|
HC AR CARTIFORM 10MM
|
Facility
OP
|
$13,860.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41608161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,889.80 |
| Rate for Payer: Aetna Commercial |
$11,697.84
|
| Rate for Payer: Aetna Medicare |
$4,573.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,573.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,959.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,663.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,259.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,031.18
|
| Rate for Payer: Cash Price |
$8,593.20
|
| Rate for Payer: Cash Price |
$8,593.20
|
| Rate for Payer: Centivo All Commercial |
$7,068.60
|
| Rate for Payer: Cigna All Commercial |
$11,961.18
|
| Rate for Payer: CORVEL All Commercial |
$12,889.80
|
| Rate for Payer: Coventry All Commercial |
$12,196.80
|
| Rate for Payer: Encore All Commercial |
$12,758.13
|
| Rate for Payer: Frontpath All Commercial |
$12,751.20
|
| Rate for Payer: Humana ChoiceCare |
$11,970.88
|
| Rate for Payer: Humana Medicare |
$7,068.60
|
| Rate for Payer: Lucent All Commercial |
$7,068.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,474.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$10,395.00
|
| Rate for Payer: PHP All Commercial |
$10,511.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,405.40
|
| Rate for Payer: Sagamore Health Network All Products |
$10,699.92
|
| Rate for Payer: Signature Care EPO |
$11,503.80
|
| Rate for Payer: Signature Care PPO |
$12,196.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,781.00
|
| Rate for Payer: United Healthcare Commercial |
$10,921.68
|
| Rate for Payer: United Healthcare Medicare |
$4,573.80
|
|
|
HC AR CARTIFORM 10MM
|
Facility
IP
|
$13,860.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41608161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,395.00 |
| Max. Negotiated Rate |
$12,889.80 |
| Rate for Payer: Aetna Commercial |
$11,975.04
|
| Rate for Payer: Cash Price |
$8,593.20
|
| Rate for Payer: Cigna All Commercial |
$11,961.18
|
| Rate for Payer: CORVEL All Commercial |
$12,889.80
|
| Rate for Payer: Coventry All Commercial |
$12,196.80
|
| Rate for Payer: Encore All Commercial |
$12,758.13
|
| Rate for Payer: Frontpath All Commercial |
$12,751.20
|
| Rate for Payer: Humana ChoiceCare |
$11,970.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,474.00
|
| Rate for Payer: PHCS All Commercial |
$10,395.00
|
| Rate for Payer: PHP All Commercial |
$10,511.42
|
| Rate for Payer: Sagamore Health Network All Products |
$10,699.92
|
| Rate for Payer: Signature Care EPO |
$11,503.80
|
| Rate for Payer: Signature Care PPO |
$12,196.80
|
| Rate for Payer: United Healthcare Commercial |
$10,921.68
|
|
|
HC AR CARTIFORM 20X25MM
|
Facility
OP
|
$43,560.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41607720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$40,510.80 |
| Rate for Payer: Aetna Commercial |
$36,764.64
|
| Rate for Payer: Aetna Medicare |
$14,374.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14,374.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25,016.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27,229.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16,531.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15,812.28
|
| Rate for Payer: Cash Price |
$27,007.20
|
| Rate for Payer: Cash Price |
$27,007.20
|
| Rate for Payer: Centivo All Commercial |
$22,215.60
|
| Rate for Payer: Cigna All Commercial |
$37,592.28
|
| Rate for Payer: CORVEL All Commercial |
$40,510.80
|
| Rate for Payer: Coventry All Commercial |
$38,332.80
|
| Rate for Payer: Encore All Commercial |
$40,096.98
|
| Rate for Payer: Frontpath All Commercial |
$40,075.20
|
| Rate for Payer: Humana ChoiceCare |
$37,622.77
|
| Rate for Payer: Humana Medicare |
$22,215.60
|
| Rate for Payer: Lucent All Commercial |
$22,215.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39,204.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$32,670.00
|
| Rate for Payer: PHP All Commercial |
$33,035.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16,988.40
|
| Rate for Payer: Sagamore Health Network All Products |
$33,628.32
|
| Rate for Payer: Signature Care EPO |
$36,154.80
|
| Rate for Payer: Signature Care PPO |
$38,332.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37,026.00
|
| Rate for Payer: United Healthcare Commercial |
$34,325.28
|
| Rate for Payer: United Healthcare Medicare |
$14,374.80
|
|
|
HC AR CARTIFORM 20X25MM
|
Facility
IP
|
$43,560.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41607720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32,670.00 |
| Max. Negotiated Rate |
$40,510.80 |
| Rate for Payer: Aetna Commercial |
$37,635.84
|
| Rate for Payer: Cash Price |
$27,007.20
