|
HC DS DRILL BIT 2.5 110 QC GOLD
|
Facility
OP
|
$882.00
|
|
| Hospital Charge Code |
41603968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$820.26 |
| Rate for Payer: Aetna Commercial |
$744.41
|
| Rate for Payer: Aetna Medicare |
$291.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$291.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$506.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$551.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$334.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$320.17
|
| Rate for Payer: Cash Price |
$546.84
|
| Rate for Payer: Cash Price |
$546.84
|
| Rate for Payer: Centivo All Commercial |
$449.82
|
| Rate for Payer: Cigna All Commercial |
$761.17
|
| Rate for Payer: CORVEL All Commercial |
$820.26
|
| Rate for Payer: Coventry All Commercial |
$776.16
|
| Rate for Payer: Encore All Commercial |
$811.88
|
| Rate for Payer: Frontpath All Commercial |
$811.44
|
| Rate for Payer: Humana ChoiceCare |
$761.78
|
| Rate for Payer: Humana Medicare |
$449.82
|
| Rate for Payer: Lucent All Commercial |
$449.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$793.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$661.50
|
| Rate for Payer: PHP All Commercial |
$668.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$343.98
|
| Rate for Payer: Sagamore Health Network All Products |
$680.90
|
| Rate for Payer: Signature Care EPO |
$732.06
|
| Rate for Payer: Signature Care PPO |
$776.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$749.70
|
| Rate for Payer: United Healthcare Commercial |
$695.02
|
| Rate for Payer: United Healthcare Medicare |
$291.06
|
|
|
HC DS DRILL BIT 2.5 180 QC GOLD
|
Facility
OP
|
$994.00
|
|
| Hospital Charge Code |
41603967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$838.94
|
| Rate for Payer: Aetna Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Centivo All Commercial |
$506.94
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Humana Medicare |
$506.94
|
| Rate for Payer: Lucent All Commercial |
$506.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.66
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.90
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
| Rate for Payer: United Healthcare Medicare |
$328.02
|
|
|
HC DS DRILL BIT 2.5 180 QC GOLD
|
Facility
IP
|
$994.00
|
|
| Hospital Charge Code |
41603967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$858.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
|
|
HC DS DRILL BIT 2.7 125 QC FLUTED
|
Facility
IP
|
$1,005.00
|
|
| Hospital Charge Code |
41603969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$753.75 |
| Max. Negotiated Rate |
$934.65 |
| Rate for Payer: Aetna Commercial |
$868.32
|
| Rate for Payer: Cash Price |
$623.10
|
| Rate for Payer: Cigna All Commercial |
$867.32
|
| Rate for Payer: CORVEL All Commercial |
$934.65
|
| Rate for Payer: Coventry All Commercial |
$884.40
|
| Rate for Payer: Encore All Commercial |
$925.10
|
| Rate for Payer: Frontpath All Commercial |
$924.60
|
| Rate for Payer: Humana ChoiceCare |
$868.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$904.50
|
| Rate for Payer: PHCS All Commercial |
$753.75
|
| Rate for Payer: PHP All Commercial |
$762.19
|
| Rate for Payer: Sagamore Health Network All Products |
$775.86
|
| Rate for Payer: Signature Care EPO |
$834.15
|
| Rate for Payer: Signature Care PPO |
$884.40
|
| Rate for Payer: United Healthcare Commercial |
$791.94
|
|
|
HC DS DRILL BIT 2.7 125 QC FLUTED
|
Facility
OP
|
$1,005.00
|
|
| Hospital Charge Code |
41603969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$934.65 |
| Rate for Payer: Aetna Commercial |
$848.22
|
| Rate for Payer: Aetna Medicare |
$331.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$331.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$577.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$628.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$381.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$364.82
|
| Rate for Payer: Cash Price |
$623.10
|
| Rate for Payer: Cash Price |
$623.10
|
| Rate for Payer: Centivo All Commercial |
