|
HC AR FIBERSTITCH 1.5 CURV 2.0
|
Facility
|
OP
|
$3,301.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,070.12 |
| Rate for Payer: Aetna Commercial |
$2,786.21
|
| Rate for Payer: Aetna Medicare |
$1,056.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,023.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,895.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,063.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,214.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,162.02
|
| Rate for Payer: Cash Price |
$1,980.72
|
| Rate for Payer: Cash Price |
$1,980.72
|
| Rate for Payer: Centivo All Commercial |
$1,795.85
|
| Rate for Payer: Cigna All Commercial |
$2,848.94
|
| Rate for Payer: CORVEL All Commercial |
$3,070.12
|
| Rate for Payer: Coventry All Commercial |
$2,905.06
|
| Rate for Payer: Encore All Commercial |
$3,038.75
|
| Rate for Payer: Frontpath All Commercial |
$3,037.10
|
| Rate for Payer: Humana ChoiceCare |
$2,851.25
|
| Rate for Payer: Humana Medicare |
$1,056.38
|
| Rate for Payer: Lucent All Commercial |
$1,795.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,971.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,475.90
|
| Rate for Payer: PHP All Commercial |
$2,503.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,287.47
|
| Rate for Payer: Sagamore Health Network All Products |
$2,548.53
|
| Rate for Payer: Signature Care EPO |
$2,740.00
|
| Rate for Payer: Signature Care PPO |
$2,905.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,806.02
|
| Rate for Payer: United Healthcare Commercial |
$2,601.35
|
| Rate for Payer: United Healthcare Medicare |
$1,056.38
|
|
|
HC AR FIBERSTITCH 1.5 CURV 24 DEG
|
Facility
|
OP
|
$3,301.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,070.12 |
| Rate for Payer: Aetna Commercial |
$2,786.21
|
| Rate for Payer: Aetna Medicare |
$1,056.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,023.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,895.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,063.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,214.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,162.02
|
| Rate for Payer: Cash Price |
$1,980.72
|
| Rate for Payer: Cash Price |
$1,980.72
|
| Rate for Payer: Centivo All Commercial |
$1,795.85
|
| Rate for Payer: Cigna All Commercial |
$2,848.94
|
| Rate for Payer: CORVEL All Commercial |
$3,070.12
|
| Rate for Payer: Coventry All Commercial |
$2,905.06
|
| Rate for Payer: Encore All Commercial |
$3,038.75
|
| Rate for Payer: Frontpath All Commercial |
$3,037.10
|
| Rate for Payer: Humana ChoiceCare |
$2,851.25
|
| Rate for Payer: Humana Medicare |
$1,056.38
|
| Rate for Payer: Lucent All Commercial |
$1,795.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,971.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,475.90
|
| Rate for Payer: PHP All Commercial |
$2,503.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,287.47
|
| Rate for Payer: Sagamore Health Network All Products |
$2,548.53
|
| Rate for Payer: Signature Care EPO |
$2,740.00
|
| Rate for Payer: Signature Care PPO |
$2,905.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,806.02
|
| Rate for Payer: United Healthcare Commercial |
$2,601.35
|
| Rate for Payer: United Healthcare Medicare |
$1,056.38
|
|
|
HC AR FIBERSTITCH 1.5 CURV 24 DEG
|
Facility
|
IP
|
$3,301.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.90 |
| Max. Negotiated Rate |
$3,070.12 |
| Rate for Payer: Aetna Commercial |
$2,852.24
|
| Rate for Payer: Cash Price |
$1,980.72
|
| Rate for Payer: Cigna All Commercial |
$2,848.94
|
| Rate for Payer: CORVEL All Commercial |
$3,070.12
|
| Rate for Payer: Coventry All Commercial |
$2,905.06
|
| Rate for Payer: Encore All Commercial |
$3,038.75
|
| Rate for Payer: Frontpath All Commercial |
$3,037.10
|
| Rate for Payer: Humana ChoiceCare |
$2,851.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,971.08
|
| Rate for Payer: PHCS All Commercial |
$2,475.90
|
| Rate for Payer: PHP All Commercial |
$2,503.63
|
| Rate for Payer: Sagamore Health Network All Products |
$2,548.53
|
| Rate for Payer: Signature Care EPO |
$2,740.00
|
| Rate for Payer: Signature Care PPO |
$2,905.06
|
| Rate for Payer: United Healthcare Commercial |
$2,601.35
|
|
|
HC AR FIBERSTITCH CURV 24 DEG
