|
HC BLADE GLIDESCOPE GVL 3
|
Facility
IP
|
$136.71
|
|
| Hospital Charge Code |
41601226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.53 |
| Max. Negotiated Rate |
$127.14 |
| Rate for Payer: Aetna Commercial |
$118.12
|
| Rate for Payer: Cash Price |
$84.76
|
| Rate for Payer: Cigna All Commercial |
$117.98
|
| Rate for Payer: CORVEL All Commercial |
$127.14
|
| Rate for Payer: Coventry All Commercial |
$120.30
|
| Rate for Payer: Encore All Commercial |
$125.84
|
| Rate for Payer: Frontpath All Commercial |
$125.77
|
| Rate for Payer: Humana ChoiceCare |
$118.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.04
|
| Rate for Payer: PHCS All Commercial |
$102.53
|
| Rate for Payer: PHP All Commercial |
$103.68
|
| Rate for Payer: Sagamore Health Network All Products |
$105.54
|
| Rate for Payer: Signature Care EPO |
$113.47
|
| Rate for Payer: Signature Care PPO |
$120.30
|
| Rate for Payer: United Healthcare Commercial |
$107.73
|
|
|
HC BLADE GLIDESCOPE GVL 4
|
Facility
OP
|
$136.71
|
|
| Hospital Charge Code |
41601227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.11 |
| Max. Negotiated Rate |
$127.14 |
| Rate for Payer: Aetna Commercial |
$115.38
|
| Rate for Payer: Aetna Medicare |
$45.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.63
|
| Rate for Payer: Cash Price |
$84.76
|
| Rate for Payer: Cash Price |
$84.76
|
| Rate for Payer: Centivo All Commercial |
$69.72
|
| Rate for Payer: Cigna All Commercial |
$117.98
|
| Rate for Payer: CORVEL All Commercial |
$127.14
|
| Rate for Payer: Coventry All Commercial |
$120.30
|
| Rate for Payer: Encore All Commercial |
$125.84
|
| Rate for Payer: Frontpath All Commercial |
$125.77
|
| Rate for Payer: Humana ChoiceCare |
$118.08
|
| Rate for Payer: Humana Medicare |
$69.72
|
| Rate for Payer: Lucent All Commercial |
$69.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.04
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$102.53
|
| Rate for Payer: PHP All Commercial |
$103.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.32
|
| Rate for Payer: Sagamore Health Network All Products |
$105.54
|
| Rate for Payer: Signature Care EPO |
$113.47
|
| Rate for Payer: Signature Care PPO |
$120.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.20
|
| Rate for Payer: United Healthcare Commercial |
$107.73
|
| Rate for Payer: United Healthcare Medicare |
$45.11
|
|
|
HC BLADE GLIDESCOPE GVL 4
|
Facility
IP
|
$136.71
|
|
| Hospital Charge Code |
41601227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.53 |
| Max. Negotiated Rate |
$127.14 |
| Rate for Payer: Aetna Commercial |
$118.12
|
| Rate for Payer: Cash Price |
$84.76
|
| Rate for Payer: Cigna All Commercial |
$117.98
|
| Rate for Payer: CORVEL All Commercial |
$127.14
|
| Rate for Payer: Coventry All Commercial |
$120.30
|
| Rate for Payer: Encore All Commercial |
$125.84
|
| Rate for Payer: Frontpath All Commercial |
$125.77
|
| Rate for Payer: Humana ChoiceCare |
$118.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.04
|
| Rate for Payer: PHCS All Commercial |
$102.53
|
| Rate for Payer: PHP All Commercial |
$103.68
|
| Rate for Payer: Sagamore Health Network All Products |
$105.54
|
| Rate for Payer: Signature Care EPO |
$113.47
|
| Rate for Payer: Signature Care PPO |
$120.30
|
| Rate for Payer: United Healthcare Commercial |
$107.73
|
|
|
HC BLADE INFERIOR TURBINATE 2.9MM
|
Facility
IP
|
$1,160.10
|
|
| Hospital Charge Code |
41602427
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.08 |
| Max. Negotiated Rate |
$1,078.89 |
| Rate for Payer: Aetna Commercial |
$1,002.33
|
| Rate for Payer: Cash Price |
$719.26
|
| Rate for Payer: Cigna All Commercial |
$1,001.17
|
| Rate for Payer: CORVEL All Commercial |
$1,078.89
|
| Rate for Payer: Coventry All Commercial |
$1,020.89