$512.55
|
| Rate for Payer: Cigna All Commercial |
$867.32
|
| Rate for Payer: CORVEL All Commercial |
$934.65
|
| Rate for Payer: Coventry All Commercial |
$884.40
|
| Rate for Payer: Encore All Commercial |
$925.10
|
| Rate for Payer: Frontpath All Commercial |
$924.60
|
| Rate for Payer: Humana ChoiceCare |
$868.02
|
| Rate for Payer: Humana Medicare |
$512.55
|
| Rate for Payer: Lucent All Commercial |
$512.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$904.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$753.75
|
| Rate for Payer: PHP All Commercial |
$762.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$391.95
|
| Rate for Payer: Sagamore Health Network All Products |
$775.86
|
| Rate for Payer: Signature Care EPO |
$834.15
|
| Rate for Payer: Signature Care PPO |
$884.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$854.25
|
| Rate for Payer: United Healthcare Commercial |
$791.94
|
| Rate for Payer: United Healthcare Medicare |
$331.65
|
|
|
HC DS DRILL BIT 2.8 200 QC CALB
|
Facility
IP
|
$1,505.00
|
|
| Hospital Charge Code |
41603971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,128.75 |
| Max. Negotiated Rate |
$1,399.65 |
| Rate for Payer: Aetna Commercial |
$1,300.32
|
| Rate for Payer: Cash Price |
$933.10
|
| Rate for Payer: Cigna All Commercial |
$1,298.82
|
| Rate for Payer: CORVEL All Commercial |
$1,399.65
|
| Rate for Payer: Coventry All Commercial |
$1,324.40
|
| Rate for Payer: Encore All Commercial |
$1,385.35
|
| Rate for Payer: Frontpath All Commercial |
$1,384.60
|
| Rate for Payer: Humana ChoiceCare |
$1,299.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,354.50
|
| Rate for Payer: PHCS All Commercial |
$1,128.75
|
| Rate for Payer: PHP All Commercial |
$1,141.39
|
| Rate for Payer: Sagamore Health Network All Products |
$1,161.86
|
| Rate for Payer: Signature Care EPO |
$1,249.15
|
| Rate for Payer: Signature Care PPO |
$1,324.40
|
| Rate for Payer: United Healthcare Commercial |
$1,185.94
|
|
|
HC DS DRILL BIT 2.8 200 QC CALB
|
Facility
OP
|
$1,505.00
|
|
| Hospital Charge Code |
41603971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,399.65 |
| Rate for Payer: Aetna Commercial |
$1,270.22
|
| Rate for Payer: Aetna Medicare |
$496.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$496.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$864.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$940.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$571.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$546.32
|
| Rate for Payer: Cash Price |
$933.10
|
| Rate for Payer: Cash Price |
$933.10
|
| Rate for Payer: Centivo All Commercial |
$767.55
|
| Rate for Payer: Cigna All Commercial |
$1,298.82
|
| Rate for Payer: CORVEL All Commercial |
$1,399.65
|
| Rate for Payer: Coventry All Commercial |
$1,324.40
|
| Rate for Payer: Encore All Commercial |
$1,385.35
|
| Rate for Payer: Frontpath All Commercial |
$1,384.60
|
| Rate for Payer: Humana ChoiceCare |
$1,299.87
|
| Rate for Payer: Humana Medicare |
$767.55
|
| Rate for Payer: Lucent All Commercial |
$767.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,354.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,128.75
|
| Rate for Payer: PHP All Commercial |
$1,141.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$586.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,161.86
|
| Rate for Payer: Signature Care EPO |
$1,249.15
|
| Rate for Payer: Signature Care PPO |
$1,324.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,279.25
|
| Rate for Payer: United Healthcare Commercial |
$1,185.94
|
| Rate for Payer: United Healthcare Medicare |
$496.65
|
|
|
HC DS DRILL BIT 3.2X145
|
Facility
IP
|
$1,260.00
|
|
| Hospital Charge Code |
41607107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Aetna Commercial |
$1,088.64
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna All Commercial |
$1,087.38
|
| Rate for Payer: CORVEL All Commercial |
$1,171.80
|
| Rate for Payer: Coventry All Commercial |
$1,108.80
|
| Rate for Payer: Encore All Commercial |
$1,159.83
|
| Rate for Payer: Frontpath All Commercial |
