|
HC AR KNOT PUSHER W/SKID
|
Facility
|
IP
|
$1,835.00
|
|
| Hospital Charge Code |
41608229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,376.25 |
| Max. Negotiated Rate |
$1,706.55 |
| Rate for Payer: Aetna Commercial |
$1,585.44
|
| Rate for Payer: Cash Price |
$1,101.00
|
| 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: Lutheran Preferred All Commercial |
$1,651.50
|
| Rate for Payer: PHCS All Commercial |
$1,376.25
|
| Rate for Payer: PHP All Commercial |
$1,391.66
|
| 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: United Healthcare Commercial |
$1,445.98
|
|
|
HC AR KWIRE 1.35
|
Facility
|
IP
|
$234.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.88 |
| Max. Negotiated Rate |
$218.09 |
| Rate for Payer: Aetna Commercial |
$202.61
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.09
|
| Rate for Payer: Coventry All Commercial |
$206.36
|
| Rate for Payer: Encore All Commercial |
$215.86
|
| Rate for Payer: Frontpath All Commercial |
$215.74
|
| Rate for Payer: Humana ChoiceCare |
$202.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.05
|
| Rate for Payer: PHCS All Commercial |
$175.88
|
| Rate for Payer: PHP All Commercial |
$177.84
|
| Rate for Payer: Sagamore Health Network All Products |
$181.03
|
| Rate for Payer: Signature Care EPO |
$194.63
|
| Rate for Payer: Signature Care PPO |
$206.36
|
| Rate for Payer: United Healthcare Commercial |
$184.79
|
|
|
HC AR KWIRE 1.35
|
Facility
|
OP
|
$234.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.69 |
| Max. Negotiated Rate |
$218.09 |
| Rate for Payer: Aetna Commercial |
$197.92
|
| Rate for Payer: Aetna Medicare |
$75.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$134.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.54
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Centivo All Commercial |
$127.57
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.09
|
| Rate for Payer: Coventry All Commercial |
$206.36
|
| Rate for Payer: Encore All Commercial |
$215.86
|
| Rate for Payer: Frontpath All Commercial |
$215.74
|
| Rate for Payer: Humana ChoiceCare |
$202.54
|
| Rate for Payer: Humana Medicare |
$75.04
|
| Rate for Payer: Lucent All Commercial |
$127.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.05
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$175.88
|
| Rate for Payer: PHP All Commercial |
$177.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.45
|
| Rate for Payer: Sagamore Health Network All Products |
$181.03
|
| Rate for Payer: Signature Care EPO |
$194.63
|
| Rate for Payer: Signature Care PPO |
$206.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$199.32
|
| Rate for Payer: United Healthcare Commercial |
$184.79
|
| Rate for Payer: United Healthcare Medicare |
$75.04
|
|
|
HC AR MENISCAL ROOT IMPLANT
|
Facility
|
IP
|
$3,940.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,955.15 |
| Max. Negotiated Rate |
$3,664.39 |
| Rate for Payer: Aetna Commercial |
$3,404.33
|
| Rate for Payer: Cash Price |
$2,364.12
|
| Rate for Payer: Cigna All Commercial |
$3,400.39
|
| Rate for Payer: CORVEL All Commercial |
$3,664.39
|
| Rate for Payer: Coventry All Commercial |
$3,467.38
|
| Rate for Payer: Encore All Commercial |
$3,626.95
|
| Rate for Payer: Frontpath All Commercial |
$3,624.98
|
| Rate for Payer: Humana ChoiceCare |
$3,403.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,546.18
|
| Rate for Payer: PHCS All Commercial |
$2,955.15
|
| Rate for Payer: PHP All Commercial |
$2,988.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,041.83
|
| Rate for Payer: Signature Care EPO |
$3,270.37
|
| Rate for Payer: Signature Care PPO |
$3,467.38
|
| Rate for Payer: United Healthcare Commercial |
$3,104.88
|
|
|
HC AR MENISCAL ROOT IMPLANT
|
Facility
|
OP
|
$3,940.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,664.39 |
| Rate for Payer: Aetna Commercial |
$3,325.53
|
| Rate for Payer: Aetna Medicare |
$1,260.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,221.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,262.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,463.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,449.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,386.95
|
| Rate for Payer: Cash Price |
$2,364.12
|
| Rate for Payer: Cash Price |
$2,364.12
|
| Rate for Payer: Centivo All Commercial |
$2,143.47
|
