|
HC AR ANGEL CPRP/BMA TRAY
|
Facility
OP
|
$3,880.80
|
|
| Hospital Charge Code |
41606173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$3,609.14 |
| Rate for Payer: Aetna Commercial |
$3,275.40
|
| Rate for Payer: Aetna Medicare |
$1,280.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,280.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,228.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,425.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,472.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,408.73
|
| Rate for Payer: Cash Price |
$2,406.10
|
| Rate for Payer: Cash Price |
$2,406.10
|
| Rate for Payer: Centivo All Commercial |
$1,979.21
|
| Rate for Payer: Cigna All Commercial |
$3,349.13
|
| Rate for Payer: CORVEL All Commercial |
$3,609.14
|
| Rate for Payer: Coventry All Commercial |
$3,415.10
|
| Rate for Payer: Encore All Commercial |
$3,572.28
|
| Rate for Payer: Frontpath All Commercial |
$3,570.34
|
| Rate for Payer: Humana ChoiceCare |
$3,351.85
|
| Rate for Payer: Humana Medicare |
$1,979.21
|
| Rate for Payer: Lucent All Commercial |
$1,979.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,492.72
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,910.60
|
| Rate for Payer: PHP All Commercial |
$2,943.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,513.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,995.98
|
| Rate for Payer: Signature Care EPO |
$3,221.06
|
| Rate for Payer: Signature Care PPO |
$3,415.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,298.68
|
| Rate for Payer: United Healthcare Commercial |
$3,058.07
|
| Rate for Payer: United Healthcare Medicare |
$1,280.66
|
|
|
HC AR ANGEL PRP SYSTEM
|
Facility
IP
|
$1,250.00
|
|
| Hospital Charge Code |
41606168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,080.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
|
|
HC AR ANGEL PRP SYSTEM
|
Facility
OP
|
$1,250.00
|
|
| Hospital Charge Code |
41606168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,055.00
|
| Rate for Payer: Aetna Medicare |
$412.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$412.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$717.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$781.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$474.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$453.75
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Centivo All Commercial |
$637.50
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Humana Medicare |
$637.50
|
| Rate for Payer: Lucent All Commercial |
$637.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$487.50
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,062.50
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
| Rate for Payer: United Healthcare Medicare |
$412.50
|
|
|
HC AR ANKLE FUSION SYSTEM
|
Facility
IP
|
$2,000.00
|
|
| Hospital Charge Code |
41604949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cigna All Commercial |
$1,726.00
|
| Rate for Payer: CORVEL All Commercial |
$1,860.00
|
| Rate for Payer: Coventry All Commercial |
$1,760.00
|
| Rate for Payer: Encore All Commercial |
$1,841.00
|
| Rate for Payer: Frontpath All Commercial |
$1,840.00
|
| Rate for Payer: Humana ChoiceCare |
$1,727.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,800.00
|
| Rate for Payer: PHCS All Commercial |
$1,500.00
|
| Rate for Payer: PHP All Commercial |
$1,516.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,544.00
|
| Rate for Payer: Signature Care EPO |
$1,660.00
|
| Rate for Payer: Signature Care PPO |
$1,760.00
|
| Rate for Payer: United Healthcare Commercial |
$1,576.00
|
|
|
HC AR ANKLE FUSION SYSTEM
|
Facility
OP
|
$2,000.00
|
|
| Hospital Charge Code |
41604949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,688.00
|
| Rate for Payer: Aetna Medicare |
$660.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$660.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,250.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$759.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$726.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Centivo All Commercial |
$1,020.00
|
| Rate for Payer: Cigna All Commercial |
$1,726.00
|
| Rate for Payer: CORVEL All Commercial |
$1,860.00
|
| Rate for Payer: Coventry All Commercial |
