|
HC AR SUTURE PASSER SWIFT
|
Facility
IP
|
$1,320.00
|
|
| Hospital Charge Code |
41607916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$990.00 |
| Max. Negotiated Rate |
$1,227.60 |
| Rate for Payer: Aetna Commercial |
$1,140.48
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna All Commercial |
$1,139.16
|
| Rate for Payer: CORVEL All Commercial |
$1,227.60
|
| Rate for Payer: Coventry All Commercial |
$1,161.60
|
| Rate for Payer: Encore All Commercial |
$1,215.06
|
| Rate for Payer: Frontpath All Commercial |
$1,214.40
|
| Rate for Payer: Humana ChoiceCare |
$1,140.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,188.00
|
| Rate for Payer: PHCS All Commercial |
$990.00
|
| Rate for Payer: PHP All Commercial |
$1,001.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,019.04
|
| Rate for Payer: Signature Care EPO |
$1,095.60
|
| Rate for Payer: Signature Care PPO |
$1,161.60
|
| Rate for Payer: United Healthcare Commercial |
$1,040.16
|
|
|
HC AR SUTURE PASSER SWIFT
|
Facility
OP
|
$1,320.00
|
|
| Hospital Charge Code |
41607916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,227.60 |
| Rate for Payer: Aetna Commercial |
$1,114.08
|
| Rate for Payer: Aetna Medicare |
$435.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$435.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$758.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$825.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$500.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$479.16
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Centivo All Commercial |
$673.20
|
| Rate for Payer: Cigna All Commercial |
$1,139.16
|
| Rate for Payer: CORVEL All Commercial |
$1,227.60
|
| Rate for Payer: Coventry All Commercial |
$1,161.60
|
| Rate for Payer: Encore All Commercial |
$1,215.06
|
| Rate for Payer: Frontpath All Commercial |
$1,214.40
|
| Rate for Payer: Humana ChoiceCare |
$1,140.08
|
| Rate for Payer: Humana Medicare |
$673.20
|
| Rate for Payer: Lucent All Commercial |
$673.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,188.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$990.00
|
| Rate for Payer: PHP All Commercial |
$1,001.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$514.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,019.04
|
| Rate for Payer: Signature Care EPO |
$1,095.60
|
| Rate for Payer: Signature Care PPO |
$1,161.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare Commercial |
$1,040.16
|
| Rate for Payer: United Healthcare Medicare |
$435.60
|
|
|
HC AR SUTURETAK KIT
|
Facility
IP
|
$797.50
|
|
| Hospital Charge Code |
41607030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.12 |
| Max. Negotiated Rate |
$741.68 |
| Rate for Payer: Aetna Commercial |
$689.04
|
| Rate for Payer: Cash Price |
$494.45
|
| Rate for Payer: Cigna All Commercial |
$688.24
|
| Rate for Payer: CORVEL All Commercial |
$741.68
|
| Rate for Payer: Coventry All Commercial |
$701.80
|
| Rate for Payer: Encore All Commercial |
$734.10
|
| Rate for Payer: Frontpath All Commercial |
$733.70
|
| Rate for Payer: Humana ChoiceCare |
$688.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$717.75
|
| Rate for Payer: PHCS All Commercial |
$598.12
|
| Rate for Payer: PHP All Commercial |
$604.82
|
| Rate for Payer: Sagamore Health Network All Products |
$615.67
|
| Rate for Payer: Signature Care EPO |
$661.92
|
| Rate for Payer: Signature Care PPO |
$701.80
|
| Rate for Payer: United Healthcare Commercial |
$628.43
|
|
|
HC AR SUTURETAK KIT
|
Facility
OP
|
$797.50
|
|
| Hospital Charge Code |
41607030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$741.68 |
| Rate for Payer: Aetna Commercial |
$673.09
|
| Rate for Payer: Aetna Medicare |
$263.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$263.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$458.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$498.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$302.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$289.49
|
| Rate for Payer: Cash Price |
$494.45
|
| Rate for Payer: Cash Price |
$494.45
|
| Rate for Payer: Centivo All Commercial |
$406.72
|
| Rate for Payer: Cigna All Commercial |
$688.24
|
| Rate for Payer: CORVEL All Commercial |
$741.68
|
| Rate for Payer: Coventry All Commercial |
$701.80
|
| Rate for Payer: Encore All Commercial |
$734.10
|
| Rate for Payer: Frontpath All Commercial |
$733.70
|
| Rate for Payer: Humana ChoiceCare |
$688.80
|
| Rate for Payer: Humana Medicare |
$406.72
|
