|
HC AR KNOTLESS SUTTAK 3X12.7 OPEN
|
Facility
IP
|
$2,117.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,588.12 |
| Max. Negotiated Rate |
$1,969.28 |
| Rate for Payer: Aetna Commercial |
$1,829.52
|
| Rate for Payer: Cash Price |
$1,312.85
|
| Rate for Payer: Cigna All Commercial |
$1,827.40
|
| Rate for Payer: CORVEL All Commercial |
$1,969.28
|
| Rate for Payer: Coventry All Commercial |
$1,863.40
|
| Rate for Payer: Encore All Commercial |
$1,949.16
|
| Rate for Payer: Frontpath All Commercial |
$1,948.10
|
| Rate for Payer: Humana ChoiceCare |
$1,828.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,905.75
|
| Rate for Payer: PHCS All Commercial |
$1,588.12
|
| Rate for Payer: PHP All Commercial |
$1,605.91
|
| Rate for Payer: Sagamore Health Network All Products |
$1,634.71
|
| Rate for Payer: Signature Care EPO |
$1,757.52
|
| Rate for Payer: Signature Care PPO |
$1,863.40
|
| Rate for Payer: United Healthcare Commercial |
$1,668.59
|
|
|
HC AR KNOTLESS SUTTAK 3X12.7 OPEN
|
Facility
OP
|
$2,117.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,969.28 |
| Rate for Payer: Aetna Commercial |
$1,787.17
|
| Rate for Payer: Aetna Medicare |
$698.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$698.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,216.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,323.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$803.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$768.65
|
| Rate for Payer: Cash Price |
$1,312.85
|
| Rate for Payer: Cash Price |
$1,312.85
|
| Rate for Payer: Centivo All Commercial |
$1,079.92
|
| Rate for Payer: Cigna All Commercial |
$1,827.40
|
| Rate for Payer: CORVEL All Commercial |
$1,969.28
|
| Rate for Payer: Coventry All Commercial |
$1,863.40
|
| Rate for Payer: Encore All Commercial |
$1,949.16
|
| Rate for Payer: Frontpath All Commercial |
$1,948.10
|
| Rate for Payer: Humana ChoiceCare |
$1,828.88
|
| Rate for Payer: Humana Medicare |
$1,079.92
|
| Rate for Payer: Lucent All Commercial |
$1,079.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,905.75
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,588.12
|
| Rate for Payer: PHP All Commercial |
$1,605.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$825.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1,634.71
|
| Rate for Payer: Signature Care EPO |
$1,757.52
|
| Rate for Payer: Signature Care PPO |
$1,863.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,799.88
|
| Rate for Payer: United Healthcare Commercial |
$1,668.59
|
| Rate for Payer: United Healthcare Medicare |
$698.78
|
|
|
HC AR KNOT PUSHER W/SKID
|
Facility
IP
|
$1,835.00
|
|
| Hospital Charge Code |
41608229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,376.25 |
| Max. Negotiated Rate |
$1,706.55 |
| Rate for Payer: Aetna Commercial |
$1,585.44
|
| Rate for Payer: Cash Price |
$1,137.70
|
| Rate for Payer: Cigna All Commercial |
$1,583.60
|
| Rate for Payer: CORVEL All Commercial |
$1,706.55
|
| Rate for Payer: Coventry All Commercial |
$1,614.80
|
| Rate for Payer: Encore All Commercial |
$1,689.12
|
| Rate for Payer: Frontpath All Commercial |
$1,688.20
|
| Rate for Payer: Humana ChoiceCare |
$1,584.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,651.50
|
| Rate for Payer: PHCS All Commercial |
$1,376.25
|
| Rate for Payer: PHP All Commercial |
$1,391.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,416.62
|
| Rate for Payer: Signature Care EPO |
$1,523.05
|
| Rate for Payer: Signature Care PPO |
$1,614.80
|
| Rate for Payer: United Healthcare Commercial |
$1,445.98
|
|
|
HC AR KNOT PUSHER W/SKID
|
Facility
OP
|
$1,835.00
|
|
| Hospital Charge Code |
41608229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,706.55 |
| Rate for Payer: Aetna Commercial |
$1,548.74
|
| Rate for Payer: Aetna Medicare |
