|
HC DS SCREW 5X55 LOCK CORE
|
Facility
IP
|
$1,444.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,083.00 |
| Max. Negotiated Rate |
$1,342.92 |
| Rate for Payer: Aetna Commercial |
$1,247.62
|
| Rate for Payer: Cash Price |
$895.28
|
| Rate for Payer: Cigna All Commercial |
$1,246.17
|
| Rate for Payer: CORVEL All Commercial |
$1,342.92
|
| Rate for Payer: Coventry All Commercial |
$1,270.72
|
| Rate for Payer: Encore All Commercial |
$1,329.20
|
| Rate for Payer: Frontpath All Commercial |
$1,328.48
|
| Rate for Payer: Humana ChoiceCare |
$1,247.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,299.60
|
| Rate for Payer: PHCS All Commercial |
$1,083.00
|
| Rate for Payer: PHP All Commercial |
$1,095.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,114.77
|
| Rate for Payer: Signature Care EPO |
$1,198.52
|
| Rate for Payer: Signature Care PPO |
$1,270.72
|
| Rate for Payer: United Healthcare Commercial |
$1,137.87
|
|
|
HC DS SCREW 5X60 LOCK CORE
|
Facility
OP
|
$1,444.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.52 |
| Max. Negotiated Rate |
$1,342.92 |
| Rate for Payer: Aetna Commercial |
$1,218.74
|
| Rate for Payer: Aetna Medicare |
$476.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$476.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$829.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$902.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$548.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$524.17
|
| Rate for Payer: Cash Price |
$895.28
|
| Rate for Payer: Cash Price |
$895.28
|
| Rate for Payer: Centivo All Commercial |
$736.44
|
| Rate for Payer: Cigna All Commercial |
$1,246.17
|
| Rate for Payer: CORVEL All Commercial |
$1,342.92
|
| Rate for Payer: Coventry All Commercial |
$1,270.72
|
| Rate for Payer: Encore All Commercial |
$1,329.20
|
| Rate for Payer: Frontpath All Commercial |
$1,328.48
|
| Rate for Payer: Humana ChoiceCare |
$1,247.18
|
| Rate for Payer: Humana Medicare |
$736.44
|
| Rate for Payer: Lucent All Commercial |
$736.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,299.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,083.00
|
| Rate for Payer: PHP All Commercial |
$1,095.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$563.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,114.77
|
| Rate for Payer: Signature Care EPO |
$1,198.52
|
| Rate for Payer: Signature Care PPO |
$1,270.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,227.40
|
| Rate for Payer: United Healthcare Commercial |
$1,137.87
|
| Rate for Payer: United Healthcare Medicare |
$476.52
|
|
|
HC DS SCREW 5X60 LOCK CORE
|
Facility
IP
|
$1,444.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,083.00 |
| Max. Negotiated Rate |
$1,342.92 |
| Rate for Payer: Aetna Commercial |
$1,247.62
|
| Rate for Payer: Cash Price |
$895.28
|
| Rate for Payer: Cigna All Commercial |
$1,246.17
|
| Rate for Payer: CORVEL All Commercial |
$1,342.92
|
| Rate for Payer: Coventry All Commercial |
$1,270.72
|
| Rate for Payer: Encore All Commercial |
$1,329.20
|
| Rate for Payer: Frontpath All Commercial |
$1,328.48
|
| Rate for Payer: Humana ChoiceCare |
$1,247.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,299.60
|
| Rate for Payer: PHCS All Commercial |
$1,083.00
|
| Rate for Payer: PHP All Commercial |
$1,095.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,114.77
|
| Rate for Payer: Signature Care EPO |
$1,198.52
|
| Rate for Payer: Signature Care PPO |
$1,270.72
|
| Rate for Payer: United Healthcare Commercial |
$1,137.87
|
|
|
HC DS SCREW 90 TFNA
|
Facility
OP
|
$5,169.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,807.73 |
| Rate for Payer: Aetna Commercial |
$4,363.14
|
| Rate for Payer: Aetna Medicare |