| Rate for Payer: Lucent All Commercial |
$406.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$717.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$598.12
|
| Rate for Payer: PHP All Commercial |
$604.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$311.02
|
| Rate for Payer: Sagamore Health Network All Products |
$615.67
|
| Rate for Payer: Signature Care EPO |
$661.92
|
| Rate for Payer: Signature Care PPO |
$701.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$677.88
|
| Rate for Payer: United Healthcare Commercial |
$628.43
|
| Rate for Payer: United Healthcare Medicare |
$263.18
|
|
|
HC AR SUTURE TAPE
|
Facility
IP
|
$269.50
|
|
| Hospital Charge Code |
41606190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$250.64 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
|
|
HC AR SUTURE TAPE
|
Facility
OP
|
$269.50
|
|
| Hospital Charge Code |
41606190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$250.64 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.83
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Centivo All Commercial |
$137.44
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Humana Medicare |
$137.44
|
| Rate for Payer: Lucent All Commercial |
$137.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.10
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.08
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
|
|
HC AR SUTURE TIGERLINK
|
Facility
IP
|
$731.50
|
|
| Hospital Charge Code |
41606313
|
|
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 TIGERLINK
|
Facility
OP
|
$731.50
|
|
| Hospital Charge Code |
41606313
|
|
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 TIGERLINK 1.3
|
Facility
IP
|
$654.50
|
|
| Hospital Charge Code |
41606541
|
|
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 TIGERLINK 1.3
|
Facility
OP
|
$654.50
|
|
| Hospital Charge Code |
41606541
|
|
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 TIGER LOOP
|
Facility
IP
|
$539.00
|
|
| Hospital Charge Code |
41605856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$404.25 |
| Max. Negotiated Rate |
$501.27 |
| Rate for Payer: Aetna Commercial |
$465.70
|
| Rate for Payer: Cash Price |
$334.18
|
| Rate for Payer: Cigna All Commercial |
$465.16
|
| Rate for Payer: CORVEL All Commercial |
$501.27
|
| Rate for Payer: Coventry All Commercial |
$474.32
|
| Rate for Payer: Encore All Commercial |
$496.15
|
| Rate for Payer: Frontpath All Commercial |
$495.88
|
| Rate for Payer: Humana ChoiceCare |
$465.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.10
|
| Rate for Payer: PHCS All Commercial |
$404.25
|
| Rate for Payer: PHP All Commercial |
$408.78
|
| Rate for Payer: Sagamore Health Network All Products |
$416.11
|
| Rate for Payer: Signature Care EPO |
$447.37
|
| Rate for Payer: Signature Care PPO |
$474.32
|
| Rate for Payer: United Healthcare Commercial |
$424.73
|
|
|
HC AR SUTURE TIGER LOOP
|
Facility
OP
|
$539.00
|
|
| Hospital Charge Code |
41605856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$501.27 |
| Rate for Payer: Aetna Commercial |
$454.92
|
| Rate for Payer: Aetna Medicare |
$177.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$309.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$204.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$195.66
|
| Rate for Payer: Cash Price |
$334.18
|
| Rate for Payer: Cash Price |
$334.18
|
| Rate for Payer: Centivo All Commercial |
$274.89
|
| Rate for Payer: Cigna All Commercial |
$465.16
|
| Rate for Payer: CORVEL All Commercial |
$501.27
|
| Rate for Payer: Coventry All Commercial |
$474.32
|
| Rate for Payer: Encore All Commercial |
$496.15
|
| Rate for Payer: Frontpath All Commercial |
$495.88
|
| Rate for Payer: Humana ChoiceCare |
$465.53
|
| Rate for Payer: Humana Medicare |
$274.89
|
| Rate for Payer: Lucent All Commercial |
$274.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$404.25
|
| Rate for Payer: PHP All Commercial |
$408.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.21
|
| Rate for Payer: Sagamore Health Network All Products |
$416.11
|
| Rate for Payer: Signature Care EPO |
$447.37
|
| Rate for Payer: Signature Care PPO |
$474.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$458.15
|
| Rate for Payer: United Healthcare Commercial |
$424.73
|
| Rate for Payer: United Healthcare Medicare |
$177.87
|
|
|
HC AR SUTURE TIGERTAPE 1.7
|
Facility
IP
|
$584.50
|
|
| Hospital Charge Code |
41608164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.38 |
| Max. Negotiated Rate |
$543.58 |
