|
HC AR GEMINI SR8 CANNULA
|
Facility
|
IP
|
$374.50
|
|
| Hospital Charge Code |
41606554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.88 |
| Max. Negotiated Rate |
$348.29 |
| Rate for Payer: Aetna Commercial |
$323.57
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cigna All Commercial |
$323.19
|
| Rate for Payer: CORVEL All Commercial |
$348.29
|
| Rate for Payer: Coventry All Commercial |
$329.56
|
| Rate for Payer: Encore All Commercial |
$344.73
|
| Rate for Payer: Frontpath All Commercial |
$344.54
|
| Rate for Payer: Humana ChoiceCare |
$323.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$337.05
|
| Rate for Payer: PHCS All Commercial |
$280.88
|
| Rate for Payer: PHP All Commercial |
$284.02
|
| Rate for Payer: Sagamore Health Network All Products |
$289.11
|
| Rate for Payer: Signature Care EPO |
$310.83
|
| Rate for Payer: Signature Care PPO |
$329.56
|
| Rate for Payer: United Healthcare Commercial |
$295.11
|
|
|
HC AR GEMINI SR8 CANNULA
|
Facility
|
OP
|
$374.50
|
|
| Hospital Charge Code |
41606554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$348.29 |
| Rate for Payer: Aetna Commercial |
$316.08
|
| Rate for Payer: Aetna Medicare |
$119.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$116.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$215.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$234.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.82
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Centivo All Commercial |
$203.73
|
| Rate for Payer: Cigna All Commercial |
$323.19
|
| Rate for Payer: CORVEL All Commercial |
$348.29
|
| Rate for Payer: Coventry All Commercial |
$329.56
|
| Rate for Payer: Encore All Commercial |
$344.73
|
| Rate for Payer: Frontpath All Commercial |
$344.54
|
| Rate for Payer: Humana ChoiceCare |
$323.46
|
| Rate for Payer: Humana Medicare |
$119.84
|
| Rate for Payer: Lucent All Commercial |
$203.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$337.05
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$280.88
|
| Rate for Payer: PHP All Commercial |
$284.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$146.06
|
| Rate for Payer: Sagamore Health Network All Products |
$289.11
|
| Rate for Payer: Signature Care EPO |
$310.83
|
| Rate for Payer: Signature Care PPO |
$329.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$318.32
|
| Rate for Payer: United Healthcare Commercial |
$295.11
|
| Rate for Payer: United Healthcare Medicare |
$119.84
|
|
|
HC AR GRAFT TENODESIS KIT
|
Facility
|
IP
|
$2,460.00
|
|
| Hospital Charge Code |
41608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,845.00 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,125.44
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
|
|
HC AR GRAFT TENODESIS KIT
|
Facility
|
OP
|
$2,460.00
|
|
| Hospital Charge Code |
41608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,076.24
|
| Rate for Payer: Aetna Medicare |
$787.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$762.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,412.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,537.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$905.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$865.92
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Centivo All Commercial |
$1,338.24
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Humana Medicare |
$787.20
|
| Rate for Payer: Lucent All Commercial |
$1,338.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$959.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,091.00
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
| Rate for Payer: United Healthcare Medicare |
$787.20
|
|
|
HC AR INTERNAL BRACE SYSTEM
|
Facility
|
IP
|
$7,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,305.50 |
| Max. Negotiated Rate |
$6,578.82 |
| Rate for Payer: Aetna Commercial |
$6,111.94
|
| Rate for Payer: Cash Price |
$4,244.40
|
