|
HC AR SUT ANCHOR FIBERTAK 1.8
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,250.60 |
| Rate for Payer: Aetna Commercial |
$2,042.48
|
| Rate for Payer: Aetna Medicare |
$774.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$750.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,389.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,512.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$890.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$851.84
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Centivo All Commercial |
$1,316.48
|
| Rate for Payer: Cigna All Commercial |
$2,088.46
|
| Rate for Payer: CORVEL All Commercial |
$2,250.60
|
| Rate for Payer: Coventry All Commercial |
$2,129.60
|
| Rate for Payer: Encore All Commercial |
$2,227.61
|
| Rate for Payer: Frontpath All Commercial |
$2,226.40
|
| Rate for Payer: Humana ChoiceCare |
$2,090.15
|
| Rate for Payer: Humana Medicare |
$774.40
|
| Rate for Payer: Lucent All Commercial |
$1,316.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,178.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,815.00
|
| Rate for Payer: PHP All Commercial |
$1,835.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$943.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,868.24
|
| Rate for Payer: Signature Care EPO |
$2,008.60
|
| Rate for Payer: Signature Care PPO |
$2,129.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,057.00
|
| Rate for Payer: United Healthcare Commercial |
$1,906.96
|
| Rate for Payer: United Healthcare Medicare |
$774.40
|
|
|
HC AR SUT ANCHOR FIBERTAK 2.6 DBL
|
Facility
|
OP
|
$2,172.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,020.42 |
| Rate for Payer: Aetna Commercial |
$1,833.59
|
| Rate for Payer: Aetna Medicare |
$695.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$673.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,247.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,358.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$799.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$764.72
|
| Rate for Payer: Cash Price |
$1,303.50
|
| Rate for Payer: Cash Price |
$1,303.50
|
| Rate for Payer: Centivo All Commercial |
$1,181.84
|
| Rate for Payer: Cigna All Commercial |
$1,874.87
|
| Rate for Payer: CORVEL All Commercial |
$2,020.42
|
| Rate for Payer: Coventry All Commercial |
$1,911.80
|
| Rate for Payer: Encore All Commercial |
$1,999.79
|
| Rate for Payer: Frontpath All Commercial |
$1,998.70
|
| Rate for Payer: Humana ChoiceCare |
$1,876.39
|
| Rate for Payer: Humana Medicare |
$695.20
|
| Rate for Payer: Lucent All Commercial |
$1,181.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,955.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,629.38
|
| Rate for Payer: PHP All Commercial |
$1,647.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$847.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,677.17
|
| Rate for Payer: Signature Care EPO |
$1,803.17
|
| Rate for Payer: Signature Care PPO |
$1,911.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,846.62
|
| Rate for Payer: United Healthcare Commercial |
$1,711.93
|
| Rate for Payer: United Healthcare Medicare |
$695.20
|
|
|
HC AR SUT ANCHOR FIBERTAK 2.6 DBL
|
Facility
|
IP
|
$2,172.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.38 |
| Max. Negotiated Rate |
$2,020.42 |
| Rate for Payer: Aetna Commercial |
$1,877.04
|
| Rate for Payer: Cash Price |
$1,303.50
|
| Rate for Payer: Cigna All Commercial |
$1,874.87
|
| Rate for Payer: CORVEL All Commercial |
$2,020.42
|
| Rate for Payer: Coventry All Commercial |
$1,911.80
|
| Rate for Payer: Encore All Commercial |
$1,999.79
|
| Rate for Payer: Frontpath All Commercial |
$1,998.70
|
| Rate for Payer: Humana ChoiceCare |
$1,876.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,955.25
|
| Rate for Payer: PHCS All Commercial |
$1,629.38
|
| Rate for Payer: PHP All Commercial |
$1,647.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,677.17
|
| Rate for Payer: Signature Care EPO |
$1,803.17
|
| Rate for Payer: Signature Care PPO |
$1,911.80
|
| Rate for Payer: United Healthcare Commercial |
$1,711.93
|
|
|
HC AR SUT ANCHOR FIBERTAK 2.6 SP
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,856.25 |
| Max. Negotiated Rate |
$2,301.75 |
| Rate for Payer: Aetna Commercial |
$2,138.40
|
| Rate for Payer: Cash Price |
$1,485.00
|
| Rate for Payer: Cigna All Commercial |
$2,135.93
|
| Rate for Payer: CORVEL All Commercial |
$2,301.75
|
| Rate for Payer: Coventry All Commercial |
$2,178.00
|