$1,159.20
|
| Rate for Payer: Humana ChoiceCare |
$1,088.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,134.00
|
| Rate for Payer: PHCS All Commercial |
$945.00
|
| Rate for Payer: PHP All Commercial |
$955.58
|
| Rate for Payer: Sagamore Health Network All Products |
$972.72
|
| Rate for Payer: Signature Care EPO |
$1,045.80
|
| Rate for Payer: Signature Care PPO |
$1,108.80
|
| Rate for Payer: United Healthcare Commercial |
$992.88
|
|
|
HC DS DRILL BIT 3.2X145
|
Facility
OP
|
$1,260.00
|
|
| Hospital Charge Code |
41607107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Aetna Commercial |
$1,063.44
|
| Rate for Payer: Aetna Medicare |
$415.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$415.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$723.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$787.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$478.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$457.38
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Centivo All Commercial |
$642.60
|
| Rate for Payer: Cigna All Commercial |
$1,087.38
|
| Rate for Payer: CORVEL All Commercial |
$1,171.80
|
| Rate for Payer: Coventry All Commercial |
$1,108.80
|
| Rate for Payer: Encore All Commercial |
$1,159.83
|
| Rate for Payer: Frontpath All Commercial |
$1,159.20
|
| Rate for Payer: Humana ChoiceCare |
$1,088.26
|
| Rate for Payer: Humana Medicare |
$642.60
|
| Rate for Payer: Lucent All Commercial |
$642.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,134.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$945.00
|
| Rate for Payer: PHP All Commercial |
$955.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$491.40
|
| Rate for Payer: Sagamore Health Network All Products |
$972.72
|
| Rate for Payer: Signature Care EPO |
$1,045.80
|
| Rate for Payer: Signature Care PPO |
$1,108.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare Commercial |
$992.88
|
| Rate for Payer: United Healthcare Medicare |
$415.80
|
|
|
HC DS DRILL BIT 3.2X330
|
Facility
OP
|
$1,768.00
|
|
| Hospital Charge Code |
41607108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,644.24 |
| Rate for Payer: Aetna Commercial |
$1,492.19
|
| Rate for Payer: Aetna Medicare |
$583.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$583.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,015.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,105.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$670.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$641.78
|
| Rate for Payer: Cash Price |
$1,096.16
|
| Rate for Payer: Cash Price |
$1,096.16
|
| Rate for Payer: Centivo All Commercial |
$901.68
|
| Rate for Payer: Cigna All Commercial |
$1,525.78
|
| Rate for Payer: CORVEL All Commercial |
$1,644.24
|
| Rate for Payer: Coventry All Commercial |
$1,555.84
|
| Rate for Payer: Encore All Commercial |
$1,627.44
|
| Rate for Payer: Frontpath All Commercial |
$1,626.56
|
| Rate for Payer: Humana ChoiceCare |
$1,527.02
|
| Rate for Payer: Humana Medicare |
$901.68
|
| Rate for Payer: Lucent All Commercial |
$901.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,591.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,326.00
|
| Rate for Payer: PHP All Commercial |
$1,340.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$689.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,364.90
|
| Rate for Payer: Signature Care EPO |
$1,467.44
|
| Rate for Payer: Signature Care PPO |
$1,555.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,502.80
|
| Rate for Payer: United Healthcare Commercial |
$1,393.18
|
| Rate for Payer: United Healthcare Medicare |
$583.44
|
|
|
HC DS DRILL BIT 3.2X330
|
Facility
IP
|
$1,768.00
|
|
| Hospital Charge Code |
41607108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,326.00 |
| Max. Negotiated Rate |
$1,644.24 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Cash Price |
$1,096.16
|
| Rate for Payer: Cigna All Commercial |
$1,525.78
|
| Rate for Payer: CORVEL All Commercial |
$1,644.24
|
| Rate for Payer: Coventry All Commercial |
$1,555.84
|
| Rate for Payer: Encore All Commercial |
