|
HC AR PUNCH DISP 3.5
|
Facility
OP
|
$577.50
|
|
| Hospital Charge Code |
41606525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$537.08 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Aetna Medicare |
$190.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$190.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$331.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$361.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$219.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$209.63
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Centivo All Commercial |
$294.52
|
| Rate for Payer: Cigna All Commercial |
$498.38
|
| Rate for Payer: CORVEL All Commercial |
$537.08
|
| Rate for Payer: Coventry All Commercial |
$508.20
|
| Rate for Payer: Encore All Commercial |
$531.59
|
| Rate for Payer: Frontpath All Commercial |
$531.30
|
| Rate for Payer: Humana ChoiceCare |
$498.79
|
| Rate for Payer: Humana Medicare |
$294.52
|
| Rate for Payer: Lucent All Commercial |
$294.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$433.12
|
| Rate for Payer: PHP All Commercial |
$437.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$225.22
|
| Rate for Payer: Sagamore Health Network All Products |
$445.83
|
| Rate for Payer: Signature Care EPO |
$479.32
|
| Rate for Payer: Signature Care PPO |
$508.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$490.88
|
| Rate for Payer: United Healthcare Commercial |
$455.07
|
| Rate for Payer: United Healthcare Medicare |
$190.58
|
|
|
HC AR PUNCH DISP 3.5
|
Facility
IP
|
$577.50
|
|
| Hospital Charge Code |
41606525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.12 |
| Max. Negotiated Rate |
$537.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Cigna All Commercial |
$498.38
|
| Rate for Payer: CORVEL All Commercial |
$537.08
|
| Rate for Payer: Coventry All Commercial |
$508.20
|
| Rate for Payer: Encore All Commercial |
$531.59
|
| Rate for Payer: Frontpath All Commercial |
$531.30
|
| Rate for Payer: Humana ChoiceCare |
$498.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.75
|
| Rate for Payer: PHCS All Commercial |
$433.12
|
| Rate for Payer: PHP All Commercial |
$437.98
|
| Rate for Payer: Sagamore Health Network All Products |
$445.83
|
| Rate for Payer: Signature Care EPO |
$479.32
|
| Rate for Payer: Signature Care PPO |
$508.20
|
| Rate for Payer: United Healthcare Commercial |
$455.07
|
|
|
HC AR PUNCH DISP FOR 4.5 CORKSCRW
|
Facility
OP
|
$577.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.58 |
| Max. Negotiated Rate |
$537.08 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Aetna Medicare |
$190.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$190.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$331.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$361.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$219.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$209.63
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Centivo All Commercial |
$294.52
|
| Rate for Payer: Cigna All Commercial |
$498.38
|
| Rate for Payer: CORVEL All Commercial |
$537.08
|
| Rate for Payer: Coventry All Commercial |
$508.20
|
| Rate for Payer: Encore All Commercial |
$531.59
|
| Rate for Payer: Frontpath All Commercial |
$531.30
|
| Rate for Payer: Humana ChoiceCare |
$498.79
|
| Rate for Payer: Humana Medicare |
$294.52
|
| Rate for Payer: Lucent All Commercial |
$294.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.75
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$433.12
|
| Rate for Payer: PHP All Commercial |
$437.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$225.22
|
| Rate for Payer: Sagamore Health Network All Products |
$445.83
|
| Rate for Payer: Signature Care EPO |
$479.32
|
| Rate for Payer: Signature Care PPO |
$508.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$490.88
|
| Rate for Payer: United Healthcare Commercial |
$455.07
|
| Rate for Payer: United Healthcare Medicare |
$190.58
|
|
|
HC AR PUNCH DISP FOR 4.5 CORKSCRW
|
Facility
IP
|
$577.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.12 |
| Max. Negotiated Rate |
$537.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Cigna All Commercial |
$498.38
|
| Rate for Payer: CORVEL All Commercial |
$537.08
