|
HC AR FIBERLOCK SUSP SYSTEM
|
Facility
OP
|
$9,572.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,902.33 |
| Rate for Payer: Aetna Commercial |
$8,079.11
|
| Rate for Payer: Aetna Medicare |
$3,158.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,158.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,497.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,983.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,632.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,474.78
|
| Rate for Payer: Cash Price |
$5,934.89
|
| Rate for Payer: Cash Price |
$5,934.89
|
| Rate for Payer: Centivo All Commercial |
$4,881.92
|
| Rate for Payer: Cigna All Commercial |
$8,260.98
|
| Rate for Payer: CORVEL All Commercial |
$8,902.33
|
| Rate for Payer: Coventry All Commercial |
$8,423.71
|
| Rate for Payer: Encore All Commercial |
$8,811.39
|
| Rate for Payer: Frontpath All Commercial |
$8,806.61
|
| Rate for Payer: Humana ChoiceCare |
$8,267.68
|
| Rate for Payer: Humana Medicare |
$4,881.92
|
| Rate for Payer: Lucent All Commercial |
$4,881.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,615.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,179.30
|
| Rate for Payer: PHP All Commercial |
$7,259.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,733.24
|
| Rate for Payer: Sagamore Health Network All Products |
$7,389.89
|
| Rate for Payer: Signature Care EPO |
$7,945.09
|
| Rate for Payer: Signature Care PPO |
$8,423.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,136.54
|
| Rate for Payer: United Healthcare Commercial |
$7,543.05
|
| Rate for Payer: United Healthcare Medicare |
$3,158.89
|
|
|
HC AR FIBERLOCK SUSP SYSTEM
|
Facility
IP
|
$9,572.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,179.30 |
| Max. Negotiated Rate |
$8,902.33 |
| Rate for Payer: Aetna Commercial |
$8,270.55
|
| Rate for Payer: Cash Price |
$5,934.89
|
| Rate for Payer: Cigna All Commercial |
$8,260.98
|
| Rate for Payer: CORVEL All Commercial |
$8,902.33
|
| Rate for Payer: Coventry All Commercial |
$8,423.71
|
| Rate for Payer: Encore All Commercial |
$8,811.39
|
| Rate for Payer: Frontpath All Commercial |
$8,806.61
|
| Rate for Payer: Humana ChoiceCare |
$8,267.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,615.16
|
| Rate for Payer: PHCS All Commercial |
$7,179.30
|
| Rate for Payer: PHP All Commercial |
$7,259.71
|
| Rate for Payer: Sagamore Health Network All Products |
$7,389.89
|
| Rate for Payer: Signature Care EPO |
$7,945.09
|
| Rate for Payer: Signature Care PPO |
$8,423.71
|
| Rate for Payer: United Healthcare Commercial |
$7,543.05
|
|
|
HC AR FIBERLOOP 7534
|
Facility
IP
|
$819.00
|
|
| Hospital Charge Code |
41608299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$761.67 |
| Rate for Payer: Aetna Commercial |
$707.62
|
| Rate for Payer: Cash Price |
$507.78
|
| Rate for Payer: Cigna All Commercial |
$706.80
|
| Rate for Payer: CORVEL All Commercial |
$761.67
|
| Rate for Payer: Coventry All Commercial |
$720.72
|
| Rate for Payer: Encore All Commercial |
$753.89
|
| Rate for Payer: Frontpath All Commercial |
$753.48
|
| Rate for Payer: Humana ChoiceCare |
$707.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$737.10
|
| Rate for Payer: PHCS All Commercial |
$614.25
|
| Rate for Payer: PHP All Commercial |
$621.13
|
| Rate for Payer: Sagamore Health Network All Products |
$632.27
|
| Rate for Payer: Signature Care EPO |
$679.77
|
| Rate for Payer: Signature Care PPO |
$720.72
|
| Rate for Payer: United Healthcare Commercial |
$645.37
|
|
|
HC AR FIBERLOOP 7534
|
Facility
OP
|
$819.00
|
|
| Hospital Charge Code |
41608299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$761.67 |
| Rate for Payer: Centivo All Commercial |
$417.69
|
| Rate for Payer: Cigna All Commercial |
$706.80
|
| Rate for Payer: CORVEL All Commercial |
$761.67
|
| Rate for Payer: Coventry All Commercial |
$720.72
|
| Rate for Payer: Encore All Commercial |
$753.89
|
| Rate for Payer: Frontpath All Commercial |
$753.48
|
| Rate for Payer: Humana ChoiceCare |
$707.37
|
| Rate for Payer: Humana Medicare |