$1,627.44
|
| Rate for Payer: Frontpath All Commercial |
$1,626.56
|
| Rate for Payer: Humana ChoiceCare |
$1,527.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,591.20
|
| Rate for Payer: PHCS All Commercial |
$1,326.00
|
| Rate for Payer: PHP All Commercial |
$1,340.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,364.90
|
| Rate for Payer: Signature Care EPO |
$1,467.44
|
| Rate for Payer: Signature Care PPO |
$1,555.84
|
| Rate for Payer: United Healthcare Commercial |
$1,393.18
|
|
|
HC DS DRILL BIT 3.5 110 QC
|
Facility
IP
|
$945.00
|
|
| Hospital Charge Code |
41603970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.75 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$816.48
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
|
|
HC DS DRILL BIT 3.5 110 QC
|
Facility
OP
|
$945.00
|
|
| Hospital Charge Code |
41603970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$797.58
|
| Rate for Payer: Aetna Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$542.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$590.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$358.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$343.04
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Centivo All Commercial |
$481.95
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Humana Medicare |
$481.95
|
| Rate for Payer: Lucent All Commercial |
$481.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$368.55
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$803.25
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
| Rate for Payer: United Healthcare Medicare |
$311.85
|
|
|
HC DS DRILL BIT 4.2 QC330-100
|
Facility
OP
|
$1,768.00
|
|
| Hospital Charge Code |
41606219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,644.24 |
| Rate for Payer: Aetna Commercial |
$1,492.19
|
| Rate for Payer: Aetna Medicare |
$583.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$583.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,015.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,105.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$670.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$641.78
|
| Rate for Payer: Cash Price |
$1,096.16
|
| Rate for Payer: Cash Price |
$1,096.16
|
| Rate for Payer: Centivo All Commercial |
$901.68
|
| Rate for Payer: Cigna All Commercial |
$1,525.78
|
| Rate for Payer: CORVEL All Commercial |
$1,644.24
|
| Rate for Payer: Coventry All Commercial |
$1,555.84
|
| Rate for Payer: Encore All Commercial |
$1,627.44
|
| Rate for Payer: Frontpath All Commercial |
$1,626.56
|
| Rate for Payer: Humana ChoiceCare |
$1,527.02
|
| Rate for Payer: Humana Medicare |
$901.68
|
| Rate for Payer: Lucent All Commercial |
$901.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,591.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,326.00
|
| Rate for Payer: PHP All Commercial |
$1,340.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$689.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,364.90
|
| Rate for Payer: Signature Care EPO |
$1,467.44
|
| Rate for Payer: Signature Care PPO |
$1,555.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,502.80
|
| Rate for Payer: United Healthcare Commercial |
$1,393.18
|
| Rate for Payer: United Healthcare Medicare |
$583.44
|
|
|
HC DS DRILL BIT 4.2 QC330-100
|
Facility
IP
|
$1,768.00
|
|
| Hospital Charge Code |
41606219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,326.00 |
| Max. Negotiated Rate |
$1,644.24 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Cash Price |
$1,096.16
|
| Rate for Payer: Cigna All Commercial |
$1,525.78
|
| Rate for Payer: CORVEL All Commercial |
$1,644.24
|
| Rate for Payer: Coventry All Commercial |
$1,555.84
|
| Rate for Payer: Encore All Commercial |
$1,627.44
|
| Rate for Payer: Frontpath All Commercial |
$1,626.56
|
| Rate for Payer: Humana ChoiceCare |
$1,527.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,591.20
|
| Rate for Payer: PHCS All Commercial |
$1,326.00
|
| Rate for Payer: PHP All Commercial |
$1,340.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,364.90
|
