|
HC AR GRAFT KNIFE HANDLE
|
Facility
OP
|
$2,282.50
|
|
| Hospital Charge Code |
41607008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,122.72 |
| Rate for Payer: Aetna Commercial |
$1,926.43
|
| Rate for Payer: Aetna Medicare |
$753.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$753.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,310.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,426.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$866.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$828.55
|
| Rate for Payer: Cash Price |
$1,415.15
|
| Rate for Payer: Cash Price |
$1,415.15
|
| Rate for Payer: Centivo All Commercial |
$1,164.08
|
| Rate for Payer: Cigna All Commercial |
$1,969.80
|
| Rate for Payer: CORVEL All Commercial |
$2,122.72
|
| Rate for Payer: Coventry All Commercial |
$2,008.60
|
| Rate for Payer: Encore All Commercial |
$2,101.04
|
| Rate for Payer: Frontpath All Commercial |
$2,099.90
|
| Rate for Payer: Humana ChoiceCare |
$1,971.40
|
| Rate for Payer: Humana Medicare |
$1,164.08
|
| Rate for Payer: Lucent All Commercial |
$1,164.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,054.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,711.88
|
| Rate for Payer: PHP All Commercial |
$1,731.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$890.18
|
| Rate for Payer: Sagamore Health Network All Products |
$1,762.09
|
| Rate for Payer: Signature Care EPO |
$1,894.48
|
| Rate for Payer: Signature Care PPO |
$2,008.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,940.12
|
| Rate for Payer: United Healthcare Commercial |
$1,798.61
|
| Rate for Payer: United Healthcare Medicare |
$753.22
|
|
|
HC AR GRAFT KNIFE HANDLE
|
Facility
IP
|
$2,282.50
|
|
| Hospital Charge Code |
41607008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,711.88 |
| Max. Negotiated Rate |
$2,122.72 |
| Rate for Payer: Aetna Commercial |
$1,972.08
|
| Rate for Payer: Cash Price |
$1,415.15
|
| Rate for Payer: Cigna All Commercial |
$1,969.80
|
| Rate for Payer: CORVEL All Commercial |
$2,122.72
|
| Rate for Payer: Coventry All Commercial |
$2,008.60
|
| Rate for Payer: Encore All Commercial |
$2,101.04
|
| Rate for Payer: Frontpath All Commercial |
$2,099.90
|
| Rate for Payer: Humana ChoiceCare |
$1,971.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,054.25
|
| Rate for Payer: PHCS All Commercial |
$1,711.88
|
| Rate for Payer: PHP All Commercial |
$1,731.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,762.09
|
| Rate for Payer: Signature Care EPO |
$1,894.48
|
| Rate for Payer: Signature Care PPO |
$2,008.60
|
| Rate for Payer: United Healthcare Commercial |
$1,798.61
|
|
|
HC AR GRAFT PRO SYSTEM
|
Facility
IP
|
$1,250.00
|
|
| Hospital Charge Code |
41606235
|
|
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 GRAFT PRO SYSTEM
|
Facility
OP
|
$1,250.00
|
|
| Hospital Charge Code |
41606235
|
|
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 GRAFT TENODESIS KIT
|
Facility
IP
|
$2,460.00
|
|
| Hospital Charge Code |
41608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,845.00 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,125.44
|
| Rate for Payer: Cash Price |
$1,525.20
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
|
|
HC AR GRAFT TENODESIS KIT
|
Facility
OP
|
$2,460.00
|
|
| Hospital Charge Code |
41608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,076.24
|
| Rate for Payer: Aetna Medicare |
$811.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$811.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,412.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,537.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$933.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$892.98
|
| Rate for Payer: Cash Price |
$1,525.20
|
| Rate for Payer: Cash Price |
$1,525.20
|
| Rate for Payer: Centivo All Commercial |
$1,254.60
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Humana Medicare |
$1,254.60
|
| Rate for Payer: Lucent All Commercial |
$1,254.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$959.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,091.00
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
| Rate for Payer: United Healthcare Medicare |