$417.69
|
| Rate for Payer: Lucent All Commercial |
$417.69
|
| Rate for Payer: Aetna Commercial |
$691.24
|
| Rate for Payer: Aetna Medicare |
$270.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$511.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$310.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.30
|
| Rate for Payer: Cash Price |
$507.78
|
| Rate for Payer: Cash Price |
$507.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$737.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$614.25
|
| Rate for Payer: PHP All Commercial |
$621.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.41
|
| Rate for Payer: Sagamore Health Network All Products |
$632.27
|
| Rate for Payer: Signature Care EPO |
$679.77
|
| Rate for Payer: Signature Care PPO |
$720.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$696.15
|
| Rate for Payer: United Healthcare Commercial |
$645.37
|
| Rate for Payer: United Healthcare Medicare |
$270.27
|
|
|
HC AR FIBERLOOP W/FIBERTAG
|
Facility
OP
|
$962.50
|
|
| Hospital Charge Code |
41606230
|
|
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 FIBERLOOP W/FIBERTAG
|
Facility
IP
|
$962.50
|
|
| Hospital Charge Code |
41606230
|
|
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 FIBERSNARE 2
|
Facility
IP
|
$808.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.38 |
| Max. Negotiated Rate |
$751.90 |
| Rate for Payer: Aetna Commercial |
$698.54
|
| Rate for Payer: Cash Price |
$501.27
|
| Rate for Payer: Cigna All Commercial |
$697.74
|
| Rate for Payer: CORVEL All Commercial |
$751.90
|
| Rate for Payer: Coventry All Commercial |
$711.48
|
| Rate for Payer: Encore All Commercial |
$744.22
|
| Rate for Payer: Frontpath All Commercial |
$743.82
|
| Rate for Payer: Humana ChoiceCare |
$698.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$727.65
|
| Rate for Payer: PHCS All Commercial |
$606.38
|
| Rate for Payer: PHP All Commercial |
$613.17
|
| Rate for Payer: Sagamore Health Network All Products |
$624.16
|
| Rate for Payer: Signature Care EPO |
$671.06
|
| Rate for Payer: Signature Care PPO |
$711.48
|
| Rate for Payer: United Healthcare Commercial |
$637.10
|
|
|
HC AR FIBERSNARE 2
|
Facility
OP
|
$808.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$751.90 |
| Rate for Payer: Aetna Commercial |
$682.37
|
| Rate for Payer: Aetna Medicare |
$266.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$266.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$464.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$505.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$306.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$293.49
|
| Rate for Payer: Cash Price |
$501.27
|
| Rate for Payer: Cash Price |
$501.27
|
| Rate for Payer: Centivo All Commercial |
$412.34
|
| Rate for Payer: Cigna All Commercial |
$697.74
|
| Rate for Payer: CORVEL All Commercial |
$751.90
|
| Rate for Payer: Coventry All Commercial |
$711.48
|
| Rate for Payer: Encore All Commercial |
$744.22
|
| Rate for Payer: Frontpath All Commercial |
$743.82
|
| Rate for Payer: Humana ChoiceCare |
$698.30
|
| Rate for Payer: Humana Medicare |
$412.34
|
| Rate for Payer: Lucent All Commercial |
$412.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$727.65
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$606.38
|
| Rate for Payer: PHP All Commercial |
$613.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$315.32
|
| Rate for Payer: Sagamore Health Network All Products |
$624.16
|
| Rate for Payer: Signature Care EPO |
$671.06
|
| Rate for Payer: Signature Care PPO |
$711.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$687.22
|
| Rate for Payer: United Healthcare Commercial |
$637.10
|
| Rate for Payer: United Healthcare Medicare |
$266.80
|
|
|
HC AR FIBERSNARE 2 BLK/WH
|
Facility
IP
|
$875.00
|
|
| Hospital Charge Code |
41608177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$813.75 |
| Rate for Payer: Aetna Commercial |
$756.00
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna All Commercial |
$755.12
|
| Rate for Payer: CORVEL All Commercial |
