|
HC AR .062 GUIDWIRE
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$286.44 |
| Rate for Payer: Aetna Commercial |
$266.11
|
| Rate for Payer: Cash Price |
$190.96
|
| Rate for Payer: Cigna All Commercial |
$265.80
|
| Rate for Payer: CORVEL All Commercial |
$286.44
|
| Rate for Payer: Coventry All Commercial |
$271.04
|
| Rate for Payer: Encore All Commercial |
$283.51
|
| Rate for Payer: Frontpath All Commercial |
$283.36
|
| Rate for Payer: Humana ChoiceCare |
$266.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$277.20
|
| Rate for Payer: PHCS All Commercial |
$231.00
|
| Rate for Payer: PHP All Commercial |
$233.59
|
| Rate for Payer: Sagamore Health Network All Products |
$237.78
|
| Rate for Payer: Signature Care EPO |
$255.64
|
| Rate for Payer: Signature Care PPO |
$271.04
|
| Rate for Payer: United Healthcare Commercial |
$242.70
|
|
|
HC AR 0.86 GUIDE WIRE TROC THRD
|
Facility
IP
|
$200.20
|
|
| Hospital Charge Code |
41602601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.15 |
| Max. Negotiated Rate |
$186.19 |
| Rate for Payer: Aetna Commercial |
$172.97
|
| Rate for Payer: Cash Price |
$124.12
|
| Rate for Payer: Cigna All Commercial |
$172.77
|
| Rate for Payer: CORVEL All Commercial |
$186.19
|
| Rate for Payer: Coventry All Commercial |
$176.18
|
| Rate for Payer: Encore All Commercial |
$184.28
|
| Rate for Payer: Frontpath All Commercial |
$184.18
|
| Rate for Payer: Humana ChoiceCare |
$172.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$180.18
|
| Rate for Payer: PHCS All Commercial |
$150.15
|
| Rate for Payer: PHP All Commercial |
$151.83
|
| Rate for Payer: Sagamore Health Network All Products |
$154.55
|
| Rate for Payer: Signature Care EPO |
$166.17
|
| Rate for Payer: Signature Care PPO |
$176.18
|
| Rate for Payer: United Healthcare Commercial |
$157.76
|
|
|
HC AR 0.86 GUIDE WIRE TROC THRD
|
Facility
OP
|
$200.20
|
|
| Hospital Charge Code |
41602601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$186.19 |
| Rate for Payer: Aetna Commercial |
$168.97
|
| Rate for Payer: Aetna Medicare |
$66.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$114.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.67
|
| Rate for Payer: Cash Price |
$124.12
|
| Rate for Payer: Cash Price |
$124.12
|
| Rate for Payer: Centivo All Commercial |
$102.10
|
| Rate for Payer: Cigna All Commercial |
$172.77
|
| Rate for Payer: CORVEL All Commercial |
$186.19
|
| Rate for Payer: Coventry All Commercial |
$176.18
|
| Rate for Payer: Encore All Commercial |
$184.28
|
| Rate for Payer: Frontpath All Commercial |
$184.18
|
| Rate for Payer: Humana ChoiceCare |
$172.91
|
| Rate for Payer: Humana Medicare |
$102.10
|
| Rate for Payer: Lucent All Commercial |
$102.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$180.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$150.15
|
| Rate for Payer: PHP All Commercial |
$151.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.08
|
| Rate for Payer: Sagamore Health Network All Products |
$154.55
|
| Rate for Payer: Signature Care EPO |
$166.17
|
| Rate for Payer: Signature Care PPO |
$176.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$170.17
|
| Rate for Payer: United Healthcare Commercial |
$157.76
|
| Rate for Payer: United Healthcare Medicare |
$66.07
|
|
|
HC AR 0.86 GUIDE WIRE TROC TIP
|
Facility
IP
|
$169.40
|
|
| Hospital Charge Code |
41602600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$146.36
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
|
|
HC AR 0.86 GUIDE WIRE TROC TIP
|
Facility
OP
|
$169.40
|
|
| Hospital Charge Code |
41602600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.49
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Centivo All Commercial |
$86.39
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$86.39
|
| Rate for Payer: Lucent All Commercial |
$86.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.07
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.99
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
| Rate for Payer: United Healthcare Medicare |
$55.90
|
|
|
HC AR .094X12 GUIDEWIRE
|
Facility
IP
|
$169.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$146.36
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
|
|
HC AR .094X12 GUIDEWIRE
|
Facility
OP
|
$169.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.49
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Centivo All Commercial |
$86.39
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$86.39
|
| Rate for Payer: Lucent All Commercial |
$86.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.07