$1,705.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,705.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,968.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,231.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,961.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,876.56
|
| Rate for Payer: Cash Price |
$3,205.15
|
| Rate for Payer: Cash Price |
$3,205.15
|
| Rate for Payer: Centivo All Commercial |
$2,636.50
|
| Rate for Payer: Cigna All Commercial |
$4,461.36
|
| Rate for Payer: CORVEL All Commercial |
$4,807.73
|
| Rate for Payer: Coventry All Commercial |
$4,549.25
|
| Rate for Payer: Encore All Commercial |
$4,758.62
|
| Rate for Payer: Frontpath All Commercial |
$4,756.03
|
| Rate for Payer: Humana ChoiceCare |
$4,464.98
|
| Rate for Payer: Humana Medicare |
$2,636.50
|
| Rate for Payer: Lucent All Commercial |
$2,636.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,652.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,877.20
|
| Rate for Payer: PHP All Commercial |
$3,920.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,016.14
|
| Rate for Payer: Sagamore Health Network All Products |
$3,990.93
|
| Rate for Payer: Signature Care EPO |
$4,290.77
|
| Rate for Payer: Signature Care PPO |
$4,549.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,394.16
|
| Rate for Payer: United Healthcare Commercial |
$4,073.64
|
| Rate for Payer: United Healthcare Medicare |
$1,705.97
|
|
|
HC DS SCREW 90 TFNA
|
Facility
IP
|
$5,169.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,877.20 |
| Max. Negotiated Rate |
$4,807.73 |
| Rate for Payer: Aetna Commercial |
$4,466.53
|
| Rate for Payer: Cash Price |
$3,205.15
|
| Rate for Payer: Cigna All Commercial |
$4,461.36
|
| Rate for Payer: CORVEL All Commercial |
$4,807.73
|
| Rate for Payer: Coventry All Commercial |
$4,549.25
|
| Rate for Payer: Encore All Commercial |
$4,758.62
|
| Rate for Payer: Frontpath All Commercial |
$4,756.03
|
| Rate for Payer: Humana ChoiceCare |
$4,464.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,652.64
|
| Rate for Payer: PHCS All Commercial |
$3,877.20
|
| Rate for Payer: PHP All Commercial |
$3,920.62
|
| Rate for Payer: Sagamore Health Network All Products |
$3,990.93
|
| Rate for Payer: Signature Care EPO |
$4,290.77
|
| Rate for Payer: Signature Care PPO |
$4,549.25
|
| Rate for Payer: United Healthcare Commercial |
$4,073.64
|
|
|
HC DS SCREW 95 TFNA
|
Facility
OP
|
$3,643.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,388.18 |
| Rate for Payer: Aetna Commercial |
$3,074.86
|
| Rate for Payer: Aetna Medicare |
$1,202.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,202.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,092.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,277.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,382.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,322.48
|
| Rate for Payer: Cash Price |
$2,258.78
|
| Rate for Payer: Cash Price |
$2,258.78
|
| Rate for Payer: Centivo All Commercial |
$1,858.03
|
| Rate for Payer: Cigna All Commercial |
$3,144.08
|
| Rate for Payer: CORVEL All Commercial |
$3,388.18
|
| Rate for Payer: Coventry All Commercial |
$3,206.02
|
| Rate for Payer: Encore All Commercial |
$3,353.57
|
| Rate for Payer: Frontpath All Commercial |
$3,351.74
|
| Rate for Payer: Humana ChoiceCare |
$3,146.63
|
| Rate for Payer: Humana Medicare |
$1,858.03
|
| Rate for Payer: Lucent All Commercial |
$1,858.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,278.88
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,732.40
|
| Rate for Payer: PHP All Commercial |
$2,763.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,420.85
|
| Rate for Payer: Sagamore Health Network All Products |
$2,812.55
|
| Rate for Payer: Signature Care EPO |
$3,023.86
|