$1,760.00
|
| Rate for Payer: Encore All Commercial |
$1,841.00
|
| Rate for Payer: Frontpath All Commercial |
$1,840.00
|
| Rate for Payer: Humana ChoiceCare |
$1,727.40
|
| Rate for Payer: Humana Medicare |
$1,020.00
|
| Rate for Payer: Lucent All Commercial |
$1,020.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,800.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,500.00
|
| Rate for Payer: PHP All Commercial |
$1,516.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$780.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,544.00
|
| Rate for Payer: Signature Care EPO |
$1,660.00
|
| Rate for Payer: Signature Care PPO |
$1,760.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,576.00
|
| Rate for Payer: United Healthcare Medicare |
$660.00
|
|
|
HC AR ARTHROFLEX 40X70X3.0
|
Facility
OP
|
$15,784.56
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$14,679.64 |
| Rate for Payer: Aetna Commercial |
$13,322.17
|
| Rate for Payer: Aetna Medicare |
$5,208.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,208.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9,065.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,866.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,990.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,729.80
|
| Rate for Payer: Cash Price |
$9,786.43
|
| Rate for Payer: Cash Price |
$9,786.43
|
| Rate for Payer: Centivo All Commercial |
$8,050.13
|
| Rate for Payer: Cigna All Commercial |
$13,622.08
|
| Rate for Payer: CORVEL All Commercial |
$14,679.64
|
| Rate for Payer: Coventry All Commercial |
$13,890.41
|
| Rate for Payer: Encore All Commercial |
$14,529.69
|
| Rate for Payer: Frontpath All Commercial |
$14,521.80
|
| Rate for Payer: Humana ChoiceCare |
$13,633.12
|
| Rate for Payer: Humana Medicare |
$8,050.13
|
| Rate for Payer: Lucent All Commercial |
$8,050.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,206.10
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$11,838.42
|
| Rate for Payer: PHP All Commercial |
$11,971.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,155.98
|
| Rate for Payer: Sagamore Health Network All Products |
$12,185.68
|
| Rate for Payer: Signature Care EPO |
$13,101.18
|
| Rate for Payer: Signature Care PPO |
$13,890.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,416.88
|
| Rate for Payer: United Healthcare Commercial |
$12,438.23
|
| Rate for Payer: United Healthcare Medicare |
$5,208.90
|
|
|
HC AR ARTHROFLEX 40X70X3.0
|
Facility
IP
|
$15,784.56
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,838.42 |
| Max. Negotiated Rate |
$14,679.64 |
| Rate for Payer: Aetna Commercial |
$13,637.86
|
| Rate for Payer: Cash Price |
$9,786.43
|
| Rate for Payer: Cigna All Commercial |
$13,622.08
|
| Rate for Payer: CORVEL All Commercial |
$14,679.64
|
| Rate for Payer: Coventry All Commercial |
$13,890.41
|
| Rate for Payer: Encore All Commercial |
$14,529.69
|
| Rate for Payer: Frontpath All Commercial |
$14,521.80
|
| Rate for Payer: Humana ChoiceCare |
$13,633.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,206.10
|
| Rate for Payer: PHCS All Commercial |
$11,838.42
|
| Rate for Payer: PHP All Commercial |
$11,971.01
|
| Rate for Payer: Sagamore Health Network All Products |
$12,185.68
|
| Rate for Payer: Signature Care EPO |
$13,101.18
|
| Rate for Payer: Signature Care PPO |
$13,890.41
|
| Rate for Payer: United Healthcare Commercial |
$12,438.23
|
|
|
HC AR ARTHRO MEASURMENT PROBE
|
Facility
OP
|
$462.00
|
|
| Hospital Charge Code |
41606990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$429.66 |
| Rate for Payer: Aetna Commercial |
$389.93
|
| Rate for Payer: Aetna Medicare |
$152.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$265.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$288.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.71
|
| Rate for Payer: Cash Price |
$286.44
|
| Rate for Payer: Cash Price |
$286.44
|
| Rate for Payer: Centivo All Commercial |
$235.62
|
| Rate for Payer: Cigna All Commercial |
$398.71
|
| Rate for Payer: CORVEL All Commercial |
$429.66
|
| Rate for Payer: Coventry All Commercial |
$406.56
|
| Rate for Payer: Encore All Commercial |
$425.27
|
| Rate for Payer: Frontpath All Commercial |
$425.04
|
| Rate for Payer: Humana ChoiceCare |