| Rate for Payer: Encore All Commercial |
$2,278.24
|
| Rate for Payer: Frontpath All Commercial |
$2,277.00
|
| Rate for Payer: Humana ChoiceCare |
$2,137.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,227.50
|
| Rate for Payer: PHCS All Commercial |
$1,856.25
|
| Rate for Payer: PHP All Commercial |
$1,877.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,910.70
|
| Rate for Payer: Signature Care EPO |
$2,054.25
|
| Rate for Payer: Signature Care PPO |
$2,178.00
|
| Rate for Payer: United Healthcare Commercial |
$1,950.30
|
|
|
HC AR SUT ANCHOR FIBERTAK 2.6 SP
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,301.75 |
| Rate for Payer: Aetna Commercial |
$2,088.90
|
| Rate for Payer: Aetna Medicare |
$792.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$767.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,421.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,547.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$910.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$871.20
|
| Rate for Payer: Cash Price |
$1,485.00
|
| Rate for Payer: Cash Price |
$1,485.00
|
| Rate for Payer: Centivo All Commercial |
$1,346.40
|
| Rate for Payer: Cigna All Commercial |
$2,135.93
|
| Rate for Payer: CORVEL All Commercial |
$2,301.75
|
| Rate for Payer: Coventry All Commercial |
$2,178.00
|
| Rate for Payer: Encore All Commercial |
$2,278.24
|
| Rate for Payer: Frontpath All Commercial |
$2,277.00
|
| Rate for Payer: Humana ChoiceCare |
$2,137.66
|
| Rate for Payer: Humana Medicare |
$792.00
|
| Rate for Payer: Lucent All Commercial |
$1,346.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,227.50
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,856.25
|
| Rate for Payer: PHP All Commercial |
$1,877.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$965.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,910.70
|
| Rate for Payer: Signature Care EPO |
$2,054.25
|
| Rate for Payer: Signature Care PPO |
$2,178.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,103.75
|
| Rate for Payer: United Healthcare Commercial |
$1,950.30
|
| Rate for Payer: United Healthcare Medicare |
$792.00
|
|
|
HC AR SUT ANCHOR SWVLCK 4.75 BC
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608356
|
|
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 SUT ANCHOR SWVLCK 4.75 BC
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608356
|
|
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 SUT LASSO 25 CURVE QP L
|
Facility
|
OP
|
$1,335.00
|
|
| Hospital Charge Code |
41608420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,241.55 |
| Rate for Payer: Aetna Commercial |
$1,126.74
|
| Rate for Payer: Aetna Medicare |
$427.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$413.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$766.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$834.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$491.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$469.92
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Centivo All Commercial |
$726.24
|
| Rate for Payer: Cigna All Commercial |
$1,152.11
|
| Rate for Payer: CORVEL All Commercial |
$1,241.55
|
| Rate for Payer: Coventry All Commercial |
$1,174.80
|
| Rate for Payer: Encore All Commercial |
$1,228.87
|
| Rate for Payer: Frontpath All Commercial |
$1,228.20
|
| Rate for Payer: Humana ChoiceCare |
$1,153.04
|
| Rate for Payer: Humana Medicare |
$427.20
|
| Rate for Payer: Lucent All Commercial |
$726.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,201.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,001.25
|
| Rate for Payer: PHP All Commercial |
$1,012.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$520.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,030.62
|
| Rate for Payer: Signature Care EPO |
$1,108.05
|
| Rate for Payer: Signature Care PPO |
$1,174.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,134.75
|
| Rate for Payer: United Healthcare Commercial |
$1,051.98
|
| Rate for Payer: United Healthcare Medicare |
$427.20
|
|
|
HC AR SUT LASSO 25 CURVE QP L
|
Facility
|
IP
|
$1,335.00
|
|
| Hospital Charge Code |
41608420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,001.25 |
| Max. Negotiated Rate |
$1,241.55 |
| Rate for Payer: Aetna Commercial |
$1,153.44
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna All Commercial |
$1,152.11
|
| Rate for Payer: CORVEL All Commercial |
$1,241.55
|
| Rate for Payer: Coventry All Commercial |
$1,174.80
|
| Rate for Payer: Encore All Commercial |
$1,228.87
|
| Rate for Payer: Frontpath All Commercial |