| Rate for Payer: Signature Care PPO |
$3,206.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,096.72
|
| Rate for Payer: United Healthcare Commercial |
$2,870.84
|
| Rate for Payer: United Healthcare Medicare |
$1,202.26
|
|
|
HC DS SCREW 95 TFNA
|
Facility
IP
|
$3,643.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,732.40 |
| Max. Negotiated Rate |
$3,388.18 |
| Rate for Payer: Aetna Commercial |
$3,147.72
|
| Rate for Payer: Cash Price |
$2,258.78
|
| Rate for Payer: Cigna All Commercial |
$3,144.08
|
| Rate for Payer: CORVEL All Commercial |
$3,388.18
|
| Rate for Payer: Coventry All Commercial |
$3,206.02
|
| Rate for Payer: Encore All Commercial |
$3,353.57
|
| Rate for Payer: Frontpath All Commercial |
$3,351.74
|
| Rate for Payer: Humana ChoiceCare |
$3,146.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,278.88
|
| Rate for Payer: PHCS All Commercial |
$2,732.40
|
| Rate for Payer: PHP All Commercial |
$2,763.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,812.55
|
| Rate for Payer: Signature Care EPO |
$3,023.86
|
| Rate for Payer: Signature Care PPO |
$3,206.02
|
| Rate for Payer: United Healthcare Commercial |
$2,870.84
|
|
|
HC DS T-PLATE ANGLE 3.5 3-H R 50
|
Facility
OP
|
$1,926.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,791.18 |
| Rate for Payer: Aetna Commercial |
$1,625.54
|
| Rate for Payer: Aetna Medicare |
$635.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,106.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$699.14
|
| Rate for Payer: Cash Price |
$1,194.12
|
| Rate for Payer: Cash Price |
$1,194.12
|
| Rate for Payer: Centivo All Commercial |
$982.26
|
| Rate for Payer: Cigna All Commercial |
$1,662.14
|
| Rate for Payer: CORVEL All Commercial |
$1,791.18
|
| Rate for Payer: Coventry All Commercial |
$1,694.88
|
| Rate for Payer: Encore All Commercial |
$1,772.88
|
| Rate for Payer: Frontpath All Commercial |
$1,771.92
|
| Rate for Payer: Humana ChoiceCare |
$1,663.49
|
| Rate for Payer: Humana Medicare |
$982.26
|
| Rate for Payer: Lucent All Commercial |
$982.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,733.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,444.50
|
| Rate for Payer: PHP All Commercial |
$1,460.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$751.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.87
|
| Rate for Payer: Signature Care EPO |
$1,598.58
|
| Rate for Payer: Signature Care PPO |
$1,694.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,637.10
|
| Rate for Payer: United Healthcare Commercial |
$1,517.69
|
| Rate for Payer: United Healthcare Medicare |
$635.58
|
|
|
HC DS T-PLATE ANGLE 3.5 3-H R 50
|
Facility
IP
|
$1,926.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.50 |
| Max. Negotiated Rate |
$1,791.18 |
| Rate for Payer: Aetna Commercial |
$1,664.06
|
| Rate for Payer: Cash Price |
$1,194.12
|
| Rate for Payer: Cigna All Commercial |
$1,662.14
|
| Rate for Payer: CORVEL All Commercial |
$1,791.18
|
| Rate for Payer: Coventry All Commercial |
$1,694.88
|
| Rate for Payer: Encore All Commercial |
$1,772.88
|
| Rate for Payer: Frontpath All Commercial |
$1,771.92
|
| Rate for Payer: Humana ChoiceCare |
$1,663.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,733.40
|
| Rate for Payer: PHCS All Commercial |
$1,444.50
|
| Rate for Payer: PHP All Commercial |
$1,460.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.87
|
| Rate for Payer: Signature Care EPO |
$1,598.58
|
| Rate for Payer: Signature Care PPO |
$1,694.88
|
| Rate for Payer: United Healthcare Commercial |
$1,517.69
|
|
|
HC DU (WEAK D)
|
Facility
OP
|
$69.56
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
63001984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Aetna Commercial |
$58.71
|