$399.03
|
| Rate for Payer: Humana Medicare |
$235.62
|
| Rate for Payer: Lucent All Commercial |
$235.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$346.50
|
| Rate for Payer: PHP All Commercial |
$350.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.18
|
| Rate for Payer: Sagamore Health Network All Products |
$356.66
|
| Rate for Payer: Signature Care EPO |
$383.46
|
| Rate for Payer: Signature Care PPO |
$406.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$392.70
|
| Rate for Payer: United Healthcare Commercial |
$364.06
|
| Rate for Payer: United Healthcare Medicare |
$152.46
|
|
|
HC AR ARTHRO MEASURMENT PROBE
|
Facility
IP
|
$462.00
|
|
| Hospital Charge Code |
41606990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$429.66 |
| Rate for Payer: Aetna Commercial |
$399.17
|
| Rate for Payer: Cash Price |
$286.44
|
| Rate for Payer: Cigna All Commercial |
$398.71
|
| Rate for Payer: CORVEL All Commercial |
$429.66
|
| Rate for Payer: Coventry All Commercial |
$406.56
|
| Rate for Payer: Encore All Commercial |
$425.27
|
| Rate for Payer: Frontpath All Commercial |
$425.04
|
| Rate for Payer: Humana ChoiceCare |
$399.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.80
|
| Rate for Payer: PHCS All Commercial |
$346.50
|
| Rate for Payer: PHP All Commercial |
$350.38
|
| Rate for Payer: Sagamore Health Network All Products |
$356.66
|
| Rate for Payer: Signature Care EPO |
$383.46
|
| Rate for Payer: Signature Care PPO |
$406.56
|
| Rate for Payer: United Healthcare Commercial |
$364.06
|
|
|
HC AR BLADE 10MM
|
Facility
IP
|
$361.90
|
|
| Hospital Charge Code |
41606362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.42 |
| Max. Negotiated Rate |
$336.57 |
| Rate for Payer: Aetna Commercial |
$312.68
|
| Rate for Payer: Cash Price |
$224.38
|
| Rate for Payer: Cigna All Commercial |
$312.32
|
| Rate for Payer: CORVEL All Commercial |
$336.57
|
| Rate for Payer: Coventry All Commercial |
$318.47
|
| Rate for Payer: Encore All Commercial |
$333.13
|
| Rate for Payer: Frontpath All Commercial |
$332.95
|
| Rate for Payer: Humana ChoiceCare |
$312.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.71
|
| Rate for Payer: PHCS All Commercial |
$271.42
|
| Rate for Payer: PHP All Commercial |
$274.46
|
| Rate for Payer: Sagamore Health Network All Products |
$279.39
|
| Rate for Payer: Signature Care EPO |
$300.38
|
| Rate for Payer: Signature Care PPO |
$318.47
|
| Rate for Payer: United Healthcare Commercial |
$285.18
|
|
|
HC AR BLADE 10MM
|
Facility
OP
|
$361.90
|
|
| Hospital Charge Code |
41606362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.43 |
| Max. Negotiated Rate |
$336.57 |
| Rate for Payer: Aetna Commercial |
$305.44
|
| Rate for Payer: Aetna Medicare |
$119.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$207.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.37
|
| Rate for Payer: Cash Price |
$224.38
|
| Rate for Payer: Cash Price |
$224.38
|
| Rate for Payer: Centivo All Commercial |
$184.57
|
| Rate for Payer: Cigna All Commercial |
$312.32
|
| Rate for Payer: CORVEL All Commercial |
$336.57
|
| Rate for Payer: Coventry All Commercial |
$318.47
|
| Rate for Payer: Encore All Commercial |
$333.13
|
| Rate for Payer: Frontpath All Commercial |
$332.95
|
| Rate for Payer: Humana ChoiceCare |
$312.57
|
| Rate for Payer: Humana Medicare |
$184.57
|
| Rate for Payer: Lucent All Commercial |
$184.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$271.42
|
| Rate for Payer: PHP All Commercial |
$274.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.14
|
| Rate for Payer: Sagamore Health Network All Products |
$279.39
|
| Rate for Payer: Signature Care EPO |
$300.38
|
| Rate for Payer: Signature Care PPO |
$318.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.62
|
| Rate for Payer: United Healthcare Commercial |
$285.18
|
| Rate for Payer: United Healthcare Medicare |
$119.43
|
|
|
HC AR BLADE 10 QUAD TENDON
|
Facility
OP
|
$962.50
|
|
| Hospital Charge Code |
41606232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.39
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Centivo All Commercial |
$490.88
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$490.88
|
| Rate for Payer: Lucent All Commercial |