$811.80
|
|
|
HC AR GRAFT TUBES
|
Facility
IP
|
$1,250.00
|
|
| Hospital Charge Code |
41606533
|
|
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 GRAFT TUBES
|
Facility
OP
|
$1,250.00
|
|
| Hospital Charge Code |
41606533
|
|
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 GUIDEWIRE THREAD .045
|
Facility
IP
|
$200.20
|
|
| Hospital Charge Code |
41602509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.15 |
| Max. Negotiated Rate |
$186.19 |
| Rate for Payer: Aetna Commercial |
$172.97
|
| Rate for Payer: Cash Price |
$124.12
|
| Rate for Payer: Cigna All Commercial |
$172.77
|
| Rate for Payer: CORVEL All Commercial |
$186.19
|
| Rate for Payer: Coventry All Commercial |
$176.18
|
| Rate for Payer: Encore All Commercial |
$184.28
|
| Rate for Payer: Frontpath All Commercial |
$184.18
|
| Rate for Payer: Humana ChoiceCare |
$172.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$180.18
|
| Rate for Payer: PHCS All Commercial |
$150.15
|
| Rate for Payer: PHP All Commercial |
$151.83
|
| Rate for Payer: Sagamore Health Network All Products |
$154.55
|
| Rate for Payer: Signature Care EPO |
$166.17
|
| Rate for Payer: Signature Care PPO |
$176.18
|
| Rate for Payer: United Healthcare Commercial |
$157.76
|
|
|
HC AR GUIDEWIRE THREAD .045
|
Facility
OP
|
$200.20
|
|
| Hospital Charge Code |
41602509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$186.19 |
| Rate for Payer: Aetna Commercial |
$168.97
|
| Rate for Payer: Aetna Medicare |
$66.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$114.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.67
|
| Rate for Payer: Cash Price |
$124.12
|
| Rate for Payer: Cash Price |
$124.12
|
| Rate for Payer: Centivo All Commercial |
$102.10
|
| Rate for Payer: Cigna All Commercial |
$172.77
|
| Rate for Payer: CORVEL All Commercial |
$186.19
|
| Rate for Payer: Coventry All Commercial |
$176.18
|
| Rate for Payer: Encore All Commercial |
$184.28
|
| Rate for Payer: Frontpath All Commercial |
$184.18
|
| Rate for Payer: Humana ChoiceCare |
$172.91
|
| Rate for Payer: Humana Medicare |
$102.10
|
| Rate for Payer: Lucent All Commercial |
$102.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$180.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$150.15
|
| Rate for Payer: PHP All Commercial |
$151.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.08
|
| Rate for Payer: Sagamore Health Network All Products |
$154.55
|
| Rate for Payer: Signature Care EPO |
$166.17
|
| Rate for Payer: Signature Care PPO |
$176.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$170.17
|
| Rate for Payer: United Healthcare Commercial |
$157.76
|
| Rate for Payer: United Healthcare Medicare |
$66.07
|
|
|
HC AR GUIDWIRE 2X150 TRCR TIP
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.27 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$100.44
|
| Rate for Payer: Aetna Medicare |
$39.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.20
|
| Rate for Payer: Cash Price |
$73.78
|
| Rate for Payer: Cash Price |
$73.78
|
| Rate for Payer: Centivo All Commercial |
$60.69
|
| Rate for Payer: Cigna All Commercial |
$102.70
|
| Rate for Payer: CORVEL All Commercial |
$110.67
|
| Rate for Payer: Coventry All Commercial |
$104.72
|
| Rate for Payer: Encore All Commercial |
$109.54
|
| Rate for Payer: Frontpath All Commercial |
$109.48
|
| Rate for Payer: Humana ChoiceCare |
$102.78
|
| Rate for Payer: Humana Medicare |
$60.69
|
| Rate for Payer: Lucent All Commercial |
$60.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.10
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$89.25
|
| Rate for Payer: PHP All Commercial |
$90.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.41
|
| Rate for Payer: Sagamore Health Network All Products |
$91.87
|
| Rate for Payer: Signature Care EPO |
$98.77
|
| Rate for Payer: Signature Care PPO |
$104.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.15
|
| Rate for Payer: United Healthcare Commercial |
$93.77
|
| Rate for Payer: United Healthcare Medicare |
$39.27
|
|
|
HC AR GUIDWIRE 2X150 TRCR TIP
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$110.67 |
| Rate for Payer: Aetna Commercial |
$102.82
|
| Rate for Payer: Cash Price |
$73.78
|