| Rate for Payer: Cigna All Commercial |
$3,400.39
|
| Rate for Payer: CORVEL All Commercial |
$3,664.39
|
| Rate for Payer: Coventry All Commercial |
$3,467.38
|
| Rate for Payer: Encore All Commercial |
$3,626.95
|
| Rate for Payer: Frontpath All Commercial |
$3,624.98
|
| Rate for Payer: Humana ChoiceCare |
$3,403.15
|
| Rate for Payer: Humana Medicare |
$1,260.86
|
| Rate for Payer: Lucent All Commercial |
$2,143.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,546.18
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,955.15
|
| Rate for Payer: PHP All Commercial |
$2,988.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,536.68
|
| Rate for Payer: Sagamore Health Network All Products |
$3,041.83
|
| Rate for Payer: Signature Care EPO |
$3,270.37
|
| Rate for Payer: Signature Care PPO |
$3,467.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,349.17
|
| Rate for Payer: United Healthcare Commercial |
$3,104.88
|
| Rate for Payer: United Healthcare Medicare |
$1,260.86
|
|
|
HC AR M-FIRE SCORPION NEEDLE
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
41605576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.25 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Aetna Commercial |
$807.84
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna All Commercial |
$806.90
|
| Rate for Payer: CORVEL All Commercial |
$869.55
|
| Rate for Payer: Coventry All Commercial |
$822.80
|
| Rate for Payer: Encore All Commercial |
$860.67
|
| Rate for Payer: Frontpath All Commercial |
$860.20
|
| Rate for Payer: Humana ChoiceCare |
$807.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$841.50
|
| Rate for Payer: PHCS All Commercial |
$701.25
|
| Rate for Payer: PHP All Commercial |
$709.10
|
| Rate for Payer: Sagamore Health Network All Products |
$721.82
|
| Rate for Payer: Signature Care EPO |
$776.05
|
| Rate for Payer: Signature Care PPO |
$822.80
|
| Rate for Payer: United Healthcare Commercial |
$736.78
|
|
|
HC AR M-FIRE SCORPION NEEDLE
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
41605576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Aetna Commercial |
$789.14
|
| Rate for Payer: Aetna Medicare |
$299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$289.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$536.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$584.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$344.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$329.12
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Centivo All Commercial |
$508.64
|
| Rate for Payer: Cigna All Commercial |
$806.90
|
| Rate for Payer: CORVEL All Commercial |
$869.55
|
| Rate for Payer: Coventry All Commercial |
$822.80
|
| Rate for Payer: Encore All Commercial |
$860.67
|
| Rate for Payer: Frontpath All Commercial |
$860.20
|
| Rate for Payer: Humana ChoiceCare |
$807.56
|
| Rate for Payer: Humana Medicare |
$299.20
|
| Rate for Payer: Lucent All Commercial |
$508.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$841.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$701.25
|
| Rate for Payer: PHP All Commercial |
$709.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$364.65
|
| Rate for Payer: Sagamore Health Network All Products |
$721.82
|
| Rate for Payer: Signature Care EPO |
$776.05
|
| Rate for Payer: Signature Care PPO |
$822.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$794.75
|
| Rate for Payer: United Healthcare Commercial |
$736.78
|
| Rate for Payer: United Healthcare Medicare |
$299.20
|
|
|
HC AR MINI SCREW 3.5X46 COMP FT
|
Facility
|
OP
|
$2,102.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,955.23 |
| Rate for Payer: Aetna Commercial |
$1,774.43
|
| Rate for Payer: Aetna Medicare |
$672.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$651.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,207.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,314.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$773.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$740.04
|
| Rate for Payer: Cash Price |
$1,261.44
|
| Rate for Payer: Cash Price |
$1,261.44
|
| Rate for Payer: Centivo All Commercial |
$1,143.71
|
| Rate for Payer: Cigna All Commercial |
$1,814.37
|
| Rate for Payer: CORVEL All Commercial |
$1,955.23
|
| Rate for Payer: Coventry All Commercial |
$1,850.11
|
| Rate for Payer: Encore All Commercial |