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,227.50 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,566.08
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.89
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
|
|
HC AR FIBERSTITCH CURV 24 DEG
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,506.68
|
| Rate for Payer: Aetna Medicare |
$950.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$920.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,856.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,092.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,045.44
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Centivo All Commercial |
$1,615.68
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.89
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Humana Medicare |
$950.40
|
| Rate for Payer: Lucent All Commercial |
$1,615.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,158.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,524.50
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
| Rate for Payer: United Healthcare Medicare |
$950.40
|
|
|
HC AR FIBERTAK 2.6 B
|
Facility
|
IP
|
$2,822.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.80 |
| Max. Negotiated Rate |
$2,624.83 |
| Rate for Payer: Aetna Commercial |
$2,438.55
|
| Rate for Payer: Cash Price |
$1,693.44
|
| Rate for Payer: Cigna All Commercial |
$2,435.73
|
| Rate for Payer: CORVEL All Commercial |
$2,624.83
|
| Rate for Payer: Coventry All Commercial |
$2,483.71
|
| Rate for Payer: Encore All Commercial |
$2,598.02
|
| Rate for Payer: Frontpath All Commercial |
$2,596.61
|
| Rate for Payer: Humana ChoiceCare |
$2,437.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,540.16
|
| Rate for Payer: PHCS All Commercial |
$2,116.80
|
| Rate for Payer: PHP All Commercial |
$2,140.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,178.89
|
| Rate for Payer: Signature Care EPO |
$2,342.59
|
| Rate for Payer: Signature Care PPO |
$2,483.71
|
| Rate for Payer: United Healthcare Commercial |
$2,224.05
|
|
|
HC AR FIBERTAK 2.6 B
|
Facility
|
OP
|
$2,822.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,624.83 |
| Rate for Payer: Aetna Commercial |
$2,382.11
|
| Rate for Payer: Aetna Medicare |
$903.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,620.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,764.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,038.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$993.48
|
| Rate for Payer: Cash Price |
$1,693.44
|
| Rate for Payer: Cash Price |
$1,693.44
|
| Rate for Payer: Centivo All Commercial |
$1,535.39
|
| Rate for Payer: Cigna All Commercial |
$2,435.73
|
| Rate for Payer: CORVEL All Commercial |
$2,624.83
|
| Rate for Payer: Coventry All Commercial |
$2,483.71
|
| Rate for Payer: Encore All Commercial |
$2,598.02
|
| Rate for Payer: Frontpath All Commercial |
$2,596.61
|
| Rate for Payer: Humana ChoiceCare |
$2,437.71
|
| Rate for Payer: Humana Medicare |
$903.17
|
| Rate for Payer: Lucent All Commercial |
$1,535.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,540.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,116.80
|
| Rate for Payer: PHP All Commercial |
$2,140.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,100.74
|
| Rate for Payer: Sagamore Health Network All Products |
$2,178.89
|
| Rate for Payer: Signature Care EPO |
$2,342.59
|
| Rate for Payer: Signature Care PPO |
$2,483.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,399.04
|
| Rate for Payer: United Healthcare Commercial |
$2,224.05
|
| Rate for Payer: United Healthcare Medicare |
$903.17
|
|
|
HC AR FIBERTAK 2.6 BLK/BL
|
Facility
|
IP
|
$2,822.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.80 |
| Max. Negotiated Rate |
$2,624.83 |
| Rate for Payer: Aetna Commercial |
$2,438.55
|
| Rate for Payer: Cash Price |
$1,693.44
|
| Rate for Payer: Cigna All Commercial |
$2,435.73
|
| Rate for Payer: CORVEL All Commercial |
$2,624.83
|
| Rate for Payer: Coventry All Commercial |
$2,483.71
|
| Rate for Payer: Encore All Commercial |
$2,598.02
|
| Rate for Payer: Frontpath All Commercial |
$2,596.61
|
| Rate for Payer: Humana ChoiceCare |
$2,437.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,540.16
|
| Rate for Payer: PHCS All Commercial |
$2,116.80
|
| Rate for Payer: PHP All Commercial |
$2,140.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,178.89