| Rate for Payer: Cigna All Commercial |
$6,104.86
|
| Rate for Payer: CORVEL All Commercial |
$6,578.82
|
| Rate for Payer: Coventry All Commercial |
$6,225.12
|
| Rate for Payer: Encore All Commercial |
$6,511.62
|
| Rate for Payer: Frontpath All Commercial |
$6,508.08
|
| Rate for Payer: Humana ChoiceCare |
$6,109.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,366.60
|
| Rate for Payer: PHCS All Commercial |
$5,305.50
|
| Rate for Payer: PHP All Commercial |
$5,364.92
|
| Rate for Payer: Sagamore Health Network All Products |
$5,461.13
|
| Rate for Payer: Signature Care EPO |
$5,871.42
|
| Rate for Payer: Signature Care PPO |
$6,225.12
|
| Rate for Payer: United Healthcare Commercial |
$5,574.31
|
|
|
HC AR INTERNAL BRACE SYSTEM
|
Facility
|
OP
|
$7,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,578.82 |
| Rate for Payer: Aetna Commercial |
$5,970.46
|
| Rate for Payer: Aetna Medicare |
$2,263.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,192.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,062.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,421.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,603.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,490.05
|
| Rate for Payer: Cash Price |
$4,244.40
|
| Rate for Payer: Cash Price |
$4,244.40
|
| Rate for Payer: Centivo All Commercial |
$3,848.26
|
| Rate for Payer: Cigna All Commercial |
$6,104.86
|
| Rate for Payer: CORVEL All Commercial |
$6,578.82
|
| Rate for Payer: Coventry All Commercial |
$6,225.12
|
| Rate for Payer: Encore All Commercial |
$6,511.62
|
| Rate for Payer: Frontpath All Commercial |
$6,508.08
|
| Rate for Payer: Humana ChoiceCare |
$6,109.81
|
| Rate for Payer: Humana Medicare |
$2,263.68
|
| Rate for Payer: Lucent All Commercial |
$3,848.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,366.60
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,305.50
|
| Rate for Payer: PHP All Commercial |
$5,364.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,758.86
|
| Rate for Payer: Sagamore Health Network All Products |
$5,461.13
|
| Rate for Payer: Signature Care EPO |
$5,871.42
|
| Rate for Payer: Signature Care PPO |
$6,225.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,012.90
|
| Rate for Payer: United Healthcare Commercial |
$5,574.31
|
| Rate for Payer: United Healthcare Medicare |
$2,263.68
|
|
|
HC AR KIT DISP FIBERTAK KNEE
|
Facility
|
IP
|
$2,045.00
|
|
| Hospital Charge Code |
41608215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,533.75 |
| Max. Negotiated Rate |
$1,901.85 |
| Rate for Payer: Aetna Commercial |
$1,766.88
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cigna All Commercial |
$1,764.84
|
| Rate for Payer: CORVEL All Commercial |
$1,901.85
|
| Rate for Payer: Coventry All Commercial |
$1,799.60
|
| Rate for Payer: Encore All Commercial |
$1,882.42
|
| Rate for Payer: Frontpath All Commercial |
$1,881.40
|
| Rate for Payer: Humana ChoiceCare |
$1,766.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,840.50
|
| Rate for Payer: PHCS All Commercial |
$1,533.75
|
| Rate for Payer: PHP All Commercial |
$1,550.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,578.74
|
| Rate for Payer: Signature Care EPO |
$1,697.35
|
| Rate for Payer: Signature Care PPO |
$1,799.60
|
| Rate for Payer: United Healthcare Commercial |
$1,611.46
|
|
|
HC AR KIT DISP FIBERTAK KNEE
|
Facility
|
OP
|
$2,045.00
|
|
| Hospital Charge Code |
41608215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,901.85 |
| Rate for Payer: Aetna Commercial |
$1,725.98
|
| Rate for Payer: Aetna Medicare |
$654.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$633.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,174.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,278.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$752.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$719.84
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Centivo All Commercial |
$1,112.48