$1,228.20
|
| Rate for Payer: Humana ChoiceCare |
$1,153.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,201.50
|
| Rate for Payer: PHCS All Commercial |
$1,001.25
|
| Rate for Payer: PHP All Commercial |
$1,012.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,030.62
|
| Rate for Payer: Signature Care EPO |
$1,108.05
|
| Rate for Payer: Signature Care PPO |
$1,174.80
|
| Rate for Payer: United Healthcare Commercial |
$1,051.98
|
|
|
HC AR SUT LASSO 25 CURVE QP R
|
Facility
|
OP
|
$1,335.00
|
|
| Hospital Charge Code |
41608382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,241.55 |
| Rate for Payer: Aetna Commercial |
$1,126.74
|
| Rate for Payer: Aetna Medicare |
$427.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$413.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$766.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$834.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$491.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$469.92
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Centivo All Commercial |
$726.24
|
| Rate for Payer: Cigna All Commercial |
$1,152.11
|
| Rate for Payer: CORVEL All Commercial |
$1,241.55
|
| Rate for Payer: Coventry All Commercial |
$1,174.80
|
| Rate for Payer: Encore All Commercial |
$1,228.87
|
| Rate for Payer: Frontpath All Commercial |
$1,228.20
|
| Rate for Payer: Humana ChoiceCare |
$1,153.04
|
| Rate for Payer: Humana Medicare |
$427.20
|
| Rate for Payer: Lucent All Commercial |
$726.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,201.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,001.25
|
| Rate for Payer: PHP All Commercial |
$1,012.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$520.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,030.62
|
| Rate for Payer: Signature Care EPO |
$1,108.05
|
| Rate for Payer: Signature Care PPO |
$1,174.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,134.75
|
| Rate for Payer: United Healthcare Commercial |
$1,051.98
|
| Rate for Payer: United Healthcare Medicare |
$427.20
|
|
|
HC AR SUT LASSO 25 CURVE QP R
|
Facility
|
IP
|
$1,335.00
|
|
| Hospital Charge Code |
41608382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,001.25 |
| Max. Negotiated Rate |
$1,241.55 |
| Rate for Payer: Aetna Commercial |
$1,153.44
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna All Commercial |
$1,152.11
|
| Rate for Payer: CORVEL All Commercial |
$1,241.55
|
| Rate for Payer: Coventry All Commercial |
$1,174.80
|
| Rate for Payer: Encore All Commercial |
$1,228.87
|
| Rate for Payer: Frontpath All Commercial |
$1,228.20
|
| Rate for Payer: Humana ChoiceCare |
$1,153.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,201.50
|
| Rate for Payer: PHCS All Commercial |
$1,001.25
|
| Rate for Payer: PHP All Commercial |
$1,012.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,030.62
|
| Rate for Payer: Signature Care EPO |
$1,108.05
|
| Rate for Payer: Signature Care PPO |
$1,174.80
|
| Rate for Payer: United Healthcare Commercial |
$1,051.98
|
|
|
HC AR SUTURE ANCHOR PEEK 5.5X14.7
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Aetna Commercial |
$1,392.60
|
| Rate for Payer: Aetna Medicare |
$528.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$511.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$947.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,031.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$607.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$580.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Centivo All Commercial |
$897.60
|
| Rate for Payer: Cigna All Commercial |
$1,423.95
|
| Rate for Payer: CORVEL All Commercial |
$1,534.50
|
| Rate for Payer: Coventry All Commercial |
$1,452.00
|
| Rate for Payer: Encore All Commercial |
$1,518.83
|
| Rate for Payer: Frontpath All Commercial |
$1,518.00
|
| Rate for Payer: Humana ChoiceCare |
$1,425.11
|
| Rate for Payer: Humana Medicare |
$528.00
|
| Rate for Payer: Lucent All Commercial |
$897.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,485.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,237.50
|
| Rate for Payer: PHP All Commercial |
$1,251.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$643.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,273.80
|
| Rate for Payer: Signature Care EPO |
$1,369.50
|
| Rate for Payer: Signature Care PPO |
$1,452.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,402.50
|
| Rate for Payer: United Healthcare Commercial |
$1,300.20
|
| Rate for Payer: United Healthcare Medicare |