|
| Rate for Payer: Coventry All Commercial |
$508.20
|
| Rate for Payer: Encore All Commercial |
$531.59
|
| Rate for Payer: Frontpath All Commercial |
$531.30
|
| Rate for Payer: Humana ChoiceCare |
$498.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.75
|
| Rate for Payer: PHCS All Commercial |
$433.12
|
| Rate for Payer: PHP All Commercial |
$437.98
|
| Rate for Payer: Sagamore Health Network All Products |
$445.83
|
| Rate for Payer: Signature Care EPO |
$479.32
|
| Rate for Payer: Signature Care PPO |
$508.20
|
| Rate for Payer: United Healthcare Commercial |
$455.07
|
|
|
HC AR PUNCH SWIVELOCK
|
Facility
OP
|
$577.50
|
|
| Hospital Charge Code |
41603251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$537.08 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Aetna Medicare |
$190.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$190.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$331.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$361.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$219.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$209.63
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Centivo All Commercial |
$294.52
|
| Rate for Payer: Cigna All Commercial |
$498.38
|
| Rate for Payer: CORVEL All Commercial |
$537.08
|
| Rate for Payer: Coventry All Commercial |
$508.20
|
| Rate for Payer: Encore All Commercial |
$531.59
|
| Rate for Payer: Frontpath All Commercial |
$531.30
|
| Rate for Payer: Humana ChoiceCare |
$498.79
|
| Rate for Payer: Humana Medicare |
$294.52
|
| Rate for Payer: Lucent All Commercial |
$294.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$433.12
|
| Rate for Payer: PHP All Commercial |
$437.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$225.22
|
| Rate for Payer: Sagamore Health Network All Products |
$445.83
|
| Rate for Payer: Signature Care EPO |
$479.32
|
| Rate for Payer: Signature Care PPO |
$508.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$490.88
|
| Rate for Payer: United Healthcare Commercial |
$455.07
|
| Rate for Payer: United Healthcare Medicare |
$190.58
|
|
|
HC AR PUNCH SWIVELOCK
|
Facility
IP
|
$577.50
|
|
| Hospital Charge Code |
41603251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.12 |
| Max. Negotiated Rate |
$537.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Cigna All Commercial |
$498.38
|
| Rate for Payer: CORVEL All Commercial |
$537.08
|
| Rate for Payer: Coventry All Commercial |
$508.20
|
| Rate for Payer: Encore All Commercial |
$531.59
|
| Rate for Payer: Frontpath All Commercial |
$531.30
|
| Rate for Payer: Humana ChoiceCare |
$498.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.75
|
| Rate for Payer: PHCS All Commercial |
$433.12
|
| Rate for Payer: PHP All Commercial |
$437.98
|
| Rate for Payer: Sagamore Health Network All Products |
$445.83
|
| Rate for Payer: Signature Care EPO |
$479.32
|
| Rate for Payer: Signature Care PPO |
$508.20
|
| Rate for Payer: United Healthcare Commercial |
$455.07
|
|
|
HC AR QUADLINK GRAFT
|
Facility
IP
|
$8,892.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41608032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,669.00 |
| Max. Negotiated Rate |
$8,269.56 |
| Rate for Payer: Aetna Commercial |
$7,682.69
|
| Rate for Payer: Cash Price |
$5,513.04
|
| Rate for Payer: Cigna All Commercial |
$7,673.80
|
| Rate for Payer: CORVEL All Commercial |
$8,269.56
|
| Rate for Payer: Coventry All Commercial |
$7,824.96
|
| Rate for Payer: Encore All Commercial |
$8,185.09
|
| Rate for Payer: Frontpath All Commercial |
$8,180.64
|
| Rate for Payer: Humana ChoiceCare |
$7,680.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,002.80
|
| Rate for Payer: PHCS All Commercial |
$6,669.00
|
| Rate for Payer: PHP All Commercial |
$6,743.69
|
| Rate for Payer: Sagamore Health Network All Products |
$6,864.62
|
| Rate for Payer: Signature Care EPO |
$7,380.36
|
| Rate for Payer: Signature Care PPO |
$7,824.96
|
| Rate for Payer: United Healthcare Commercial |
$7,006.90
|
|
|
HC AR QUADLINK GRAFT
|
Facility
OP
|
$8,892.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41608032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,269.56 |
| Rate for Payer: Aetna Commercial |
$7,504.85
|
| Rate for Payer: Aetna Medicare |