|
| Rate for Payer: Cigna All Commercial |
$37,592.28
|
| Rate for Payer: CORVEL All Commercial |
$40,510.80
|
| Rate for Payer: Coventry All Commercial |
$38,332.80
|
| Rate for Payer: Encore All Commercial |
$40,096.98
|
| Rate for Payer: Frontpath All Commercial |
$40,075.20
|
| Rate for Payer: Humana ChoiceCare |
$37,622.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39,204.00
|
| Rate for Payer: PHCS All Commercial |
$32,670.00
|
| Rate for Payer: PHP All Commercial |
$33,035.90
|
| Rate for Payer: Sagamore Health Network All Products |
$33,628.32
|
| Rate for Payer: Signature Care EPO |
$36,154.80
|
| Rate for Payer: Signature Care PPO |
$38,332.80
|
| Rate for Payer: United Healthcare Commercial |
$34,325.28
|
|
|
HC AR CFS DRILL BIT 1.3
|
Facility
IP
|
$962.50
|
|
| Hospital Charge Code |
41603516
|
|
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 CFS DRILL BIT 1.3
|
Facility
OP
|
$962.50
|
|
| Hospital Charge Code |
41603516
|
|
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 CFS DRILL BIT 2.0 CANN
|
Facility
IP
|
$962.50
|
|
| Hospital Charge Code |
41603517
|
|
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 CFS DRILL BIT 2.0 CANN
|
Facility
OP
|
$962.50
|
|
| Hospital Charge Code |
41603517
|
|
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 CHFS SCREW 2.5X11
|
Facility
OP
|
$1,475.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.75 |
| Max. Negotiated Rate |
$1,371.75 |
| Rate for Payer: Aetna Commercial |
$1,244.90
|
| Rate for Payer: Aetna Medicare |
$486.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$486.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$847.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$922.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$559.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$535.42
|
| Rate for Payer: Cash Price |
$914.50
|
| Rate for Payer: Cash Price |
$914.50
|
| Rate for Payer: Centivo All Commercial |
$752.25
|
| Rate for Payer: Cigna All Commercial |
$1,272.92
|
| Rate for Payer: CORVEL All Commercial |
$1,371.75
|
| Rate for Payer: Coventry All Commercial |
$1,298.00
|
| Rate for Payer: Encore All Commercial |
$1,357.74
|
| Rate for Payer: Frontpath All Commercial |
$1,357.00
|
| Rate for Payer: Humana ChoiceCare |
$1,273.96
|
| Rate for Payer: Humana Medicare |
$752.25
|
| Rate for Payer: Lucent All Commercial |
$752.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,327.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,106.25
|
| Rate for Payer: PHP All Commercial |
$1,118.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$575.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,138.70
|
| Rate for Payer: Signature Care EPO |
$1,224.25
|
| Rate for Payer: Signature Care PPO |
$1,298.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,253.75
|
| Rate for Payer: United Healthcare Commercial |
$1,162.30
|
| Rate for Payer: United Healthcare Medicare |
$486.75
|
|
|
HC AR CHFS SCREW 2.5X11
|
Facility
IP
|
$1,475.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$1,371.75 |
| Rate for Payer: Aetna Commercial |
$1,274.40
|
| Rate for Payer: Cash Price |
$914.50
|
| Rate for Payer: Cigna All Commercial |
$1,272.92
|
| Rate for Payer: CORVEL All Commercial |
$1,371.75
|
| Rate for Payer: Coventry All Commercial |
$1,298.00
|
| Rate for Payer: Encore All Commercial |
$1,357.74
|
| Rate for Payer: Frontpath All Commercial |
$1,357.00
|
| Rate for Payer: Humana ChoiceCare |
$1,273.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,327.50
|
| Rate for Payer: PHCS All Commercial |
$1,106.25
|
| Rate for Payer: PHP All Commercial |
$1,118.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,138.70
|
| Rate for Payer: Signature Care EPO |
$1,224.25
|
| Rate for Payer: Signature Care PPO |
$1,298.00
|
| Rate for Payer: United Healthcare Commercial |
$1,162.30
|
|
|
HC AR CHONDRAL DART 18MM
|
Facility
OP
|
$931.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.46 |
| Max. Negotiated Rate |
$866.48 |
| Rate for Payer: Aetna Commercial |
$786.35
|
| Rate for Payer: Aetna Medicare |
$307.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$535.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.21
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Centivo All Commercial |
$475.17
|
| Rate for Payer: Cigna All Commercial |
$804.06
|
| Rate for Payer: CORVEL All Commercial |
$866.48
|
| Rate for Payer: Coventry All Commercial |
$819.90
|
| Rate for Payer: Encore All Commercial |
$857.63
|
| Rate for Payer: Frontpath All Commercial |
$857.16
|
| Rate for Payer: Humana ChoiceCare |
$804.71
|
| Rate for Payer: Humana Medicare |
$475.17
|
| Rate for Payer: Lucent All Commercial |
$475.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.53
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$698.78
