|
HC AR MINI SCREW 3.5X46 COMP FT
|
Facility
OP
|
$2,102.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,955.23 |
| Rate for Payer: Aetna Commercial |
$1,774.43
|
| Rate for Payer: Aetna Medicare |
$693.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$693.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,207.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,314.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$797.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$763.17
|
| Rate for Payer: Cash Price |
$1,303.49
|
| Rate for Payer: Cash Price |
$1,303.49
|
| Rate for Payer: Centivo All Commercial |
$1,072.22
|
| 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: Humana Medicare |
$1,072.22
|
| Rate for Payer: Lucent All Commercial |
$1,072.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,892.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,576.80
|
| Rate for Payer: PHP All Commercial |
$1,594.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$819.94
|
| 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: Three Rivers Preferred All Commercial |
$1,787.04
|
| Rate for Payer: United Healthcare Commercial |
$1,656.69
|
| Rate for Payer: United Healthcare Medicare |
$693.79
|
|
|
HC AR MINI SCREW 3.5X48 COMP FT
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,790.25 |
| 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: 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: 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 3.5X48 COMP FT
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608293
|
|
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 SUTURE ANCHOR 2.5X8
|
Facility
OP
|
$8,640.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,035.20 |
| Rate for Payer: Aetna Commercial |
$7,292.16
|
| Rate for Payer: Aetna Medicare |
$2,851.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,851.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,961.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,400.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,278.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,136.32
|
| Rate for Payer: Cash Price |
$5,356.80
|
| Rate for Payer: Cash Price |
$5,356.80
|
| Rate for Payer: Centivo All Commercial |
$4,406.40
|
| Rate for Payer: Cigna All Commercial |
$7,456.32
|
| Rate for Payer: CORVEL All Commercial |
$8,035.20
|
| Rate for Payer: Coventry All Commercial |
$7,603.20
|
| Rate for Payer: Encore All Commercial |
$7,953.12
|
| Rate for Payer: Frontpath All Commercial |
$7,948.80
|
| Rate for Payer: Humana ChoiceCare |
$7,462.37
|
| Rate for Payer: Humana Medicare |
$4,406.40
|
| Rate for Payer: Lucent All Commercial |
$4,406.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,776.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,480.00
|
| Rate for Payer: PHP All Commercial |
$6,552.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,369.60
|
| Rate for Payer: Sagamore Health Network All Products |
$6,670.08
|
| Rate for Payer: Signature Care EPO |
$7,171.20
|
| Rate for Payer: Signature Care PPO |
$7,603.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,344.00
|
| Rate for Payer: United Healthcare Commercial |
$6,808.32
|
| Rate for Payer: United Healthcare Medicare |
$2,851.20
|
|
|
HC AR MINI SUTURE ANCHOR 2.5X8
|
Facility
IP
|
$8,640.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,480.00 |
| Max. Negotiated Rate |
$8,035.20 |
| Rate for Payer: Aetna Commercial |
$7,464.96
|
| Rate for Payer: Cash Price |
$5,356.80
|
| Rate for Payer: Cigna All Commercial |
$7,456.32
|
| Rate for Payer: CORVEL All Commercial |
$8,035.20
|
| Rate for Payer: Coventry All Commercial |
$7,603.20
|
| Rate for Payer: Encore All Commercial |
$7,953.12
|
| Rate for Payer: Frontpath All Commercial |
$7,948.80
|
| Rate for Payer: Humana ChoiceCare |
$7,462.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,776.00
|
| Rate for Payer: PHCS All Commercial |
$6,480.00
|
| Rate for Payer: PHP All Commercial |
$6,552.58
|
| Rate for Payer: Sagamore Health Network All Products |
$6,670.08
|
| Rate for Payer: Signature Care EPO |
$7,171.20
|
| Rate for Payer: Signature Care PPO |
$7,603.20
|
| Rate for Payer: United Healthcare Commercial |
$6,808.32
|
|
|
HC AR MINI SUTURE ANCHOR PUSH
|
Facility
OP
|
$2,337.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,173.88 |
| Rate for Payer: Aetna Commercial |
$1,972.85
|
| Rate for Payer: Aetna Medicare |
$771.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$771.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,342.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,461.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$887.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$848.51
|
| Rate for Payer: Cash Price |
$1,449.25
|