$813.75
|
| Rate for Payer: Coventry All Commercial |
$770.00
|
| Rate for Payer: Encore All Commercial |
$805.44
|
| Rate for Payer: Frontpath All Commercial |
$805.00
|
| Rate for Payer: Humana ChoiceCare |
$755.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.50
|
| Rate for Payer: PHCS All Commercial |
$656.25
|
| Rate for Payer: PHP All Commercial |
$663.60
|
| Rate for Payer: Sagamore Health Network All Products |
$675.50
|
| Rate for Payer: Signature Care EPO |
$726.25
|
| Rate for Payer: Signature Care PPO |
$770.00
|
| Rate for Payer: United Healthcare Commercial |
$689.50
|
|
|
HC AR FIBERSNARE 2 BLK/WH
|
Facility
OP
|
$875.00
|
|
| Hospital Charge Code |
41608177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$813.75 |
| Rate for Payer: Aetna Commercial |
$738.50
|
| Rate for Payer: Aetna Medicare |
$288.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$288.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$502.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$546.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$332.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$317.62
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Centivo All Commercial |
$446.25
|
| Rate for Payer: Cigna All Commercial |
$755.12
|
| Rate for Payer: CORVEL All Commercial |
$813.75
|
| Rate for Payer: Coventry All Commercial |
$770.00
|
| Rate for Payer: Encore All Commercial |
$805.44
|
| Rate for Payer: Frontpath All Commercial |
$805.00
|
| Rate for Payer: Humana ChoiceCare |
$755.74
|
| Rate for Payer: Humana Medicare |
$446.25
|
| Rate for Payer: Lucent All Commercial |
$446.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$656.25
|
| Rate for Payer: PHP All Commercial |
$663.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$341.25
|
| Rate for Payer: Sagamore Health Network All Products |
$675.50
|
| Rate for Payer: Signature Care EPO |
$726.25
|
| Rate for Payer: Signature Care PPO |
$770.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$743.75
|
| Rate for Payer: United Healthcare Commercial |
$689.50
|
| Rate for Payer: United Healthcare Medicare |
$288.75
|
|
|
HC AR FIBERSTICK #2
|
Facility
IP
|
$385.00
|
|
| Hospital Charge Code |
41606575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cigna All Commercial |
$332.26
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
|
|
HC AR FIBERSTICK #2
|
Facility
OP
|
$385.00
|
|
| Hospital Charge Code |
41606575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Aetna Medicare |
$127.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$127.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$221.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.76
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Centivo All Commercial |
$196.35
|
| Rate for Payer: Cigna All Commercial |
$332.26
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Humana Medicare |
$196.35
|
| Rate for Payer: Lucent All Commercial |
$196.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.15
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.25
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
| Rate for Payer: United Healthcare Medicare |
$127.05
|
|
|
HC AR FIBERSTITCH 1.5 CURV 2.0
|
Facility
OP
|
$3,301.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,070.12 |
| Rate for Payer: Aetna Commercial |
$2,786.21
|
| Rate for Payer: Aetna Medicare |
$1,089.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,089.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,895.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,063.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,252.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,198.34
|
| Rate for Payer: Cash Price |
$2,046.74
|
| Rate for Payer: Cash Price |
$2,046.74
|
| Rate for Payer: Centivo All Commercial |
$1,683.61
|
| Rate for Payer: Cigna All Commercial |
$2,848.94
|
| Rate for Payer: CORVEL All Commercial |
$3,070.12
|
| Rate for Payer: Coventry All Commercial |
$2,905.06
|
| Rate for Payer: Encore All Commercial |
$3,038.75
|
