|
HC MENISCAL MENDER REPAIR SET
|
Facility
IP
|
$947.87
|
|
| Hospital Charge Code |
41602501
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$710.90 |
| Max. Negotiated Rate |
$881.52 |
| Rate for Payer: Aetna Commercial |
$818.96
|
| Rate for Payer: Cash Price |
$587.68
|
| Rate for Payer: Cigna All Commercial |
$818.01
|
| Rate for Payer: CORVEL All Commercial |
$881.52
|
| Rate for Payer: Coventry All Commercial |
$834.13
|
| Rate for Payer: Encore All Commercial |
$872.51
|
| Rate for Payer: Frontpath All Commercial |
$872.04
|
| Rate for Payer: Humana ChoiceCare |
$818.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$853.08
|
| Rate for Payer: PHCS All Commercial |
$710.90
|
| Rate for Payer: PHP All Commercial |
$718.86
|
| Rate for Payer: Sagamore Health Network All Products |
$731.76
|
| Rate for Payer: Signature Care EPO |
$786.73
|
| Rate for Payer: Signature Care PPO |
$834.13
|
| Rate for Payer: United Healthcare Commercial |
$746.92
|
|
|
HC MENISCAL MENDER REPAIR SET
|
Facility
OP
|
$947.87
|
|
| Hospital Charge Code |
41602501
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$881.52 |
| Rate for Payer: Aetna Commercial |
$800.00
|
| Rate for Payer: Aetna Medicare |
$312.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$312.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$544.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$592.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$359.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.08
|
| Rate for Payer: Cash Price |
$587.68
|
| Rate for Payer: Cash Price |
$587.68
|
| Rate for Payer: Centivo All Commercial |
$483.41
|
| Rate for Payer: Cigna All Commercial |
$818.01
|
| Rate for Payer: CORVEL All Commercial |
$881.52
|
| Rate for Payer: Coventry All Commercial |
$834.13
|
| Rate for Payer: Encore All Commercial |
$872.51
|
| Rate for Payer: Frontpath All Commercial |
$872.04
|
| Rate for Payer: Humana ChoiceCare |
$818.68
|
| Rate for Payer: Humana Medicare |
$483.41
|
| Rate for Payer: Lucent All Commercial |
$483.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$853.08
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$710.90
|
| Rate for Payer: PHP All Commercial |
$718.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$369.67
|
| Rate for Payer: Sagamore Health Network All Products |
$731.76
|
| Rate for Payer: Signature Care EPO |
$786.73
|
| Rate for Payer: Signature Care PPO |
$834.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$805.69
|
| Rate for Payer: United Healthcare Commercial |
$746.92
|
| Rate for Payer: United Healthcare Medicare |
$312.80
|
|
|
HC MEPERIDINE MS
|
Facility
OP
|
$314.66
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.12 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$265.57
|
| Rate for Payer: Aetna Medicare |
$103.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.22
|
| Rate for Payer: Cash Price |
$195.09
|
| Rate for Payer: Cash Price |
$195.09
|
| Rate for Payer: Centivo All Commercial |
$160.48
|
| Rate for Payer: Cigna All Commercial |
$271.55
|
| Rate for Payer: CORVEL All Commercial |
$292.63
|
| Rate for Payer: Coventry All Commercial |
$276.90
|
| Rate for Payer: Encore All Commercial |
$289.64
|
| Rate for Payer: Frontpath All Commercial |
$289.49
|
| Rate for Payer: Humana ChoiceCare |
$271.77
|
| Rate for Payer: Humana Medicare |
$160.48
|
| Rate for Payer: Lucent All Commercial |
$160.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$235.99
|
| Rate for Payer: PHP All Commercial |
$238.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.72
|
| Rate for Payer: Sagamore Health Network All Products |
$242.92
|
| Rate for Payer: Signature Care EPO |
$261.17
|
| Rate for Payer: Signature Care PPO |
$276.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$267.46
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$103.84
|
|
|
HC MEPERIDINE MS