| Rate for Payer: Cigna All Commercial |
$102.70
|
| Rate for Payer: CORVEL All Commercial |
$110.67
|
| Rate for Payer: Coventry All Commercial |
$104.72
|
| Rate for Payer: Encore All Commercial |
$109.54
|
| Rate for Payer: Frontpath All Commercial |
$109.48
|
| Rate for Payer: Humana ChoiceCare |
$102.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.10
|
| Rate for Payer: PHCS All Commercial |
$89.25
|
| Rate for Payer: PHP All Commercial |
$90.25
|
| Rate for Payer: Sagamore Health Network All Products |
$91.87
|
| Rate for Payer: Signature Care EPO |
$98.77
|
| Rate for Payer: Signature Care PPO |
$104.72
|
| Rate for Payer: United Healthcare Commercial |
$93.77
|
|
|
HC AR INS ACL CRUCIATE
|
Facility
IP
|
$84,546.00
|
|
| Hospital Charge Code |
41605849
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63,409.50 |
| Max. Negotiated Rate |
$78,627.78 |
| Rate for Payer: Aetna Commercial |
$73,047.74
|
| Rate for Payer: Cash Price |
$52,418.52
|
| Rate for Payer: Cigna All Commercial |
$72,963.20
|
| Rate for Payer: CORVEL All Commercial |
$78,627.78
|
| Rate for Payer: Coventry All Commercial |
$74,400.48
|
| Rate for Payer: Encore All Commercial |
$77,824.59
|
| Rate for Payer: Frontpath All Commercial |
$77,782.32
|
| Rate for Payer: Humana ChoiceCare |
$73,022.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76,091.40
|
| Rate for Payer: PHCS All Commercial |
$63,409.50
|
| Rate for Payer: PHP All Commercial |
$64,119.69
|
| Rate for Payer: Sagamore Health Network All Products |
$65,269.51
|
| Rate for Payer: Signature Care EPO |
$70,173.18
|
| Rate for Payer: Signature Care PPO |
$74,400.48
|
| Rate for Payer: United Healthcare Commercial |
$66,622.25
|
|
|
HC AR INS ACL CRUCIATE
|
Facility
OP
|
$84,546.00
|
|
| Hospital Charge Code |
41605849
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$78,627.78 |
| Rate for Payer: Aetna Commercial |
$71,356.82
|
| Rate for Payer: Aetna Medicare |
$27,900.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27,900.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48,554.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52,849.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32,085.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30,690.20
|
| Rate for Payer: Cash Price |
$52,418.52
|
| Rate for Payer: Cash Price |
$52,418.52
|
| Rate for Payer: Centivo All Commercial |
$43,118.46
|
| Rate for Payer: Cigna All Commercial |
$72,963.20
|
| Rate for Payer: CORVEL All Commercial |
$78,627.78
|
| Rate for Payer: Coventry All Commercial |
$74,400.48
|
| Rate for Payer: Encore All Commercial |
$77,824.59
|
| Rate for Payer: Frontpath All Commercial |
$77,782.32
|
| Rate for Payer: Humana ChoiceCare |
$73,022.38
|
| Rate for Payer: Humana Medicare |
$43,118.46
|
| Rate for Payer: Lucent All Commercial |
$43,118.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76,091.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$63,409.50
|
| Rate for Payer: PHP All Commercial |
$64,119.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32,972.94
|
| Rate for Payer: Sagamore Health Network All Products |
$65,269.51
|
| Rate for Payer: Signature Care EPO |
$70,173.18
|
| Rate for Payer: Signature Care PPO |
$74,400.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71,864.10
|
| Rate for Payer: United Healthcare Commercial |
$66,622.25
|
| Rate for Payer: United Healthcare Medicare |
$27,900.18
|
|
|
HC AR INST SET
|
Facility
OP
|
$13,464.00
|
|
| Hospital Charge Code |
41605893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$12,521.52 |
| Rate for Payer: Aetna Commercial |
$11,363.62
|
| Rate for Payer: Aetna Medicare |
$4,443.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,443.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,732.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,416.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,109.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,887.43
|
| Rate for Payer: Cash Price |
$8,347.68
|
| Rate for Payer: Cash Price |
$8,347.68
|
| Rate for Payer: Centivo All Commercial |
$6,866.64
|
| Rate for Payer: Cigna All Commercial |
$11,619.43
|
| Rate for Payer: CORVEL All Commercial |
$12,521.52
|