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.99
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
| Rate for Payer: United Healthcare Medicare |
$55.90
|
|
|
HC AR .094X8 GUIDEWIRE
|
Facility
OP
|
$115.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$97.48
|
| Rate for Payer: Aetna Medicare |
$38.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.93
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Centivo All Commercial |
$58.90
|
| Rate for Payer: Cigna All Commercial |
$99.68
|
| Rate for Payer: CORVEL All Commercial |
$107.42
|
| Rate for Payer: Coventry All Commercial |
$101.64
|
| Rate for Payer: Encore All Commercial |
$106.32
|
| Rate for Payer: Frontpath All Commercial |
$106.26
|
| Rate for Payer: Humana ChoiceCare |
$99.76
|
| Rate for Payer: Humana Medicare |
$58.90
|
| Rate for Payer: Lucent All Commercial |
$58.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.95
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$86.62
|
| Rate for Payer: PHP All Commercial |
$87.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.04
|
| Rate for Payer: Sagamore Health Network All Products |
$89.17
|
| Rate for Payer: Signature Care EPO |
$95.86
|
| Rate for Payer: Signature Care PPO |
$101.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.18
|
| Rate for Payer: United Healthcare Commercial |
$91.01
|
| Rate for Payer: United Healthcare Medicare |
$38.12
|
|
|
HC AR .094X8 GUIDEWIRE
|
Facility
IP
|
$115.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.62 |
| Max. Negotiated Rate |
$107.42 |
| Rate for Payer: Aetna Commercial |
$99.79
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Cigna All Commercial |
$99.68
|
| Rate for Payer: CORVEL All Commercial |
$107.42
|
| Rate for Payer: Coventry All Commercial |
$101.64
|
| Rate for Payer: Encore All Commercial |
$106.32
|
| Rate for Payer: Frontpath All Commercial |
$106.26
|
| Rate for Payer: Humana ChoiceCare |
$99.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.95
|
| Rate for Payer: PHCS All Commercial |
$86.62
|
| Rate for Payer: PHP All Commercial |
$87.60
|
| Rate for Payer: Sagamore Health Network All Products |
$89.17
|
| Rate for Payer: Signature Care EPO |
$95.86
|
| Rate for Payer: Signature Care PPO |
$101.64
|
| Rate for Payer: United Healthcare Commercial |
$91.01
|
|
|
HC AR 1.35 GUIDEWIRE
|
Facility
IP
|
$479.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.62 |
| Max. Negotiated Rate |
$445.94 |
| Rate for Payer: Aetna Commercial |
$414.29
|
| Rate for Payer: Cash Price |
$297.29
|
| Rate for Payer: Cigna All Commercial |
$413.81
|
| Rate for Payer: CORVEL All Commercial |
$445.94
|
| Rate for Payer: Coventry All Commercial |
$421.96
|
| Rate for Payer: Encore All Commercial |
$441.38
|
| Rate for Payer: Frontpath All Commercial |
$441.14
|
| Rate for Payer: Humana ChoiceCare |
$414.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.55
|
| Rate for Payer: PHCS All Commercial |
$359.62
|
| Rate for Payer: PHP All Commercial |
$363.65
|
| Rate for Payer: Sagamore Health Network All Products |
$370.17
|
| Rate for Payer: Signature Care EPO |
$397.98
|
| Rate for Payer: Signature Care PPO |
$421.96
|
| Rate for Payer: United Healthcare Commercial |
$377.85
|
|
|
HC AR 1.35 GUIDEWIRE
|
Facility
OP
|
$479.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.24 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$404.70
|
| Rate for Payer: Aetna Medicare |
$158.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$275.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$299.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$181.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.06
|
| Rate for Payer: Cash Price |
$297.29
|
| Rate for Payer: Cash Price |
$297.29
|
| Rate for Payer: Centivo All Commercial |
$244.54
|
| Rate for Payer: Cigna All Commercial |
$413.81
|
| Rate for Payer: CORVEL All Commercial |
$445.94
|
| Rate for Payer: Coventry All Commercial |
$421.96
|
| Rate for Payer: Encore All Commercial |
$441.38
|
| Rate for Payer: Frontpath All Commercial |
$441.14
|
| Rate for Payer: Humana ChoiceCare |
$414.14
|
| Rate for Payer: Humana Medicare |
$244.54
|
| Rate for Payer: Lucent All Commercial |
$244.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$359.62
|
| Rate for Payer: PHP All Commercial |
$363.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.00
|
| Rate for Payer: Sagamore Health Network All Products |
$370.17
|
| Rate for Payer: Signature Care EPO |
$397.98
|
| Rate for Payer: Signature Care PPO |
$421.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$407.58
|