|
Facility
IP
|
$314.66
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$235.99 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$271.87
|
| Rate for Payer: Cash Price |
$195.09
|
| Rate for Payer: Cigna All Commercial |
$271.55
|
| Rate for Payer: CORVEL All Commercial |
$292.63
|
| Rate for Payer: Coventry All Commercial |
$276.90
|
| Rate for Payer: Encore All Commercial |
$289.64
|
| Rate for Payer: Frontpath All Commercial |
$289.49
|
| Rate for Payer: Humana ChoiceCare |
$271.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: PHCS All Commercial |
$235.99
|
| Rate for Payer: PHP All Commercial |
$238.64
|
| Rate for Payer: Sagamore Health Network All Products |
$242.92
|
| Rate for Payer: Signature Care EPO |
$261.17
|
| Rate for Payer: Signature Care PPO |
$276.90
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
|
HC MEPROBAMATE CONFIRM, URINE
|
Facility
OP
|
$155.30
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.25 |
| Max. Negotiated Rate |
$144.42 |
| Rate for Payer: Aetna Commercial |
$131.07
|
| Rate for Payer: Aetna Medicare |
$51.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.37
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Centivo All Commercial |
$79.20
|
| Rate for Payer: Cigna All Commercial |
$134.02
|
| Rate for Payer: CORVEL All Commercial |
$144.42
|
| Rate for Payer: Coventry All Commercial |
$136.66
|
| Rate for Payer: Encore All Commercial |
$142.95
|
| Rate for Payer: Frontpath All Commercial |
$142.87
|
| Rate for Payer: Humana ChoiceCare |
$134.13
|
| Rate for Payer: Humana Medicare |
$79.20
|
| Rate for Payer: Lucent All Commercial |
$79.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.77
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$116.47
|
| Rate for Payer: PHP All Commercial |
$117.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.57
|
| Rate for Payer: Sagamore Health Network All Products |
$119.89
|
| Rate for Payer: Signature Care EPO |
$128.89
|
| Rate for Payer: Signature Care PPO |
$136.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$122.37
|
| Rate for Payer: United Healthcare Medicare |
$51.25
|
|
|
HC MEPROBAMATE CONFIRM, URINE
|
Facility
IP
|
$155.30
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.47 |
| Max. Negotiated Rate |
$144.42 |
| Rate for Payer: Aetna Commercial |
$134.17
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cigna All Commercial |
$134.02
|
| Rate for Payer: CORVEL All Commercial |
$144.42
|
| Rate for Payer: Coventry All Commercial |
$136.66
|
| Rate for Payer: Encore All Commercial |
$142.95
|
| Rate for Payer: Frontpath All Commercial |
$142.87
|
| Rate for Payer: Humana ChoiceCare |
$134.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.77
|
| Rate for Payer: PHCS All Commercial |
$116.47
|
| Rate for Payer: PHP All Commercial |
$117.78
|
| Rate for Payer: Sagamore Health Network All Products |
$119.89
|
| Rate for Payer: Signature Care EPO |
$128.89
|
| Rate for Payer: Signature Care PPO |
$136.66
|
| Rate for Payer: United Healthcare Commercial |
$122.37
|
|
|
HC MERCURY
|
Facility
OP
|
$145.33
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
63001633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Aetna Commercial |
$122.66
|
| Rate for Payer: Aetna Medicare |
$47.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.75
|
| Rate for Payer: Cash Price |
$90.10
|
| Rate for Payer: Cash Price |
$90.10
|
| Rate for Payer: Centivo All Commercial |
$74.12
|
| Rate for Payer: Cigna All Commercial |
$125.42
|
| Rate for Payer: CORVEL All Commercial |
$135.16
|
| Rate for Payer: Coventry All Commercial |
$127.89
|
| Rate for Payer: Encore All Commercial |
$133.78
|
| Rate for Payer: Frontpath All Commercial |
$133.70
|
| Rate for Payer: Humana ChoiceCare |
$125.52
|
| Rate for Payer: Humana Medicare |
$74.12
|
| Rate for Payer: Lucent All Commercial |