|
| Rate for Payer: Encore All Commercial |
$1,067.87
|
| Rate for Payer: Frontpath All Commercial |
$1,067.29
|
| Rate for Payer: Humana ChoiceCare |
$1,001.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,044.09
|
| Rate for Payer: PHCS All Commercial |
$870.08
|
| Rate for Payer: PHP All Commercial |
$879.82
|
| Rate for Payer: Sagamore Health Network All Products |
$895.60
|
| Rate for Payer: Signature Care EPO |
$962.88
|
| Rate for Payer: Signature Care PPO |
$1,020.89
|
| Rate for Payer: United Healthcare Commercial |
$914.16
|
|
|
HC BLADE INFERIOR TURBINATE 2.9MM
|
Facility
OP
|
$1,160.10
|
|
| Hospital Charge Code |
41602427
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,078.89 |
| Rate for Payer: Aetna Commercial |
$979.12
|
| Rate for Payer: Aetna Medicare |
$382.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$382.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$666.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$725.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$440.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$421.12
|
| Rate for Payer: Cash Price |
$719.26
|
| Rate for Payer: Cash Price |
$719.26
|
| Rate for Payer: Centivo All Commercial |
$591.65
|
| Rate for Payer: Cigna All Commercial |
$1,001.17
|
| Rate for Payer: CORVEL All Commercial |
$1,078.89
|
| Rate for Payer: Coventry All Commercial |
$1,020.89
|
| Rate for Payer: Encore All Commercial |
$1,067.87
|
| Rate for Payer: Frontpath All Commercial |
$1,067.29
|
| Rate for Payer: Humana ChoiceCare |
$1,001.98
|
| Rate for Payer: Humana Medicare |
$591.65
|
| Rate for Payer: Lucent All Commercial |
$591.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,044.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$870.08
|
| Rate for Payer: PHP All Commercial |
$879.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$452.44
|
| Rate for Payer: Sagamore Health Network All Products |
$895.60
|
| Rate for Payer: Signature Care EPO |
$962.88
|
| Rate for Payer: Signature Care PPO |
$1,020.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$986.08
|
| Rate for Payer: United Healthcare Commercial |
$914.16
|
| Rate for Payer: United Healthcare Medicare |
$382.83
|
|
|
HC BLADE INFERIOR TURBINATE 2MM
|
Facility
OP
|
$1,160.10
|
|
| Hospital Charge Code |
41602428
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,078.89 |
| Rate for Payer: Aetna Commercial |
$979.12
|
| Rate for Payer: Aetna Medicare |
$382.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$382.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$666.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$725.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$440.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$421.12
|
| Rate for Payer: Cash Price |
$719.26
|
| Rate for Payer: Cash Price |
$719.26
|
| Rate for Payer: Centivo All Commercial |
$591.65
|
| Rate for Payer: Cigna All Commercial |
$1,001.17
|
| Rate for Payer: CORVEL All Commercial |
$1,078.89
|
| Rate for Payer: Coventry All Commercial |
$1,020.89
|
| Rate for Payer: Encore All Commercial |
$1,067.87
|
| Rate for Payer: Frontpath All Commercial |
$1,067.29
|
| Rate for Payer: Humana ChoiceCare |
$1,001.98
|
| Rate for Payer: Humana Medicare |
$591.65
|
| Rate for Payer: Lucent All Commercial |
$591.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,044.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$870.08
|
| Rate for Payer: PHP All Commercial |
$879.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$452.44
|
| Rate for Payer: Sagamore Health Network All Products |
$895.60
|
| Rate for Payer: Signature Care EPO |
$962.88
|
| Rate for Payer: Signature Care PPO |
$1,020.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$986.08
|