| Rate for Payer: United Healthcare Commercial |
$377.85
|
| Rate for Payer: United Healthcare Medicare |
$158.24
|
|
|
HC AR 1.35 GUIDEWIRE TROC TIP
|
Facility
IP
|
$234.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.88 |
| Max. Negotiated Rate |
$218.08 |
| Rate for Payer: Aetna Commercial |
$202.61
|
| Rate for Payer: Cash Price |
$145.39
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.08
|
| Rate for Payer: Coventry All Commercial |
$206.36
|
| Rate for Payer: Encore All Commercial |
$215.86
|
| Rate for Payer: Frontpath All Commercial |
$215.74
|
| Rate for Payer: Humana ChoiceCare |
$202.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.05
|
| Rate for Payer: PHCS All Commercial |
$175.88
|
| Rate for Payer: PHP All Commercial |
$177.84
|
| Rate for Payer: Sagamore Health Network All Products |
$181.03
|
| Rate for Payer: Signature Care EPO |
$194.64
|
| Rate for Payer: Signature Care PPO |
$206.36
|
| Rate for Payer: United Healthcare Commercial |
$184.79
|
|
|
HC AR 1.35 GUIDEWIRE TROC TIP
|
Facility
OP
|
$234.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.38 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$197.92
|
| Rate for Payer: Aetna Medicare |
$77.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.12
|
| Rate for Payer: Cash Price |
$145.39
|
| Rate for Payer: Cash Price |
$145.39
|
| Rate for Payer: Centivo All Commercial |
$119.60
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.08
|
| Rate for Payer: Coventry All Commercial |
$206.36
|
| Rate for Payer: Encore All Commercial |
$215.86
|
| Rate for Payer: Frontpath All Commercial |
$215.74
|
| Rate for Payer: Humana ChoiceCare |
$202.54
|
| Rate for Payer: Humana Medicare |
$119.60
|
| Rate for Payer: Lucent All Commercial |
$119.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$175.88
|
| Rate for Payer: PHP All Commercial |
$177.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.46
|
| Rate for Payer: Sagamore Health Network All Products |
$181.03
|
| Rate for Payer: Signature Care EPO |
$194.64
|
| Rate for Payer: Signature Care PPO |
$206.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$199.32
|
| Rate for Payer: United Healthcare Commercial |
$184.79
|
| Rate for Payer: United Healthcare Medicare |
$77.38
|
|
|
HC AR 1.4X3.5 GUIDEWIRE BV FT
|
Facility
OP
|
$574.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.42 |
| Max. Negotiated Rate |
$533.82 |
| Rate for Payer: Aetna Commercial |
$484.46
|
| Rate for Payer: Aetna Medicare |
$189.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$189.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$329.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$217.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$208.36
|
| Rate for Payer: Cash Price |
$355.88
|
| Rate for Payer: Cash Price |
$355.88
|
| Rate for Payer: Centivo All Commercial |
$292.74
|
| Rate for Payer: Cigna All Commercial |
$495.36
|
| Rate for Payer: CORVEL All Commercial |
$533.82
|
| Rate for Payer: Coventry All Commercial |
$505.12
|
| Rate for Payer: Encore All Commercial |
$528.37
|
| Rate for Payer: Frontpath All Commercial |
$528.08
|
| Rate for Payer: Humana ChoiceCare |
$495.76
|
| Rate for Payer: Humana Medicare |
$292.74
|
| Rate for Payer: Lucent All Commercial |
$292.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$516.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$430.50
|
| Rate for Payer: PHP All Commercial |
$435.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$223.86
|
| Rate for Payer: Sagamore Health Network All Products |
$443.13
|
| Rate for Payer: Signature Care EPO |
$476.42
|
| Rate for Payer: Signature Care PPO |
$505.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$487.90
|
| Rate for Payer: United Healthcare Commercial |
$452.31
|
| Rate for Payer: United Healthcare Medicare |
$189.42
|
|
|
HC AR 1.4X3.5 GUIDEWIRE BV FT
|
Facility
IP
|
$574.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$533.82 |
| Rate for Payer: Aetna Commercial |
$495.94
|
| Rate for Payer: Cash Price |
$355.88
|
| Rate for Payer: Cigna All Commercial |
$495.36
|
| Rate for Payer: CORVEL All Commercial |
$533.82
|
| Rate for Payer: Coventry All Commercial |
$505.12
|
| Rate for Payer: Encore All Commercial |
$528.37
|
| Rate for Payer: Frontpath All Commercial |
$528.08
|
| Rate for Payer: Humana ChoiceCare |
$495.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$516.60
|
| Rate for Payer: PHCS All Commercial |
$430.50
|
| Rate for Payer: PHP All Commercial |
$435.32
|
| Rate for Payer: Sagamore Health Network All Products |
$443.13
|
| Rate for Payer: Signature Care EPO |