$2,934.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,934.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,106.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,558.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,374.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,227.80
|
| Rate for Payer: Cash Price |
$5,513.04
|
| Rate for Payer: Cash Price |
$5,513.04
|
| Rate for Payer: Centivo All Commercial |
$4,534.92
|
| Rate for Payer: Cigna All Commercial |
$7,673.80
|
| Rate for Payer: CORVEL All Commercial |
$8,269.56
|
| Rate for Payer: Coventry All Commercial |
$7,824.96
|
| Rate for Payer: Encore All Commercial |
$8,185.09
|
| Rate for Payer: Frontpath All Commercial |
$8,180.64
|
| Rate for Payer: Humana ChoiceCare |
$7,680.02
|
| Rate for Payer: Humana Medicare |
$4,534.92
|
| Rate for Payer: Lucent All Commercial |
$4,534.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,002.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,669.00
|
| Rate for Payer: PHP All Commercial |
$6,743.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,467.88
|
| Rate for Payer: Sagamore Health Network All Products |
$6,864.62
|
| Rate for Payer: Signature Care EPO |
$7,380.36
|
| Rate for Payer: Signature Care PPO |
$7,824.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,558.20
|
| Rate for Payer: United Healthcare Commercial |
$7,006.90
|
| Rate for Payer: United Healthcare Medicare |
$2,934.36
|
|
|
HC AR QUAD TENDON FLEXIGRAFT
|
Facility
IP
|
$8,892.00
|
|
|
Service Code
|
CPT C9356
|
| Hospital Charge Code |
41607382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,669.00 |
| Max. Negotiated Rate |
$8,269.56 |
| Rate for Payer: Aetna Commercial |
$7,682.69
|
| Rate for Payer: Cash Price |
$5,513.04
|
| Rate for Payer: Cigna All Commercial |
$7,673.80
|
| Rate for Payer: CORVEL All Commercial |
$8,269.56
|
| Rate for Payer: Coventry All Commercial |
$7,824.96
|
| Rate for Payer: Encore All Commercial |
$8,185.09
|
| Rate for Payer: Frontpath All Commercial |
$8,180.64
|
| Rate for Payer: Humana ChoiceCare |
$7,680.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,002.80
|
| Rate for Payer: PHCS All Commercial |
$6,669.00
|
| Rate for Payer: PHP All Commercial |
$6,743.69
|
| Rate for Payer: Sagamore Health Network All Products |
$6,864.62
|
| Rate for Payer: Signature Care EPO |
$7,380.36
|
| Rate for Payer: Signature Care PPO |
$7,824.96
|
| Rate for Payer: United Healthcare Commercial |
$7,006.90
|
|
|
HC AR QUAD TENDON FLEXIGRAFT
|
Facility
OP
|
$8,892.00
|
|
|
Service Code
|
CPT C9356
|
| Hospital Charge Code |
41607382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,269.56 |
| Rate for Payer: Aetna Commercial |
$7,504.85
|
| Rate for Payer: Aetna Medicare |
$2,934.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,934.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,106.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,558.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,374.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,227.80
|
| Rate for Payer: Cash Price |
$5,513.04
|
| Rate for Payer: Cash Price |
$5,513.04
|
| Rate for Payer: Centivo All Commercial |
$4,534.92
|
| Rate for Payer: Cigna All Commercial |
$7,673.80
|
| Rate for Payer: CORVEL All Commercial |
$8,269.56
|
| Rate for Payer: Coventry All Commercial |
$7,824.96
|
| Rate for Payer: Encore All Commercial |
$8,185.09
|
| Rate for Payer: Frontpath All Commercial |
$8,180.64
|
| Rate for Payer: Humana ChoiceCare |
$7,680.02
|
| Rate for Payer: Humana Medicare |
$4,534.92
|
| Rate for Payer: Lucent All Commercial |
$4,534.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,002.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,669.00
|
| Rate for Payer: PHP All Commercial |
$6,743.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,467.88
|
| Rate for Payer: Sagamore Health Network All Products |
$6,864.62
|
| Rate for Payer: Signature Care EPO |
$7,380.36
|
| Rate for Payer: Signature Care PPO |
$7,824.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,558.20
|
| Rate for Payer: United Healthcare Commercial |
$7,006.90
|
| Rate for Payer: United Healthcare Medicare |
$2,934.36
|
|
|
HC AR QUAD TENDON SET
|
Facility
IP
|
$1,250.00
|
|
| Hospital Charge Code |