$74.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.80
|
| Rate for Payer: Managed Health Services Medicaid |
$16.26
|
| Rate for Payer: MDWise Medicaid |
$16.26
|
| Rate for Payer: PHCS All Commercial |
$109.00
|
| Rate for Payer: PHP All Commercial |
$110.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.68
|
| Rate for Payer: Sagamore Health Network All Products |
$112.19
|
| Rate for Payer: Signature Care EPO |
$120.62
|
| Rate for Payer: Signature Care PPO |
$127.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.53
|
| Rate for Payer: United Healthcare Commercial |
$114.52
|
| Rate for Payer: United Healthcare Medicare |
$47.96
|
|
|
HC MERCURY
|
Facility
IP
|
$145.33
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
63001633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Aetna Commercial |
$125.56
|
| Rate for Payer: Cash Price |
$90.10
|
| Rate for Payer: Cigna All Commercial |
$125.42
|
| Rate for Payer: CORVEL All Commercial |
$135.16
|
| Rate for Payer: Coventry All Commercial |
$127.89
|
| Rate for Payer: Encore All Commercial |
$133.78
|
| Rate for Payer: Frontpath All Commercial |
$133.70
|
| Rate for Payer: Humana ChoiceCare |
$125.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.80
|
| Rate for Payer: PHCS All Commercial |
$109.00
|
| Rate for Payer: PHP All Commercial |
$110.22
|
| Rate for Payer: Sagamore Health Network All Products |
$112.19
|
| Rate for Payer: Signature Care EPO |
$120.62
|
| Rate for Payer: Signature Care PPO |
$127.89
|
| Rate for Payer: United Healthcare Commercial |
$114.52
|
|
|
HC MERCURY - BLOOD
|
Facility
OP
|
$117.30
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
63001634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$109.09 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$67.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.58
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Centivo All Commercial |
$59.82
|
| Rate for Payer: Cigna All Commercial |
$101.23
|
| Rate for Payer: CORVEL All Commercial |
$109.09
|
| Rate for Payer: Coventry All Commercial |
$103.22
|
| Rate for Payer: Encore All Commercial |
$107.97
|
| Rate for Payer: Frontpath All Commercial |
$107.92
|
| Rate for Payer: Humana ChoiceCare |
$101.31
|
| Rate for Payer: Humana Medicare |
$59.82
|
| Rate for Payer: Lucent All Commercial |
$59.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.57
|
| Rate for Payer: Managed Health Services Medicaid |
$16.26
|
| Rate for Payer: MDWise Medicaid |
$16.26
|
| Rate for Payer: PHCS All Commercial |
$87.98
|
| Rate for Payer: PHP All Commercial |
$88.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.75
|
| Rate for Payer: Sagamore Health Network All Products |
$90.56
|
| Rate for Payer: Signature Care EPO |
$97.36
|
| Rate for Payer: Signature Care PPO |
$103.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99.70
|
| Rate for Payer: United Healthcare Commercial |
$92.43
|
| Rate for Payer: United Healthcare Medicare |
$38.71
|
|
|
HC MERCURY - BLOOD
|
Facility
IP
|
$117.30
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
63001634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.98 |
| Max. Negotiated Rate |
$109.09 |
| Rate for Payer: Aetna Commercial |
$101.35
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cigna All Commercial |
$101.23
|
| Rate for Payer: CORVEL All Commercial |
$109.09
|
| Rate for Payer: Coventry All Commercial |
$103.22
|
| Rate for Payer: Encore All Commercial |
$107.97
|
| Rate for Payer: Frontpath All Commercial |
$107.92
|
| Rate for Payer: Humana ChoiceCare |
$101.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.57
|
| Rate for Payer: PHCS All Commercial |
$87.98
|
| Rate for Payer: PHP All Commercial |
$88.96
|
| Rate for Payer: Sagamore Health Network All Products |
$90.56
|
| Rate for Payer: Signature Care EPO |
$97.36
|
| Rate for Payer: Signature Care PPO |
$103.22
|