$528.00
|
|
|
HC AR SUTURE ANCHOR PEEK 5.5X14.7
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Aetna Commercial |
$1,425.60
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna All Commercial |
$1,423.95
|
| Rate for Payer: CORVEL All Commercial |
$1,534.50
|
| Rate for Payer: Coventry All Commercial |
$1,452.00
|
| Rate for Payer: Encore All Commercial |
$1,518.83
|
| Rate for Payer: Frontpath All Commercial |
$1,518.00
|
| Rate for Payer: Humana ChoiceCare |
$1,425.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,485.00
|
| Rate for Payer: PHCS All Commercial |
$1,237.50
|
| Rate for Payer: PHP All Commercial |
$1,251.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,273.80
|
| Rate for Payer: Signature Care EPO |
$1,369.50
|
| Rate for Payer: Signature Care PPO |
$1,452.00
|
| Rate for Payer: United Healthcare Commercial |
$1,300.20
|
|
|
HC AR SUTURE FIBERLINK
|
Facility
|
IP
|
$731.50
|
|
| Hospital Charge Code |
41606312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$680.29 |
| Rate for Payer: Aetna Commercial |
$632.02
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: Cigna All Commercial |
$631.28
|
| Rate for Payer: CORVEL All Commercial |
$680.29
|
| Rate for Payer: Coventry All Commercial |
$643.72
|
| Rate for Payer: Encore All Commercial |
$673.35
|
| Rate for Payer: Frontpath All Commercial |
$672.98
|
| Rate for Payer: Humana ChoiceCare |
$631.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$658.35
|
| Rate for Payer: PHCS All Commercial |
$548.62
|
| Rate for Payer: PHP All Commercial |
$554.77
|
| Rate for Payer: Sagamore Health Network All Products |
$564.72
|
| Rate for Payer: Signature Care EPO |
$607.14
|
| Rate for Payer: Signature Care PPO |
$643.72
|
| Rate for Payer: United Healthcare Commercial |
$576.42
|
|
|
HC AR SUTURE FIBERLINK
|
Facility
|
OP
|
$731.50
|
|
| Hospital Charge Code |
41606312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$680.29 |
| Rate for Payer: Aetna Commercial |
$617.39
|
| Rate for Payer: Aetna Medicare |
$234.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$226.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$420.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$457.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$269.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$257.49
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: Centivo All Commercial |
$397.94
|
| Rate for Payer: Cigna All Commercial |
$631.28
|
| Rate for Payer: CORVEL All Commercial |
$680.29
|
| Rate for Payer: Coventry All Commercial |
$643.72
|
| Rate for Payer: Encore All Commercial |
$673.35
|
| Rate for Payer: Frontpath All Commercial |
$672.98
|
| Rate for Payer: Humana ChoiceCare |
$631.80
|
| Rate for Payer: Humana Medicare |
$234.08
|
| Rate for Payer: Lucent All Commercial |
$397.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$658.35
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$548.62
|
| Rate for Payer: PHP All Commercial |
$554.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$285.29
|
| Rate for Payer: Sagamore Health Network All Products |
$564.72
|
| Rate for Payer: Signature Care EPO |
$607.14
|
| Rate for Payer: Signature Care PPO |
$643.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$621.77
|
| Rate for Payer: United Healthcare Commercial |
$576.42
|
| Rate for Payer: United Healthcare Medicare |
$234.08
|
|
|
HC AR SUTURE FIBERLINK 1.3
|
Facility
|
OP
|
$654.50
|
|
| Hospital Charge Code |
41606209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$552.40
|
| Rate for Payer: Aetna Medicare |
$209.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$375.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$240.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$230.38
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Centivo All Commercial |
$356.05
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Humana Medicare |
$209.44
|
| Rate for Payer: Lucent All Commercial |
$356.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.25
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.33
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
| Rate for Payer: United Healthcare Medicare |
$209.44
|
|
|
HC AR SUTURE FIBERLINK 1.3
|
Facility
|
IP
|
$654.50
|
|
| Hospital Charge Code |
41606209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.88 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$565.49
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
|
|
HC AR SUTURE FIBERTAPE #2
|
Facility
|
OP
|
$577.50
|
|