41606234
|
|
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 QUAD TENDON SET
|
Facility
OP
|
$1,250.00
|
|
| Hospital Charge Code |
41606234
|
|
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 QUAD TENDON W/BONE BLK
|
Facility
OP
|
$6,732.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41607961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,260.76 |
| Rate for Payer: Aetna Commercial |
$5,681.81
|
| Rate for Payer: Aetna Medicare |
$2,221.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,221.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,866.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,208.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,554.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,443.72
|
| Rate for Payer: Cash Price |
$4,173.84
|
| Rate for Payer: Cash Price |
$4,173.84
|
| Rate for Payer: Centivo All Commercial |
$3,433.32
|
| Rate for Payer: Cigna All Commercial |
$5,809.72
|
| Rate for Payer: CORVEL All Commercial |
$6,260.76
|
| Rate for Payer: Coventry All Commercial |
$5,924.16
|
| Rate for Payer: Encore All Commercial |
$6,196.81
|
| Rate for Payer: Frontpath All Commercial |
$6,193.44
|
| Rate for Payer: Humana ChoiceCare |
$5,814.43
|
| Rate for Payer: Humana Medicare |
$3,433.32
|
| Rate for Payer: Lucent All Commercial |
$3,433.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,058.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,049.00
|
| Rate for Payer: PHP All Commercial |
$5,105.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,625.48
|
| Rate for Payer: Sagamore Health Network All Products |
$5,197.10
|
| Rate for Payer: Signature Care EPO |
$5,587.56
|
| Rate for Payer: Signature Care PPO |
$5,924.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,722.20
|
| Rate for Payer: United Healthcare Commercial |
$5,304.82
|
| Rate for Payer: United Healthcare Medicare |
$2,221.56
|
|
|
HC AR QUAD TENDON W/BONE BLK
|
Facility
IP
|
$6,732.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41607961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,049.00 |
| Max. Negotiated Rate |
$6,260.76 |
| Rate for Payer: Aetna Commercial |
$5,816.45
|
| Rate for Payer: Cash Price |
$4,173.84
|
| Rate for Payer: Cigna All Commercial |
$5,809.72
|
| Rate for Payer: CORVEL All Commercial |
$6,260.76
|
| Rate for Payer: Coventry All Commercial |
$5,924.16
|
| Rate for Payer: Encore All Commercial |
$6,196.81
|
| Rate for Payer: Frontpath All Commercial |
$6,193.44
|
| Rate for Payer: Humana ChoiceCare |
$5,814.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,058.80
|
| Rate for Payer: PHCS All Commercial |
$5,049.00
|
| Rate for Payer: PHP All Commercial |
$5,105.55
|
| Rate for Payer: Sagamore Health Network All Products |
$5,197.10
|
| Rate for Payer: Signature Care EPO |
$5,587.56
|
| Rate for Payer: Signature Care PPO |
$5,924.16
|
| Rate for Payer: United Healthcare Commercial |
$5,304.82
|
|
|
HC AR REAMER 10 MM
|
Facility
IP
|
$1,243.00
|
|
| Hospital Charge Code |
41606363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$932.25 |
| Max. Negotiated Rate |
$1,155.99 |
| Rate for Payer: Aetna Commercial |
$1,073.95
|
| Rate for Payer: Cash Price |
$770.66
|
| Rate for Payer: Cigna All Commercial |
$1,072.71
|
| Rate for Payer: CORVEL All Commercial |
$1,155.99
|
| Rate for Payer: Coventry All Commercial |
$1,093.84
|
| Rate for Payer: Encore All Commercial |
$1,144.18
|
| Rate for Payer: Frontpath All Commercial |
$1,143.56
|
| Rate for Payer: Humana ChoiceCare |
$1,073.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,118.70
|
| Rate for Payer: PHCS All Commercial |
$932.25
|
| Rate for Payer: PHP All Commercial |
$942.69
|
| Rate for Payer: Sagamore Health Network All Products |
$959.60
|
| Rate for Payer: Signature Care EPO |
$1,031.69
|
| Rate for Payer: Signature Care PPO |
$1,093.84
|
| Rate for Payer: United Healthcare Commercial |
$979.48
|
|
|
HC AR REAMER 10 MM
|
Facility
OP
|
$1,243.00
|
|
| Hospital Charge Code |
41606363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,155.99 |
| Rate for Payer: Aetna Commercial |
$1,049.09
|
| Rate for Payer: Aetna Medicare |