| Rate for Payer: United Healthcare Commercial |
$914.16
|
| Rate for Payer: United Healthcare Medicare |
$382.83
|
|
|
HC BLADE INFERIOR TURBINATE 2MM
|
Facility
IP
|
$1,160.10
|
|
| Hospital Charge Code |
41602428
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.08 |
| Max. Negotiated Rate |
$1,078.89 |
| Rate for Payer: Aetna Commercial |
$1,002.33
|
| Rate for Payer: Cash Price |
$719.26
|
| Rate for Payer: Cigna All Commercial |
$1,001.17
|
| Rate for Payer: CORVEL All Commercial |
$1,078.89
|
| Rate for Payer: Coventry All Commercial |
$1,020.89
|
| Rate for Payer: Encore All Commercial |
$1,067.87
|
| Rate for Payer: Frontpath All Commercial |
$1,067.29
|
| Rate for Payer: Humana ChoiceCare |
$1,001.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,044.09
|
| Rate for Payer: PHCS All Commercial |
$870.08
|
| Rate for Payer: PHP All Commercial |
$879.82
|
| Rate for Payer: Sagamore Health Network All Products |
$895.60
|
| Rate for Payer: Signature Care EPO |
$962.88
|
| Rate for Payer: Signature Care PPO |
$1,020.89
|
| Rate for Payer: United Healthcare Commercial |
$914.16
|
|
|
HC BLADE PEAK SURGICAL PLASMA
|
Facility
OP
|
$1,175.00
|
|
| Hospital Charge Code |
41602429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,092.75 |
| Rate for Payer: Aetna Commercial |
$991.70
|
| Rate for Payer: Aetna Medicare |
$387.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$387.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$674.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$734.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$426.52
|
| Rate for Payer: Cash Price |
$728.50
|
| Rate for Payer: Cash Price |
$728.50
|
| Rate for Payer: Centivo All Commercial |
$599.25
|
| Rate for Payer: Cigna All Commercial |
$1,014.02
|
| Rate for Payer: CORVEL All Commercial |
$1,092.75
|
| Rate for Payer: Coventry All Commercial |
$1,034.00
|
| Rate for Payer: Encore All Commercial |
$1,081.59
|
| Rate for Payer: Frontpath All Commercial |
$1,081.00
|
| Rate for Payer: Humana ChoiceCare |
$1,014.85
|
| Rate for Payer: Humana Medicare |
$599.25
|
| Rate for Payer: Lucent All Commercial |
$599.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,057.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$881.25
|
| Rate for Payer: PHP All Commercial |
$891.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$458.25
|
| Rate for Payer: Sagamore Health Network All Products |
$907.10
|
| Rate for Payer: Signature Care EPO |
$975.25
|
| Rate for Payer: Signature Care PPO |
$1,034.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$998.75
|
| Rate for Payer: United Healthcare Commercial |
$925.90
|
| Rate for Payer: United Healthcare Medicare |
$387.75
|
|
|
HC BLADE PEAK SURGICAL PLASMA
|
Facility
IP
|
$1,175.00
|
|
| Hospital Charge Code |
41602429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$1,092.75 |
| Rate for Payer: Aetna Commercial |
$1,015.20
|
| Rate for Payer: Cash Price |
$728.50
|
| Rate for Payer: Cigna All Commercial |
$1,014.02
|
| Rate for Payer: CORVEL All Commercial |
$1,092.75
|
| Rate for Payer: Coventry All Commercial |
$1,034.00
|
| Rate for Payer: Encore All Commercial |
$1,081.59
|
| Rate for Payer: Frontpath All Commercial |
$1,081.00
|
| Rate for Payer: Humana ChoiceCare |
$1,014.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,057.50
|
| Rate for Payer: PHCS All Commercial |
$881.25
|
| Rate for Payer: PHP All Commercial |
$891.12
|
| Rate for Payer: Sagamore Health Network All Products |
$907.10
|
| Rate for Payer: Signature Care EPO |
$975.25
|
| Rate for Payer: Signature Care PPO |
$1,034.00
|
| Rate for Payer: United Healthcare Commercial |
$925.90
|
|
|
HC BLADE RAD 40 CVD SINUS
|
Facility
OP
|
$949.20
|
|
| Hospital Charge Code |
41602430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$882.76 |