| Rate for Payer: Aetna Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.25
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Centivo All Commercial |
$35.48
|
| Rate for Payer: Cigna All Commercial |
$60.03
|
| Rate for Payer: CORVEL All Commercial |
$64.69
|
| Rate for Payer: Coventry All Commercial |
$61.22
|
| Rate for Payer: Encore All Commercial |
$64.03
|
| Rate for Payer: Frontpath All Commercial |
$64.00
|
| Rate for Payer: Humana ChoiceCare |
$60.08
|
| Rate for Payer: Humana Medicare |
$35.48
|
| Rate for Payer: Lucent All Commercial |
$35.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.61
|
| Rate for Payer: Managed Health Services Medicaid |
$2.99
|
| Rate for Payer: MDWise Medicaid |
$2.99
|
| Rate for Payer: PHCS All Commercial |
$52.17
|
| Rate for Payer: PHP All Commercial |
$52.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.13
|
| Rate for Payer: Sagamore Health Network All Products |
$53.70
|
| Rate for Payer: Signature Care EPO |
$57.74
|
| Rate for Payer: Signature Care PPO |
$61.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.13
|
| Rate for Payer: United Healthcare Commercial |
$54.82
|
| Rate for Payer: United Healthcare Medicare |
$22.96
|
|
|
HC DU (WEAK D)
|
Facility
IP
|
$69.56
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
63001984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cigna All Commercial |
$60.03
|
| Rate for Payer: CORVEL All Commercial |
$64.69
|
| Rate for Payer: Coventry All Commercial |
$61.22
|
| Rate for Payer: Encore All Commercial |
$64.03
|
| Rate for Payer: Frontpath All Commercial |
$64.00
|
| Rate for Payer: Humana ChoiceCare |
$60.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.61
|
| Rate for Payer: PHCS All Commercial |
$52.17
|
| Rate for Payer: PHP All Commercial |
$52.76
|
| Rate for Payer: Sagamore Health Network All Products |
$53.70
|
| Rate for Payer: Signature Care EPO |
$57.74
|
| Rate for Payer: Signature Care PPO |
$61.22
|
| Rate for Payer: United Healthcare Commercial |
$54.82
|
|
|
HC DVT GARMENT 17 IN
|
Facility
OP
|
$89.92
|
|
| Hospital Charge Code |
41601059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.67 |
| Max. Negotiated Rate |
$83.63 |
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$29.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.64
|
| Rate for Payer: Cash Price |
$55.75
|
| Rate for Payer: Cash Price |
$55.75
|
| Rate for Payer: Centivo All Commercial |
$45.86
|
| Rate for Payer: Cigna All Commercial |
$77.60
|
| Rate for Payer: CORVEL All Commercial |
$83.63
|
| Rate for Payer: Coventry All Commercial |
$79.13
|
| Rate for Payer: Encore All Commercial |
$82.77
|
| Rate for Payer: Frontpath All Commercial |
$82.73
|
| Rate for Payer: Humana ChoiceCare |
$77.66
|
| Rate for Payer: Humana Medicare |
$45.86
|
| Rate for Payer: Lucent All Commercial |
$45.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.93
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$67.44
|
| Rate for Payer: PHP All Commercial |
$68.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.07
|
| Rate for Payer: Sagamore Health Network All Products |
$69.42
|
| Rate for Payer: Signature Care EPO |
$74.63
|
| Rate for Payer: Signature Care PPO |
$79.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.43
|
| Rate for Payer: United Healthcare Commercial |
$70.86
|
| Rate for Payer: United Healthcare Medicare |
$29.67
|
|
|
HC DVT GARMENT 17 IN
|
Facility
IP
|
$89.92
|
|
| Hospital Charge Code |
41601059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$83.63 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Cash Price |
$55.75
|
| Rate for Payer: Cigna All Commercial |
$77.60
|
| Rate for Payer: CORVEL All Commercial |
$83.63
|
| Rate for Payer: Coventry All Commercial |
$79.13
|
| Rate for Payer: Encore All Commercial |
