|
HC AR SUT LASSO 45-CURVE QP L
|
Facility
OP
|
$880.00
|
|
| Hospital Charge Code |
41607714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$818.40 |
| Rate for Payer: Aetna Commercial |
$742.72
|
| Rate for Payer: Aetna Medicare |
$290.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$290.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$505.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$550.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$333.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$319.44
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Centivo All Commercial |
$448.80
|
| Rate for Payer: Cigna All Commercial |
$759.44
|
| Rate for Payer: CORVEL All Commercial |
$818.40
|
| Rate for Payer: Coventry All Commercial |
$774.40
|
| Rate for Payer: Encore All Commercial |
$810.04
|
| Rate for Payer: Frontpath All Commercial |
$809.60
|
| Rate for Payer: Humana ChoiceCare |
$760.06
|
| Rate for Payer: Humana Medicare |
$448.80
|
| Rate for Payer: Lucent All Commercial |
$448.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$792.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$660.00
|
| Rate for Payer: PHP All Commercial |
$667.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$343.20
|
| Rate for Payer: Sagamore Health Network All Products |
$679.36
|
| Rate for Payer: Signature Care EPO |
$730.40
|
| Rate for Payer: Signature Care PPO |
$774.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$748.00
|
| Rate for Payer: United Healthcare Commercial |
$693.44
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
|
|
HC AR SUT TAK INSERT 3.0
|
Facility
IP
|
$1,952.50
|
|
| Hospital Charge Code |
41607798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,464.38 |
| Max. Negotiated Rate |
$1,815.82 |
| Rate for Payer: Aetna Commercial |
$1,686.96
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cigna All Commercial |
$1,685.01
|
| Rate for Payer: CORVEL All Commercial |
$1,815.82
|
| Rate for Payer: Coventry All Commercial |
$1,718.20
|
| Rate for Payer: Encore All Commercial |
$1,797.28
|
| Rate for Payer: Frontpath All Commercial |
$1,796.30
|
| Rate for Payer: Humana ChoiceCare |
$1,686.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,757.25
|
| Rate for Payer: PHCS All Commercial |
$1,464.38
|
| Rate for Payer: PHP All Commercial |
$1,480.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,507.33
|
| Rate for Payer: Signature Care EPO |
$1,620.58
|
| Rate for Payer: Signature Care PPO |
$1,718.20
|
| Rate for Payer: United Healthcare Commercial |
$1,538.57
|
|
|
HC AR SUT TAK INSERT 3.0
|
Facility
OP
|
$1,952.50
|
|
| Hospital Charge Code |
41607798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,815.82 |
| Rate for Payer: Aetna Commercial |
$1,647.91
|
| Rate for Payer: Aetna Medicare |
$644.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$644.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,121.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,220.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$740.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$708.76
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Centivo All Commercial |
$995.78
|
| Rate for Payer: Cigna All Commercial |
$1,685.01
|
| Rate for Payer: CORVEL All Commercial |
$1,815.82
|
| Rate for Payer: Coventry All Commercial |
$1,718.20
|
| Rate for Payer: Encore All Commercial |
$1,797.28
|
| Rate for Payer: Frontpath All Commercial |
$1,796.30
|
| Rate for Payer: Humana ChoiceCare |
$1,686.37
|
| Rate for Payer: Humana Medicare |
$995.78
|
| Rate for Payer: Lucent All Commercial |
$995.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,757.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,464.38
|
| Rate for Payer: PHP All Commercial |
$1,480.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$761.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,507.33
|
| Rate for Payer: Signature Care EPO |
$1,620.58
|
| Rate for Payer: Signature Care PPO |
$1,718.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,659.62
|
| Rate for Payer: United Healthcare Commercial |
$1,538.57
|
| Rate for Payer: United Healthcare Medicare |
$644.32
|
|
|
HC AR SUT TAK INSERT 3.0 S-TAK
|
Facility
IP
|
$1,072.50
|
|
| Hospital Charge Code |
41607801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$804.38 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$926.64
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.18
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
|
|
HC AR SUT TAK INSERT 3.0 S-TAK
|
Facility
OP
|
$1,072.50
|
|
| Hospital Charge Code |
41607801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$905.19
|
| Rate for Payer: Aetna Medicare |
$353.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$615.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$670.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$407.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$389.32
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Centivo All Commercial |
$546.98
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Humana Medicare |
$546.98
|
| Rate for Payer: Lucent All Commercial |
$546.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$418.28
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.18