|
| Rate for Payer: Cigna All Commercial |
$1,764.84
|
| Rate for Payer: CORVEL All Commercial |
$1,901.85
|
| Rate for Payer: Coventry All Commercial |
$1,799.60
|
| Rate for Payer: Encore All Commercial |
$1,882.42
|
| Rate for Payer: Frontpath All Commercial |
$1,881.40
|
| Rate for Payer: Humana ChoiceCare |
$1,766.27
|
| Rate for Payer: Humana Medicare |
$654.40
|
| Rate for Payer: Lucent All Commercial |
$1,112.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,840.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,533.75
|
| Rate for Payer: PHP All Commercial |
$1,550.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$797.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,578.74
|
| Rate for Payer: Signature Care EPO |
$1,697.35
|
| Rate for Payer: Signature Care PPO |
$1,799.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,738.25
|
| Rate for Payer: United Healthcare Commercial |
$1,611.46
|
| Rate for Payer: United Healthcare Medicare |
$654.40
|
|
|
HC AR KIT INST TENODESIS SCREW
|
Facility
|
IP
|
$1,072.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.38 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$926.64
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.17
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
|
|
HC AR KIT INST TENODESIS SCREW
|
Facility
|
OP
|
$1,072.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$905.19
|
| Rate for Payer: Aetna Medicare |
$343.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$332.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$615.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$670.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$394.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$377.52
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Centivo All Commercial |
$583.44
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Humana Medicare |
$343.20
|
| Rate for Payer: Lucent All Commercial |
$583.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$418.27
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.17
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$911.62
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
| Rate for Payer: United Healthcare Medicare |
$343.20
|
|
|
HC AR KIT SPEEDBRIDGE JUMPSTART
|
Facility
|
OP
|
$7,900.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,347.19 |
| Rate for Payer: Aetna Commercial |
$6,667.77
|
| Rate for Payer: Aetna Medicare |
$2,528.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,449.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,537.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,938.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,907.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,780.87
|
| Rate for Payer: Cash Price |
$4,740.12
|
| Rate for Payer: Cash Price |
$4,740.12
|
| Rate for Payer: Centivo All Commercial |
$4,297.71
|
| Rate for Payer: Cigna All Commercial |
$6,817.87
|
| Rate for Payer: CORVEL All Commercial |
$7,347.19
|
| Rate for Payer: Coventry All Commercial |
$6,952.18
|
| Rate for Payer: Encore All Commercial |
$7,272.13
|
| Rate for Payer: Frontpath All Commercial |
$7,268.18
|
| Rate for Payer: Humana ChoiceCare |
$6,823.40
|
| Rate for Payer: Humana Medicare |
$2,528.06
|
| Rate for Payer: Lucent All Commercial |
$4,297.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,110.18
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,925.15
|
| Rate for Payer: PHP All Commercial |
$5,991.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,081.08
|
| Rate for Payer: Sagamore Health Network All Products |
$6,098.95
|
| Rate for Payer: Signature Care EPO |
$6,557.17
|
| Rate for Payer: Signature Care PPO |
$6,952.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,715.17
|
| Rate for Payer: United Healthcare Commercial |
$6,225.36
|
| Rate for Payer: United Healthcare Medicare |
$2,528.06
|
|
|
HC AR KIT SPEEDBRIDGE JUMPSTART
|
Facility
|
IP
|