$82.77
|
| Rate for Payer: Frontpath All Commercial |
$82.73
|
| Rate for Payer: Humana ChoiceCare |
$77.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.93
|
| Rate for Payer: PHCS All Commercial |
$67.44
|
| Rate for Payer: PHP All Commercial |
$68.20
|
| Rate for Payer: Sagamore Health Network All Products |
$69.42
|
| Rate for Payer: Signature Care EPO |
$74.63
|
| Rate for Payer: Signature Care PPO |
$79.13
|
| Rate for Payer: United Healthcare Commercial |
$70.86
|
|
|
HC DVT GARMENT 32 IN CALF MAX
|
Facility
IP
|
$182.13
|
|
| Hospital Charge Code |
41601060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$169.38 |
| Rate for Payer: Aetna Commercial |
$157.36
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cigna All Commercial |
$157.18
|
| Rate for Payer: CORVEL All Commercial |
$169.38
|
| Rate for Payer: Coventry All Commercial |
$160.27
|
| Rate for Payer: Encore All Commercial |
$167.65
|
| Rate for Payer: Frontpath All Commercial |
$167.56
|
| Rate for Payer: Humana ChoiceCare |
$157.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$163.92
|
| Rate for Payer: PHCS All Commercial |
$136.60
|
| Rate for Payer: PHP All Commercial |
$138.13
|
| Rate for Payer: Sagamore Health Network All Products |
$140.60
|
| Rate for Payer: Signature Care EPO |
$151.17
|
| Rate for Payer: Signature Care PPO |
$160.27
|
| Rate for Payer: United Healthcare Commercial |
$143.52
|
|
|
HC DVT GARMENT 32 IN CALF MAX
|
Facility
OP
|
$182.13
|
|
| Hospital Charge Code |
41601060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$169.38 |
| Rate for Payer: Aetna Commercial |
$153.72
|
| Rate for Payer: Aetna Medicare |
$60.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$104.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.11
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Centivo All Commercial |
$92.89
|
| Rate for Payer: Cigna All Commercial |
$157.18
|
| Rate for Payer: CORVEL All Commercial |
$169.38
|
| Rate for Payer: Coventry All Commercial |
$160.27
|
| Rate for Payer: Encore All Commercial |
$167.65
|
| Rate for Payer: Frontpath All Commercial |
$167.56
|
| Rate for Payer: Humana ChoiceCare |
$157.31
|
| Rate for Payer: Humana Medicare |
$92.89
|
| Rate for Payer: Lucent All Commercial |
$92.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$163.92
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$136.60
|
| Rate for Payer: PHP All Commercial |
$138.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.03
|
| Rate for Payer: Sagamore Health Network All Products |
$140.60
|
| Rate for Payer: Signature Care EPO |
$151.17
|
| Rate for Payer: Signature Care PPO |
$160.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$154.81
|
| Rate for Payer: United Healthcare Commercial |
$143.52
|
| Rate for Payer: United Healthcare Medicare |
$60.10
|
|
|
HC DX LMBR SPI PNXR W/FLUOR
|
Facility
OP
|
$663.00
|
|
| Hospital Charge Code |
01612328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.79 |
| Max. Negotiated Rate |
$616.59 |
| Rate for Payer: Aetna Commercial |
$559.57
|
| Rate for Payer: Aetna Medicare |
$218.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$218.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$380.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$414.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$251.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$240.67
|
| Rate for Payer: Cash Price |
$411.06
|
| Rate for Payer: Centivo All Commercial |
$338.13
|
| Rate for Payer: Cigna All Commercial |
$572.17
|
| Rate for Payer: CORVEL All Commercial |
$616.59
|
| Rate for Payer: Coventry All Commercial |
$583.44
|
| Rate for Payer: Encore All Commercial |
$610.29
|
| Rate for Payer: Frontpath All Commercial |
$609.96
|