| Rate for Payer: United Healthcare Commercial |
$92.43
|
|
|
HC MERCURY UR RANDOM
|
Facility
IP
|
$135.02
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
63001635
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.26 |
| Max. Negotiated Rate |
$125.57 |
| Rate for Payer: Aetna Commercial |
$116.66
|
| Rate for Payer: Cash Price |
$83.71
|
| Rate for Payer: Cigna All Commercial |
$116.52
|
| Rate for Payer: CORVEL All Commercial |
$125.57
|
| Rate for Payer: Coventry All Commercial |
$118.82
|
| Rate for Payer: Encore All Commercial |
$124.28
|
| Rate for Payer: Frontpath All Commercial |
$124.22
|
| Rate for Payer: Humana ChoiceCare |
$116.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.52
|
| Rate for Payer: PHCS All Commercial |
$101.26
|
| Rate for Payer: PHP All Commercial |
$102.40
|
| Rate for Payer: Sagamore Health Network All Products |
$104.23
|
| Rate for Payer: Signature Care EPO |
$112.06
|
| Rate for Payer: Signature Care PPO |
$118.82
|
| Rate for Payer: United Healthcare Commercial |
$106.39
|
|
|
HC MERCURY UR RANDOM
|
Facility
OP
|
$135.02
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
63001635
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$125.57 |
| Rate for Payer: Aetna Commercial |
$113.95
|
| Rate for Payer: Aetna Medicare |
$44.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$84.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.01
|
| Rate for Payer: Cash Price |
$83.71
|
| Rate for Payer: Cash Price |
$83.71
|
| Rate for Payer: Centivo All Commercial |
$68.86
|
| Rate for Payer: Cigna All Commercial |
$116.52
|
| Rate for Payer: CORVEL All Commercial |
$125.57
|
| Rate for Payer: Coventry All Commercial |
$118.82
|
| Rate for Payer: Encore All Commercial |
$124.28
|
| Rate for Payer: Frontpath All Commercial |
$124.22
|
| Rate for Payer: Humana ChoiceCare |
$116.61
|
| Rate for Payer: Humana Medicare |
$68.86
|
| Rate for Payer: Lucent All Commercial |
$68.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.52
|
| Rate for Payer: Managed Health Services Medicaid |
$16.26
|
| Rate for Payer: MDWise Medicaid |
$16.26
|
| Rate for Payer: PHCS All Commercial |
$101.26
|
| Rate for Payer: PHP All Commercial |
$102.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.66
|
| Rate for Payer: Sagamore Health Network All Products |
$104.23
|
| Rate for Payer: Signature Care EPO |
$112.06
|
| Rate for Payer: Signature Care PPO |
$118.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114.76
|
| Rate for Payer: United Healthcare Commercial |
$106.39
|
| Rate for Payer: United Healthcare Medicare |
$44.56
|
|
|
HC MESH 3D MAX LIGHT LG LT
|
Facility
OP
|
$1,194.50
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.18 |
| Max. Negotiated Rate |
$1,110.88 |
| Rate for Payer: Aetna Commercial |
$1,008.16
|
| Rate for Payer: Aetna Medicare |
$394.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$394.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$686.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$746.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$453.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$433.60
|
| Rate for Payer: Cash Price |
$740.59
|
| Rate for Payer: Cash Price |
$740.59
|
| Rate for Payer: Centivo All Commercial |
$609.20
|
| Rate for Payer: Cigna All Commercial |
$1,030.85
|
| Rate for Payer: CORVEL All Commercial |
$1,110.88
|
| Rate for Payer: Coventry All Commercial |
$1,051.16
|
| Rate for Payer: Encore All Commercial |
$1,099.54
|
| Rate for Payer: Frontpath All Commercial |
$1,098.94
|
| Rate for Payer: Humana ChoiceCare |
$1,031.69
|
| Rate for Payer: Humana Medicare |
$609.20
|
| Rate for Payer: Lucent All Commercial |
$609.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,075.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$895.88
|
| Rate for Payer: PHP All Commercial |
$905.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$465.86