$7,900.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,925.15 |
| Max. Negotiated Rate |
$7,347.19 |
| Rate for Payer: Aetna Commercial |
$6,825.77
|
| Rate for Payer: Cash Price |
$4,740.12
|
| Rate for Payer: Cigna All Commercial |
$6,817.87
|
| Rate for Payer: CORVEL All Commercial |
$7,347.19
|
| Rate for Payer: Coventry All Commercial |
$6,952.18
|
| Rate for Payer: Encore All Commercial |
$7,272.13
|
| Rate for Payer: Frontpath All Commercial |
$7,268.18
|
| Rate for Payer: Humana ChoiceCare |
$6,823.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,110.18
|
| Rate for Payer: PHCS All Commercial |
$5,925.15
|
| Rate for Payer: PHP All Commercial |
$5,991.51
|
| Rate for Payer: Sagamore Health Network All Products |
$6,098.95
|
| Rate for Payer: Signature Care EPO |
$6,557.17
|
| Rate for Payer: Signature Care PPO |
$6,952.18
|
| Rate for Payer: United Healthcare Commercial |
$6,225.36
|
|
|
HC AR KNEE BUTTON 2.6
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608298
|
|
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 KNEE BUTTON 2.6
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608298
|
|
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 KNEE LIGAMENT AUG SYSTEM
|
Facility
|
IP
|
$4,732.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,549.15 |
| Max. Negotiated Rate |
$4,400.95 |
| Rate for Payer: Aetna Commercial |
$4,088.62
|
| Rate for Payer: Cash Price |
$2,839.32
|
| Rate for Payer: Cigna All Commercial |
$4,083.89
|
| Rate for Payer: CORVEL All Commercial |
$4,400.95
|
| Rate for Payer: Coventry All Commercial |
$4,164.34
|
| Rate for Payer: Encore All Commercial |
$4,355.99
|
| Rate for Payer: Frontpath All Commercial |
$4,353.62
|
| Rate for Payer: Humana ChoiceCare |
$4,087.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,258.98
|
| Rate for Payer: PHCS All Commercial |
$3,549.15
|
| Rate for Payer: PHP All Commercial |
$3,588.90
|
| Rate for Payer: Sagamore Health Network All Products |
$3,653.26
|
| Rate for Payer: Signature Care EPO |
$3,927.73
|
| Rate for Payer: Signature Care PPO |
$4,164.34
|
| Rate for Payer: United Healthcare Commercial |
$3,728.97
|
|
|
HC AR KNEE LIGAMENT AUG SYSTEM
|
Facility
|
OP
|
$4,732.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,400.95 |
| Rate for Payer: Aetna Commercial |
$3,993.98
|
| Rate for Payer: Aetna Medicare |
$1,514.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,466.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,717.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,958.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,741.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,665.73
|
| Rate for Payer: Cash Price |
$2,839.32
|
| Rate for Payer: Cash Price |
$2,839.32
|
| Rate for Payer: Centivo All Commercial |
$2,574.32
|
| Rate for Payer: Cigna All Commercial |
$4,083.89
|
| Rate for Payer: CORVEL All Commercial |
$4,400.95
|
| Rate for Payer: Coventry All Commercial |
$4,164.34
|
| Rate for Payer: Encore All Commercial |
$4,355.99
|
| Rate for Payer: Frontpath All Commercial |
$4,353.62
|
| Rate for Payer: Humana ChoiceCare |
$4,087.20
|
| Rate for Payer: Humana Medicare |
$1,514.30
|
| Rate for Payer: Lucent All Commercial |
$2,574.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,258.98
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,549.15
|
| Rate for Payer: PHP All Commercial |
$3,588.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,845.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3,653.26
|
| Rate for Payer: Signature Care EPO |
$3,927.73
|
| Rate for Payer: Signature Care PPO |
$4,164.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,022.37
|
| Rate for Payer: United Healthcare Commercial |
$3,728.97
|
| Rate for Payer: United Healthcare Medicare |
$1,514.30
|
|
|
HC AR KNOTLESS FIBERTAK 2.56 BLUE
|
Facility
|
OP
|
$3,182.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,959.63 |
| Rate for Payer: Aetna Commercial |
$2,685.95
|