| Rate for Payer: Signature Care EPO |
$1,467.44
|
| Rate for Payer: Signature Care PPO |
$1,555.84
|
| Rate for Payer: United Healthcare Commercial |
$1,393.18
|
|
|
HC DS DRILL BIT 4.2X145
|
Facility
IP
|
$1,260.00
|
|
| Hospital Charge Code |
41607106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Aetna Commercial |
$1,088.64
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna All Commercial |
$1,087.38
|
| Rate for Payer: CORVEL All Commercial |
$1,171.80
|
| Rate for Payer: Coventry All Commercial |
$1,108.80
|
| Rate for Payer: Encore All Commercial |
$1,159.83
|
| Rate for Payer: Frontpath All Commercial |
$1,159.20
|
| Rate for Payer: Humana ChoiceCare |
$1,088.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,134.00
|
| Rate for Payer: PHCS All Commercial |
$945.00
|
| Rate for Payer: PHP All Commercial |
$955.58
|
| Rate for Payer: Sagamore Health Network All Products |
$972.72
|
| Rate for Payer: Signature Care EPO |
$1,045.80
|
| Rate for Payer: Signature Care PPO |
$1,108.80
|
| Rate for Payer: United Healthcare Commercial |
$992.88
|
|
|
HC DS DRILL BIT 4.2X145
|
Facility
OP
|
$1,260.00
|
|
| Hospital Charge Code |
41607106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Aetna Commercial |
$1,063.44
|
| Rate for Payer: Aetna Medicare |
$415.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$415.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$723.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$787.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$478.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$457.38
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Centivo All Commercial |
$642.60
|
| Rate for Payer: Cigna All Commercial |
$1,087.38
|
| Rate for Payer: CORVEL All Commercial |
$1,171.80
|
| Rate for Payer: Coventry All Commercial |
$1,108.80
|
| Rate for Payer: Encore All Commercial |
$1,159.83
|
| Rate for Payer: Frontpath All Commercial |
$1,159.20
|
| Rate for Payer: Humana ChoiceCare |
$1,088.26
|
| Rate for Payer: Humana Medicare |
$642.60
|
| Rate for Payer: Lucent All Commercial |
$642.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,134.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$945.00
|
| Rate for Payer: PHP All Commercial |
$955.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$491.40
|
| Rate for Payer: Sagamore Health Network All Products |
$972.72
|
| Rate for Payer: Signature Care EPO |
$1,045.80
|
| Rate for Payer: Signature Care PPO |
$1,108.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare Commercial |
$992.88
|
| Rate for Payer: United Healthcare Medicare |
$415.80
|
|
|
HC DS GUIDE WIRE 3.2X400
|
Facility
IP
|
$1,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.00 |
| Max. Negotiated Rate |
$937.44 |
| Rate for Payer: Aetna Commercial |
$870.91
|
| Rate for Payer: Cash Price |
$624.96
|
| Rate for Payer: Cigna All Commercial |
$869.90
|
| Rate for Payer: CORVEL All Commercial |
$937.44
|
| Rate for Payer: Coventry All Commercial |
$887.04
|
| Rate for Payer: Encore All Commercial |
$927.86
|
| Rate for Payer: Frontpath All Commercial |
$927.36
|
| Rate for Payer: Humana ChoiceCare |
$870.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$907.20
|
| Rate for Payer: PHCS All Commercial |
$756.00
|
| Rate for Payer: PHP All Commercial |
$764.47
|
| Rate for Payer: Sagamore Health Network All Products |
$778.18
|
| Rate for Payer: Signature Care EPO |
$836.64
|
| Rate for Payer: Signature Care PPO |
$887.04
|
| Rate for Payer: United Healthcare Commercial |
$794.30
|
|
|
HC DS GUIDE WIRE 3.2X400
|
Facility
OP
|
$1,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$937.44 |
| Rate for Payer: Aetna Commercial |
$850.75
|
| Rate for Payer: Aetna Medicare |
$332.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$332.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$578.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$630.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$382.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$365.90
|
| Rate for Payer: Cash Price |
$624.96
|
| Rate for Payer: Cash Price |
$624.96
|