$490.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$317.62
|
|
|
HC AR BLADE 10 QUAD TENDON
|
Facility
IP
|
$962.50
|
|
| Hospital Charge Code |
41606232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC AR BLADE 9MM
|
Facility
IP
|
$361.90
|
|
| Hospital Charge Code |
41606531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.42 |
| Max. Negotiated Rate |
$336.57 |
| Rate for Payer: Aetna Commercial |
$312.68
|
| Rate for Payer: Cash Price |
$224.38
|
| Rate for Payer: Cigna All Commercial |
$312.32
|
| Rate for Payer: CORVEL All Commercial |
$336.57
|
| Rate for Payer: Coventry All Commercial |
$318.47
|
| Rate for Payer: Encore All Commercial |
$333.13
|
| Rate for Payer: Frontpath All Commercial |
$332.95
|
| Rate for Payer: Humana ChoiceCare |
$312.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.71
|
| Rate for Payer: PHCS All Commercial |
$271.42
|
| Rate for Payer: PHP All Commercial |
$274.46
|
| Rate for Payer: Sagamore Health Network All Products |
$279.39
|
| Rate for Payer: Signature Care EPO |
$300.38
|
| Rate for Payer: Signature Care PPO |
$318.47
|
| Rate for Payer: United Healthcare Commercial |
$285.18
|
|
|
HC AR BLADE 9MM
|
Facility
OP
|
$361.90
|
|
| Hospital Charge Code |
41606531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.43 |
| Max. Negotiated Rate |
$336.57 |
| Rate for Payer: Aetna Commercial |
$305.44
|
| Rate for Payer: Aetna Medicare |
$119.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$207.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.37
|
| Rate for Payer: Cash Price |
$224.38
|
| Rate for Payer: Cash Price |
$224.38
|
| Rate for Payer: Centivo All Commercial |
$184.57
|
| Rate for Payer: Cigna All Commercial |
$312.32
|
| Rate for Payer: CORVEL All Commercial |
$336.57
|
| Rate for Payer: Coventry All Commercial |
$318.47
|
| Rate for Payer: Encore All Commercial |
$333.13
|
| Rate for Payer: Frontpath All Commercial |
$332.95
|
| Rate for Payer: Humana ChoiceCare |
$312.57
|
| Rate for Payer: Humana Medicare |
$184.57
|
| Rate for Payer: Lucent All Commercial |
$184.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$271.42
|
| Rate for Payer: PHP All Commercial |
$274.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.14
|
| Rate for Payer: Sagamore Health Network All Products |
$279.39
|
| Rate for Payer: Signature Care EPO |
$300.38
|
| Rate for Payer: Signature Care PPO |
$318.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.62
|
| Rate for Payer: United Healthcare Commercial |
$285.18
|
| Rate for Payer: United Healthcare Medicare |
$119.43
|
|
|
HC AR BONE MARROW NEEDLE CLOSED
|
Facility
IP
|
$1,787.50
|
|
| Hospital Charge Code |
41606169
|
|
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 BONE MARROW NEEDLE CLOSED
|
Facility
OP
|
$1,787.50
|
|
| Hospital Charge Code |
41606169
|
|
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
|
|
|
HC AR BONE MARROW NEEDLE OPEN
|
Facility
IP
|
$1,650.00
|
|
| Hospital Charge Code |
41606170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Aetna Commercial |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Cigna All Commercial |
$1,423.95
|
| Rate for Payer: CORVEL All Commercial |
$1,534.50
|
| Rate for Payer: Coventry All Commercial |
$1,452.00
|
| Rate for Payer: Encore All Commercial |
$1,518.82
|
| Rate for Payer: Frontpath All Commercial |
$1,518.00
|
| Rate for Payer: Humana ChoiceCare |
$1,425.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,485.00
|
| Rate for Payer: PHCS All Commercial |
$1,237.50
|
| Rate for Payer: PHP All Commercial |
$1,251.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,273.80
|
| Rate for Payer: Signature Care EPO |
$1,369.50
|
| Rate for Payer: Signature Care PPO |
$1,452.00
|
| Rate for Payer: United Healthcare Commercial |
$1,300.20
|
|
|
HC AR BONE MARROW NEEDLE OPEN
|
Facility
OP
|
$1,650.00
|
|
| Hospital Charge Code |
41606170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Aetna Commercial |
$1,392.60
|
| Rate for Payer: Aetna Medicare |
$544.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$544.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$947.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,031.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$626.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$598.95
|