| Rate for Payer: Cash Price |
$1,449.25
|
| Rate for Payer: Centivo All Commercial |
$1,192.12
|
| Rate for Payer: Cigna All Commercial |
$2,017.26
|
| Rate for Payer: CORVEL All Commercial |
$2,173.88
|
| Rate for Payer: Coventry All Commercial |
$2,057.00
|
| Rate for Payer: Encore All Commercial |
$2,151.67
|
| Rate for Payer: Frontpath All Commercial |
$2,150.50
|
| Rate for Payer: Humana ChoiceCare |
$2,018.90
|
| Rate for Payer: Humana Medicare |
$1,192.12
|
| Rate for Payer: Lucent All Commercial |
$1,192.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,103.75
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,753.12
|
| Rate for Payer: PHP All Commercial |
$1,772.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$911.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,804.55
|
| Rate for Payer: Signature Care EPO |
$1,940.12
|
| Rate for Payer: Signature Care PPO |
$2,057.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,986.88
|
| Rate for Payer: United Healthcare Commercial |
$1,841.95
|
| Rate for Payer: United Healthcare Medicare |
$771.38
|
|
|
HC AR MINI SUTURE ANCHOR PUSH
|
Facility
IP
|
$2,337.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,753.12 |
| Max. Negotiated Rate |
$2,173.88 |
| Rate for Payer: Aetna Commercial |
$2,019.60
|
| Rate for Payer: Cash Price |
$1,449.25
|
| Rate for Payer: Cigna All Commercial |
$2,017.26
|
| Rate for Payer: CORVEL All Commercial |
$2,173.88
|
| Rate for Payer: Coventry All Commercial |
$2,057.00
|
| Rate for Payer: Encore All Commercial |
$2,151.67
|
| Rate for Payer: Frontpath All Commercial |
$2,150.50
|
| Rate for Payer: Humana ChoiceCare |
$2,018.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,103.75
|
| Rate for Payer: PHCS All Commercial |
$1,753.12
|
| Rate for Payer: PHP All Commercial |
$1,772.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,804.55
|
| Rate for Payer: Signature Care EPO |
$1,940.12
|
| Rate for Payer: Signature Care PPO |
$2,057.00
|
| Rate for Payer: United Healthcare Commercial |
$1,841.95
|
|
|
HC AR MINI TIGHTROPE 1.1 DISP KIT
|
Facility
IP
|
$2,752.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.15 |
| Max. Negotiated Rate |
$2,559.55 |
| Rate for Payer: Aetna Commercial |
$2,377.90
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Cigna All Commercial |
$2,375.15
|
| Rate for Payer: CORVEL All Commercial |
$2,559.55
|
| Rate for Payer: Coventry All Commercial |
$2,421.94
|
| Rate for Payer: Encore All Commercial |
$2,533.40
|
| Rate for Payer: Frontpath All Commercial |
$2,532.02
|
| Rate for Payer: Humana ChoiceCare |
$2,377.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,476.98
|
| Rate for Payer: PHCS All Commercial |
$2,064.15
|
| Rate for Payer: PHP All Commercial |
$2,087.27
|
| Rate for Payer: Sagamore Health Network All Products |
$2,124.70
|
| Rate for Payer: Signature Care EPO |
$2,284.33
|
| Rate for Payer: Signature Care PPO |
$2,421.94
|
| Rate for Payer: United Healthcare Commercial |
$2,168.73
|
|
|
HC AR MINI TIGHTROPE 1.1 DISP KIT
|
Facility
OP
|
$2,752.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,559.55 |
| Rate for Payer: Aetna Commercial |
$2,322.86
|
| Rate for Payer: Aetna Medicare |
$908.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$908.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,580.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,720.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,044.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$999.05
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Centivo All Commercial |
$1,403.62
|
| Rate for Payer: Cigna All Commercial |
$2,375.15
|
| Rate for Payer: CORVEL All Commercial |
$2,559.55
|
| Rate for Payer: Coventry All Commercial |
$2,421.94
|
| Rate for Payer: Encore All Commercial |
$2,533.40
|
| Rate for Payer: Frontpath All Commercial |
$2,532.02
|
| Rate for Payer: Humana ChoiceCare |
$2,377.08
|
| Rate for Payer: Humana Medicare |
$1,403.62
|
| Rate for Payer: Lucent All Commercial |
$1,403.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,476.98
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,064.15
|
| Rate for Payer: PHP All Commercial |
$2,087.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,073.36
|
| Rate for Payer: Sagamore Health Network All Products |
$2,124.70
|
| Rate for Payer: Signature Care EPO |
$2,284.33
|
| Rate for Payer: Signature Care PPO |
$2,421.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,339.37
|
| Rate for Payer: United Healthcare Commercial |
$2,168.73
|
| Rate for Payer: United Healthcare Medicare |
$908.23
|
|
|
HC AR MIRCO SUTURE LASSO
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41606123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC AR MIRCO SUTURE LASSO