| Rate for Payer: Humana ChoiceCare |
$572.63
|
| Rate for Payer: Humana Medicare |
$338.13
|
| Rate for Payer: Lucent All Commercial |
$338.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.70
|
| Rate for Payer: PHCS All Commercial |
$497.25
|
| Rate for Payer: PHP All Commercial |
$502.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$258.57
|
| Rate for Payer: Sagamore Health Network All Products |
$511.84
|
| Rate for Payer: Signature Care EPO |
$550.29
|
| Rate for Payer: Signature Care PPO |
$583.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$563.55
|
| Rate for Payer: United Healthcare Commercial |
$522.44
|
| Rate for Payer: United Healthcare Medicare |
$218.79
|
|
|
HC DX LMBR SPI PNXR W/FLUOR
|
Facility
IP
|
$663.00
|
|
| Hospital Charge Code |
01612328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.25 |
| Max. Negotiated Rate |
$616.59 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Cash Price |
$411.06
|
| Rate for Payer: Cigna All Commercial |
$572.17
|
| Rate for Payer: CORVEL All Commercial |
$616.59
|
| Rate for Payer: Coventry All Commercial |
$583.44
|
| Rate for Payer: Encore All Commercial |
$610.29
|
| Rate for Payer: Frontpath All Commercial |
$609.96
|
| Rate for Payer: Humana ChoiceCare |
$572.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.70
|
| Rate for Payer: PHCS All Commercial |
$497.25
|
| Rate for Payer: PHP All Commercial |
$502.82
|
| Rate for Payer: Sagamore Health Network All Products |
$511.84
|
| Rate for Payer: Signature Care EPO |
$550.29
|
| Rate for Payer: Signature Care PPO |
$583.44
|
| Rate for Payer: United Healthcare Commercial |
$522.44
|
|
|
HC DYE SPOT SYR
|
Facility
IP
|
$266.00
|
|
| Hospital Charge Code |
41601911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$247.38 |
| Rate for Payer: Aetna Commercial |
$229.82
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cigna All Commercial |
$229.56
|
| Rate for Payer: CORVEL All Commercial |
$247.38
|
| Rate for Payer: Coventry All Commercial |
$234.08
|
| Rate for Payer: Encore All Commercial |
$244.85
|
| Rate for Payer: Frontpath All Commercial |
$244.72
|
| Rate for Payer: Humana ChoiceCare |
$229.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.40
|
| Rate for Payer: PHCS All Commercial |
$199.50
|
| Rate for Payer: PHP All Commercial |
$201.73
|
| Rate for Payer: Sagamore Health Network All Products |
$205.35
|
| Rate for Payer: Signature Care EPO |
$220.78
|
| Rate for Payer: Signature Care PPO |
$234.08
|
| Rate for Payer: United Healthcare Commercial |
$209.61
|
|
|
HC DYE SPOT SYR
|
Facility
OP
|
$266.00
|
|
| Hospital Charge Code |
41601911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$224.50
|
| Rate for Payer: Aetna Medicare |
$87.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$152.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.56
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Centivo All Commercial |
$135.66
|
| Rate for Payer: Cigna All Commercial |
$229.56
|
| Rate for Payer: CORVEL All Commercial |
$247.38
|
| Rate for Payer: Coventry All Commercial |
$234.08
|
| Rate for Payer: Encore All Commercial |
$244.85
|
| Rate for Payer: Frontpath All Commercial |
$244.72
|
| Rate for Payer: Humana ChoiceCare |
$229.74
|
| Rate for Payer: Humana Medicare |
$135.66
|
| Rate for Payer: Lucent All Commercial |
$135.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$199.50
|
| Rate for Payer: PHP All Commercial |
$201.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.74
|
| Rate for Payer: Sagamore Health Network All Products |
$205.35
|
| Rate for Payer: Signature Care EPO |
$220.78
|
| Rate for Payer: Signature Care PPO |
$234.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$226.10
|
| Rate for Payer: United Healthcare Commercial |