| Rate for Payer: Centivo All Commercial |
$514.08
|
| Rate for Payer: Cigna All Commercial |
$869.90
|
| Rate for Payer: CORVEL All Commercial |
$937.44
|
| Rate for Payer: Coventry All Commercial |
$887.04
|
| Rate for Payer: Encore All Commercial |
$927.86
|
| Rate for Payer: Frontpath All Commercial |
$927.36
|
| Rate for Payer: Humana ChoiceCare |
$870.61
|
| Rate for Payer: Humana Medicare |
$514.08
|
| Rate for Payer: Lucent All Commercial |
$514.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$907.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$756.00
|
| Rate for Payer: PHP All Commercial |
$764.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$393.12
|
| Rate for Payer: Sagamore Health Network All Products |
$778.18
|
| Rate for Payer: Signature Care EPO |
$836.64
|
| Rate for Payer: Signature Care PPO |
$887.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$856.80
|
| Rate for Payer: United Healthcare Commercial |
$794.30
|
| Rate for Payer: United Healthcare Medicare |
$332.64
|
|
|
HC DS K-WIRE 1.6 150 TROC TIP
|
Facility
IP
|
$775.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.25 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: Cigna All Commercial |
$668.82
|
| Rate for Payer: CORVEL All Commercial |
$720.75
|
| Rate for Payer: Coventry All Commercial |
$682.00
|
| Rate for Payer: Encore All Commercial |
$713.39
|
| Rate for Payer: Frontpath All Commercial |
$713.00
|
| Rate for Payer: Humana ChoiceCare |
$669.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.50
|
| Rate for Payer: PHCS All Commercial |
$581.25
|
| Rate for Payer: PHP All Commercial |
$587.76
|
| Rate for Payer: Sagamore Health Network All Products |
$598.30
|
| Rate for Payer: Signature Care EPO |
$643.25
|
| Rate for Payer: Signature Care PPO |
$682.00
|
| Rate for Payer: United Healthcare Commercial |
$610.70
|
|
|
HC DS K-WIRE 1.6 150 TROC TIP
|
Facility
OP
|
$775.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Aetna Commercial |
$654.10
|
| Rate for Payer: Aetna Medicare |
$255.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$255.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$445.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$484.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$294.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$281.32
|
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: Centivo All Commercial |
$395.25
|
| Rate for Payer: Cigna All Commercial |
$668.82
|
| Rate for Payer: CORVEL All Commercial |
$720.75
|
| Rate for Payer: Coventry All Commercial |
$682.00
|
| Rate for Payer: Encore All Commercial |
$713.39
|
| Rate for Payer: Frontpath All Commercial |
$713.00
|
| Rate for Payer: Humana ChoiceCare |
$669.37
|
| Rate for Payer: Humana Medicare |
$395.25
|
| Rate for Payer: Lucent All Commercial |
$395.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$581.25
|
| Rate for Payer: PHP All Commercial |
$587.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$302.25
|
| Rate for Payer: Sagamore Health Network All Products |
$598.30
|
| Rate for Payer: Signature Care EPO |
$643.25
|
| Rate for Payer: Signature Care PPO |
$682.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$658.75
|
| Rate for Payer: United Healthcare Commercial |
$610.70
|
| Rate for Payer: United Healthcare Medicare |
$255.75
|
|
|
HC DS K-WIRE 2.0 150 TROC TIP
|
Facility
IP
|
$775.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.25 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: Cigna All Commercial |
$668.82
|
| Rate for Payer: CORVEL All Commercial |
$720.75
|
| Rate for Payer: Coventry All Commercial |
$682.00
|
| Rate for Payer: Encore All Commercial |
$713.39
|
| Rate for Payer: Frontpath All Commercial |
$713.00
|
| Rate for Payer: Humana ChoiceCare |
$669.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.50
|
| Rate for Payer: PHCS All Commercial |
$581.25
|
| Rate for Payer: PHP All Commercial |
$587.76
|
| Rate for Payer: Sagamore Health Network All Products |
$598.30
|
| Rate for Payer: Signature Care EPO |
$643.25
|
| Rate for Payer: Signature Care PPO |
$682.00
|