$410.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$410.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$713.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$777.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$471.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$451.21
|
| Rate for Payer: Cash Price |
$770.66
|
| Rate for Payer: Cash Price |
$770.66
|
| Rate for Payer: Centivo All Commercial |
$633.93
|
| Rate for Payer: Cigna All Commercial |
$1,072.71
|
| Rate for Payer: CORVEL All Commercial |
$1,155.99
|
| Rate for Payer: Coventry All Commercial |
$1,093.84
|
| Rate for Payer: Encore All Commercial |
$1,144.18
|
| Rate for Payer: Frontpath All Commercial |
$1,143.56
|
| Rate for Payer: Humana ChoiceCare |
$1,073.58
|
| Rate for Payer: Humana Medicare |
$633.93
|
| Rate for Payer: Lucent All Commercial |
$633.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,118.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$932.25
|
| Rate for Payer: PHP All Commercial |
$942.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$484.77
|
| Rate for Payer: Sagamore Health Network All Products |
$959.60
|
| Rate for Payer: Signature Care EPO |
$1,031.69
|
| Rate for Payer: Signature Care PPO |
$1,093.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,056.55
|
| Rate for Payer: United Healthcare Commercial |
$979.48
|
| Rate for Payer: United Healthcare Medicare |
$410.19
|
|
|
HC AR REAMER 11 CANN
|
Facility
OP
|
$1,243.00
|
|
| Hospital Charge Code |
41605847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,155.99 |
| Rate for Payer: Aetna Commercial |
$1,049.09
|
| Rate for Payer: Aetna Medicare |
$410.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$410.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$713.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$777.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$471.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$451.21
|
| Rate for Payer: Cash Price |
$770.66
|
| Rate for Payer: Cash Price |
$770.66
|
| Rate for Payer: Centivo All Commercial |
$633.93
|
| Rate for Payer: Cigna All Commercial |
$1,072.71
|
| Rate for Payer: CORVEL All Commercial |
$1,155.99
|
| Rate for Payer: Coventry All Commercial |
$1,093.84
|
| Rate for Payer: Encore All Commercial |
$1,144.18
|
| Rate for Payer: Frontpath All Commercial |
$1,143.56
|
| Rate for Payer: Humana ChoiceCare |
$1,073.58
|
| Rate for Payer: Humana Medicare |
$633.93
|
| Rate for Payer: Lucent All Commercial |
$633.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,118.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$932.25
|
| Rate for Payer: PHP All Commercial |
$942.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$484.77
|
| Rate for Payer: Sagamore Health Network All Products |
$959.60
|
| Rate for Payer: Signature Care EPO |
$1,031.69
|
| Rate for Payer: Signature Care PPO |
$1,093.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,056.55
|
| Rate for Payer: United Healthcare Commercial |
$979.48
|
| Rate for Payer: United Healthcare Medicare |
$410.19
|
|
|
HC AR REAMER 11 CANN
|
Facility
IP
|
$1,243.00
|
|
| Hospital Charge Code |
41605847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$932.25 |
| Max. Negotiated Rate |
$1,155.99 |
| Rate for Payer: Aetna Commercial |
$1,073.95
|
| Rate for Payer: Cash Price |
$770.66
|
| Rate for Payer: Cigna All Commercial |
$1,072.71
|
| Rate for Payer: CORVEL All Commercial |
$1,155.99
|
| Rate for Payer: Coventry All Commercial |
$1,093.84
|
| Rate for Payer: Encore All Commercial |
$1,144.18
|
| Rate for Payer: Frontpath All Commercial |
$1,143.56
|
| Rate for Payer: Humana ChoiceCare |
$1,073.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,118.70
|
| Rate for Payer: PHCS All Commercial |
$932.25
|
| Rate for Payer: PHP All Commercial |
$942.69
|
| Rate for Payer: Sagamore Health Network All Products |
$959.60
|
| Rate for Payer: Signature Care EPO |
$1,031.69
|
| Rate for Payer: Signature Care PPO |
$1,093.84
|
| Rate for Payer: United Healthcare Commercial |
$979.48
|
|
|
HC AR REAMER 4MM CANN
|
Facility
IP
|
$1,012.00
|
|
| Hospital Charge Code |
41606172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$759.00 |
| Max. Negotiated Rate |
$941.16 |
| Rate for Payer: Aetna Commercial |
$874.37
|
| Rate for Payer: Cash Price |
$627.44
|
| Rate for Payer: Cigna All Commercial |