$1,935.26
|
| Rate for Payer: Frontpath All Commercial |
$1,934.21
|
| Rate for Payer: Humana ChoiceCare |
$1,815.84
|
| Rate for Payer: Humana Medicare |
$672.77
|
| Rate for Payer: Lucent All Commercial |
$1,143.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,892.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,576.80
|
| Rate for Payer: PHP All Commercial |
$1,594.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$819.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,623.05
|
| Rate for Payer: Signature Care EPO |
$1,744.99
|
| Rate for Payer: Signature Care PPO |
$1,850.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,787.04
|
| Rate for Payer: United Healthcare Commercial |
$1,656.69
|
| Rate for Payer: United Healthcare Medicare |
$672.77
|
|
|
HC AR MINI SCREW 3.5X46 COMP FT
|
Facility
|
IP
|
$2,102.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,576.80 |
| Max. Negotiated Rate |
$1,955.23 |
| Rate for Payer: Aetna Commercial |
$1,816.47
|
| Rate for Payer: Cash Price |
$1,261.44
|
| Rate for Payer: Cigna All Commercial |
$1,814.37
|
| Rate for Payer: CORVEL All Commercial |
$1,955.23
|
| Rate for Payer: Coventry All Commercial |
$1,850.11
|
| Rate for Payer: Encore All Commercial |
$1,935.26
|
| Rate for Payer: Frontpath All Commercial |
$1,934.21
|
| Rate for Payer: Humana ChoiceCare |
$1,815.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,892.16
|
| Rate for Payer: PHCS All Commercial |
$1,576.80
|
| Rate for Payer: PHP All Commercial |
$1,594.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,623.05
|
| Rate for Payer: Signature Care EPO |
$1,744.99
|
| Rate for Payer: Signature Care PPO |
$1,850.11
|
| Rate for Payer: United Healthcare Commercial |
$1,656.69
|
|
|
HC AR MINI SCREW 3.5X48 COMP FT
|
Facility
|
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$616.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$596.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$708.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$677.60
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Centivo All Commercial |
$1,047.20
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Humana Medicare |
$616.00
|
| Rate for Payer: Lucent All Commercial |
$1,047.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$750.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,636.25
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
| Rate for Payer: United Healthcare Medicare |
$616.00
|
|
|
HC AR MINI SCREW 3.5X48 COMP FT
|
Facility
|
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC AR MINI SUTURE ANCHOR 2.5X8
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,480.00 |
| Max. Negotiated Rate |
$8,035.20 |
| Rate for Payer: Aetna Commercial |
$7,464.96
|
| Rate for Payer: Cash Price |
$5,184.00
|
| Rate for Payer: Cigna All Commercial |
$7,456.32
|
| Rate for Payer: CORVEL All Commercial |
$8,035.20
|
| Rate for Payer: Coventry All Commercial |
$7,603.20
|
| Rate for Payer: Encore All Commercial |
$7,953.12
|
| Rate for Payer: Frontpath All Commercial |
$7,948.80
|
| Rate for Payer: Humana ChoiceCare |
$7,462.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,776.00
|
| Rate for Payer: PHCS All Commercial |
$6,480.00
|
| Rate for Payer: PHP All Commercial |
$6,552.58
|
| Rate for Payer: Sagamore Health Network All Products |
$6,670.08
|
| Rate for Payer: Signature Care EPO |
$7,171.20
|
| Rate for Payer: Signature Care PPO |
$7,603.20
|
| Rate for Payer: United Healthcare Commercial |
$6,808.32
|
|
|
HC AR MINI SUTURE ANCHOR 2.5X8
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$8,035.20 |
| Rate for Payer: Aetna Commercial |
$7,292.16
|
| Rate for Payer: Aetna Medicare |
$2,764.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,678.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,961.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,400.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,179.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,041.28
|
| Rate for Payer: Cash Price |
$5,184.00
|
| Rate for Payer: Cash Price |
$5,184.00
|
| Rate for Payer: Centivo All Commercial |
$4,700.16
|
| Rate for Payer: Cigna All Commercial |
$7,456.32
|
| Rate for Payer: CORVEL All Commercial |
$8,035.20
|
| Rate for Payer: Coventry All Commercial |
$7,603.20
|
| Rate for Payer: Encore All Commercial |
$7,953.12