| Rate for Payer: Aetna Commercial |
$505.01
|
| Rate for Payer: Cash Price |
$362.39
|
| Rate for Payer: Cigna All Commercial |
$504.42
|
| Rate for Payer: CORVEL All Commercial |
$543.58
|
| Rate for Payer: Coventry All Commercial |
$514.36
|
| Rate for Payer: Encore All Commercial |
$538.03
|
| Rate for Payer: Frontpath All Commercial |
$537.74
|
| Rate for Payer: Humana ChoiceCare |
$504.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.05
|
| Rate for Payer: PHCS All Commercial |
$438.38
|
| Rate for Payer: PHP All Commercial |
$443.28
|
| Rate for Payer: Sagamore Health Network All Products |
$451.23
|
| Rate for Payer: Signature Care EPO |
$485.14
|
| Rate for Payer: Signature Care PPO |
$514.36
|
| Rate for Payer: United Healthcare Commercial |
$460.59
|
|
|
HC AR SUTURE TIGERTAPE 1.7
|
Facility
OP
|
$584.50
|
|
| Hospital Charge Code |
41608164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$543.58 |
| Rate for Payer: Aetna Commercial |
$493.32
|
| Rate for Payer: Aetna Medicare |
$192.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$335.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$365.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$212.17
|
| Rate for Payer: Cash Price |
$362.39
|
| Rate for Payer: Cash Price |
$362.39
|
| Rate for Payer: Centivo All Commercial |
$298.10
|
| Rate for Payer: Cigna All Commercial |
$504.42
|
| Rate for Payer: CORVEL All Commercial |
$543.58
|
| Rate for Payer: Coventry All Commercial |
$514.36
|
| Rate for Payer: Encore All Commercial |
$538.03
|
| Rate for Payer: Frontpath All Commercial |
$537.74
|
| Rate for Payer: Humana ChoiceCare |
$504.83
|
| Rate for Payer: Humana Medicare |
$298.10
|
| Rate for Payer: Lucent All Commercial |
$298.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$438.38
|
| Rate for Payer: PHP All Commercial |
$443.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.96
|
| Rate for Payer: Sagamore Health Network All Products |
$451.23
|
| Rate for Payer: Signature Care EPO |
$485.14
|
| Rate for Payer: Signature Care PPO |
$514.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$496.82
|
| Rate for Payer: United Healthcare Commercial |
$460.59
|
| Rate for Payer: United Healthcare Medicare |
$192.88
|
|
|
HC AR SUTURE TIGERTAPE #2
|
Facility
OP
|
$385.00
|
|
| Hospital Charge Code |
41606207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Aetna Medicare |
$127.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$127.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$221.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.76
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Centivo All Commercial |
$196.35
|
| Rate for Payer: Cigna All Commercial |
$332.26
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Humana Medicare |
$196.35
|
| Rate for Payer: Lucent All Commercial |
$196.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.15
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.25
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
| Rate for Payer: United Healthcare Medicare |
$127.05
|
|
|
HC AR SUTURE TIGERTAPE #2
|
Facility
IP
|
$385.00
|
|
| Hospital Charge Code |
41606207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cigna All Commercial |
$332.26
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
|
|
HC AR SWIVELLOCK 3.5X13.5
|
Facility
OP
|
$2,552.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,373.73 |
| Rate for Payer: Centivo All Commercial |
$1,301.72
|
| Rate for Payer: Cigna All Commercial |
$2,202.72
|
| Rate for Payer: CORVEL All Commercial |
$2,373.73
|
| Rate for Payer: Coventry All Commercial |
$2,246.11
|
| Rate for Payer: Encore All Commercial |
$2,349.48
|
| Rate for Payer: Frontpath All Commercial |
$2,348.21
|
| Rate for Payer: Humana ChoiceCare |
$2,204.51
|
| Rate for Payer: Humana Medicare |
$1,301.72
|
| Rate for Payer: Lucent All Commercial |
$1,301.72
|
| Rate for Payer: Aetna Commercial |
$2,154.23
|
| Rate for Payer: Aetna Medicare |
$842.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$842.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,465.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,595.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$968.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$926.52
|
| Rate for Payer: Cash Price |
$1,582.49
|
| Rate for Payer: Cash Price |
$1,582.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,297.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,914.30
|
| Rate for Payer: PHP All Commercial |