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Centivo All Commercial |
$841.50
|
| Rate for Payer: Cigna All Commercial |
$1,423.95
|
| Rate for Payer: CORVEL All Commercial |
$1,534.50
|
| Rate for Payer: Coventry All Commercial |
$1,452.00
|
| Rate for Payer: Encore All Commercial |
$1,518.82
|
| Rate for Payer: Frontpath All Commercial |
$1,518.00
|
| Rate for Payer: Humana ChoiceCare |
$1,425.10
|
| Rate for Payer: Humana Medicare |
$841.50
|
| Rate for Payer: Lucent All Commercial |
$841.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,485.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,237.50
|
| Rate for Payer: PHP All Commercial |
$1,251.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$643.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,273.80
|
| Rate for Payer: Signature Care EPO |
$1,369.50
|
| Rate for Payer: Signature Care PPO |
$1,452.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,402.50
|
| Rate for Payer: United Healthcare Commercial |
$1,300.20
|
| Rate for Payer: United Healthcare Medicare |
$544.50
|
|
|
HC AR BUTTON EXT 5X20
|
Facility
IP
|
$1,237.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.12 |
| Max. Negotiated Rate |
$1,150.88 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cigna All Commercial |
$1,067.96
|
| Rate for Payer: CORVEL All Commercial |
$1,150.88
|
| Rate for Payer: Coventry All Commercial |
$1,089.00
|
| Rate for Payer: Encore All Commercial |
$1,139.12
|
| Rate for Payer: Frontpath All Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$1,068.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.75
|
| Rate for Payer: PHCS All Commercial |
$928.12
|
| Rate for Payer: PHP All Commercial |
$938.52
|
| Rate for Payer: Sagamore Health Network All Products |
$955.35
|
| Rate for Payer: Signature Care EPO |
$1,027.12
|
| Rate for Payer: Signature Care PPO |
$1,089.00
|
| Rate for Payer: United Healthcare Commercial |
$975.15
|
|
|
HC AR BUTTON EXT 5X20
|
Facility
OP
|
$1,237.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.38 |
| Max. Negotiated Rate |
$1,150.88 |
| Rate for Payer: Aetna Commercial |
$1,044.45
|
| Rate for Payer: Aetna Medicare |
$408.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$408.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$710.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$773.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$469.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$449.21
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Centivo All Commercial |
$631.12
|
| Rate for Payer: Cigna All Commercial |
$1,067.96
|
| Rate for Payer: CORVEL All Commercial |
$1,150.88
|
| Rate for Payer: Coventry All Commercial |
$1,089.00
|
| Rate for Payer: Encore All Commercial |
$1,139.12
|
| Rate for Payer: Frontpath All Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$1,068.83
|
| Rate for Payer: Humana Medicare |
$631.12
|
| Rate for Payer: Lucent All Commercial |
$631.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.75
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$928.12
|
| Rate for Payer: PHP All Commercial |
$938.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$482.62
|
| Rate for Payer: Sagamore Health Network All Products |
$955.35
|
| Rate for Payer: Signature Care EPO |
$1,027.12
|
| Rate for Payer: Signature Care PPO |
$1,089.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,051.88
|
| Rate for Payer: United Healthcare Commercial |
$975.15
|
| Rate for Payer: United Healthcare Medicare |
$408.38
|
|
|
HC AR BUTTON TR ABS
|
Facility
IP
|
$1,232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$924.00 |
| Max. Negotiated Rate |
$1,145.76 |
| Rate for Payer: Aetna Commercial |
$1,064.45
|
| Rate for Payer: Cash Price |
$763.84
|
| Rate for Payer: Cigna All Commercial |
$1,063.22
|
| Rate for Payer: CORVEL All Commercial |
$1,145.76
|
| Rate for Payer: Coventry All Commercial |
$1,084.16
|
| Rate for Payer: Encore All Commercial |
$1,134.06
|
| Rate for Payer: Frontpath All Commercial |
$1,133.44
|
| Rate for Payer: Humana ChoiceCare |
$1,064.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,108.80
|
| Rate for Payer: PHCS All Commercial |
$924.00
|
| Rate for Payer: PHP All Commercial |
$934.35
|
| Rate for Payer: Sagamore Health Network All Products |