|
| Rate for Payer: Frontpath All Commercial |
$7,948.80
|
| Rate for Payer: Humana ChoiceCare |
$7,462.37
|
| Rate for Payer: Humana Medicare |
$2,764.80
|
| Rate for Payer: Lucent All Commercial |
$4,700.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,776.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,480.00
|
| Rate for Payer: PHP All Commercial |
$6,552.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,369.60
|
| Rate for Payer: Sagamore Health Network All Products |
$6,670.08
|
| Rate for Payer: Signature Care EPO |
$7,171.20
|
| Rate for Payer: Signature Care PPO |
$7,603.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,344.00
|
| Rate for Payer: United Healthcare Commercial |
$6,808.32
|
| Rate for Payer: United Healthcare Medicare |
$2,764.80
|
|
|
HC AR OBSTURATOR FLEX
|
Facility
|
IP
|
$962.50
|
|
| Hospital Charge Code |
41606971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC AR OBSTURATOR FLEX
|
Facility
|
OP
|
$962.50
|
|
| Hospital Charge Code |
41606971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$308.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$298.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.80
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Centivo All Commercial |
$523.60
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$308.00
|
| Rate for Payer: Lucent All Commercial |
$523.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$308.00
|
|
|
HC AR PASSPORT BUTTON 6X3
|
Facility
|
OP
|
$246.40
|
|
| Hospital Charge Code |
41606548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$78.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.73
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Centivo All Commercial |
$134.04
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$78.85
|
| Rate for Payer: Lucent All Commercial |
$134.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$78.85
|
|
|
HC AR PASSPORT BUTTON 6X3
|
Facility
|
IP
|
$246.40
|
|
| Hospital Charge Code |
41606548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 6X4
|
Facility
|
OP
|
$246.40
|
|
| Hospital Charge Code |
41606206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$78.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.73
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Centivo All Commercial |
$134.04
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$78.85
|
| Rate for Payer: Lucent All Commercial |
$134.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$78.85
|
|
|
HC AR PASSPORT BUTTON 6X4
|
Facility
|
IP
|
$246.40
|
|
| Hospital Charge Code |
41606206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 8X3
|
Facility
|
IP
|
$246.40
|
|
| Hospital Charge Code |
41606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 8X3
|
Facility
|
OP
|
$246.40
|
|
| Hospital Charge Code |
41606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$78.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.73
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Centivo All Commercial |
$134.04
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$78.85
|
| Rate for Payer: Lucent All Commercial |
$134.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$78.85
|
|
|
HC AR PASSPORT BUTTON 8X4
|
Facility
|
OP
|
$246.40
|
|
| Hospital Charge Code |
41606200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$78.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.73
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Centivo All Commercial |
$134.04
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$78.85
|
| Rate for Payer: Lucent All Commercial |
$134.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$78.85
|
|
|
HC AR PASSPORT BUTTON 8X4
|
Facility
|
IP
|
$246.40
|
|
| Hospital Charge Code |
41606200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 8X5
|
Facility
|
IP
|
$246.40
|
|
| Hospital Charge Code |
41606205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 8X5
|
Facility
|
OP
|
$246.40
|
|
| Hospital Charge Code |
41606205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$78.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.73
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Centivo All Commercial |
$134.04
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$78.85
|
| Rate for Payer: Lucent All Commercial |
$134.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$78.85
|
|