|
| Rate for Payer: Signature Care EPO |
$2,342.59
|
| Rate for Payer: Signature Care PPO |
$2,483.71
|
| Rate for Payer: United Healthcare Commercial |
$2,224.05
|
|
|
HC AR FIBERTAK 2.6 BLK/BL
|
Facility
|
OP
|
$2,822.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,624.83 |
| Rate for Payer: Aetna Commercial |
$2,382.11
|
| Rate for Payer: Aetna Medicare |
$903.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,620.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,764.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,038.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$993.48
|
| Rate for Payer: Cash Price |
$1,693.44
|
| Rate for Payer: Cash Price |
$1,693.44
|
| Rate for Payer: Centivo All Commercial |
$1,535.39
|
| Rate for Payer: Cigna All Commercial |
$2,435.73
|
| Rate for Payer: CORVEL All Commercial |
$2,624.83
|
| Rate for Payer: Coventry All Commercial |
$2,483.71
|
| Rate for Payer: Encore All Commercial |
$2,598.02
|
| Rate for Payer: Frontpath All Commercial |
$2,596.61
|
| Rate for Payer: Humana ChoiceCare |
$2,437.71
|
| Rate for Payer: Humana Medicare |
$903.17
|
| Rate for Payer: Lucent All Commercial |
$1,535.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,540.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,116.80
|
| Rate for Payer: PHP All Commercial |
$2,140.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,100.74
|
| Rate for Payer: Sagamore Health Network All Products |
$2,178.89
|
| Rate for Payer: Signature Care EPO |
$2,342.59
|
| Rate for Payer: Signature Care PPO |
$2,483.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,399.04
|
| Rate for Payer: United Healthcare Commercial |
$2,224.05
|
| Rate for Payer: United Healthcare Medicare |
$903.17
|
|
|
HC AR FIBERTAK 2.6 DL
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,506.68
|
| Rate for Payer: Aetna Medicare |
$950.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$920.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,856.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,092.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,045.44
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Centivo All Commercial |
$1,615.68
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.89
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Humana Medicare |
$950.40
|
| Rate for Payer: Lucent All Commercial |
$1,615.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,158.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,524.50
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
| Rate for Payer: United Healthcare Medicare |
$950.40
|
|
|
HC AR FIBERTAK 2.6 DL
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,227.50 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,566.08
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.89
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
|
|
HC AR FIBERTAK 2.6 TL
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.25 |
| Max. Negotiated Rate |
$2,097.15 |
| Rate for Payer: Aetna Commercial |
$1,948.32
|
| Rate for Payer: Cash Price |
$1,353.00
|
| Rate for Payer: Cigna All Commercial |
$1,946.07
|
| Rate for Payer: CORVEL All Commercial |
$2,097.15
|
| Rate for Payer: Coventry All Commercial |
$1,984.40
|
| Rate for Payer: Encore All Commercial |
$2,075.73
|
| Rate for Payer: Frontpath All Commercial |
$2,074.60
|
| Rate for Payer: Humana ChoiceCare |
$1,947.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,029.50
|
| Rate for Payer: PHCS All Commercial |
$1,691.25
|
| Rate for Payer: PHP All Commercial |
$1,710.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,740.86
|
| Rate for Payer: Signature Care EPO |
$1,871.65
|
| Rate for Payer: Signature Care PPO |
$1,984.40
|
| Rate for Payer: United Healthcare Commercial |
$1,776.94
|
|
|
HC AR FIBERTAK 2.6 TL
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,097.15 |
| Rate for Payer: Aetna Commercial |
$1,903.22
|
| Rate for Payer: Aetna Medicare |
$721.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$699.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,295.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,409.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$829.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$793.76
|
| Rate for Payer: Cash Price |
$1,353.00
|