$476.42
|
| Rate for Payer: Signature Care PPO |
$505.12
|
| Rate for Payer: United Healthcare Commercial |
$452.31
|
|
|
HC AR 2.4 DRILL/WIRE CANN
|
Facility
IP
|
$2,460.00
|
|
| Hospital Charge Code |
41608240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,845.00 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,125.44
|
| Rate for Payer: Cash Price |
$1,525.20
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
|
|
HC AR 2.4 DRILL/WIRE CANN
|
Facility
OP
|
$2,460.00
|
|
| Hospital Charge Code |
41608240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,076.24
|
| Rate for Payer: Aetna Medicare |
$811.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$811.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,412.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,537.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$933.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$892.98
|
| Rate for Payer: Cash Price |
$1,525.20
|
| Rate for Payer: Cash Price |
$1,525.20
|
| Rate for Payer: Centivo All Commercial |
$1,254.60
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Humana Medicare |
$1,254.60
|
| Rate for Payer: Lucent All Commercial |
$1,254.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$959.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,091.00
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
| Rate for Payer: United Healthcare Medicare |
$811.80
|
|
|
HC AR 2.7MM DRILL BIT CMP FT CAL
|
Facility
IP
|
$1,072.50
|
|
| Hospital Charge Code |
41602614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$804.38 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$926.64
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.18
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
|
|
HC AR 2.7MM DRILL BIT CMP FT CAL
|
Facility
OP
|
$1,072.50
|
|
| Hospital Charge Code |
41602614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$905.19
|
| Rate for Payer: Aetna Medicare |
$353.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$615.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$670.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$407.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$389.32
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Centivo All Commercial |
$546.98
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Humana Medicare |
$546.98
|
| Rate for Payer: Lucent All Commercial |
$546.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$418.28
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.18
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$911.62
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
| Rate for Payer: United Healthcare Medicare |
$353.92
|
|
|
HC AR 3.2MM DRILL BIT CMP FT CAL
|
Facility
OP
|
$1,072.50
|
|
| Hospital Charge Code |
41602603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$905.19
|
| Rate for Payer: Aetna Medicare |
$353.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$615.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$670.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$407.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$389.32
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Centivo All Commercial |
$546.98
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Humana Medicare |
$546.98
|
| Rate for Payer: Lucent All Commercial |
$546.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$418.28
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.18
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$911.62
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
| Rate for Payer: United Healthcare Medicare |
$353.92
|
|
|
HC AR 3.2MM DRILL BIT CMP FT CAL
|
Facility
IP
|
$1,072.50
|
|
| Hospital Charge Code |
41602603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$804.38 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$926.64
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.18
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
|
|
HC AR 3.9 LOOP TACK TENODESIS
|
Facility
IP
|
$3,168.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.00 |
| Max. Negotiated Rate |
$2,946.24 |
| Rate for Payer: Aetna Commercial |
$2,737.15
|
| Rate for Payer: Cash Price |
$1,964.16
|
| Rate for Payer: Cigna All Commercial |
$2,733.98
|
| Rate for Payer: CORVEL All Commercial |
$2,946.24
|
| Rate for Payer: Coventry All Commercial |
$2,787.84
|
| Rate for Payer: Encore All Commercial |
$2,916.14
|
| Rate for Payer: Frontpath All Commercial |
$2,914.56
|
| Rate for Payer: Humana ChoiceCare |
$2,736.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,851.20