| Rate for Payer: Aetna Medicare |
$1,018.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$986.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,827.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,989.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,171.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,120.20
|
| Rate for Payer: Cash Price |
$1,909.44
|
| Rate for Payer: Cash Price |
$1,909.44
|
| Rate for Payer: Centivo All Commercial |
$1,731.23
|
| Rate for Payer: Cigna All Commercial |
$2,746.41
|
| Rate for Payer: CORVEL All Commercial |
$2,959.63
|
| Rate for Payer: Coventry All Commercial |
$2,800.51
|
| Rate for Payer: Encore All Commercial |
$2,929.40
|
| Rate for Payer: Frontpath All Commercial |
$2,927.81
|
| Rate for Payer: Humana ChoiceCare |
$2,748.64
|
| Rate for Payer: Humana Medicare |
$1,018.37
|
| Rate for Payer: Lucent All Commercial |
$1,731.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,864.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,386.80
|
| Rate for Payer: PHP All Commercial |
$2,413.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,241.14
|
| Rate for Payer: Sagamore Health Network All Products |
$2,456.81
|
| Rate for Payer: Signature Care EPO |
$2,641.39
|
| Rate for Payer: Signature Care PPO |
$2,800.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,705.04
|
| Rate for Payer: United Healthcare Commercial |
$2,507.73
|
| Rate for Payer: United Healthcare Medicare |
$1,018.37
|
|
|
HC AR KNOTLESS FIBERTAK 2.56 BLUE
|
Facility
|
IP
|
$3,182.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,386.80 |
| Max. Negotiated Rate |
$2,959.63 |
| Rate for Payer: Aetna Commercial |
$2,749.59
|
| Rate for Payer: Cash Price |
$1,909.44
|
| Rate for Payer: Cigna All Commercial |
$2,746.41
|
| Rate for Payer: CORVEL All Commercial |
$2,959.63
|
| Rate for Payer: Coventry All Commercial |
$2,800.51
|
| Rate for Payer: Encore All Commercial |
$2,929.40
|
| Rate for Payer: Frontpath All Commercial |
$2,927.81
|
| Rate for Payer: Humana ChoiceCare |
$2,748.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,864.16
|
| Rate for Payer: PHCS All Commercial |
$2,386.80
|
| Rate for Payer: PHP All Commercial |
$2,413.53
|
| Rate for Payer: Sagamore Health Network All Products |
$2,456.81
|
| Rate for Payer: Signature Care EPO |
$2,641.39
|
| Rate for Payer: Signature Care PPO |
$2,800.51
|
| Rate for Payer: United Healthcare Commercial |
$2,507.73
|
|
|
HC AR KNOTLESS FIBERTAK 2.6 B/B
|
Facility
|
OP
|
$2,098.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,951.88 |
| Rate for Payer: Aetna Commercial |
$1,771.39
|
| Rate for Payer: Aetna Medicare |
$671.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$650.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,205.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,311.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$772.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$738.78
|
| Rate for Payer: Cash Price |
$1,259.28
|
| Rate for Payer: Cash Price |
$1,259.28
|
| Rate for Payer: Centivo All Commercial |
$1,141.75
|
| Rate for Payer: Cigna All Commercial |
$1,811.26
|
| Rate for Payer: CORVEL All Commercial |
$1,951.88
|
| Rate for Payer: Coventry All Commercial |
$1,846.94
|
| Rate for Payer: Encore All Commercial |
$1,931.95
|
| Rate for Payer: Frontpath All Commercial |
$1,930.90
|
| Rate for Payer: Humana ChoiceCare |
$1,812.73
|
| Rate for Payer: Humana Medicare |
$671.62
|
| Rate for Payer: Lucent All Commercial |
$1,141.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,888.92
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,574.10
|
| Rate for Payer: PHP All Commercial |
$1,591.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$818.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,620.27
|
| Rate for Payer: Signature Care EPO |
$1,742.00
|
| Rate for Payer: Signature Care PPO |
$1,846.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,783.98