$1,935.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$995.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,970.45
|
| Rate for Payer: Signature Care EPO |
$2,118.49
|
| Rate for Payer: Signature Care PPO |
$2,246.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,169.54
|
| Rate for Payer: United Healthcare Commercial |
$2,011.29
|
| Rate for Payer: United Healthcare Medicare |
$842.29
|
|
|
HC AR SWIVELLOCK 3.5X13.5
|
Facility
IP
|
$2,552.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,914.30 |
| Max. Negotiated Rate |
$2,373.73 |
| Rate for Payer: Aetna Commercial |
$2,205.27
|
| Rate for Payer: Cash Price |
$1,582.49
|
| Rate for Payer: Cigna All Commercial |
$2,202.72
|
| Rate for Payer: CORVEL All Commercial |
$2,373.73
|
| Rate for Payer: Coventry All Commercial |
$2,246.11
|
| Rate for Payer: Encore All Commercial |
$2,349.48
|
| Rate for Payer: Frontpath All Commercial |
$2,348.21
|
| Rate for Payer: Humana ChoiceCare |
$2,204.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,297.16
|
| Rate for Payer: PHCS All Commercial |
$1,914.30
|
| Rate for Payer: PHP All Commercial |
$1,935.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,970.45
|
| Rate for Payer: Signature Care EPO |
$2,118.49
|
| Rate for Payer: Signature Care PPO |
$2,246.11
|
| Rate for Payer: United Healthcare Commercial |
$2,011.29
|
|
|
HC AR SWIVELOCK 3.9X17.9
|
Facility
IP
|
$2,200.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$2,046.00 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cigna All Commercial |
$1,898.60
|
| Rate for Payer: CORVEL All Commercial |
$2,046.00
|
| Rate for Payer: Coventry All Commercial |
$1,936.00
|
| Rate for Payer: Encore All Commercial |
$2,025.10
|
| Rate for Payer: Frontpath All Commercial |
$2,024.00
|
| Rate for Payer: Humana ChoiceCare |
$1,900.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,980.00
|
| Rate for Payer: PHCS All Commercial |
$1,650.00
|
| Rate for Payer: PHP All Commercial |
$1,668.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,698.40
|
| Rate for Payer: Signature Care EPO |
$1,826.00
|
| Rate for Payer: Signature Care PPO |
$1,936.00
|
| Rate for Payer: United Healthcare Commercial |
$1,733.60
|
|
|
HC AR SWIVELOCK 3.9X17.9
|
Facility
OP
|
$2,200.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,046.00 |
| Rate for Payer: Aetna Commercial |
$1,856.80
|
| Rate for Payer: Aetna Medicare |
$726.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$726.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,263.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,375.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$834.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$798.60
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Centivo All Commercial |
$1,122.00
|
| Rate for Payer: Cigna All Commercial |
$1,898.60
|
| Rate for Payer: CORVEL All Commercial |
$2,046.00
|
| Rate for Payer: Coventry All Commercial |
$1,936.00
|
| Rate for Payer: Encore All Commercial |
$2,025.10
|
| Rate for Payer: Frontpath All Commercial |
$2,024.00
|
| Rate for Payer: Humana ChoiceCare |
$1,900.14
|
| Rate for Payer: Humana Medicare |
$1,122.00
|
| Rate for Payer: Lucent All Commercial |
$1,122.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,980.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,650.00
|
| Rate for Payer: PHP All Commercial |
$1,668.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$858.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,698.40
|
| Rate for Payer: Signature Care EPO |
$1,826.00
|
| Rate for Payer: Signature Care PPO |
$1,936.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,733.60
|
| Rate for Payer: United Healthcare Medicare |
$726.00
|
|
|
HC AR SWVLCK MENISCAL REPAIR KIT
|
Facility
IP
|
$8,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,277.50 |
| Max. Negotiated Rate |
$7,784.10 |
| Rate for Payer: Aetna Commercial |
$7,231.68
|
| Rate for Payer: Cash Price |
$5,189.40
|
| Rate for Payer: Cigna All Commercial |
$7,223.31
|
| Rate for Payer: CORVEL All Commercial |
$7,784.10
|
| Rate for Payer: Coventry All Commercial |
$7,365.60
|
| Rate for Payer: Encore All Commercial |
$7,704.58
|
| Rate for Payer: Frontpath All Commercial |
$7,700.40
|
| Rate for Payer: Humana ChoiceCare |
$7,229.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,533.00
|
| Rate for Payer: PHCS All Commercial |
$6,277.50
|
| Rate for Payer: PHP All Commercial |
$6,347.81
|
| Rate for Payer: Sagamore Health Network All Products |
$6,461.64
|
| Rate for Payer: Signature Care EPO |
$6,947.10