$605.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$605.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,053.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,147.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$696.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$666.10
|
| Rate for Payer: Cash Price |
$1,137.70
|
| Rate for Payer: Cash Price |
$1,137.70
|
| Rate for Payer: Centivo All Commercial |
$935.85
|
| Rate for Payer: Cigna All Commercial |
$1,583.60
|
| Rate for Payer: CORVEL All Commercial |
$1,706.55
|
| Rate for Payer: Coventry All Commercial |
$1,614.80
|
| Rate for Payer: Encore All Commercial |
$1,689.12
|
| Rate for Payer: Frontpath All Commercial |
$1,688.20
|
| Rate for Payer: Humana ChoiceCare |
$1,584.89
|
| Rate for Payer: Humana Medicare |
$935.85
|
| Rate for Payer: Lucent All Commercial |
$935.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,651.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,376.25
|
| Rate for Payer: PHP All Commercial |
$1,391.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$715.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,416.62
|
| Rate for Payer: Signature Care EPO |
$1,523.05
|
| Rate for Payer: Signature Care PPO |
$1,614.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,559.75
|
| Rate for Payer: United Healthcare Commercial |
$1,445.98
|
| Rate for Payer: United Healthcare Medicare |
$605.55
|
|
|
HC AR KWIRE .045
|
Facility
IP
|
$53.90
|
|
| Hospital Charge Code |
41605890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$50.13 |
| Rate for Payer: Aetna Commercial |
$46.57
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna All Commercial |
$46.52
|
| Rate for Payer: CORVEL All Commercial |
$50.13
|
| Rate for Payer: Coventry All Commercial |
$47.43
|
| Rate for Payer: Encore All Commercial |
$49.61
|
| Rate for Payer: Frontpath All Commercial |
$49.59
|
| Rate for Payer: Humana ChoiceCare |
$46.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.51
|
| Rate for Payer: PHCS All Commercial |
$40.42
|
| Rate for Payer: PHP All Commercial |
$40.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.61
|
| Rate for Payer: Signature Care EPO |
$44.74
|
| Rate for Payer: Signature Care PPO |
$47.43
|
| Rate for Payer: United Healthcare Commercial |
$42.47
|
|
|
HC AR KWIRE .045
|
Facility
OP
|
$53.90
|
|
| Hospital Charge Code |
41605890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.49
|
| Rate for Payer: Aetna Medicare |
$17.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.57
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Centivo All Commercial |
$27.49
|
| Rate for Payer: Cigna All Commercial |
$46.52
|
| Rate for Payer: CORVEL All Commercial |
$50.13
|
| Rate for Payer: Coventry All Commercial |
$47.43
|
| Rate for Payer: Encore All Commercial |
$49.61
|
| Rate for Payer: Frontpath All Commercial |
$49.59
|
| Rate for Payer: Humana ChoiceCare |
$46.55
|
| Rate for Payer: Humana Medicare |
$27.49
|
| Rate for Payer: Lucent All Commercial |
$27.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.42
|
| Rate for Payer: PHP All Commercial |
$40.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.02
|
| Rate for Payer: Sagamore Health Network All Products |
$41.61
|
| Rate for Payer: Signature Care EPO |
$44.74
|
| Rate for Payer: Signature Care PPO |
$47.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.82
|
| Rate for Payer: United Healthcare Commercial |
$42.47
|
| Rate for Payer: United Healthcare Medicare |
$17.79
|
|
|
HC AR KWIRE 1.35
|
Facility
OP
|
$234.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.38 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$197.92
|
| Rate for Payer: Aetna Medicare |
$77.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.12
|
| Rate for Payer: Cash Price |
$145.39
|
| Rate for Payer: Cash Price |
$145.39
|
| Rate for Payer: Centivo All Commercial |
$119.60
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.08
|
| Rate for Payer: Coventry All Commercial |
