for Payer: Encore All Commercial |
$252.20
|
| Rate for Payer: Frontpath All Commercial |
$252.06
|
| Rate for Payer: Humana ChoiceCare |
$236.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.58
|
| Rate for Payer: PHCS All Commercial |
$205.48
|
| Rate for Payer: PHP All Commercial |
$207.79
|
| Rate for Payer: Sagamore Health Network All Products |
$211.51
|
| Rate for Payer: Signature Care EPO |
$227.40
|
| Rate for Payer: Signature Care PPO |
$241.10
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
|
|
HC STERIFLATE INFLATION DEVICE
|
Facility
OP
|
$273.98
|
|
| Hospital Charge Code |
41608202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.41 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$231.24
|
| Rate for Payer: Aetna Medicare |
$90.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$157.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.45
|
| Rate for Payer: Cash Price |
$169.87
|
| Rate for Payer: Cash Price |
$169.87
|
| Rate for Payer: Centivo All Commercial |
$139.73
|
| Rate for Payer: Cigna All Commercial |
$236.44
|
| Rate for Payer: CORVEL All Commercial |
$254.80
|
| Rate for Payer: Coventry All Commercial |
$241.10
|
| Rate for Payer: Encore All Commercial |
$252.20
|
| Rate for Payer: Frontpath All Commercial |
$252.06
|
| Rate for Payer: Humana ChoiceCare |
$236.64
|
| Rate for Payer: Humana Medicare |
$139.73
|
| Rate for Payer: Lucent All Commercial |
$139.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$205.48
|
| Rate for Payer: PHP All Commercial |
$207.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.85
|
| Rate for Payer: Sagamore Health Network All Products |
$211.51
|
| Rate for Payer: Signature Care EPO |
$227.40
|
| Rate for Payer: Signature Care PPO |
$241.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.88
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
| Rate for Payer: United Healthcare Medicare |
$90.41
|
|
|
HC S TIB BASEPLATE 2
|
Facility
OP
|
$5,838.55
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,429.85 |
| Rate for Payer: Aetna Commercial |
$4,927.74
|
| Rate for Payer: Aetna Medicare |
$1,926.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,926.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,353.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,649.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,215.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,119.39
|
| Rate for Payer: Cash Price |
$3,619.90
|
| Rate for Payer: Cash Price |
$3,619.90
|
| Rate for Payer: Centivo All Commercial |
$2,977.66
|
| Rate for Payer: Cigna All Commercial |
$5,038.67
|
| Rate for Payer: CORVEL All Commercial |
$5,429.85
|
| Rate for Payer: Coventry All Commercial |
$5,137.92
|
| Rate for Payer: Encore All Commercial |
$5,374.39
|
| Rate for Payer: Frontpath All Commercial |
$5,371.47
|
| Rate for Payer: Humana ChoiceCare |
$5,042.76
|
| Rate for Payer: Humana Medicare |
$2,977.66
|
| Rate for Payer: Lucent All Commercial |
$2,977.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,254.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,378.91
|
| Rate for Payer: PHP All Commercial |
$4,427.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,277.03
|
| Rate for Payer: Sagamore Health Network All Products |
$4,507.36
|
| Rate for Payer: Signature Care EPO |
$4,846.00
|
| Rate for Payer: Signature Care PPO |
$5,137.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,962.77
|
| Rate for Payer: United Healthcare Commercial |
$4,600.78
|
| Rate for Payer: United Healthcare Medicare |
$1,926.72
|
|
|
HC S TIB BASEPLATE 2
|
Facility
IP
|
$5,838.55
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,378.91 |
| Max. Negotiated Rate |
$5,429.85 |
| Rate for Payer: Aetna Commercial |
$5,044.51
|
| Rate for Payer: Cash Price |
$3,619.90
|
| Rate for Payer: Cigna All Commercial |
$5,038.67
|
| Rate for Payer: CORVEL All Commercial |
$5,429.85
|
| Rate for Payer: Coventry All Commercial |
$5,137.92
|
| Rate for Payer: Encore All Commercial |
$5,374.39
|
| Rate for Payer: Frontpath All Commercial |
$5,371.47
|
| Rate for Payer: Humana ChoiceCare |
$5,042.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,254.70
|
| Rate for Payer: PHCS All Commercial |
$4,378.91
|
| Rate for Payer: PHP All Commercial |
$4,427.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4,507.36
|
| Rate for Payer: Signature Care EPO |
$4,846.00
|
| Rate for Payer: Signature Care PPO |
$5,137.92
|
| Rate for Payer: United Healthcare Commercial |
$4,600.78
|
|
|
HC S TIB BASEPLATE 3
|
Facility
OP
|
$4,865.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,106.46
|
| Rate for Payer: Aetna Medicare |
$1,605.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,605.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,794.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,041.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,846.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,766.17
|
| Rate for Payer: Cash Price |
$3,016.59
|
| Rate for Payer: Cash Price |
$3,016.59
|
| Rate for Payer: Centivo All Commercial |
$2,481.39
|
| Rate for Payer: Cigna All Commercial |
$4,198.90
|
| Rate for Payer: CORVEL All Commercial |
$4,524.89
|
| Rate for Payer: Coventry All Commercial |
$4,281.61
|
| Rate for Payer: Encore All Commercial |
$4,478.67
|
| Rate for Payer: Frontpath All Commercial |
$4,476.23
|
| Rate for Payer: Humana ChoiceCare |
$4,202.31
|
| Rate for Payer: Humana Medicare |
$2,481.39
|
| Rate for Payer: Lucent All Commercial |
$2,481.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,897.53
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.14
|
| Rate for Payer: Signature Care EPO |
$4,038.34
|
| Rate for Payer: Signature Care PPO |
$4,281.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,135.65
|
| Rate for Payer: United Healthcare Commercial |
$3,833.99
|
| Rate for Payer: United Healthcare Medicare |
$1,605.61
|
|