|
| Rate for Payer: PHP All Commercial |
$706.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.36
|
| Rate for Payer: Sagamore Health Network All Products |
$719.27
|
| Rate for Payer: Signature Care EPO |
$773.31
|
| Rate for Payer: Signature Care PPO |
$819.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.94
|
| Rate for Payer: United Healthcare Commercial |
$734.18
|
| Rate for Payer: United Healthcare Medicare |
$307.46
|
|
|
HC AR CHONDRAL DART 18MM
|
Facility
IP
|
$931.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.78 |
| Max. Negotiated Rate |
$866.48 |
| Rate for Payer: Aetna Commercial |
$804.99
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna All Commercial |
$804.06
|
| Rate for Payer: CORVEL All Commercial |
$866.48
|
| Rate for Payer: Coventry All Commercial |
$819.90
|
| Rate for Payer: Encore All Commercial |
$857.63
|
| Rate for Payer: Frontpath All Commercial |
$857.16
|
| Rate for Payer: Humana ChoiceCare |
$804.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.53
|
| Rate for Payer: PHCS All Commercial |
$698.78
|
| Rate for Payer: PHP All Commercial |
$706.60
|
| Rate for Payer: Sagamore Health Network All Products |
$719.27
|
| Rate for Payer: Signature Care EPO |
$773.31
|
| Rate for Payer: Signature Care PPO |
$819.90
|
| Rate for Payer: United Healthcare Commercial |
$734.18
|
|
|
HC AR CMC MINI T-ROPE 1.1 DISP KIT
|
Facility
IP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC AR CMC MINI T-ROPE 1.1 DISP KIT
|
Facility
OP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC AR COM FT SCRW 2.5 MICRO 10MM
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC AR COM FT SCRW 2.5 MICRO 10MM
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$698.78
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Centivo All Commercial |
$981.75
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Humana Medicare |
$981.75
|
| Rate for Payer: Lucent All Commercial |
$981.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$750.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,636.25
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
| Rate for Payer: United Healthcare Medicare |
$635.25
|
|
|
HC AR COM FT SCRW 2.5 MICRO 12MM
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$698.78
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Centivo All Commercial |
$981.75
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Humana Medicare |
$981.75
|
| Rate for Payer: Lucent All Commercial |
$981.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$750.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,636.25
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
| Rate for Payer: United Healthcare Medicare |
$635.25
|
|
|
HC AR COM FT SCRW 2.5 MICRO 12MM
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC AR COM FT SCRW 2.5 MICRO 13MM
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC AR COM FT SCRW 2.5 MICRO 13MM
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$698.78
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Centivo All Commercial |
$981.75
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Humana Medicare |
$981.75
|
| Rate for Payer: Lucent All Commercial |
$981.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$750.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,636.25
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
| Rate for Payer: United Healthcare Medicare |
$635.25
|
|
|
HC AR COM FT SCRW 2.5 MICRO 14MM
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC AR COM FT SCRW 2.5 MICRO 14MM
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$698.78
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Centivo All Commercial |
$981.75
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Humana Medicare |
$981.75
|
| Rate for Payer: Lucent All Commercial |
$981.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$750.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,636.25
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
| Rate for Payer: United Healthcare Medicare |
$635.25
|
|
|
HC AR COM FT SCRW 2.5 MICRO 16MM
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC AR COM FT SCRW 2.5 MICRO 16MM
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$698.78
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Centivo All Commercial |
$981.75
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Humana Medicare |
$981.75
|
| Rate for Payer: Lucent All Commercial |
$981.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$750.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,636.25
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
| Rate for Payer: United Healthcare Medicare |
$635.25
|
|
|
HC AR COM FT SCRW 2.5 MICRO 18MM
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