$206.36
|
| Rate for Payer: Encore All Commercial |
$215.86
|
| Rate for Payer: Frontpath All Commercial |
$215.74
|
| Rate for Payer: Humana ChoiceCare |
$202.54
|
| Rate for Payer: Humana Medicare |
$119.60
|
| Rate for Payer: Lucent All Commercial |
$119.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$175.88
|
| Rate for Payer: PHP All Commercial |
$177.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.46
|
| Rate for Payer: Sagamore Health Network All Products |
$181.03
|
| Rate for Payer: Signature Care EPO |
$194.64
|
| Rate for Payer: Signature Care PPO |
$206.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$199.32
|
| Rate for Payer: United Healthcare Commercial |
$184.79
|
| Rate for Payer: United Healthcare Medicare |
$77.38
|
|
|
HC AR KWIRE 1.35
|
Facility
IP
|
$234.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.88 |
| Max. Negotiated Rate |
$218.08 |
| Rate for Payer: Aetna Commercial |
$202.61
|
| Rate for Payer: Cash Price |
$145.39
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.08
|
| Rate for Payer: Coventry All Commercial |
$206.36
|
| Rate for Payer: Encore All Commercial |
$215.86
|
| Rate for Payer: Frontpath All Commercial |
$215.74
|
| Rate for Payer: Humana ChoiceCare |
$202.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.05
|
| Rate for Payer: PHCS All Commercial |
$175.88
|
| Rate for Payer: PHP All Commercial |
$177.84
|
| Rate for Payer: Sagamore Health Network All Products |
$181.03
|
| Rate for Payer: Signature Care EPO |
$194.64
|
| Rate for Payer: Signature Care PPO |
$206.36
|
| Rate for Payer: United Healthcare Commercial |
$184.79
|
|
|
HC AR K-WIRE 2.8, 110
|
Facility
IP
|
$53.90
|
|
| Hospital Charge Code |
41603540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$50.13 |
| Rate for Payer: Aetna Commercial |
$46.57
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna All Commercial |
$46.52
|
| Rate for Payer: CORVEL All Commercial |
$50.13
|
| Rate for Payer: Coventry All Commercial |
$47.43
|
| Rate for Payer: Encore All Commercial |
$49.61
|
| Rate for Payer: Frontpath All Commercial |
$49.59
|
| Rate for Payer: Humana ChoiceCare |
$46.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.51
|
| Rate for Payer: PHCS All Commercial |
$40.42
|
| Rate for Payer: PHP All Commercial |
$40.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.61
|
| Rate for Payer: Signature Care EPO |
$44.74
|
| Rate for Payer: Signature Care PPO |
$47.43
|
| Rate for Payer: United Healthcare Commercial |
$42.47
|
|
|
HC AR K-WIRE 2.8, 110
|
Facility
OP
|
$53.90
|
|
| Hospital Charge Code |
41603540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$45.49
|
| Rate for Payer: Aetna Medicare |
$17.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.57
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Centivo All Commercial |
$27.49
|
| Rate for Payer: Cigna All Commercial |
$46.52
|
| Rate for Payer: CORVEL All Commercial |
$50.13
|
| Rate for Payer: Coventry All Commercial |
$47.43
|
| Rate for Payer: Encore All Commercial |
$49.61
|
| Rate for Payer: Frontpath All Commercial |
$49.59
|
| Rate for Payer: Humana ChoiceCare |
$46.55
|
| Rate for Payer: Humana Medicare |
$27.49
|
| Rate for Payer: Lucent All Commercial |
$27.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$40.42
|
| Rate for Payer: PHP All Commercial |
$40.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.02
|
| Rate for Payer: Sagamore Health Network All Products |
$41.61
|
| Rate for Payer: Signature Care EPO |
$44.74
|
| Rate for Payer: Signature Care PPO |
$47.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.82
|
| Rate for Payer: United Healthcare Commercial |
$42.47
|
| Rate for Payer: United Healthcare Medicare |
$17.79
|
|
|
HC AR MASTER GRAFT SET
|
Facility
OP
|
$1,250.00
|
|
| Hospital Charge Code |
41607383
|
|
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 MASTER GRAFT SET