$873.36
|
| Rate for Payer: CORVEL All Commercial |
$941.16
|
| Rate for Payer: Coventry All Commercial |
$890.56
|
| Rate for Payer: Encore All Commercial |
$931.55
|
| Rate for Payer: Frontpath All Commercial |
$931.04
|
| Rate for Payer: Humana ChoiceCare |
$874.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$910.80
|
| Rate for Payer: PHCS All Commercial |
$759.00
|
| Rate for Payer: PHP All Commercial |
$767.50
|
| Rate for Payer: Sagamore Health Network All Products |
$781.26
|
| Rate for Payer: Signature Care EPO |
$839.96
|
| Rate for Payer: Signature Care PPO |
$890.56
|
| Rate for Payer: United Healthcare Commercial |
$797.46
|
|
|
HC AR REAMER 4MM CANN
|
Facility
OP
|
$1,012.00
|
|
| Hospital Charge Code |
41606172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$941.16 |
| Rate for Payer: Aetna Commercial |
$854.13
|
| Rate for Payer: Aetna Medicare |
$333.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$333.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$581.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$632.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$384.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$367.36
|
| Rate for Payer: Cash Price |
$627.44
|
| Rate for Payer: Cash Price |
$627.44
|
| Rate for Payer: Centivo All Commercial |
$516.12
|
| Rate for Payer: Cigna All Commercial |
$873.36
|
| Rate for Payer: CORVEL All Commercial |
$941.16
|
| Rate for Payer: Coventry All Commercial |
$890.56
|
| Rate for Payer: Encore All Commercial |
$931.55
|
| Rate for Payer: Frontpath All Commercial |
$931.04
|
| Rate for Payer: Humana ChoiceCare |
$874.06
|
| Rate for Payer: Humana Medicare |
$516.12
|
| Rate for Payer: Lucent All Commercial |
$516.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$910.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$759.00
|
| Rate for Payer: PHP All Commercial |
$767.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$394.68
|
| Rate for Payer: Sagamore Health Network All Products |
$781.26
|
| Rate for Payer: Signature Care EPO |
$839.96
|
| Rate for Payer: Signature Care PPO |
$890.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$860.20
|
| Rate for Payer: United Healthcare Commercial |
$797.46
|
| Rate for Payer: United Healthcare Medicare |
$333.96
|
|
|
HC AR REAMER 5.0 CANN
|
Facility
OP
|
$1,182.50
|
|
| Hospital Charge Code |
41606984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,099.72 |
| Rate for Payer: Aetna Commercial |
$998.03
|
| Rate for Payer: Aetna Medicare |
$390.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$390.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$679.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$739.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$448.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$429.25
|
| Rate for Payer: Cash Price |
$733.15
|
| Rate for Payer: Cash Price |
$733.15
|
| Rate for Payer: Centivo All Commercial |
$603.08
|
| Rate for Payer: Cigna All Commercial |
$1,020.50
|
| Rate for Payer: CORVEL All Commercial |
$1,099.72
|
| Rate for Payer: Coventry All Commercial |
$1,040.60
|
| Rate for Payer: Encore All Commercial |
$1,088.49
|
| Rate for Payer: Frontpath All Commercial |
$1,087.90
|
| Rate for Payer: Humana ChoiceCare |
$1,021.33
|
| Rate for Payer: Humana Medicare |
$603.08
|
| Rate for Payer: Lucent All Commercial |
$603.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,064.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$886.88
|
| Rate for Payer: PHP All Commercial |
$896.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$461.18
|
| Rate for Payer: Sagamore Health Network All Products |
$912.89
|
| Rate for Payer: Signature Care EPO |
$981.48
|
| Rate for Payer: Signature Care PPO |
$1,040.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,005.12
|
| Rate for Payer: United Healthcare Commercial |
$931.81
|
| Rate for Payer: United Healthcare Medicare |
$390.22
|
|
|
HC AR REAMER 5.0 CANN
|
Facility
IP
|
$1,182.50
|
|
| Hospital Charge Code |
41606984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.88 |
| Max. Negotiated Rate |
$1,099.72 |
| Rate for Payer: Aetna Commercial |
$1,021.68
|
| Rate for Payer: Cash Price |
$733.15
|
| Rate for Payer: Cigna All Commercial |
$1,020.50