$209.61
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
|
|
HC DYSPHAGIA TREATMENT-15 MIN-SP
|
Facility
IP
|
$325.73
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
01748025
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$302.93 |
| Rate for Payer: Aetna Commercial |
$281.43
|
| Rate for Payer: Cash Price |
$201.95
|
| Rate for Payer: Cigna All Commercial |
$281.10
|
| Rate for Payer: CORVEL All Commercial |
$302.93
|
| Rate for Payer: Coventry All Commercial |
$286.64
|
| Rate for Payer: Encore All Commercial |
$299.83
|
| Rate for Payer: Frontpath All Commercial |
$299.67
|
| Rate for Payer: Humana ChoiceCare |
$281.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.15
|
| Rate for Payer: PHCS All Commercial |
$244.30
|
| Rate for Payer: PHP All Commercial |
$247.03
|
| Rate for Payer: Sagamore Health Network All Products |
$251.46
|
| Rate for Payer: Signature Care EPO |
$270.35
|
| Rate for Payer: Signature Care PPO |
$286.64
|
| Rate for Payer: United Healthcare Commercial |
$256.67
|
|
|
HC DYSPHAGIA TREATMENT-15 MIN-SP
|
Facility
OP
|
$325.73
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
01748025
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$107.49 |
| Max. Negotiated Rate |
$302.93 |
| Rate for Payer: Aetna Commercial |
$274.91
|
| Rate for Payer: Aetna Medicare |
$107.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$187.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$203.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.24
|
| Rate for Payer: Cash Price |
$201.95
|
| Rate for Payer: Centivo All Commercial |
$166.12
|
| Rate for Payer: Cigna All Commercial |
$281.10
|
| Rate for Payer: CORVEL All Commercial |
$302.93
|
| Rate for Payer: Coventry All Commercial |
$286.64
|
| Rate for Payer: Encore All Commercial |
$299.83
|
| Rate for Payer: Frontpath All Commercial |
$299.67
|
| Rate for Payer: Humana ChoiceCare |
$281.33
|
| Rate for Payer: Humana Medicare |
$166.12
|
| Rate for Payer: Lucent All Commercial |
$166.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.15
|
| Rate for Payer: PHCS All Commercial |
$244.30
|
| Rate for Payer: PHP All Commercial |
$247.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.03
|
| Rate for Payer: Sagamore Health Network All Products |
$251.46
|
| Rate for Payer: Signature Care EPO |
$270.35
|
| Rate for Payer: Signature Care PPO |
$286.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$276.87
|
| Rate for Payer: United Healthcare Commercial |
$256.67
|
| Rate for Payer: United Healthcare Medicare |
$107.49
|
|
|
HC DYSPHAGIA TREATMENT-30 MIN-SP
|
Facility
OP
|
$325.73
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
01748026
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$107.49 |
| Max. Negotiated Rate |
$302.93 |
| Rate for Payer: Aetna Commercial |
$274.91
|
| Rate for Payer: Aetna Medicare |
$107.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$187.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$203.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.24
|
| Rate for Payer: Cash Price |
$201.95
|
| Rate for Payer: Centivo All Commercial |
$166.12
|
| Rate for Payer: Cigna All Commercial |
$281.10
|
| Rate for Payer: CORVEL All Commercial |
$302.93
|
| Rate for Payer: Coventry All Commercial |
$286.64
|
| Rate for Payer: Encore All Commercial |
$299.83
|
| Rate for Payer: Frontpath All Commercial |
$299.67
|
| Rate for Payer: Humana ChoiceCare |
$281.33
|
| Rate for Payer: Humana Medicare |
$166.12
|
| Rate for Payer: Lucent All Commercial |
$166.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.15
|
| Rate for Payer: PHCS All Commercial |
$244.30
|
| Rate for Payer: PHP All Commercial |
$247.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.03
|