| Rate for Payer: Coventry All Commercial |
$11,848.32
|
| Rate for Payer: Encore All Commercial |
$12,393.61
|
| Rate for Payer: Frontpath All Commercial |
$12,386.88
|
| Rate for Payer: Humana ChoiceCare |
$11,628.86
|
| Rate for Payer: Humana Medicare |
$6,866.64
|
| Rate for Payer: Lucent All Commercial |
$6,866.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,117.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10,098.00
|
| Rate for Payer: PHP All Commercial |
$10,211.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,250.96
|
| Rate for Payer: Sagamore Health Network All Products |
$10,394.21
|
| Rate for Payer: Signature Care EPO |
$11,175.12
|
| Rate for Payer: Signature Care PPO |
$11,848.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,444.40
|
| Rate for Payer: United Healthcare Commercial |
$10,609.63
|
| Rate for Payer: United Healthcare Medicare |
$4,443.12
|
|
|
HC AR INST SET
|
Facility
IP
|
$13,464.00
|
|
| Hospital Charge Code |
41605893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,098.00 |
| Max. Negotiated Rate |
$12,521.52 |
| Rate for Payer: Aetna Commercial |
$11,632.90
|
| Rate for Payer: Cash Price |
$8,347.68
|
| Rate for Payer: Cigna All Commercial |
$11,619.43
|
| Rate for Payer: CORVEL All Commercial |
$12,521.52
|
| Rate for Payer: Coventry All Commercial |
$11,848.32
|
| Rate for Payer: Encore All Commercial |
$12,393.61
|
| Rate for Payer: Frontpath All Commercial |
$12,386.88
|
| Rate for Payer: Humana ChoiceCare |
$11,628.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,117.60
|
| Rate for Payer: PHCS All Commercial |
$10,098.00
|
| Rate for Payer: PHP All Commercial |
$10,211.10
|
| Rate for Payer: Sagamore Health Network All Products |
$10,394.21
|
| Rate for Payer: Signature Care EPO |
$11,175.12
|
| Rate for Payer: Signature Care PPO |
$11,848.32
|
| Rate for Payer: United Healthcare Commercial |
$10,609.63
|
|
|
HC AR INST SET RETRO GUIDE
|
Facility
IP
|
$16,536.96
|
|
| Hospital Charge Code |
41606577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12,402.72 |
| Max. Negotiated Rate |
$15,379.37 |
| Rate for Payer: Aetna Commercial |
$14,287.93
|
| Rate for Payer: Cash Price |
$10,252.92
|
| Rate for Payer: Cigna All Commercial |
$14,271.40
|
| Rate for Payer: CORVEL All Commercial |
$15,379.37
|
| Rate for Payer: Coventry All Commercial |
$14,552.52
|
| Rate for Payer: Encore All Commercial |
$15,222.27
|
| Rate for Payer: Frontpath All Commercial |
$15,214.00
|
| Rate for Payer: Humana ChoiceCare |
$14,282.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,883.26
|
| Rate for Payer: PHCS All Commercial |
$12,402.72
|
| Rate for Payer: PHP All Commercial |
$12,541.63
|
| Rate for Payer: Sagamore Health Network All Products |
$12,766.53
|
| Rate for Payer: Signature Care EPO |
$13,725.68
|
| Rate for Payer: Signature Care PPO |
$14,552.52
|
| Rate for Payer: United Healthcare Commercial |
$13,031.12
|
|
|
HC AR INST SET RETRO GUIDE
|
Facility
OP
|
$16,536.96
|
|
| Hospital Charge Code |
41606577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$15,379.37 |
| Rate for Payer: Aetna Commercial |
$13,957.19
|
| Rate for Payer: Aetna Medicare |
$5,457.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,457.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9,497.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,337.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,275.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,002.92
|
| Rate for Payer: Cash Price |
$10,252.92
|
| Rate for Payer: Cash Price |
$10,252.92
|
| Rate for Payer: Centivo All Commercial |
$8,433.85
|
| Rate for Payer: Cigna All Commercial |
$14,271.40
|
| Rate for Payer: CORVEL All Commercial |
$15,379.37
|
| Rate for Payer: Coventry All Commercial |
$14,552.52
|
| Rate for Payer: Encore All Commercial |
$15,222.27
|
| Rate for Payer: Frontpath All Commercial |
$15,214.00
|
| Rate for Payer: Humana ChoiceCare |
$14,282.97
|
| Rate for Payer: Humana Medicare |
$8,433.85
|
| Rate for Payer: Lucent All Commercial |
$8,433.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,883.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12,402.72
|
| Rate for Payer: PHP All Commercial |
$12,541.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,449.41