| Rate for Payer: Frontpath All Commercial |
$3,037.10
|
| Rate for Payer: Humana ChoiceCare |
$2,851.25
|
| Rate for Payer: Humana Medicare |
$1,683.61
|
| Rate for Payer: Lucent All Commercial |
$1,683.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,971.08
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,475.90
|
| Rate for Payer: PHP All Commercial |
$2,503.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,287.47
|
| Rate for Payer: Sagamore Health Network All Products |
$2,548.53
|
| Rate for Payer: Signature Care EPO |
$2,740.00
|
| Rate for Payer: Signature Care PPO |
$2,905.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,806.02
|
| Rate for Payer: United Healthcare Commercial |
$2,601.35
|
| Rate for Payer: United Healthcare Medicare |
$1,089.40
|
|
|
HC AR FIBERSTITCH 1.5 CURV 2.0
|
Facility
IP
|
$3,301.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.90 |
| Max. Negotiated Rate |
$3,070.12 |
| Rate for Payer: Aetna Commercial |
$2,852.24
|
| Rate for Payer: Cash Price |
$2,046.74
|
| Rate for Payer: Cigna All Commercial |
$2,848.94
|
| Rate for Payer: CORVEL All Commercial |
$3,070.12
|
| Rate for Payer: Coventry All Commercial |
$2,905.06
|
| Rate for Payer: Encore All Commercial |
$3,038.75
|
| Rate for Payer: Frontpath All Commercial |
$3,037.10
|
| Rate for Payer: Humana ChoiceCare |
$2,851.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,971.08
|
| Rate for Payer: PHCS All Commercial |
$2,475.90
|
| Rate for Payer: PHP All Commercial |
$2,503.63
|
| Rate for Payer: Sagamore Health Network All Products |
$2,548.53
|
| Rate for Payer: Signature Care EPO |
$2,740.00
|
| Rate for Payer: Signature Care PPO |
$2,905.06
|
| Rate for Payer: United Healthcare Commercial |
$2,601.35
|
|
|
HC AR FIBERSTITCH 1.5 CURV 24 DEG
|
Facility
IP
|
$3,301.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.90 |
| Max. Negotiated Rate |
$3,070.12 |
| Rate for Payer: Aetna Commercial |
$2,852.24
|
| Rate for Payer: Cash Price |
$2,046.74
|
| Rate for Payer: Cigna All Commercial |
$2,848.94
|
| Rate for Payer: CORVEL All Commercial |
$3,070.12
|
| Rate for Payer: Coventry All Commercial |
$2,905.06
|
| Rate for Payer: Encore All Commercial |
$3,038.75
|
| Rate for Payer: Frontpath All Commercial |
$3,037.10
|
| Rate for Payer: Humana ChoiceCare |
$2,851.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,971.08
|
| Rate for Payer: PHCS All Commercial |
$2,475.90
|
| Rate for Payer: PHP All Commercial |
$2,503.63
|
| Rate for Payer: Sagamore Health Network All Products |
$2,548.53
|
| Rate for Payer: Signature Care EPO |
$2,740.00
|
| Rate for Payer: Signature Care PPO |
$2,905.06
|
| Rate for Payer: United Healthcare Commercial |
$2,601.35
|
|
|
HC AR FIBERSTITCH 1.5 CURV 24 DEG
|
Facility
OP
|
$3,301.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,070.12 |
| Rate for Payer: Aetna Commercial |
$2,786.21
|
| Rate for Payer: Aetna Medicare |
$1,089.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,089.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,895.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,063.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,252.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,198.34
|
| Rate for Payer: Cash Price |
$2,046.74
|
| Rate for Payer: Cash Price |
$2,046.74
|
| Rate for Payer: Centivo All Commercial |
$1,683.61
|
| Rate for Payer: Cigna All Commercial |
$2,848.94
|
| Rate for Payer: CORVEL All Commercial |
$3,070.12
|
| Rate for Payer: Coventry All Commercial |
$2,905.06
|
| Rate for Payer: Encore All Commercial |
$3,038.75
|
| Rate for Payer: Frontpath All Commercial |
$3,037.10
|
| Rate for Payer: Humana ChoiceCare |
$2,851.25
|
| Rate for Payer: Humana Medicare |
$1,683.61
|
| Rate for Payer: Lucent All Commercial |
$1,683.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,971.08
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,475.90
|
| Rate for Payer: PHP All Commercial |
$2,503.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,287.47
|
| Rate for Payer: Sagamore Health Network All Products |
$2,548.53
|