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41606123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.51
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Centivo All Commercial |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$392.70
|
| Rate for Payer: Lucent All Commercial |
$392.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
|
|
HC AR NAVIGATOR CANNULA SYSTEM
|
Facility
IP
|
$825.00
|
|
| Hospital Charge Code |
41606309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
|
HC AR NAVIGATOR CANNULA SYSTEM
|
Facility
OP
|
$825.00
|
|
| Hospital Charge Code |
41606309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC AR NAVIGATOR SYSTEM HANDLE
|
Facility
OP
|
$1,375.00
|
|
| Hospital Charge Code |
41606310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$1,160.50
|
| Rate for Payer: Aetna Medicare |
$453.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$453.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$789.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$859.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$521.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$499.12
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Centivo All Commercial |
$701.25
|
| Rate for Payer: Cigna All Commercial |
$1,186.62
|
| Rate for Payer: CORVEL All Commercial |
$1,278.75
|
| Rate for Payer: Coventry All Commercial |
$1,210.00
|
| Rate for Payer: Encore All Commercial |
$1,265.69
|
| Rate for Payer: Frontpath All Commercial |
$1,265.00
|
| Rate for Payer: Humana ChoiceCare |
$1,187.59
|
| Rate for Payer: Humana Medicare |
$701.25
|
| Rate for Payer: Lucent All Commercial |
$701.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,237.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,031.25
|
| Rate for Payer: PHP All Commercial |
$1,042.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$536.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,061.50
|
| Rate for Payer: Signature Care EPO |
$1,141.25
|
| Rate for Payer: Signature Care PPO |
$1,210.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,168.75
|
| Rate for Payer: United Healthcare Commercial |
$1,083.50
|
| Rate for Payer: United Healthcare Medicare |
$453.75
|
|
|
HC AR NAVIGATOR SYSTEM HANDLE
|
Facility
IP
|
$1,375.00
|
|
| Hospital Charge Code |
41606310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.25 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$1,188.00
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna All Commercial |
$1,186.62
|
| Rate for Payer: CORVEL All Commercial |
$1,278.75
|
| Rate for Payer: Coventry All Commercial |
$1,210.00
|
| Rate for Payer: Encore All Commercial |
$1,265.69
|
| Rate for Payer: Frontpath All Commercial |
$1,265.00
|
| Rate for Payer: Humana ChoiceCare |
$1,187.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,237.50
|
| Rate for Payer: PHCS All Commercial |
$1,031.25
|
| Rate for Payer: PHP All Commercial |
$1,042.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,061.50
|
| Rate for Payer: Signature Care EPO |
$1,141.25
|
| Rate for Payer: Signature Care PPO |
$1,210.00
|
| Rate for Payer: United Healthcare Commercial |
$1,083.50
|
|
|
HC AR OBSTURATOR FLEX
|
Facility
OP
|
$962.50
|
|
| Hospital Charge Code |
41606971
|
|
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 OBSTURATOR FLEX
|
Facility
IP
|
$962.50
|
|
| Hospital Charge Code |
41606971
|
|
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 OCD INST FLAP REPAIR KIT
|
Facility
OP
|
$1,127.50
|
|
| Hospital Charge Code |
41606535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,048.58 |
| Rate for Payer: Aetna Commercial |
$951.61
|
| Rate for Payer: Aetna Medicare |
$372.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$372.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$647.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$704.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$427.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$409.28
|
| Rate for Payer: Cash Price |
$699.05
|
| Rate for Payer: Cash Price |
$699.05
|
| Rate for Payer: Centivo All Commercial |
$575.02
|
| Rate for Payer: Cigna All Commercial |
$973.03
|
| Rate for Payer: CORVEL All Commercial |
$1,048.58
|
| Rate for Payer: Coventry All Commercial |
$992.20
|
| Rate for Payer: Encore All Commercial |
$1,037.86
|
| Rate for Payer: Frontpath All Commercial |
$1,037.30
|
| Rate for Payer: Humana ChoiceCare |
$973.82
|
| Rate for Payer: Humana Medicare |
$575.02
|
| Rate for Payer: Lucent All Commercial |
$575.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,014.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$845.62
|
| Rate for Payer: PHP All Commercial |
$855.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$439.72
|
| Rate for Payer: Sagamore Health Network All Products |