| Rate for Payer: Cash Price |
$1,353.00
|
| Rate for Payer: Centivo All Commercial |
$1,226.72
|
| Rate for Payer: Cigna All Commercial |
$1,946.07
|
| Rate for Payer: CORVEL All Commercial |
$2,097.15
|
| Rate for Payer: Coventry All Commercial |
$1,984.40
|
| Rate for Payer: Encore All Commercial |
$2,075.73
|
| Rate for Payer: Frontpath All Commercial |
$2,074.60
|
| Rate for Payer: Humana ChoiceCare |
$1,947.64
|
| Rate for Payer: Humana Medicare |
$721.60
|
| Rate for Payer: Lucent All Commercial |
$1,226.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,029.50
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,691.25
|
| Rate for Payer: PHP All Commercial |
$1,710.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$879.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,740.86
|
| Rate for Payer: Signature Care EPO |
$1,871.65
|
| Rate for Payer: Signature Care PPO |
$1,984.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,916.75
|
| Rate for Payer: United Healthcare Commercial |
$1,776.94
|
| Rate for Payer: United Healthcare Medicare |
$721.60
|
|
|
HC AR FIBERTAK 2.6 W/BL
|
Facility
|
IP
|
$1,861.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,395.90 |
| Max. Negotiated Rate |
$1,730.92 |
| Rate for Payer: Aetna Commercial |
$1,608.08
|
| Rate for Payer: Cash Price |
$1,116.72
|
| Rate for Payer: Cigna All Commercial |
$1,606.22
|
| Rate for Payer: CORVEL All Commercial |
$1,730.92
|
| Rate for Payer: Coventry All Commercial |
$1,637.86
|
| Rate for Payer: Encore All Commercial |
$1,713.23
|
| Rate for Payer: Frontpath All Commercial |
$1,712.30
|
| Rate for Payer: Humana ChoiceCare |
$1,607.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,675.08
|
| Rate for Payer: PHCS All Commercial |
$1,395.90
|
| Rate for Payer: PHP All Commercial |
$1,411.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,436.85
|
| Rate for Payer: Signature Care EPO |
$1,544.80
|
| Rate for Payer: Signature Care PPO |
$1,637.86
|
| Rate for Payer: United Healthcare Commercial |
$1,466.63
|
|
|
HC AR FIBERTAK 2.6 W/BL
|
Facility
|
OP
|
$1,861.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,730.92 |
| Rate for Payer: Aetna Commercial |
$1,570.85
|
| Rate for Payer: Aetna Medicare |
$595.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$576.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,068.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,163.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$684.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$655.14
|
| Rate for Payer: Cash Price |
$1,116.72
|
| Rate for Payer: Cash Price |
$1,116.72
|
| Rate for Payer: Centivo All Commercial |
$1,012.49
|
| Rate for Payer: Cigna All Commercial |
$1,606.22
|
| Rate for Payer: CORVEL All Commercial |
$1,730.92
|
| Rate for Payer: Coventry All Commercial |
$1,637.86
|
| Rate for Payer: Encore All Commercial |
$1,713.23
|
| Rate for Payer: Frontpath All Commercial |
$1,712.30
|
| Rate for Payer: Humana ChoiceCare |
$1,607.52
|
| Rate for Payer: Humana Medicare |
$595.58
|
| Rate for Payer: Lucent All Commercial |
$1,012.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,675.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,395.90
|
| Rate for Payer: PHP All Commercial |
$1,411.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$725.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,436.85
|
| Rate for Payer: Signature Care EPO |
$1,544.80
|
| Rate for Payer: Signature Care PPO |
$1,637.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,582.02
|
| Rate for Payer: United Healthcare Commercial |
$1,466.63
|
| Rate for Payer: United Healthcare Medicare |
$595.58
|
|
|
HC AR FIBERTAK KIT
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
41607617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,404.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
|
|
HC AR FIBERTAK KIT
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
41607617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Aetna Medicare |
$520.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$503.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$933.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,015.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$598.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$572.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Centivo All Commercial |