|
| Rate for Payer: Sagamore Health Network All Products |
$12,766.53
|
| Rate for Payer: Signature Care EPO |
$13,725.68
|
| Rate for Payer: Signature Care PPO |
$14,552.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,056.42
|
| Rate for Payer: United Healthcare Commercial |
$13,031.12
|
| Rate for Payer: United Healthcare Medicare |
$5,457.20
|
|
|
HC AR INTERNAL BRACE SYSTEM
|
Facility
OP
|
$7,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,578.82 |
| Rate for Payer: Aetna Commercial |
$5,970.46
|
| Rate for Payer: Aetna Medicare |
$2,334.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,334.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,062.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,421.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,684.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,567.86
|
| Rate for Payer: Cash Price |
$4,385.88
|
| Rate for Payer: Cash Price |
$4,385.88
|
| Rate for Payer: Centivo All Commercial |
$3,607.74
|
| Rate for Payer: Cigna All Commercial |
$6,104.86
|
| Rate for Payer: CORVEL All Commercial |
$6,578.82
|
| Rate for Payer: Coventry All Commercial |
$6,225.12
|
| Rate for Payer: Encore All Commercial |
$6,511.62
|
| Rate for Payer: Frontpath All Commercial |
$6,508.08
|
| Rate for Payer: Humana ChoiceCare |
$6,109.81
|
| Rate for Payer: Humana Medicare |
$3,607.74
|
| Rate for Payer: Lucent All Commercial |
$3,607.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,366.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,305.50
|
| Rate for Payer: PHP All Commercial |
$5,364.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,758.86
|
| Rate for Payer: Sagamore Health Network All Products |
$5,461.13
|
| Rate for Payer: Signature Care EPO |
$5,871.42
|
| Rate for Payer: Signature Care PPO |
$6,225.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,012.90
|
| Rate for Payer: United Healthcare Commercial |
$5,574.31
|
| Rate for Payer: United Healthcare Medicare |
$2,334.42
|
|
|
HC AR INTERNAL BRACE SYSTEM
|
Facility
IP
|
$7,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,305.50 |
| Max. Negotiated Rate |
$6,578.82 |
| Rate for Payer: Aetna Commercial |
$6,111.94
|
| Rate for Payer: Cash Price |
$4,385.88
|
| Rate for Payer: Cigna All Commercial |
$6,104.86
|
| Rate for Payer: CORVEL All Commercial |
$6,578.82
|
| Rate for Payer: Coventry All Commercial |
$6,225.12
|
| Rate for Payer: Encore All Commercial |
$6,511.62
|
| Rate for Payer: Frontpath All Commercial |
$6,508.08
|
| Rate for Payer: Humana ChoiceCare |
$6,109.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,366.60
|
| Rate for Payer: PHCS All Commercial |
$5,305.50
|
| Rate for Payer: PHP All Commercial |
$5,364.92
|
| Rate for Payer: Sagamore Health Network All Products |
$5,461.13
|
| Rate for Payer: Signature Care EPO |
$5,871.42
|
| Rate for Payer: Signature Care PPO |
$6,225.12
|
| Rate for Payer: United Healthcare Commercial |
$5,574.31
|
|
|
HC AR IOBP DELIVERY KIT
|
Facility
IP
|
$2,277.00
|
|
| Hospital Charge Code |
41606171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.75 |
| Max. Negotiated Rate |
$2,117.61 |
| Rate for Payer: Aetna Commercial |
$1,967.33
|
| Rate for Payer: Cash Price |
$1,411.74
|
| Rate for Payer: Cigna All Commercial |
$1,965.05
|
| Rate for Payer: CORVEL All Commercial |
$2,117.61
|
| Rate for Payer: Coventry All Commercial |
$2,003.76
|
| Rate for Payer: Encore All Commercial |
$2,095.98
|
| Rate for Payer: Frontpath All Commercial |
$2,094.84
|
| Rate for Payer: Humana ChoiceCare |
$1,966.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,049.30
|
| Rate for Payer: PHCS All Commercial |
$1,707.75
|
| Rate for Payer: PHP All Commercial |
$1,726.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,757.84
|
| Rate for Payer: Signature Care EPO |
$1,889.91
|
| Rate for Payer: Signature Care PPO |
$2,003.76
|
| Rate for Payer: United Healthcare Commercial |
$1,794.28
|
|
|
HC AR IOBP DELIVERY KIT
|
Facility
OP
|
$2,277.00
|
|
| Hospital Charge Code |
41606171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,117.61 |
| Rate for Payer: Aetna Commercial |
$1,921.79
|
| Rate for Payer: Aetna Medicare |