$870.43
|
| Rate for Payer: Signature Care EPO |
$935.82
|
| Rate for Payer: Signature Care PPO |
$992.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$958.38
|
| Rate for Payer: United Healthcare Commercial |
$888.47
|
| Rate for Payer: United Healthcare Medicare |
$372.08
|
|
|
HC AR OCD INST FLAP REPAIR KIT
|
Facility
IP
|
$1,127.50
|
|
| Hospital Charge Code |
41606535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$1,048.58 |
| Rate for Payer: Aetna Commercial |
$974.16
|
| Rate for Payer: Cash Price |
$699.05
|
| Rate for Payer: Cigna All Commercial |
$973.03
|
| Rate for Payer: CORVEL All Commercial |
$1,048.58
|
| Rate for Payer: Coventry All Commercial |
$992.20
|
| Rate for Payer: Encore All Commercial |
$1,037.86
|
| Rate for Payer: Frontpath All Commercial |
$1,037.30
|
| Rate for Payer: Humana ChoiceCare |
$973.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,014.75
|
| Rate for Payer: PHCS All Commercial |
$845.62
|
| Rate for Payer: PHP All Commercial |
$855.10
|
| Rate for Payer: Sagamore Health Network All Products |
$870.43
|
| Rate for Payer: Signature Care EPO |
$935.82
|
| Rate for Payer: Signature Care PPO |
$992.20
|
| Rate for Payer: United Healthcare Commercial |
$888.47
|
|
|
HC AR PASSPORT BUTTON 10X3
|
Facility
IP
|
$246.40
|
|
| Hospital Charge Code |
41608024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 10X3
|
Facility
OP
|
$246.40
|
|
| Hospital Charge Code |
41608024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.44
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$125.66
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$125.66
|
| Rate for Payer: Lucent All Commercial |
$125.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$81.31
|
|
|
HC AR PASSPORT BUTTON 10X4
|
Facility
IP
|
$246.40
|
|
| Hospital Charge Code |
41607914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 10X4
|
Facility
OP
|
$246.40
|
|
| Hospital Charge Code |
41607914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.44
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$125.66
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$125.66
|
| Rate for Payer: Lucent All Commercial |
$125.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$81.31
|
|
|
HC AR PASSPORT BUTTON 12X3
|
Facility
IP
|
$1,100.00
|
|
| Hospital Charge Code |
41606989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,023.00 |
| Rate for Payer: Aetna Commercial |
$950.40
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna All Commercial |
$949.30
|
| Rate for Payer: CORVEL All Commercial |
$1,023.00
|
| Rate for Payer: Coventry All Commercial |
$968.00
|
| Rate for Payer: Encore All Commercial |
$1,012.55
|
| Rate for Payer: Frontpath All Commercial |
$1,012.00
|
| Rate for Payer: Humana ChoiceCare |
$950.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$990.00
|
| Rate for Payer: PHCS All Commercial |
$825.00
|
| Rate for Payer: PHP All Commercial |
$834.24
|
| Rate for Payer: Sagamore Health Network All Products |
$849.20
|
| Rate for Payer: Signature Care EPO |
$913.00
|
| Rate for Payer: Signature Care PPO |
$968.00
|
| Rate for Payer: United Healthcare Commercial |
$866.80
|
|
|
HC AR PASSPORT BUTTON 12X3
|
Facility
OP
|
$1,100.00
|
|
| Hospital Charge Code |
41606989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,023.00 |
| Rate for Payer: Aetna Commercial |
$928.40
|
| Rate for Payer: Aetna Medicare |
$363.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$363.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$631.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$687.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$417.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$399.30
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Centivo All Commercial |
$561.00
|
| Rate for Payer: Cigna All Commercial |
$949.30
|
| Rate for Payer: CORVEL All Commercial |
$1,023.00
|
| Rate for Payer: Coventry All Commercial |
$968.00
|
| Rate for Payer: Encore All Commercial |
$1,012.55
|
| Rate for Payer: Frontpath All Commercial |
$1,012.00
|
| Rate for Payer: Humana ChoiceCare |
$950.07
|
| Rate for Payer: Humana Medicare |
$561.00
|
| Rate for Payer: Lucent All Commercial |
$561.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$990.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$825.00
|
| Rate for Payer: PHP All Commercial |
$834.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$429.00
|
| Rate for Payer: Sagamore Health Network All Products |
$849.20
|
| Rate for Payer: Signature Care EPO |
$913.00
|
| Rate for Payer: Signature Care PPO |
$968.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$935.00
|
| Rate for Payer: United Healthcare Commercial |
$866.80
|
| Rate for Payer: United Healthcare Medicare |
$363.00
|
|