$884.00
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Humana Medicare |
$520.00
|
| Rate for Payer: Lucent All Commercial |
$884.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$633.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,381.25
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
| Rate for Payer: United Healthcare Medicare |
$520.00
|
|
|
HC AR FIBERTAK W NEEDLE HYBRID
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,362.50 |
| Max. Negotiated Rate |
$2,929.50 |
| Rate for Payer: Aetna Commercial |
$2,721.60
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cigna All Commercial |
$2,718.45
|
| Rate for Payer: CORVEL All Commercial |
$2,929.50
|
| Rate for Payer: Coventry All Commercial |
$2,772.00
|
| Rate for Payer: Encore All Commercial |
$2,899.57
|
| Rate for Payer: Frontpath All Commercial |
$2,898.00
|
| Rate for Payer: Humana ChoiceCare |
$2,720.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,835.00
|
| Rate for Payer: PHCS All Commercial |
$2,362.50
|
| Rate for Payer: PHP All Commercial |
$2,388.96
|
| Rate for Payer: Sagamore Health Network All Products |
$2,431.80
|
| Rate for Payer: Signature Care EPO |
$2,614.50
|
| Rate for Payer: Signature Care PPO |
$2,772.00
|
| Rate for Payer: United Healthcare Commercial |
$2,482.20
|
|
|
HC AR FIBERTAK W NEEDLE HYBRID
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,929.50 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Medicare |
$1,008.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$976.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,809.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,969.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,159.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Centivo All Commercial |
$1,713.60
|
| Rate for Payer: Cigna All Commercial |
$2,718.45
|
| Rate for Payer: CORVEL All Commercial |
$2,929.50
|
| Rate for Payer: Coventry All Commercial |
$2,772.00
|
| Rate for Payer: Encore All Commercial |
$2,899.57
|
| Rate for Payer: Frontpath All Commercial |
$2,898.00
|
| Rate for Payer: Humana ChoiceCare |
$2,720.66
|
| Rate for Payer: Humana Medicare |
$1,008.00
|
| Rate for Payer: Lucent All Commercial |
$1,713.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,835.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,362.50
|
| Rate for Payer: PHP All Commercial |
$2,388.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,228.50
|
| Rate for Payer: Sagamore Health Network All Products |
$2,431.80
|
| Rate for Payer: Signature Care EPO |
$2,614.50
|
| Rate for Payer: Signature Care PPO |
$2,772.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,677.50
|
| Rate for Payer: United Healthcare Commercial |
$2,482.20
|
| Rate for Payer: United Healthcare Medicare |
$1,008.00
|
|
|
HC AR FIBERTAPE 1.7
|
Facility
|
OP
|
$585.20
|
|
| Hospital Charge Code |
41607954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$544.24 |
| Rate for Payer: Aetna Commercial |
$493.91
|
| Rate for Payer: Aetna Medicare |
$187.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$181.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$336.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$365.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$205.99
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Centivo All Commercial |
$318.35
|
| Rate for Payer: Cigna All Commercial |
$505.03
|
| Rate for Payer: CORVEL All Commercial |
$544.24
|
| Rate for Payer: Coventry All Commercial |
$514.98
|
| Rate for Payer: Encore All Commercial |
$538.68
|
| Rate for Payer: Frontpath All Commercial |
$538.38
|
| Rate for Payer: Humana ChoiceCare |
$505.44
|
| Rate for Payer: Humana Medicare |
$187.26
|
| Rate for Payer: Lucent All Commercial |
$318.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.68
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$438.90
|
| Rate for Payer: PHP All Commercial |
$443.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.23
|
| Rate for Payer: Sagamore Health Network All Products |
$451.77
|
| Rate for Payer: Signature Care EPO |
$485.72
|
| Rate for Payer: Signature Care PPO |
$514.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$497.42
|
| Rate for Payer: United Healthcare Commercial |
$461.14
|
| Rate for Payer: United Healthcare Medicare |
$187.26