$951.10
|
| Rate for Payer: Signature Care EPO |
$1,022.56
|
| Rate for Payer: Signature Care PPO |
$1,084.16
|
| Rate for Payer: United Healthcare Commercial |
$970.82
|
|
|
HC AR BUTTON TR ABS
|
Facility
OP
|
$1,232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$1,145.76 |
| Rate for Payer: Aetna Commercial |
$1,039.81
|
| Rate for Payer: Aetna Medicare |
$406.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$406.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$707.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$770.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$467.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$447.22
|
| Rate for Payer: Cash Price |
$763.84
|
| Rate for Payer: Cash Price |
$763.84
|
| Rate for Payer: Centivo All Commercial |
$628.32
|
| Rate for Payer: Cigna All Commercial |
$1,063.22
|
| Rate for Payer: CORVEL All Commercial |
$1,145.76
|
| Rate for Payer: Coventry All Commercial |
$1,084.16
|
| Rate for Payer: Encore All Commercial |
$1,134.06
|
| Rate for Payer: Frontpath All Commercial |
$1,133.44
|
| Rate for Payer: Humana ChoiceCare |
$1,064.08
|
| Rate for Payer: Humana Medicare |
$628.32
|
| Rate for Payer: Lucent All Commercial |
$628.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,108.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$924.00
|
| Rate for Payer: PHP All Commercial |
$934.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$480.48
|
| Rate for Payer: Sagamore Health Network All Products |
$951.10
|
| Rate for Payer: Signature Care EPO |
$1,022.56
|
| Rate for Payer: Signature Care PPO |
$1,084.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,047.20
|
| Rate for Payer: United Healthcare Commercial |
$970.82
|
| Rate for Payer: United Healthcare Medicare |
$406.56
|
|
|
HC AR BUTTON TR ABS 17MM
|
Facility
IP
|
$2,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.25 |
| Max. Negotiated Rate |
$2,134.35 |
| Rate for Payer: Aetna Commercial |
$1,982.88
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cigna All Commercial |
$1,980.58
|
| Rate for Payer: CORVEL All Commercial |
$2,134.35
|
| Rate for Payer: Coventry All Commercial |
$2,019.60
|
| Rate for Payer: Encore All Commercial |
$2,112.55
|
| Rate for Payer: Frontpath All Commercial |
$2,111.40
|
| Rate for Payer: Humana ChoiceCare |
$1,982.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,065.50
|
| Rate for Payer: PHCS All Commercial |
$1,721.25
|
| Rate for Payer: PHP All Commercial |
$1,740.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,771.74
|
| Rate for Payer: Signature Care EPO |
$1,904.85
|
| Rate for Payer: Signature Care PPO |
$2,019.60
|
| Rate for Payer: United Healthcare Commercial |
$1,808.46
|
|
|
HC AR BUTTON TR ABS 17MM
|
Facility
OP
|
$2,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,134.35 |
| Rate for Payer: Aetna Commercial |
$1,936.98
|
| Rate for Payer: Aetna Medicare |
$757.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$757.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,318.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,434.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$870.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$833.08
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Centivo All Commercial |
$1,170.45
|
| Rate for Payer: Cigna All Commercial |
$1,980.58
|
| Rate for Payer: CORVEL All Commercial |
$2,134.35
|
| Rate for Payer: Coventry All Commercial |
$2,019.60
|
| Rate for Payer: Encore All Commercial |
$2,112.55
|
| Rate for Payer: Frontpath All Commercial |
$2,111.40
|
| Rate for Payer: Humana ChoiceCare |
$1,982.19
|
| Rate for Payer: Humana Medicare |
$1,170.45
|
| Rate for Payer: Lucent All Commercial |
$1,170.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,065.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,721.25
|
| Rate for Payer: PHP All Commercial |
$1,740.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$895.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,771.74
|
| Rate for Payer: Signature Care EPO |
$1,904.85
|
| Rate for Payer: Signature Care PPO |
$2,019.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,950.75
|
| Rate for Payer: United Healthcare Commercial |
$1,808.46
|
| Rate for Payer: United Healthcare Medicare |
$757.35
|
|