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$911.62
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
| Rate for Payer: United Healthcare Medicare |
$353.92
|
|
|
HC AR SUTURE ANCHOR PEEK 4.75X14
|
Facility
OP
|
$1,732.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,611.22 |
| Rate for Payer: Aetna Commercial |
$1,462.23
|
| Rate for Payer: Aetna Medicare |
$571.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$571.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$994.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,082.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$657.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$628.90
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Centivo All Commercial |
$883.58
|
| Rate for Payer: Cigna All Commercial |
$1,495.15
|
| Rate for Payer: CORVEL All Commercial |
$1,611.22
|
| Rate for Payer: Coventry All Commercial |
$1,524.60
|
| Rate for Payer: Encore All Commercial |
$1,594.77
|
| Rate for Payer: Frontpath All Commercial |
$1,593.90
|
| Rate for Payer: Humana ChoiceCare |
$1,496.36
|
| Rate for Payer: Humana Medicare |
$883.58
|
| Rate for Payer: Lucent All Commercial |
$883.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,559.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,299.38
|
| Rate for Payer: PHP All Commercial |
$1,313.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$675.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,337.49
|
| Rate for Payer: Signature Care EPO |
$1,437.98
|
| Rate for Payer: Signature Care PPO |
$1,524.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,472.62
|
| Rate for Payer: United Healthcare Commercial |
$1,365.21
|
| Rate for Payer: United Healthcare Medicare |
$571.72
|
|
|
HC AR SUTURE ANCHOR PEEK 4.75X14
|
Facility
IP
|
$1,732.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,299.38 |
| Max. Negotiated Rate |
$1,611.22 |
| Rate for Payer: Aetna Commercial |
$1,496.88
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cigna All Commercial |
$1,495.15
|
| Rate for Payer: CORVEL All Commercial |
$1,611.22
|
| Rate for Payer: Coventry All Commercial |
$1,524.60
|
| Rate for Payer: Encore All Commercial |
$1,594.77
|
| Rate for Payer: Frontpath All Commercial |
$1,593.90
|
| Rate for Payer: Humana ChoiceCare |
$1,496.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,559.25
|
| Rate for Payer: PHCS All Commercial |
$1,299.38
|
| Rate for Payer: PHP All Commercial |
$1,313.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,337.49
|
| Rate for Payer: Signature Care EPO |
$1,437.98
|
| Rate for Payer: Signature Care PPO |
$1,524.60
|
| Rate for Payer: United Healthcare Commercial |
$1,365.21
|
|
|
HC AR SUTURE FIBERLINK
|
Facility
IP
|
$731.50
|
|
| Hospital Charge Code |
41606312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$680.30 |
| Rate for Payer: Aetna Commercial |
$632.02
|
| Rate for Payer: Cash Price |
$453.53
|
| Rate for Payer: Cigna All Commercial |
$631.28
|
| Rate for Payer: CORVEL All Commercial |
$680.30
|
| Rate for Payer: Coventry All Commercial |
$643.72
|
| Rate for Payer: Encore All Commercial |
$673.35
|
| Rate for Payer: Frontpath All Commercial |
$672.98
|
| Rate for Payer: Humana ChoiceCare |
$631.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$658.35
|
| Rate for Payer: PHCS All Commercial |
$548.62
|
| Rate for Payer: PHP All Commercial |
$554.77
|
| Rate for Payer: Sagamore Health Network All Products |
$564.72
|
| Rate for Payer: Signature Care EPO |
$607.14
|
| Rate for Payer: Signature Care PPO |
$643.72
|
| Rate for Payer: United Healthcare Commercial |
$576.42
|
|
|
HC AR SUTURE FIBERLINK
|
Facility
OP
|
$731.50
|
|
| Hospital Charge Code |
41606312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$680.30 |
| Rate for Payer: Aetna Commercial |
$617.39
|
| Rate for Payer: Aetna Medicare |
$241.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$241.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$420.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$457.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$277.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$265.53
|
| Rate for Payer: Cash Price |
$453.53
|
| Rate for Payer: Cash Price |
$453.53
|
| Rate for Payer: Centivo All Commercial |
$373.06
|
| Rate for Payer: Cigna All Commercial |
$631.28
|
| Rate for Payer: CORVEL All Commercial |
$680.30
|
| Rate for Payer: Coventry All Commercial |
$643.72
|
| Rate for Payer: Encore All Commercial |
$673.35
|
| Rate for Payer: Frontpath All Commercial |
$672.98
|
| Rate for Payer: Humana ChoiceCare |
$631.80
|
| Rate for Payer: Humana Medicare |
$373.06
|
| Rate for Payer: Lucent All Commercial |
$373.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$658.35
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$548.62
|
| Rate for Payer: PHP All Commercial |
$554.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$285.28
|
| Rate for Payer: Sagamore Health Network All Products |
$564.72
|
| Rate for Payer: Signature Care EPO |
$607.14
|
| Rate for Payer: Signature Care PPO |
$643.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$621.78
|
| Rate for Payer: United Healthcare Commercial |
$576.42
|