| Rate for Payer: Sagamore Health Network All Products |
$251.46
|
| Rate for Payer: Signature Care EPO |
$270.35
|
| Rate for Payer: Signature Care PPO |
$286.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$276.87
|
| Rate for Payer: United Healthcare Commercial |
$256.67
|
| Rate for Payer: United Healthcare Medicare |
$107.49
|
|
|
HC DYSPHAGIA TREATMENT-30 MIN-SP
|
Facility
IP
|
$325.73
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
01748026
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$302.93 |
| Rate for Payer: Aetna Commercial |
$281.43
|
| Rate for Payer: Cash Price |
$201.95
|
| Rate for Payer: Cigna All Commercial |
$281.10
|
| Rate for Payer: CORVEL All Commercial |
$302.93
|
| Rate for Payer: Coventry All Commercial |
$286.64
|
| Rate for Payer: Encore All Commercial |
$299.83
|
| Rate for Payer: Frontpath All Commercial |
$299.67
|
| Rate for Payer: Humana ChoiceCare |
$281.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.15
|
| Rate for Payer: PHCS All Commercial |
$244.30
|
| Rate for Payer: PHP All Commercial |
$247.03
|
| Rate for Payer: Sagamore Health Network All Products |
$251.46
|
| Rate for Payer: Signature Care EPO |
$270.35
|
| Rate for Payer: Signature Care PPO |
$286.64
|
| Rate for Payer: United Healthcare Commercial |
$256.67
|
|
|
HC DYSPHAGIA TREATMENT-45 MIN-SP
|
Facility
OP
|
$325.73
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
01748089
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$107.49 |
| Max. Negotiated Rate |
$302.93 |
| Rate for Payer: Aetna Commercial |
$274.91
|
| Rate for Payer: Aetna Medicare |
$107.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$187.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$203.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.24
|
| Rate for Payer: Cash Price |
$201.95
|
| Rate for Payer: Centivo All Commercial |
$166.12
|
| Rate for Payer: Cigna All Commercial |
$281.10
|
| Rate for Payer: CORVEL All Commercial |
$302.93
|
| Rate for Payer: Coventry All Commercial |
$286.64
|
| Rate for Payer: Encore All Commercial |
$299.83
|
| Rate for Payer: Frontpath All Commercial |
$299.67
|
| Rate for Payer: Humana ChoiceCare |
$281.33
|
| Rate for Payer: Humana Medicare |
$166.12
|
| Rate for Payer: Lucent All Commercial |
$166.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.15
|
| Rate for Payer: PHCS All Commercial |
$244.30
|
| Rate for Payer: PHP All Commercial |
$247.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.03
|
| Rate for Payer: Sagamore Health Network All Products |
$251.46
|
| Rate for Payer: Signature Care EPO |
$270.35
|
| Rate for Payer: Signature Care PPO |
$286.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$276.87
|
| Rate for Payer: United Healthcare Commercial |
$256.67
|
| Rate for Payer: United Healthcare Medicare |
$107.49
|
|
|
HC DYSPHAGIA TREATMENT-45 MIN-SP
|
Facility
IP
|
$325.73
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
01748089
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$302.93 |
| Rate for Payer: Aetna Commercial |
$281.43
|
| Rate for Payer: Cash Price |
$201.95
|
| Rate for Payer: Cigna All Commercial |
$281.10
|
| Rate for Payer: CORVEL All Commercial |
$302.93
|
| Rate for Payer: Coventry All Commercial |
$286.64
|
| Rate for Payer: Encore All Commercial |
$299.83
|
| Rate for Payer: Frontpath All Commercial |
$299.67
|
| Rate for Payer: Humana ChoiceCare |
$281.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.15
|
| Rate for Payer: PHCS All Commercial |
$244.30
|
| Rate for Payer: PHP All Commercial |
$247.03
|
| Rate for Payer: Sagamore Health Network All Products |
$251.46
|
| Rate for Payer: Signature Care EPO |
$270.35
|
| Rate for Payer: Signature Care PPO |
$286.64
|
| Rate for Payer: United Healthcare Commercial |
$256.67
|
|