|
| Rate for Payer: United Healthcare Commercial |
$1,653.85
|
| Rate for Payer: United Healthcare Medicare |
$671.62
|
|
|
HC AR KNOTLESS FIBERTAK 2.6 B/B
|
Facility
|
IP
|
$2,098.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,574.10 |
| Max. Negotiated Rate |
$1,951.88 |
| Rate for Payer: Aetna Commercial |
$1,813.36
|
| Rate for Payer: Cash Price |
$1,259.28
|
| Rate for Payer: Cigna All Commercial |
$1,811.26
|
| Rate for Payer: CORVEL All Commercial |
$1,951.88
|
| Rate for Payer: Coventry All Commercial |
$1,846.94
|
| Rate for Payer: Encore All Commercial |
$1,931.95
|
| Rate for Payer: Frontpath All Commercial |
$1,930.90
|
| Rate for Payer: Humana ChoiceCare |
$1,812.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,888.92
|
| Rate for Payer: PHCS All Commercial |
$1,574.10
|
| Rate for Payer: PHP All Commercial |
$1,591.73
|
| Rate for Payer: Sagamore Health Network All Products |
$1,620.27
|
| Rate for Payer: Signature Care EPO |
$1,742.00
|
| Rate for Payer: Signature Care PPO |
$1,846.94
|
| Rate for Payer: United Healthcare Commercial |
$1,653.85
|
|
|
HC AR KNOTLESS FIBERTAK 2.6 W/B
|
Facility
|
IP
|
$2,098.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,574.10 |
| Max. Negotiated Rate |
$1,951.88 |
| Rate for Payer: Aetna Commercial |
$1,813.36
|
| Rate for Payer: Cash Price |
$1,259.28
|
| Rate for Payer: Cigna All Commercial |
$1,811.26
|
| Rate for Payer: CORVEL All Commercial |
$1,951.88
|
| Rate for Payer: Coventry All Commercial |
$1,846.94
|
| Rate for Payer: Encore All Commercial |
$1,931.95
|
| Rate for Payer: Frontpath All Commercial |
$1,930.90
|
| Rate for Payer: Humana ChoiceCare |
$1,812.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,888.92
|
| Rate for Payer: PHCS All Commercial |
$1,574.10
|
| Rate for Payer: PHP All Commercial |
$1,591.73
|
| Rate for Payer: Sagamore Health Network All Products |
$1,620.27
|
| Rate for Payer: Signature Care EPO |
$1,742.00
|
| Rate for Payer: Signature Care PPO |
$1,846.94
|
| Rate for Payer: United Healthcare Commercial |
$1,653.85
|
|
|
HC AR KNOTLESS FIBERTAK 2.6 W/B
|
Facility
|
OP
|
$2,098.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,951.88 |
| Rate for Payer: Aetna Commercial |
$1,771.39
|
| Rate for Payer: Aetna Medicare |
$671.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$650.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,205.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,311.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$772.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$738.78
|
| Rate for Payer: Cash Price |
$1,259.28
|
| Rate for Payer: Cash Price |
$1,259.28
|
| Rate for Payer: Centivo All Commercial |
$1,141.75
|
| Rate for Payer: Cigna All Commercial |
$1,811.26
|
| Rate for Payer: CORVEL All Commercial |
$1,951.88
|
| Rate for Payer: Coventry All Commercial |
$1,846.94
|
| Rate for Payer: Encore All Commercial |
$1,931.95
|
| Rate for Payer: Frontpath All Commercial |
$1,930.90
|
| Rate for Payer: Humana ChoiceCare |
$1,812.73
|
| Rate for Payer: Humana Medicare |
$671.62
|
| Rate for Payer: Lucent All Commercial |
$1,141.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,888.92
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,574.10
|
| Rate for Payer: PHP All Commercial |
$1,591.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$818.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,620.27
|
| Rate for Payer: Signature Care EPO |
$1,742.00
|
| Rate for Payer: Signature Care PPO |
$1,846.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,783.98
|
| Rate for Payer: United Healthcare Commercial |
$1,653.85
|
| Rate for Payer: United Healthcare Medicare |
$671.62
|
|
|
HC AR KNOTLESS SUTTAK 3X12.7 OPEN
|
Facility
|
OP
|
$2,117.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,969.28 |
| Rate for Payer: Aetna Commercial |
$1,787.17
|
| Rate for Payer: Aetna Medicare |