|
Facility
IP
|
$1,250.00
|
|
| Hospital Charge Code |
41607383
|
|
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 MASTER SHOULDER SET
|
Facility
OP
|
$110,246.40
|
|
| Hospital Charge Code |
41606202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$102,529.15 |
| Rate for Payer: Aetna Commercial |
$93,047.96
|
| Rate for Payer: Aetna Medicare |
$36,381.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36,381.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63,314.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68,915.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41,838.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40,019.44
|
| Rate for Payer: Cash Price |
$68,352.77
|
| Rate for Payer: Cash Price |
$68,352.77
|
| Rate for Payer: Centivo All Commercial |
$56,225.66
|
| Rate for Payer: Cigna All Commercial |
$95,142.64
|
| Rate for Payer: CORVEL All Commercial |
$102,529.15
|
| Rate for Payer: Coventry All Commercial |
$97,016.83
|
| Rate for Payer: Encore All Commercial |
$101,481.81
|
| Rate for Payer: Frontpath All Commercial |
$101,426.69
|
| Rate for Payer: Humana ChoiceCare |
$95,219.82
|
| Rate for Payer: Humana Medicare |
$56,225.66
|
| Rate for Payer: Lucent All Commercial |
$56,225.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99,221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$82,684.80
|
| Rate for Payer: PHP All Commercial |
$83,610.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42,996.10
|
| Rate for Payer: Sagamore Health Network All Products |
$85,110.22
|
| Rate for Payer: Signature Care EPO |
$91,504.51
|
| Rate for Payer: Signature Care PPO |
$97,016.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93,709.44
|
| Rate for Payer: United Healthcare Commercial |
$86,874.16
|
| Rate for Payer: United Healthcare Medicare |
$36,381.31
|
|
|
HC AR MASTER SHOULDER SET
|
Facility
IP
|
$110,246.40
|
|
| Hospital Charge Code |
41606202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82,684.80 |
| Max. Negotiated Rate |
$102,529.15 |
| Rate for Payer: Aetna Commercial |
$95,252.89
|
| Rate for Payer: Cash Price |
$68,352.77
|
| Rate for Payer: Cigna All Commercial |
$95,142.64
|
| Rate for Payer: CORVEL All Commercial |
$102,529.15
|
| Rate for Payer: Coventry All Commercial |
$97,016.83
|
| Rate for Payer: Encore All Commercial |
$101,481.81
|
| Rate for Payer: Frontpath All Commercial |
$101,426.69
|
| Rate for Payer: Humana ChoiceCare |
$95,219.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99,221.76
|
| Rate for Payer: PHCS All Commercial |
$82,684.80
|
| Rate for Payer: PHP All Commercial |
$83,610.87
|
| Rate for Payer: Sagamore Health Network All Products |
$85,110.22
|
| Rate for Payer: Signature Care EPO |
$91,504.51
|
| Rate for Payer: Signature Care PPO |
$97,016.83
|
| Rate for Payer: United Healthcare Commercial |
$86,874.16
|
|
|
HC AR MENISCAL ROOT IMPLANT
|
Facility
IP
|
$3,940.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,955.15 |
| Max. Negotiated Rate |
$3,664.39 |
| Rate for Payer: Aetna Commercial |
$3,404.33
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Cigna All Commercial |
$3,400.39
|
| Rate for Payer: CORVEL All Commercial |
$3,664.39
|
| Rate for Payer: Coventry All Commercial |
$3,467.38
|
| Rate for Payer: Encore All Commercial |
$3,626.95
|
| Rate for Payer: Frontpath All Commercial |
$3,624.98
|
| Rate for Payer: Humana ChoiceCare |
$3,403.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,546.18
|
| Rate for Payer: PHCS All Commercial |
$2,955.15
|
| Rate for Payer: PHP All Commercial |
$2,988.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,041.83
|
| Rate for Payer: Signature Care EPO |
$3,270.37
|
| Rate for Payer: Signature Care PPO |
$3,467.38
|
| Rate for Payer: United Healthcare Commercial |
$3,104.88
|
|
|
HC AR MENISCAL ROOT IMPLANT
|
Facility
OP
|
$3,940.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,664.39 |