|
| Rate for Payer: PHCS All Commercial |
$2,376.00
|
| Rate for Payer: PHP All Commercial |
$2,402.61
|
| Rate for Payer: Sagamore Health Network All Products |
$2,445.70
|
| Rate for Payer: Signature Care EPO |
$2,629.44
|
| Rate for Payer: Signature Care PPO |
$2,787.84
|
| Rate for Payer: United Healthcare Commercial |
$2,496.38
|
|
|
HC AR 3.9 LOOP TACK TENODESIS
|
Facility
OP
|
$3,168.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,946.24 |
| Rate for Payer: Aetna Commercial |
$2,673.79
|
| Rate for Payer: Aetna Medicare |
$1,045.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,045.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,819.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,980.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,202.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,149.98
|
| Rate for Payer: Cash Price |
$1,964.16
|
| Rate for Payer: Cash Price |
$1,964.16
|
| Rate for Payer: Centivo All Commercial |
$1,615.68
|
| Rate for Payer: Cigna All Commercial |
$2,733.98
|
| Rate for Payer: CORVEL All Commercial |
$2,946.24
|
| Rate for Payer: Coventry All Commercial |
$2,787.84
|
| Rate for Payer: Encore All Commercial |
$2,916.14
|
| Rate for Payer: Frontpath All Commercial |
$2,914.56
|
| Rate for Payer: Humana ChoiceCare |
$2,736.20
|
| Rate for Payer: Humana Medicare |
$1,615.68
|
| Rate for Payer: Lucent All Commercial |
$1,615.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,851.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,376.00
|
| Rate for Payer: PHP All Commercial |
$2,402.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,235.52
|
| Rate for Payer: Sagamore Health Network All Products |
$2,445.70
|
| Rate for Payer: Signature Care EPO |
$2,629.44
|
| Rate for Payer: Signature Care PPO |
$2,787.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,692.80
|
| Rate for Payer: United Healthcare Commercial |
$2,496.38
|
| Rate for Payer: United Healthcare Medicare |
$1,045.44
|
|
|
HC AR 9.0 FLIPCUTTER II
|
Facility
IP
|
$1,787.50
|
|
| Hospital Charge Code |
41606576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,340.62 |
| Max. Negotiated Rate |
$1,662.38 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,108.25
|
| Rate for Payer: Cigna All Commercial |
$1,542.61
|
| Rate for Payer: CORVEL All Commercial |
$1,662.38
|
| Rate for Payer: Coventry All Commercial |
$1,573.00
|
| Rate for Payer: Encore All Commercial |
$1,645.39
|
| Rate for Payer: Frontpath All Commercial |
$1,644.50
|
| Rate for Payer: Humana ChoiceCare |
$1,543.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,608.75
|
| Rate for Payer: PHCS All Commercial |
$1,340.62
|
| Rate for Payer: PHP All Commercial |
$1,355.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,379.95
|
| Rate for Payer: Signature Care EPO |
$1,483.62
|
| Rate for Payer: Signature Care PPO |
$1,573.00
|
| Rate for Payer: United Healthcare Commercial |
$1,408.55
|
|
|
HC AR 9.0 FLIPCUTTER II
|
Facility
OP
|
$1,787.50
|
|
| Hospital Charge Code |
41606576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,662.38 |
| Rate for Payer: Aetna Commercial |
$1,508.65
|
| Rate for Payer: Aetna Medicare |
$589.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$589.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,026.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,117.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$678.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$648.86
|
| Rate for Payer: Cash Price |
$1,108.25
|
| Rate for Payer: Cash Price |
$1,108.25
|
| Rate for Payer: Centivo All Commercial |
$911.62
|
| Rate for Payer: Cigna All Commercial |
$1,542.61
|
| Rate for Payer: CORVEL All Commercial |
$1,662.38
|
| Rate for Payer: Coventry All Commercial |
$1,573.00
|
| Rate for Payer: Encore All Commercial |
$1,645.39
|
| Rate for Payer: Frontpath All Commercial |
$1,644.50
|
| Rate for Payer: Humana ChoiceCare |
$1,543.86
|
| Rate for Payer: Humana Medicare |
$911.62
|
| Rate for Payer: Lucent All Commercial |
$911.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,608.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,340.62
|
| Rate for Payer: PHP All Commercial |
$1,355.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$697.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,379.95
|
| Rate for Payer: Signature Care EPO |
$1,483.62
|
| Rate for Payer: Signature Care PPO |
$1,573.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,519.38
|
| Rate for Payer: United Healthcare Commercial |
$1,408.55
|
| Rate for Payer: United Healthcare Medicare |
$589.88
|
|