|
| Rate for Payer: CORVEL All Commercial |
$1,099.72
|
| Rate for Payer: Coventry All Commercial |
$1,040.60
|
| Rate for Payer: Encore All Commercial |
$1,088.49
|
| Rate for Payer: Frontpath All Commercial |
$1,087.90
|
| Rate for Payer: Humana ChoiceCare |
$1,021.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,064.25
|
| Rate for Payer: PHCS All Commercial |
$886.88
|
| Rate for Payer: PHP All Commercial |
$896.81
|
| Rate for Payer: Sagamore Health Network All Products |
$912.89
|
| Rate for Payer: Signature Care EPO |
$981.48
|
| Rate for Payer: Signature Care PPO |
$1,040.60
|
| Rate for Payer: United Healthcare Commercial |
$931.81
|
|
|
HC AR REAMER 6 CANN
|
Facility
OP
|
$1,182.50
|
|
| Hospital Charge Code |
41607090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,099.72 |
| Rate for Payer: Aetna Commercial |
$998.03
|
| Rate for Payer: Aetna Medicare |
$390.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$390.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$679.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$739.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$448.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$429.25
|
| Rate for Payer: Cash Price |
$733.15
|
| Rate for Payer: Cash Price |
$733.15
|
| Rate for Payer: Centivo All Commercial |
$603.08
|
| Rate for Payer: Cigna All Commercial |
$1,020.50
|
| Rate for Payer: CORVEL All Commercial |
$1,099.72
|
| Rate for Payer: Coventry All Commercial |
$1,040.60
|
| Rate for Payer: Encore All Commercial |
$1,088.49
|
| Rate for Payer: Frontpath All Commercial |
$1,087.90
|
| Rate for Payer: Humana ChoiceCare |
$1,021.33
|
| Rate for Payer: Humana Medicare |
$603.08
|
| Rate for Payer: Lucent All Commercial |
$603.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,064.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$886.88
|
| Rate for Payer: PHP All Commercial |
$896.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$461.18
|
| Rate for Payer: Sagamore Health Network All Products |
$912.89
|
| Rate for Payer: Signature Care EPO |
$981.48
|
| Rate for Payer: Signature Care PPO |
$1,040.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,005.12
|
| Rate for Payer: United Healthcare Commercial |
$931.81
|
| Rate for Payer: United Healthcare Medicare |
$390.22
|
|
|
HC AR REAMER 6 CANN
|
Facility
IP
|
$1,182.50
|
|
| Hospital Charge Code |
41607090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.88 |
| Max. Negotiated Rate |
$1,099.72 |
| Rate for Payer: Aetna Commercial |
$1,021.68
|
| Rate for Payer: Cash Price |
$733.15
|
| Rate for Payer: Cigna All Commercial |
$1,020.50
|
| Rate for Payer: CORVEL All Commercial |
$1,099.72
|
| Rate for Payer: Coventry All Commercial |
$1,040.60
|
| Rate for Payer: Encore All Commercial |
$1,088.49
|
| Rate for Payer: Frontpath All Commercial |
$1,087.90
|
| Rate for Payer: Humana ChoiceCare |
$1,021.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,064.25
|
| Rate for Payer: PHCS All Commercial |
$886.88
|
| Rate for Payer: PHP All Commercial |
$896.81
|
| Rate for Payer: Sagamore Health Network All Products |
$912.89
|
| Rate for Payer: Signature Care EPO |
$981.48
|
| Rate for Payer: Signature Care PPO |
$1,040.60
|
| Rate for Payer: United Healthcare Commercial |
$931.81
|
|
|
HC AR REAMER 7.5 CANN
|
Facility
IP
|
$1,182.50
|
|
| Hospital Charge Code |
41606983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.88 |
| Max. Negotiated Rate |
$1,099.72 |
| Rate for Payer: Aetna Commercial |
$1,021.68
|
| Rate for Payer: Cash Price |
$733.15
|
| Rate for Payer: Cigna All Commercial |
$1,020.50
|
| Rate for Payer: CORVEL All Commercial |
$1,099.72
|
| Rate for Payer: Coventry All Commercial |
$1,040.60
|
| Rate for Payer: Encore All Commercial |
$1,088.49
|
| Rate for Payer: Frontpath All Commercial |
$1,087.90
|
| Rate for Payer: Humana ChoiceCare |
$1,021.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,064.25
|
| Rate for Payer: PHCS All Commercial |
$886.88
|
| Rate for Payer: PHP All Commercial |
$896.81
|
| Rate for Payer: Sagamore Health Network All Products |
$912.89
|
| Rate for Payer: Signature Care EPO |
$981.48
|
| Rate for Payer: Signature Care PPO |
$1,040.60
|
| Rate for Payer: United Healthcare Commercial |
$931.81
|
|