| Rate for Payer: Aetna Commercial |
$3,325.53
|
| Rate for Payer: Aetna Medicare |
$1,300.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,300.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,262.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,463.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,495.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,430.29
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Centivo All Commercial |
$2,009.50
|
| Rate for Payer: Cigna All Commercial |
$3,400.39
|
| Rate for Payer: CORVEL All Commercial |
$3,664.39
|
| Rate for Payer: Coventry All Commercial |
$3,467.38
|
| Rate for Payer: Encore All Commercial |
$3,626.95
|
| Rate for Payer: Frontpath All Commercial |
$3,624.98
|
| Rate for Payer: Humana ChoiceCare |
$3,403.15
|
| Rate for Payer: Humana Medicare |
$2,009.50
|
| Rate for Payer: Lucent All Commercial |
$2,009.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,546.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,955.15
|
| Rate for Payer: PHP All Commercial |
$2,988.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,536.68
|
| Rate for Payer: Sagamore Health Network All Products |
$3,041.83
|
| Rate for Payer: Signature Care EPO |
$3,270.37
|
| Rate for Payer: Signature Care PPO |
$3,467.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,349.17
|
| Rate for Payer: United Healthcare Commercial |
$3,104.88
|
| Rate for Payer: United Healthcare Medicare |
$1,300.27
|
|
|
HC AR MENISCAL ROOT REPAIR SET
|
Facility
OP
|
$2,000.00
|
|
| Hospital Charge Code |
41606314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,688.00
|
| Rate for Payer: Aetna Medicare |
$660.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$660.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,250.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$759.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$726.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Centivo All Commercial |
$1,020.00
|
| Rate for Payer: Cigna All Commercial |
$1,726.00
|
| Rate for Payer: CORVEL All Commercial |
$1,860.00
|
| Rate for Payer: Coventry All Commercial |
$1,760.00
|
| Rate for Payer: Encore All Commercial |
$1,841.00
|
| Rate for Payer: Frontpath All Commercial |
$1,840.00
|
| Rate for Payer: Humana ChoiceCare |
$1,727.40
|
| Rate for Payer: Humana Medicare |
$1,020.00
|
| Rate for Payer: Lucent All Commercial |
$1,020.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,800.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,500.00
|
| Rate for Payer: PHP All Commercial |
$1,516.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$780.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,544.00
|
| Rate for Payer: Signature Care EPO |
$1,660.00
|
| Rate for Payer: Signature Care PPO |
$1,760.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,576.00
|
| Rate for Payer: United Healthcare Medicare |
$660.00
|
|
|
HC AR MENISCAL ROOT REPAIR SET
|
Facility
IP
|
$2,000.00
|
|
| Hospital Charge Code |
41606314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cigna All Commercial |
$1,726.00
|
| Rate for Payer: CORVEL All Commercial |
$1,860.00
|
| Rate for Payer: Coventry All Commercial |
$1,760.00
|
| Rate for Payer: Encore All Commercial |
$1,841.00
|
| Rate for Payer: Frontpath All Commercial |
$1,840.00
|
| Rate for Payer: Humana ChoiceCare |
$1,727.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,800.00
|
| Rate for Payer: PHCS All Commercial |
$1,500.00
|
| Rate for Payer: PHP All Commercial |
$1,516.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,544.00
|
| Rate for Payer: Signature Care EPO |
$1,660.00
|
| Rate for Payer: Signature Care PPO |
$1,760.00
|
| Rate for Payer: United Healthcare Commercial |
$1,576.00
|
|
|
HC AR M-FIRE SCORPION NEEDLE
|
Facility
OP
|
$935.00
|
|
| Hospital Charge Code |
41605576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Aetna Commercial |