| Rate for Payer: Signature Care EPO |
$2,740.00
|
| Rate for Payer: Signature Care PPO |
$2,905.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,806.02
|
| Rate for Payer: United Healthcare Commercial |
$2,601.35
|
| Rate for Payer: United Healthcare Medicare |
$1,089.40
|
|
|
HC AR FIBERSTITCH CURV 24 DEG
|
Facility
OP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,506.68
|
| Rate for Payer: Aetna Medicare |
$980.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$980.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,705.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,856.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,127.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,078.11
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Centivo All Commercial |
$1,514.70
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.88
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Humana Medicare |
$1,514.70
|
| Rate for Payer: Lucent All Commercial |
$1,514.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,158.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,524.50
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
| Rate for Payer: United Healthcare Medicare |
$980.10
|
|
|
HC AR FIBERSTITCH CURV 24 DEG
|
Facility
IP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,227.50 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,566.08
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.88
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
|
|
HC AR FIBERSTITCH CURVED
|
Facility
OP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,506.68
|
| Rate for Payer: Aetna Medicare |
$980.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$980.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,705.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,856.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,127.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,078.11
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Centivo All Commercial |
$1,514.70
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.88
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Humana Medicare |
$1,514.70
|
| Rate for Payer: Lucent All Commercial |
$1,514.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,158.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,524.50
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
| Rate for Payer: United Healthcare Medicare |
$980.10
|
|
|
HC AR FIBERSTITCH CURVED
|
Facility
IP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,227.50 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,566.08
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.88
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
|
|
HC AR FIBERTAK 2.6 B
|
Facility
OP
|
$2,822.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,624.83 |
| Rate for Payer: Aetna Commercial |
$2,382.11
|
| Rate for Payer: Aetna Medicare |
$931.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$931.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,620.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,764.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,071.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,024.53
|
| Rate for Payer: Cash Price |
$1,749.89
|
| Rate for Payer: Cash Price |
$1,749.89
|
| Rate for Payer: Centivo All Commercial |
$1,439.42
|
| Rate for Payer: Cigna All Commercial |
$2,435.73
|
| Rate for Payer: CORVEL All Commercial |
$2,624.83
|
| Rate for Payer: Coventry All Commercial |
$2,483.71
|
| Rate for Payer: Encore All Commercial |
$2,598.02
|
| Rate for Payer: Frontpath All Commercial |
$2,596.61
|
| Rate for Payer: Humana ChoiceCare |
$2,437.71
|
| Rate for Payer: Humana Medicare |
$1,439.42
|
| Rate for Payer: Lucent All Commercial |
$1,439.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,540.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,116.80
|
| Rate for Payer: PHP All Commercial |
$2,140.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,100.74
|
| Rate for Payer: Sagamore Health Network All Products |
$2,178.89
|