| Rate for Payer: Aetna Commercial |
$801.12
|
| Rate for Payer: Aetna Medicare |
$313.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$313.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$545.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$593.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.56
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Centivo All Commercial |
$484.09
|
| Rate for Payer: Cigna All Commercial |
$819.16
|
| Rate for Payer: CORVEL All Commercial |
$882.76
|
| Rate for Payer: Coventry All Commercial |
$835.30
|
| Rate for Payer: Encore All Commercial |
$873.74
|
| Rate for Payer: Frontpath All Commercial |
$873.26
|
| Rate for Payer: Humana ChoiceCare |
$819.82
|
| Rate for Payer: Humana Medicare |
$484.09
|
| Rate for Payer: Lucent All Commercial |
$484.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$854.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$711.90
|
| Rate for Payer: PHP All Commercial |
$719.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$370.19
|
| Rate for Payer: Sagamore Health Network All Products |
$732.78
|
| Rate for Payer: Signature Care EPO |
$787.84
|
| Rate for Payer: Signature Care PPO |
$835.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$806.82
|
| Rate for Payer: United Healthcare Commercial |
$747.97
|
| Rate for Payer: United Healthcare Medicare |
$313.24
|
|
|
HC BLADE RAD 40 CVD SINUS
|
Facility
IP
|
$949.20
|
|
| Hospital Charge Code |
41602430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$711.90 |
| Max. Negotiated Rate |
$882.76 |
| Rate for Payer: Aetna Commercial |
$820.11
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cigna All Commercial |
$819.16
|
| Rate for Payer: CORVEL All Commercial |
$882.76
|
| Rate for Payer: Coventry All Commercial |
$835.30
|
| Rate for Payer: Encore All Commercial |
$873.74
|
| Rate for Payer: Frontpath All Commercial |
$873.26
|
| Rate for Payer: Humana ChoiceCare |
$819.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$854.28
|
| Rate for Payer: PHCS All Commercial |
$711.90
|
| Rate for Payer: PHP All Commercial |
$719.87
|
| Rate for Payer: Sagamore Health Network All Products |
$732.78
|
| Rate for Payer: Signature Care EPO |
$787.84
|
| Rate for Payer: Signature Care PPO |
$835.30
|
| Rate for Payer: United Healthcare Commercial |
$747.97
|
|
|
HC BLADE RED 40 ADENOID
|
Facility
OP
|
$935.10
|
|
| Hospital Charge Code |
41602431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$869.64 |
| Rate for Payer: Aetna Commercial |
$789.22
|
| Rate for Payer: Aetna Medicare |
$308.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$308.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$537.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$584.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.44
|
| Rate for Payer: Cash Price |
$579.76
|
| Rate for Payer: Cash Price |
$579.76
|
| Rate for Payer: Centivo All Commercial |
$476.90
|
| Rate for Payer: Cigna All Commercial |
$806.99
|
| Rate for Payer: CORVEL All Commercial |
$869.64
|
| Rate for Payer: Coventry All Commercial |
$822.89
|
| Rate for Payer: Encore All Commercial |
$860.76
|
| Rate for Payer: Frontpath All Commercial |
$860.29
|
| Rate for Payer: Humana ChoiceCare |
$807.65
|
| Rate for Payer: Humana Medicare |
$476.90
|
| Rate for Payer: Lucent All Commercial |
$476.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$841.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$701.32
|
| Rate for Payer: PHP All Commercial |
$709.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$364.69
|
| Rate for Payer: Sagamore Health Network All Products |
$721.90
|
| Rate for Payer: Signature Care EPO |
$776.13
|
| Rate for Payer: Signature Care PPO |