| Rate for Payer: United Healthcare Commercial |
$610.70
|
|
|
HC DS K-WIRE 2.0 150 TROC TIP
|
Facility
OP
|
$775.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Aetna Commercial |
$654.10
|
| Rate for Payer: Aetna Medicare |
$255.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$255.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$445.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$484.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$294.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$281.32
|
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: Centivo All Commercial |
$395.25
|
| Rate for Payer: Cigna All Commercial |
$668.82
|
| Rate for Payer: CORVEL All Commercial |
$720.75
|
| Rate for Payer: Coventry All Commercial |
$682.00
|
| Rate for Payer: Encore All Commercial |
$713.39
|
| Rate for Payer: Frontpath All Commercial |
$713.00
|
| Rate for Payer: Humana ChoiceCare |
$669.37
|
| Rate for Payer: Humana Medicare |
$395.25
|
| Rate for Payer: Lucent All Commercial |
$395.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$581.25
|
| Rate for Payer: PHP All Commercial |
$587.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$302.25
|
| Rate for Payer: Sagamore Health Network All Products |
$598.30
|
| Rate for Payer: Signature Care EPO |
$643.25
|
| Rate for Payer: Signature Care PPO |
$682.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$658.75
|
| Rate for Payer: United Healthcare Commercial |
$610.70
|
| Rate for Payer: United Healthcare Medicare |
$255.75
|
|
|
HC DS MENISCAL REPAIR 0
|
Facility
IP
|
$2,869.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,151.90 |
| Max. Negotiated Rate |
$2,668.36 |
| Rate for Payer: Aetna Commercial |
$2,478.99
|
| Rate for Payer: Cash Price |
$1,778.90
|
| Rate for Payer: Cigna All Commercial |
$2,476.12
|
| Rate for Payer: CORVEL All Commercial |
$2,668.36
|
| Rate for Payer: Coventry All Commercial |
$2,524.90
|
| Rate for Payer: Encore All Commercial |
$2,641.10
|
| Rate for Payer: Frontpath All Commercial |
$2,639.66
|
| Rate for Payer: Humana ChoiceCare |
$2,478.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,582.28
|
| Rate for Payer: PHCS All Commercial |
$2,151.90
|
| Rate for Payer: PHP All Commercial |
$2,176.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,215.02
|
| Rate for Payer: Signature Care EPO |
$2,381.44
|
| Rate for Payer: Signature Care PPO |
$2,524.90
|
| Rate for Payer: United Healthcare Commercial |
$2,260.93
|
|
|
HC DS MENISCAL REPAIR 0
|
Facility
OP
|
$2,869.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,668.36 |
| Rate for Payer: Aetna Commercial |
$2,421.60
|
| Rate for Payer: Aetna Medicare |
$946.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$946.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,647.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,793.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,088.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,041.52
|
| Rate for Payer: Cash Price |
$1,778.90
|
| Rate for Payer: Cash Price |
$1,778.90
|
| Rate for Payer: Centivo All Commercial |
$1,463.29
|
| Rate for Payer: Cigna All Commercial |
$2,476.12
|
| Rate for Payer: CORVEL All Commercial |
$2,668.36
|
| Rate for Payer: Coventry All Commercial |
$2,524.90
|
| Rate for Payer: Encore All Commercial |
$2,641.10
|
| Rate for Payer: Frontpath All Commercial |
$2,639.66
|
| Rate for Payer: Humana ChoiceCare |
$2,478.13
|
| Rate for Payer: Humana Medicare |
$1,463.29
|
| Rate for Payer: Lucent All Commercial |
$1,463.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,582.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,151.90
|
| Rate for Payer: PHP All Commercial |
$2,176.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,118.99
|
| Rate for Payer: Sagamore Health Network All Products |
$2,215.02
|
| Rate for Payer: Signature Care EPO |
$2,381.44
|
| Rate for Payer: Signature Care PPO |
$2,524.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,438.82
|
| Rate for Payer: United Healthcare Commercial |
$2,260.93
|
| Rate for Payer: United Healthcare Medicare |
$946.84
|
|