| Rate for Payer: Signature Care EPO |
$2,342.59
|
| Rate for Payer: Signature Care PPO |
$2,483.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,399.04
|
| Rate for Payer: United Healthcare Commercial |
$2,224.05
|
| Rate for Payer: United Healthcare Medicare |
$931.39
|
|
|
HC AR FIBERTAK 2.6 B
|
Facility
IP
|
$2,822.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.80 |
| Max. Negotiated Rate |
$2,624.83 |
| Rate for Payer: Aetna Commercial |
$2,438.55
|
| Rate for Payer: Cash Price |
$1,749.89
|
| Rate for Payer: Cigna All Commercial |
$2,435.73
|
| Rate for Payer: CORVEL All Commercial |
$2,624.83
|
| Rate for Payer: Coventry All Commercial |
$2,483.71
|
| Rate for Payer: Encore All Commercial |
$2,598.02
|
| Rate for Payer: Frontpath All Commercial |
$2,596.61
|
| Rate for Payer: Humana ChoiceCare |
$2,437.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,540.16
|
| Rate for Payer: PHCS All Commercial |
$2,116.80
|
| Rate for Payer: PHP All Commercial |
$2,140.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,178.89
|
| Rate for Payer: Signature Care EPO |
$2,342.59
|
| Rate for Payer: Signature Care PPO |
$2,483.71
|
| Rate for Payer: United Healthcare Commercial |
$2,224.05
|
|
|
HC AR FIBERTAK 2.6 BLK/BL
|
Facility
OP
|
$2,822.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,624.83 |
| Rate for Payer: Aetna Commercial |
$2,382.11
|
| Rate for Payer: Aetna Medicare |
$931.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$931.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,620.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,764.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,071.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,024.53
|
| Rate for Payer: Cash Price |
$1,749.89
|
| Rate for Payer: Cash Price |
$1,749.89
|
| Rate for Payer: Centivo All Commercial |
$1,439.42
|
| Rate for Payer: Cigna All Commercial |
$2,435.73
|
| Rate for Payer: CORVEL All Commercial |
$2,624.83
|
| Rate for Payer: Coventry All Commercial |
$2,483.71
|
| Rate for Payer: Encore All Commercial |
$2,598.02
|
| Rate for Payer: Frontpath All Commercial |
$2,596.61
|
| Rate for Payer: Humana ChoiceCare |
$2,437.71
|
| Rate for Payer: Humana Medicare |
$1,439.42
|
| Rate for Payer: Lucent All Commercial |
$1,439.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,540.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,116.80
|
| Rate for Payer: PHP All Commercial |
$2,140.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,100.74
|
| Rate for Payer: Sagamore Health Network All Products |
$2,178.89
|
| Rate for Payer: Signature Care EPO |
$2,342.59
|
| Rate for Payer: Signature Care PPO |
$2,483.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,399.04
|
| Rate for Payer: United Healthcare Commercial |
$2,224.05
|
| Rate for Payer: United Healthcare Medicare |
$931.39
|
|
|
HC AR FIBERTAK 2.6 BLK/BL
|
Facility
IP
|
$2,822.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.80 |
| Max. Negotiated Rate |
$2,624.83 |
| Rate for Payer: Aetna Commercial |
$2,438.55
|
| Rate for Payer: Cash Price |
$1,749.89
|
| Rate for Payer: Cigna All Commercial |
$2,435.73
|
| Rate for Payer: CORVEL All Commercial |
$2,624.83
|
| Rate for Payer: Coventry All Commercial |
$2,483.71
|
| Rate for Payer: Encore All Commercial |
$2,598.02
|
| Rate for Payer: Frontpath All Commercial |
$2,596.61
|
| Rate for Payer: Humana ChoiceCare |
$2,437.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,540.16
|
| Rate for Payer: PHCS All Commercial |
$2,116.80
|
| Rate for Payer: PHP All Commercial |
$2,140.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,178.89
|
| Rate for Payer: Signature Care EPO |
$2,342.59
|
| Rate for Payer: Signature Care PPO |
$2,483.71
|
| Rate for Payer: United Healthcare Commercial |
$2,224.05
|
|
|
HC AR FIBERTAK 2.6 DL
|
Facility
IP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,227.50 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,566.08
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.88
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
|