$822.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$794.84
|
| Rate for Payer: United Healthcare Commercial |
$736.86
|
| Rate for Payer: United Healthcare Medicare |
$308.58
|
|
|
HC BLADE RED 40 ADENOID
|
Facility
IP
|
$935.10
|
|
| Hospital Charge Code |
41602431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.32 |
| Max. Negotiated Rate |
$869.64 |
| Rate for Payer: Aetna Commercial |
$807.93
|
| Rate for Payer: Cash Price |
$579.76
|
| Rate for Payer: Cigna All Commercial |
$806.99
|
| Rate for Payer: CORVEL All Commercial |
$869.64
|
| Rate for Payer: Coventry All Commercial |
$822.89
|
| Rate for Payer: Encore All Commercial |
$860.76
|
| Rate for Payer: Frontpath All Commercial |
$860.29
|
| Rate for Payer: Humana ChoiceCare |
$807.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$841.59
|
| Rate for Payer: PHCS All Commercial |
$701.32
|
| Rate for Payer: PHP All Commercial |
$709.18
|
| Rate for Payer: Sagamore Health Network All Products |
$721.90
|
| Rate for Payer: Signature Care EPO |
$776.13
|
| Rate for Payer: Signature Care PPO |
$822.89
|
| Rate for Payer: United Healthcare Commercial |
$736.86
|
|
|
HC BLADE SAW LONG NARR
|
Facility
IP
|
$237.30
|
|
| Hospital Charge Code |
41601238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.98 |
| Max. Negotiated Rate |
$220.69 |
| Rate for Payer: Aetna Commercial |
$205.03
|
| Rate for Payer: Cash Price |
$147.13
|
| Rate for Payer: Cigna All Commercial |
$204.79
|
| Rate for Payer: CORVEL All Commercial |
$220.69
|
| Rate for Payer: Coventry All Commercial |
$208.82
|
| Rate for Payer: Encore All Commercial |
$218.43
|
| Rate for Payer: Frontpath All Commercial |
$218.32
|
| Rate for Payer: Humana ChoiceCare |
$204.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.57
|
| Rate for Payer: PHCS All Commercial |
$177.98
|
| Rate for Payer: PHP All Commercial |
$179.97
|
| Rate for Payer: Sagamore Health Network All Products |
$183.20
|
| Rate for Payer: Signature Care EPO |
$196.96
|
| Rate for Payer: Signature Care PPO |
$208.82
|
| Rate for Payer: United Healthcare Commercial |
$186.99
|
|
|
HC BLADE SAW LONG NARR
|
Facility
OP
|
$237.30
|
|
| Hospital Charge Code |
41601238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.31 |
| Max. Negotiated Rate |
$220.69 |
| Rate for Payer: Aetna Commercial |
$200.28
|
| Rate for Payer: Aetna Medicare |
$78.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.14
|
| Rate for Payer: Cash Price |
$147.13
|
| Rate for Payer: Cash Price |
$147.13
|
| Rate for Payer: Centivo All Commercial |
$121.02
|
| Rate for Payer: Cigna All Commercial |
$204.79
|
| Rate for Payer: CORVEL All Commercial |
$220.69
|
| Rate for Payer: Coventry All Commercial |
$208.82
|
| Rate for Payer: Encore All Commercial |
$218.43
|
| Rate for Payer: Frontpath All Commercial |
$218.32
|
| Rate for Payer: Humana ChoiceCare |
$204.96
|
| Rate for Payer: Humana Medicare |
$121.02
|
| Rate for Payer: Lucent All Commercial |
$121.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$177.98
|
| Rate for Payer: PHP All Commercial |
$179.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.55
|
| Rate for Payer: Sagamore Health Network All Products |
$183.20
|
| Rate for Payer: Signature Care EPO |
$196.96
|
| Rate for Payer: Signature Care PPO |
$208.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$201.70
|
| Rate for Payer: United Healthcare Commercial |
$186.99
|
| Rate for Payer: United Healthcare Medicare |
$78.31
|
|
|
HC BLADE SAW MED NARR
|
Facility
OP
|
$229.39
|
|
| Hospital Charge Code |
41601237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.70 |
| Max. Negotiated Rate |
$213.33 |
| Rate for Payer: Aetna Commercial |
$193.61
|
| Rate for Payer: Aetna Medicare |
$75.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$131.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.27