|
| Rate for Payer: Signature Care PPO |
$7,365.60
|
| Rate for Payer: United Healthcare Commercial |
$6,595.56
|
|
|
HC AR SWVLCK MENISCAL REPAIR KIT
|
Facility
OP
|
$8,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,784.10 |
| Rate for Payer: Aetna Commercial |
$7,064.28
|
| Rate for Payer: Aetna Medicare |
$2,762.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,762.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,806.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,232.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,176.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,038.31
|
| Rate for Payer: Cash Price |
$5,189.40
|
| Rate for Payer: Cash Price |
$5,189.40
|
| Rate for Payer: Centivo All Commercial |
$4,268.70
|
| Rate for Payer: Cigna All Commercial |
$7,223.31
|
| Rate for Payer: CORVEL All Commercial |
$7,784.10
|
| Rate for Payer: Coventry All Commercial |
$7,365.60
|
| Rate for Payer: Encore All Commercial |
$7,704.58
|
| Rate for Payer: Frontpath All Commercial |
$7,700.40
|
| Rate for Payer: Humana ChoiceCare |
$7,229.17
|
| Rate for Payer: Humana Medicare |
$4,268.70
|
| Rate for Payer: Lucent All Commercial |
$4,268.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,533.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,277.50
|
| Rate for Payer: PHP All Commercial |
$6,347.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,264.30
|
| Rate for Payer: Sagamore Health Network All Products |
$6,461.64
|
| Rate for Payer: Signature Care EPO |
$6,947.10
|
| Rate for Payer: Signature Care PPO |
$7,365.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,114.50
|
| Rate for Payer: United Healthcare Commercial |
$6,595.56
|
| Rate for Payer: United Healthcare Medicare |
$2,762.10
|
|
|
HC AR SYN T-ROPE W/DRV
|
Facility
IP
|
$5,920.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,440.15 |
| Max. Negotiated Rate |
$5,505.79 |
| Rate for Payer: Aetna Commercial |
$5,115.05
|
| Rate for Payer: Cash Price |
$3,670.52
|
| Rate for Payer: Cigna All Commercial |
$5,109.13
|
| Rate for Payer: CORVEL All Commercial |
$5,505.79
|
| Rate for Payer: Coventry All Commercial |
$5,209.78
|
| Rate for Payer: Encore All Commercial |
$5,449.54
|
| Rate for Payer: Frontpath All Commercial |
$5,446.58
|
| Rate for Payer: Humana ChoiceCare |
$5,113.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,328.18
|
| Rate for Payer: PHCS All Commercial |
$4,440.15
|
| Rate for Payer: PHP All Commercial |
$4,489.88
|
| Rate for Payer: Sagamore Health Network All Products |
$4,570.39
|
| Rate for Payer: Signature Care EPO |
$4,913.77
|
| Rate for Payer: Signature Care PPO |
$5,209.78
|
| Rate for Payer: United Healthcare Commercial |
$4,665.12
|
|
|
HC AR SYN T-ROPE W/DRV
|
Facility
OP
|
$5,920.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,505.79 |
| Rate for Payer: Aetna Commercial |
$4,996.65
|
| Rate for Payer: Aetna Medicare |
$1,953.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,953.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,399.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,700.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,246.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,149.03
|
| Rate for Payer: Cash Price |
$3,670.52
|
| Rate for Payer: Cash Price |
$3,670.52
|
| Rate for Payer: Centivo All Commercial |
$3,019.30
|
| Rate for Payer: Cigna All Commercial |
$5,109.13
|
| Rate for Payer: CORVEL All Commercial |
$5,505.79
|
| Rate for Payer: Coventry All Commercial |
$5,209.78
|
| Rate for Payer: Encore All Commercial |
$5,449.54
|
| Rate for Payer: Frontpath All Commercial |
$5,446.58
|
| Rate for Payer: Humana ChoiceCare |
$5,113.28
|
| Rate for Payer: Humana Medicare |
$3,019.30
|
| Rate for Payer: Lucent All Commercial |
$3,019.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,328.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,440.15
|
| Rate for Payer: PHP All Commercial |
$4,489.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,308.88
|
| Rate for Payer: Sagamore Health Network All Products |
$4,570.39
|
| Rate for Payer: Signature Care EPO |
$4,913.77
|
| Rate for Payer: Signature Care PPO |
$5,209.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,032.17
|
| Rate for Payer: United Healthcare Commercial |
$4,665.12
|
| Rate for Payer: United Healthcare Medicare |
$1,953.67
|
|
|
HC AR TENODESIS SCREW 7X10
|
Facility
OP
|
$1,732.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607878
|
|
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
|
|