$789.14
|
| Rate for Payer: Aetna Medicare |
$308.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$308.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$536.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$584.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.40
|
| Rate for Payer: Cash Price |
$579.70
|
| Rate for Payer: Cash Price |
$579.70
|
| Rate for Payer: Centivo All Commercial |
$476.85
|
| Rate for Payer: Cigna All Commercial |
$806.90
|
| Rate for Payer: CORVEL All Commercial |
$869.55
|
| Rate for Payer: Coventry All Commercial |
$822.80
|
| Rate for Payer: Encore All Commercial |
$860.67
|
| Rate for Payer: Frontpath All Commercial |
$860.20
|
| Rate for Payer: Humana ChoiceCare |
$807.56
|
| Rate for Payer: Humana Medicare |
$476.85
|
| Rate for Payer: Lucent All Commercial |
$476.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$841.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$701.25
|
| Rate for Payer: PHP All Commercial |
$709.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$364.65
|
| Rate for Payer: Sagamore Health Network All Products |
$721.82
|
| Rate for Payer: Signature Care EPO |
$776.05
|
| Rate for Payer: Signature Care PPO |
$822.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$794.75
|
| Rate for Payer: United Healthcare Commercial |
$736.78
|
| Rate for Payer: United Healthcare Medicare |
$308.55
|
|
|
HC AR M-FIRE SCORPION NEEDLE
|
Facility
IP
|
$935.00
|
|
| Hospital Charge Code |
41605576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.25 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Aetna Commercial |
$807.84
|
| Rate for Payer: Cash Price |
$579.70
|
| Rate for Payer: Cigna All Commercial |
$806.90
|
| Rate for Payer: CORVEL All Commercial |
$869.55
|
| Rate for Payer: Coventry All Commercial |
$822.80
|
| Rate for Payer: Encore All Commercial |
$860.67
|
| Rate for Payer: Frontpath All Commercial |
$860.20
|
| Rate for Payer: Humana ChoiceCare |
$807.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$841.50
|
| Rate for Payer: PHCS All Commercial |
$701.25
|
| Rate for Payer: PHP All Commercial |
$709.10
|
| Rate for Payer: Sagamore Health Network All Products |
$721.82
|
| Rate for Payer: Signature Care EPO |
$776.05
|
| Rate for Payer: Signature Care PPO |
$822.80
|
| Rate for Payer: United Healthcare Commercial |
$736.78
|
|
|
HC AR MINI SCREW 3.5X32 COMP FT
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603588
|
|
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 MINI SCREW 3.5X32 COMP FT
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603588
|
|
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 MINI SCREW 3.5X34 COMP FT
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603589
|
|
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 MINI SCREW 3.5X34 COMP FT
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603589
|
|
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 MINI SCREW 3.5X46 COMP FT
|
Facility
IP
|
$2,102.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,576.80 |
| Max. Negotiated Rate |
$1,955.23 |
| Rate for Payer: Aetna Commercial |
$1,816.47
|
| Rate for Payer: Cash Price |
$1,303.49
|
| Rate for Payer: Cigna All Commercial |
$1,814.37
|
| Rate for Payer: CORVEL All Commercial |
$1,955.23
|
| Rate for Payer: Coventry All Commercial |
$1,850.11
|
| Rate for Payer: Encore All Commercial |
$1,935.26
|
| Rate for Payer: Frontpath All Commercial |
$1,934.21
|
| Rate for Payer: Humana ChoiceCare |
$1,815.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,892.16
|
| Rate for Payer: PHCS All Commercial |
$1,576.80
|
| Rate for Payer: PHP All Commercial |
$1,594.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,623.05
|
| Rate for Payer: Signature Care EPO |
$1,744.99
|
| Rate for Payer: Signature Care PPO |
$1,850.11
|
| Rate for Payer: United Healthcare Commercial |
$1,656.69
|
|