|
| Rate for Payer: Cash Price |
$142.22
|
| Rate for Payer: Cash Price |
$142.22
|
| Rate for Payer: Centivo All Commercial |
$116.99
|
| Rate for Payer: Cigna All Commercial |
$197.96
|
| Rate for Payer: CORVEL All Commercial |
$213.33
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Encore All Commercial |
$211.15
|
| Rate for Payer: Frontpath All Commercial |
$211.04
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Humana Medicare |
$116.99
|
| Rate for Payer: Lucent All Commercial |
$116.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$172.04
|
| Rate for Payer: PHP All Commercial |
$173.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.46
|
| Rate for Payer: Sagamore Health Network All Products |
$177.09
|
| Rate for Payer: Signature Care EPO |
$190.39
|
| Rate for Payer: Signature Care PPO |
$201.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194.98
|
| Rate for Payer: United Healthcare Commercial |
$180.76
|
| Rate for Payer: United Healthcare Medicare |
$75.70
|
|
|
HC BLADE SAW MED NARR
|
Facility
IP
|
$229.39
|
|
| Hospital Charge Code |
41601237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$213.33 |
| Rate for Payer: Aetna Commercial |
$198.19
|
| Rate for Payer: Cash Price |
$142.22
|
| Rate for Payer: Cigna All Commercial |
$197.96
|
| Rate for Payer: CORVEL All Commercial |
$213.33
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Encore All Commercial |
$211.15
|
| Rate for Payer: Frontpath All Commercial |
$211.04
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.45
|
| Rate for Payer: PHCS All Commercial |
$172.04
|
| Rate for Payer: PHP All Commercial |
$173.97
|
| Rate for Payer: Sagamore Health Network All Products |
$177.09
|
| Rate for Payer: Signature Care EPO |
$190.39
|
| Rate for Payer: Signature Care PPO |
$201.86
|
| Rate for Payer: United Healthcare Commercial |
$180.76
|
|
|
HC BLADE SAW MICRO SAG 9.5X2.5
|
Facility
OP
|
$553.00
|
|
| Hospital Charge Code |
41602410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$514.29 |
| Rate for Payer: Aetna Commercial |
$466.73
|
| Rate for Payer: Aetna Medicare |
$182.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$182.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$317.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$345.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$209.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$200.74
|
| Rate for Payer: Cash Price |
$342.86
|
| Rate for Payer: Cash Price |
$342.86
|
| Rate for Payer: Centivo All Commercial |
$282.03
|
| Rate for Payer: Cigna All Commercial |
$477.24
|
| Rate for Payer: CORVEL All Commercial |
$514.29
|
| Rate for Payer: Coventry All Commercial |
$486.64
|
| Rate for Payer: Encore All Commercial |
$509.04
|
| Rate for Payer: Frontpath All Commercial |
$508.76
|
| Rate for Payer: Humana ChoiceCare |
$477.63
|
| Rate for Payer: Humana Medicare |
$282.03
|
| Rate for Payer: Lucent All Commercial |
$282.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$497.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$414.75
|
| Rate for Payer: PHP All Commercial |
$419.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$215.67
|
| Rate for Payer: Sagamore Health Network All Products |
$426.92
|
| Rate for Payer: Signature Care EPO |
$458.99
|
| Rate for Payer: Signature Care PPO |
$486.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$470.05
|
| Rate for Payer: United Healthcare Commercial |
$435.76
|
| Rate for Payer: United Healthcare Medicare |
$182.49
|
|
|
HC BLADE SAW MICRO SAG 9.5X2.5
|
Facility
IP
|
$553.00
|
|
| Hospital Charge Code |
41602410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.75 |
| Max. Negotiated Rate |
$514.29 |
| Rate for Payer: Aetna Commercial |