| Hospital Charge Code |
41606201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$537.08 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Aetna Medicare |
$184.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$179.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$331.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$361.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.28
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Centivo All Commercial |
$314.16
|
| Rate for Payer: Cigna All Commercial |
$498.38
|
| Rate for Payer: CORVEL All Commercial |
$537.08
|
| Rate for Payer: Coventry All Commercial |
$508.20
|
| Rate for Payer: Encore All Commercial |
$531.59
|
| Rate for Payer: Frontpath All Commercial |
$531.30
|
| Rate for Payer: Humana ChoiceCare |
$498.79
|
| Rate for Payer: Humana Medicare |
$184.80
|
| Rate for Payer: Lucent All Commercial |
$314.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.75
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$433.12
|
| Rate for Payer: PHP All Commercial |
$437.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$225.22
|
| Rate for Payer: Sagamore Health Network All Products |
$445.83
|
| Rate for Payer: Signature Care EPO |
$479.32
|
| Rate for Payer: Signature Care PPO |
$508.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$490.88
|
| Rate for Payer: United Healthcare Commercial |
$455.07
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
|
|
HC AR SUTURE FIBERTAPE #2
|
Facility
|
IP
|
$577.50
|
|
| Hospital Charge Code |
41606201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.12 |
| Max. Negotiated Rate |
$537.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna All Commercial |
$498.38
|
| Rate for Payer: CORVEL All Commercial |
$537.08
|
| Rate for Payer: Coventry All Commercial |
$508.20
|
| Rate for Payer: Encore All Commercial |
$531.59
|
| Rate for Payer: Frontpath All Commercial |
$531.30
|
| Rate for Payer: Humana ChoiceCare |
$498.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.75
|
| Rate for Payer: PHCS All Commercial |
$433.12
|
| Rate for Payer: PHP All Commercial |
$437.98
|
| Rate for Payer: Sagamore Health Network All Products |
$445.83
|
| Rate for Payer: Signature Care EPO |
$479.32
|
| Rate for Payer: Signature Care PPO |
$508.20
|
| Rate for Payer: United Healthcare Commercial |
$455.07
|
|
|
HC AR SUTURELASSO 25 CURVE L
|
Facility
|
IP
|
$770.00
|
|
| Hospital Charge Code |
41607702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC AR SUTURELASSO 25 CURVE L
|
Facility
|
OP
|
$770.00
|
|
| Hospital Charge Code |
41607702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$246.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$238.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$283.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$271.04
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Centivo All Commercial |
$418.88
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$246.40
|
| Rate for Payer: Lucent All Commercial |
$418.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$246.40
|
|
|
HC AR SUTURELASSO 25 CURVE R
|
Facility
|
OP
|
$770.00
|
|
| Hospital Charge Code |
41607627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$246.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$238.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$283.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$271.04
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Centivo All Commercial |
$418.88
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$246.40
|
| Rate for Payer: Lucent All Commercial |
$418.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$246.40
|
|
|
HC AR SUTURELASSO 25 CURVE R
|
Facility
|
IP
|
$770.00
|
|
| Hospital Charge Code |
41607627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC AR SUTURE LASSO CRESCENT
|
Facility
|
OP
|
$770.00
|
|
| Hospital Charge Code |
41607869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$246.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$238.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$283.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$271.04
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Centivo All Commercial |
$418.88
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$246.40
|
| Rate for Payer: Lucent All Commercial |
$418.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$246.40
|
|
|
HC AR SUTURE LASSO CRESCENT
|
Facility
|
IP
|
$770.00
|
|
| Hospital Charge Code |
41607869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