$677.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$656.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,216.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,323.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$779.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$745.36
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Centivo All Commercial |
$1,151.92
|
| Rate for Payer: Cigna All Commercial |
$1,827.40
|
| Rate for Payer: CORVEL All Commercial |
$1,969.28
|
| Rate for Payer: Coventry All Commercial |
$1,863.40
|
| Rate for Payer: Encore All Commercial |
$1,949.16
|
| Rate for Payer: Frontpath All Commercial |
$1,948.10
|
| Rate for Payer: Humana ChoiceCare |
$1,828.88
|
| Rate for Payer: Humana Medicare |
$677.60
|
| Rate for Payer: Lucent All Commercial |
$1,151.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,905.75
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,588.12
|
| Rate for Payer: PHP All Commercial |
$1,605.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$825.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,634.71
|
| Rate for Payer: Signature Care EPO |
$1,757.53
|
| Rate for Payer: Signature Care PPO |
$1,863.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,799.88
|
| Rate for Payer: United Healthcare Commercial |
$1,668.59
|
| Rate for Payer: United Healthcare Medicare |
$677.60
|
|
|
HC AR KNOTLESS SUTTAK 3X12.7 OPEN
|
Facility
|
IP
|
$2,117.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,588.12 |
| Max. Negotiated Rate |
$1,969.28 |
| Rate for Payer: Aetna Commercial |
$1,829.52
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Cigna All Commercial |
$1,827.40
|
| Rate for Payer: CORVEL All Commercial |
$1,969.28
|
| Rate for Payer: Coventry All Commercial |
$1,863.40
|
| Rate for Payer: Encore All Commercial |
$1,949.16
|
| Rate for Payer: Frontpath All Commercial |
$1,948.10
|
| Rate for Payer: Humana ChoiceCare |
$1,828.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,905.75
|
| Rate for Payer: PHCS All Commercial |
$1,588.12
|
| Rate for Payer: PHP All Commercial |
$1,605.91
|
| Rate for Payer: Sagamore Health Network All Products |
$1,634.71
|
| Rate for Payer: Signature Care EPO |
$1,757.53
|
| Rate for Payer: Signature Care PPO |
$1,863.40
|
| Rate for Payer: United Healthcare Commercial |
$1,668.59
|
|
|
HC AR KNOT PUSHER W/SKID
|
Facility
|
OP
|
$1,835.00
|
|
| Hospital Charge Code |
41608229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,706.55 |
| Rate for Payer: Aetna Commercial |
$1,548.74
|
| Rate for Payer: Aetna Medicare |
$587.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$568.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,053.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,147.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$675.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$645.92
|
| Rate for Payer: Cash Price |
$1,101.00
|
| Rate for Payer: Cash Price |
$1,101.00
|
| Rate for Payer: Centivo All Commercial |
$998.24
|
| Rate for Payer: Cigna All Commercial |
$1,583.61
|
| Rate for Payer: CORVEL All Commercial |
$1,706.55
|
| Rate for Payer: Coventry All Commercial |
$1,614.80
|
| Rate for Payer: Encore All Commercial |
$1,689.12
|
| Rate for Payer: Frontpath All Commercial |
$1,688.20
|
| Rate for Payer: Humana ChoiceCare |
$1,584.89
|
| Rate for Payer: Humana Medicare |
$587.20
|
| Rate for Payer: Lucent All Commercial |
$998.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,651.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,376.25
|
| Rate for Payer: PHP All Commercial |
$1,391.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$715.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,416.62
|
| Rate for Payer: Signature Care EPO |
$1,523.05
|
| Rate for Payer: Signature Care PPO |
$1,614.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,559.75
|
| Rate for Payer: United Healthcare Commercial |
$1,445.98
|
| Rate for Payer: United Healthcare Medicare |
$587.20
|
|