$477.79
|
| Rate for Payer: Cash Price |
$342.86
|
| Rate for Payer: Cigna All Commercial |
$477.24
|
| Rate for Payer: CORVEL All Commercial |
$514.29
|
| Rate for Payer: Coventry All Commercial |
$486.64
|
| Rate for Payer: Encore All Commercial |
$509.04
|
| Rate for Payer: Frontpath All Commercial |
$508.76
|
| Rate for Payer: Humana ChoiceCare |
$477.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$497.70
|
| Rate for Payer: PHCS All Commercial |
$414.75
|
| Rate for Payer: PHP All Commercial |
$419.40
|
| Rate for Payer: Sagamore Health Network All Products |
$426.92
|
| Rate for Payer: Signature Care EPO |
$458.99
|
| Rate for Payer: Signature Care PPO |
$486.64
|
| Rate for Payer: United Healthcare Commercial |
$435.76
|
|
|
HC BLADE SAW PREC THIN 9X.38X18.5
|
Facility
OP
|
$229.39
|
|
| Hospital Charge Code |
41601899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.70 |
| Max. Negotiated Rate |
$213.33 |
| Rate for Payer: Aetna Commercial |
$193.61
|
| Rate for Payer: Aetna Medicare |
$75.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$131.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.27
|
| Rate for Payer: Cash Price |
$142.22
|
| Rate for Payer: Cash Price |
$142.22
|
| Rate for Payer: Centivo All Commercial |
$116.99
|
| Rate for Payer: Cigna All Commercial |
$197.96
|
| Rate for Payer: CORVEL All Commercial |
$213.33
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Encore All Commercial |
$211.15
|
| Rate for Payer: Frontpath All Commercial |
$211.04
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Humana Medicare |
$116.99
|
| Rate for Payer: Lucent All Commercial |
$116.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$172.04
|
| Rate for Payer: PHP All Commercial |
$173.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.46
|
| Rate for Payer: Sagamore Health Network All Products |
$177.09
|
| Rate for Payer: Signature Care EPO |
$190.39
|
| Rate for Payer: Signature Care PPO |
$201.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194.98
|
| Rate for Payer: United Healthcare Commercial |
$180.76
|
| Rate for Payer: United Healthcare Medicare |
$75.70
|
|
|
HC BLADE SAW PREC THIN 9X.38X18.5
|
Facility
IP
|
$229.39
|
|
| Hospital Charge Code |
41601899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$213.33 |
| Rate for Payer: Aetna Commercial |
$198.19
|
| Rate for Payer: Cash Price |
$142.22
|
| Rate for Payer: Cigna All Commercial |
$197.96
|
| Rate for Payer: CORVEL All Commercial |
$213.33
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Encore All Commercial |
$211.15
|
| Rate for Payer: Frontpath All Commercial |
$211.04
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.45
|
| Rate for Payer: PHCS All Commercial |
$172.04
|
| Rate for Payer: PHP All Commercial |
$173.97
|
| Rate for Payer: Sagamore Health Network All Products |
$177.09
|
| Rate for Payer: Signature Care EPO |
$190.39
|
| Rate for Payer: Signature Care PPO |
$201.86
|
| Rate for Payer: United Healthcare Commercial |
$180.76
|
|
|
HC BLADE SAW PREC THIN 9X.38X25
|
Facility
OP
|
$245.56
|
|
| Hospital Charge Code |
41602409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$228.37 |
| Rate for Payer: Aetna Commercial |
$207.25
|
| Rate for Payer: Aetna Medicare |
$81.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.14
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Centivo All Commercial |
$125.24
|
| Rate for Payer: Cigna All Commercial |
$211.92
|
| Rate for Payer: CORVEL All Commercial |
$228.37
|
| Rate for Payer: Coventry All Commercial |
$216.09
|
| Rate for Payer: Encore All Commercial |
$226.04
|
| Rate for Payer: Frontpath All Commercial |
$225.92
|
| Rate for Payer: Humana ChoiceCare |
$212.09
|
| Rate for Payer: Humana Medicare |
$125.24
|