| Rate for Payer: United Healthcare Medicare |
$241.40
|
|
|
HC AR SUTURE FIBERLINK 1.3
|
Facility
IP
|
$654.50
|
|
| Hospital Charge Code |
41606209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.88 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$565.49
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
|
|
HC AR SUTURE FIBERLINK 1.3
|
Facility
OP
|
$654.50
|
|
| Hospital Charge Code |
41606209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$552.40
|
| Rate for Payer: Aetna Medicare |
$215.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$215.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$375.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.58
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Centivo All Commercial |
$333.80
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Humana Medicare |
$333.80
|
| Rate for Payer: Lucent All Commercial |
$333.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.26
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.32
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
| Rate for Payer: United Healthcare Medicare |
$215.98
|
|
|
HC AR SUTURE FIBERTAPE #2
|
Facility
IP
|
$577.50
|
|
| Hospital Charge Code |
41606201
|
|
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 SUTURE FIBERTAPE #2
|
Facility
OP
|
$577.50
|
|
| Hospital Charge Code |
41606201
|
|
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 SUTURELASSO 25 CURVE L
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41607702
|
|
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 SUTURELASSO 25 CURVE L
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41607702
|
|
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 SUTURELASSO 25 CURVE R
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41607627
|
|
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 SUTURELASSO 25 CURVE R
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41607627
|
|
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 SUTURE LASSO 45-CURVE L
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41607615
|
|
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 SUTURE LASSO 45-CURVE L
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41607615
|
|
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 SUTURELASSO 45 CURVE R
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41607390
|
|
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 SUTURELASSO 45 CURVE R
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41607390
|
|
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 SUTURE LASSO CRESCENT
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41607869
|
|
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 SUTURE LASSO CRESCENT
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41607869
|
|
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 SUTURE MENISCUS REPAIR
|
Facility
IP
|
$885.50
|
|
| Hospital Charge Code |
41606311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$664.12 |
| Max. Negotiated Rate |
$823.52 |
| Rate for Payer: Aetna Commercial |
$765.07
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Cigna All Commercial |
$764.19
|
| Rate for Payer: CORVEL All Commercial |
$823.52
|
| Rate for Payer: Coventry All Commercial |
$779.24
|
| Rate for Payer: Encore All Commercial |
$815.10
|
| Rate for Payer: Frontpath All Commercial |
$814.66
|
| Rate for Payer: Humana ChoiceCare |
$764.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.95
|
| Rate for Payer: PHCS All Commercial |
$664.12
|
| Rate for Payer: PHP All Commercial |
$671.56
|
| Rate for Payer: Sagamore Health Network All Products |
$683.61
|
| Rate for Payer: Signature Care EPO |
$734.96
|
| Rate for Payer: Signature Care PPO |
$779.24
|
| Rate for Payer: United Healthcare Commercial |
$697.77
|
|
|
HC AR SUTURE MENISCUS REPAIR
|
Facility
OP
|
$885.50
|
|
| Hospital Charge Code |
41606311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$823.52 |
| Rate for Payer: Aetna Commercial |
$747.36
|
| Rate for Payer: Aetna Medicare |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$508.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$553.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$336.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.44
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Centivo All Commercial |
$451.60
|
| Rate for Payer: Cigna All Commercial |
$764.19
|
| Rate for Payer: CORVEL All Commercial |
$823.52
|
| Rate for Payer: Coventry All Commercial |
$779.24
|
| Rate for Payer: Encore All Commercial |
$815.10
|
| Rate for Payer: Frontpath All Commercial |
$814.66
|
| Rate for Payer: Humana ChoiceCare |
$764.81
|
| Rate for Payer: Humana Medicare |
$451.60
|
| Rate for Payer: Lucent All Commercial |
$451.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$664.12
|
| Rate for Payer: PHP All Commercial |
$671.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.34
|
| Rate for Payer: Sagamore Health Network All Products |
$683.61
|
| Rate for Payer: Signature Care EPO |
$734.96
|
| Rate for Payer: Signature Care PPO |
$779.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$752.68
|
| Rate for Payer: United Healthcare Commercial |
$697.77
|
| Rate for Payer: United Healthcare Medicare |
$292.22
|
|