|
|
|
HC AR FIBERTAPE 1.7
|
Facility
|
IP
|
$585.20
|
|
| Hospital Charge Code |
41607954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$544.24 |
| Rate for Payer: Aetna Commercial |
$505.61
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cigna All Commercial |
$505.03
|
| Rate for Payer: CORVEL All Commercial |
$544.24
|
| Rate for Payer: Coventry All Commercial |
$514.98
|
| Rate for Payer: Encore All Commercial |
$538.68
|
| Rate for Payer: Frontpath All Commercial |
$538.38
|
| Rate for Payer: Humana ChoiceCare |
$505.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.68
|
| Rate for Payer: PHCS All Commercial |
$438.90
|
| Rate for Payer: PHP All Commercial |
$443.82
|
| Rate for Payer: Sagamore Health Network All Products |
$451.77
|
| Rate for Payer: Signature Care EPO |
$485.72
|
| Rate for Payer: Signature Care PPO |
$514.98
|
| Rate for Payer: United Healthcare Commercial |
$461.14
|
|
|
HC AR FIBERTAPE 2MM
|
Facility
|
IP
|
$97.15
|
|
| Hospital Charge Code |
41608101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.86 |
| Max. Negotiated Rate |
$90.35 |
| Rate for Payer: Aetna Commercial |
$83.94
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Cigna All Commercial |
$83.84
|
| Rate for Payer: CORVEL All Commercial |
$90.35
|
| Rate for Payer: Coventry All Commercial |
$85.49
|
| Rate for Payer: Encore All Commercial |
$89.43
|
| Rate for Payer: Frontpath All Commercial |
$89.38
|
| Rate for Payer: Humana ChoiceCare |
$83.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.44
|
| Rate for Payer: PHCS All Commercial |
$72.86
|
| Rate for Payer: PHP All Commercial |
$73.68
|
| Rate for Payer: Sagamore Health Network All Products |
$75.00
|
| Rate for Payer: Signature Care EPO |
$80.63
|
| Rate for Payer: Signature Care PPO |
$85.49
|
| Rate for Payer: United Healthcare Commercial |
$76.55
|
|
|
HC AR FIBERTAPE 2MM
|
Facility
|
OP
|
$97.15
|
|
| Hospital Charge Code |
41608101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$90.35 |
| Rate for Payer: Aetna Commercial |
$81.99
|
| Rate for Payer: Aetna Medicare |
$31.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$55.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.20
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Centivo All Commercial |
$52.85
|
| Rate for Payer: Cigna All Commercial |
$83.84
|
| Rate for Payer: CORVEL All Commercial |
$90.35
|
| Rate for Payer: Coventry All Commercial |
$85.49
|
| Rate for Payer: Encore All Commercial |
$89.43
|
| Rate for Payer: Frontpath All Commercial |
$89.38
|
| Rate for Payer: Humana ChoiceCare |
$83.91
|
| Rate for Payer: Humana Medicare |
$31.09
|
| Rate for Payer: Lucent All Commercial |
$52.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.44
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$72.86
|
| Rate for Payer: PHP All Commercial |
$73.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.89
|
| Rate for Payer: Sagamore Health Network All Products |
$75.00
|
| Rate for Payer: Signature Care EPO |
$80.63
|
| Rate for Payer: Signature Care PPO |
$85.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.58
|
| Rate for Payer: United Healthcare Commercial |
$76.55
|
| Rate for Payer: United Healthcare Medicare |
$31.09
|
|
|
HC AR FIBERTAPE 2MM 17LN
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
41608159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Aetna Medicare |
$520.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$503.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$933.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,015.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$598.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$572.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Centivo All Commercial |
$884.00
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Humana Medicare |
$520.00
|
| Rate for Payer: Lucent All Commercial |
$884.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$633.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,381.25
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
| Rate for Payer: United Healthcare Medicare |
$520.00
|
|
|
HC AR FIBERTAPE 2MM 17LN
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
41608159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,404.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
|