$751.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$751.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,307.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,423.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$864.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$826.55
|
| Rate for Payer: Cash Price |
$1,411.74
|
| Rate for Payer: Cash Price |
$1,411.74
|
| Rate for Payer: Centivo All Commercial |
$1,161.27
|
| Rate for Payer: Cigna All Commercial |
$1,965.05
|
| Rate for Payer: CORVEL All Commercial |
$2,117.61
|
| Rate for Payer: Coventry All Commercial |
$2,003.76
|
| Rate for Payer: Encore All Commercial |
$2,095.98
|
| Rate for Payer: Frontpath All Commercial |
$2,094.84
|
| Rate for Payer: Humana ChoiceCare |
$1,966.64
|
| Rate for Payer: Humana Medicare |
$1,161.27
|
| Rate for Payer: Lucent All Commercial |
$1,161.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,049.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,707.75
|
| Rate for Payer: PHP All Commercial |
$1,726.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$888.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,757.84
|
| Rate for Payer: Signature Care EPO |
$1,889.91
|
| Rate for Payer: Signature Care PPO |
$2,003.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,935.45
|
| Rate for Payer: United Healthcare Commercial |
$1,794.28
|
| Rate for Payer: United Healthcare Medicare |
$751.41
|
|
|
HC AR KIT DISP FIBERTAK KNEE
|
Facility
IP
|
$2,045.00
|
|
| Hospital Charge Code |
41608215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,533.75 |
| Max. Negotiated Rate |
$1,901.85 |
| Rate for Payer: Aetna Commercial |
$1,766.88
|
| Rate for Payer: Cash Price |
$1,267.90
|
| Rate for Payer: Cigna All Commercial |
$1,764.84
|
| Rate for Payer: CORVEL All Commercial |
$1,901.85
|
| Rate for Payer: Coventry All Commercial |
$1,799.60
|
| Rate for Payer: Encore All Commercial |
$1,882.42
|
| Rate for Payer: Frontpath All Commercial |
$1,881.40
|
| Rate for Payer: Humana ChoiceCare |
$1,766.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,840.50
|
| Rate for Payer: PHCS All Commercial |
$1,533.75
|
| Rate for Payer: PHP All Commercial |
$1,550.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,578.74
|
| Rate for Payer: Signature Care EPO |
$1,697.35
|
| Rate for Payer: Signature Care PPO |
$1,799.60
|
| Rate for Payer: United Healthcare Commercial |
$1,611.46
|
|
|
HC AR KIT DISP FIBERTAK KNEE
|
Facility
OP
|
$2,045.00
|
|
| Hospital Charge Code |
41608215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,901.85 |
| Rate for Payer: Aetna Commercial |
$1,725.98
|
| Rate for Payer: Aetna Medicare |
$674.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$674.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,174.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,278.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$776.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$742.34
|
| Rate for Payer: Cash Price |
$1,267.90
|
| Rate for Payer: Cash Price |
$1,267.90
|
| Rate for Payer: Centivo All Commercial |
$1,042.95
|
| Rate for Payer: Cigna All Commercial |
$1,764.84
|
| Rate for Payer: CORVEL All Commercial |
$1,901.85
|
| Rate for Payer: Coventry All Commercial |
$1,799.60
|
| Rate for Payer: Encore All Commercial |
$1,882.42
|
| Rate for Payer: Frontpath All Commercial |
$1,881.40
|
| Rate for Payer: Humana ChoiceCare |
$1,766.27
|
| Rate for Payer: Humana Medicare |
$1,042.95
|
| Rate for Payer: Lucent All Commercial |
$1,042.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,840.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,533.75
|
| Rate for Payer: PHP All Commercial |
$1,550.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$797.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,578.74
|
| Rate for Payer: Signature Care EPO |
$1,697.35
|
| Rate for Payer: Signature Care PPO |
$1,799.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,738.25
|
| Rate for Payer: United Healthcare Commercial |
$1,611.46
|
| Rate for Payer: United Healthcare Medicare |
$674.85
|
|
|
HC AR KIT DISP INST MINI SUT TAK
|
Facility
IP
|
$875.00
|
|
| Hospital Charge Code |
41603476
|
|
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
|
|