| Rate for Payer: Lucent All Commercial |
$125.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.17
|
| Rate for Payer: PHP All Commercial |
$186.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.77
|
| Rate for Payer: Sagamore Health Network All Products |
$189.57
|
| Rate for Payer: Signature Care EPO |
$203.81
|
| Rate for Payer: Signature Care PPO |
$216.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.73
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Medicare |
$81.03
|
|
|
HC BLADE SAW PREC THIN 9X.38X25
|
Facility
IP
|
$245.56
|
|
| Hospital Charge Code |
41602409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.17 |
| Max. Negotiated Rate |
$228.37 |
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Cigna All Commercial |
$211.92
|
| Rate for Payer: CORVEL All Commercial |
$228.37
|
| Rate for Payer: Coventry All Commercial |
$216.09
|
| Rate for Payer: Encore All Commercial |
$226.04
|
| Rate for Payer: Frontpath All Commercial |
$225.92
|
| Rate for Payer: Humana ChoiceCare |
$212.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.00
|
| Rate for Payer: PHCS All Commercial |
$184.17
|
| Rate for Payer: PHP All Commercial |
$186.23
|
| Rate for Payer: Sagamore Health Network All Products |
$189.57
|
| Rate for Payer: Signature Care EPO |
$203.81
|
| Rate for Payer: Signature Care PPO |
$216.09
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
|
|
HC BLADE SAW PREC THIN 9X.51X25
|
Facility
OP
|
$265.58
|
|
| Hospital Charge Code |
41602105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.64 |
| Max. Negotiated Rate |
$246.99 |
| Rate for Payer: Aetna Commercial |
$224.15
|
| Rate for Payer: Aetna Medicare |
$87.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$152.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.41
|
| Rate for Payer: Cash Price |
$164.66
|
| Rate for Payer: Cash Price |
$164.66
|
| Rate for Payer: Centivo All Commercial |
$135.45
|
| Rate for Payer: Cigna All Commercial |
$229.20
|
| Rate for Payer: CORVEL All Commercial |
$246.99
|
| Rate for Payer: Coventry All Commercial |
$233.71
|
| Rate for Payer: Encore All Commercial |
$244.47
|
| Rate for Payer: Frontpath All Commercial |
$244.33
|
| Rate for Payer: Humana ChoiceCare |
$229.38
|
| Rate for Payer: Humana Medicare |
$135.45
|
| Rate for Payer: Lucent All Commercial |
$135.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$199.18
|
| Rate for Payer: PHP All Commercial |
$201.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.58
|
| Rate for Payer: Sagamore Health Network All Products |
$205.03
|
| Rate for Payer: Signature Care EPO |
$220.43
|
| Rate for Payer: Signature Care PPO |
$233.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$225.74
|
| Rate for Payer: United Healthcare Commercial |
$209.28
|
| Rate for Payer: United Healthcare Medicare |
$87.64
|
|
|
HC BLADE SAW PREC THIN 9X.51X25
|
Facility
IP
|
$265.58
|
|
| Hospital Charge Code |
41602105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.18 |
| Max. Negotiated Rate |
$246.99 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Cash Price |
$164.66
|
| Rate for Payer: Cigna All Commercial |
$229.20
|
| Rate for Payer: CORVEL All Commercial |
$246.99
|
| Rate for Payer: Coventry All Commercial |
$233.71
|
| Rate for Payer: Encore All Commercial |
$244.47
|
| Rate for Payer: Frontpath All Commercial |
$244.33
|
| Rate for Payer: Humana ChoiceCare |
$229.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.02
|
| Rate for Payer: PHCS All Commercial |
$199.18
|
| Rate for Payer: PHP All Commercial |
$201.42
|
| Rate for Payer: Sagamore Health Network All Products |
$205.03
|
| Rate for Payer: Signature Care EPO |
$220.43
|
| Rate for Payer: Signature Care PPO |
$233.71
|
| Rate for Payer: United Healthcare Commercial |
$209.28
|
|