|
| Rate for Payer: Sagamore Health Network All Products |
$922.15
|
| Rate for Payer: Signature Care EPO |
$991.44
|
| Rate for Payer: Signature Care PPO |
$1,051.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,015.32
|
| Rate for Payer: United Healthcare Commercial |
$941.27
|
| Rate for Payer: United Healthcare Medicare |
$394.18
|
|
|
HC MESH 3D MAX LIGHT LG LT
|
Facility
IP
|
$1,194.50
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.88 |
| Max. Negotiated Rate |
$1,110.88 |
| Rate for Payer: Aetna Commercial |
$1,032.05
|
| Rate for Payer: Cash Price |
$740.59
|
| Rate for Payer: Cigna All Commercial |
$1,030.85
|
| Rate for Payer: CORVEL All Commercial |
$1,110.88
|
| Rate for Payer: Coventry All Commercial |
$1,051.16
|
| Rate for Payer: Encore All Commercial |
$1,099.54
|
| Rate for Payer: Frontpath All Commercial |
$1,098.94
|
| Rate for Payer: Humana ChoiceCare |
$1,031.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,075.05
|
| Rate for Payer: PHCS All Commercial |
$895.88
|
| Rate for Payer: PHP All Commercial |
$905.91
|
| Rate for Payer: Sagamore Health Network All Products |
$922.15
|
| Rate for Payer: Signature Care EPO |
$991.44
|
| Rate for Payer: Signature Care PPO |
$1,051.16
|
| Rate for Payer: United Healthcare Commercial |
$941.27
|
|
|
HC MESH 3D MAX LIGHT LG RT
|
Facility
OP
|
$1,194.50
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.18 |
| Max. Negotiated Rate |
$1,110.88 |
| Rate for Payer: Aetna Commercial |
$1,008.16
|
| Rate for Payer: Aetna Medicare |
$394.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$394.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$686.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$746.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$453.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$433.60
|
| Rate for Payer: Cash Price |
$740.59
|
| Rate for Payer: Cash Price |
$740.59
|
| Rate for Payer: Centivo All Commercial |
$609.20
|
| Rate for Payer: Cigna All Commercial |
$1,030.85
|
| Rate for Payer: CORVEL All Commercial |
$1,110.88
|
| Rate for Payer: Coventry All Commercial |
$1,051.16
|
| Rate for Payer: Encore All Commercial |
$1,099.54
|
| Rate for Payer: Frontpath All Commercial |
$1,098.94
|
| Rate for Payer: Humana ChoiceCare |
$1,031.69
|
| Rate for Payer: Humana Medicare |
$609.20
|
| Rate for Payer: Lucent All Commercial |
$609.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,075.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$895.88
|
| Rate for Payer: PHP All Commercial |
$905.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$465.86
|
| Rate for Payer: Sagamore Health Network All Products |
$922.15
|
| Rate for Payer: Signature Care EPO |
$991.44
|
| Rate for Payer: Signature Care PPO |
$1,051.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,015.32
|
| Rate for Payer: United Healthcare Commercial |
$941.27
|
| Rate for Payer: United Healthcare Medicare |
$394.18
|
|
|
HC MESH 3D MAX LIGHT LG RT
|
Facility
IP
|
$1,194.50
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.88 |
| Max. Negotiated Rate |
$1,110.88 |
| Rate for Payer: Aetna Commercial |
$1,032.05
|
| Rate for Payer: Cash Price |
$740.59
|
| Rate for Payer: Cigna All Commercial |
$1,030.85
|
| Rate for Payer: CORVEL All Commercial |
$1,110.88
|
| Rate for Payer: Coventry All Commercial |
$1,051.16
|
| Rate for Payer: Encore All Commercial |
$1,099.54
|
| Rate for Payer: Frontpath All Commercial |
$1,098.94
|
| Rate for Payer: Humana ChoiceCare |
$1,031.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,075.05
|
| Rate for Payer: PHCS All Commercial |
$895.88
|
| Rate for Payer: PHP All Commercial |
$905.91
|
| Rate for Payer: Sagamore Health Network All Products |
$922.15
|
| Rate for Payer: Signature Care EPO |
$991.44
|
| Rate for Payer: Signature Care PPO |
$1,051.16
|
| Rate for Payer: United Healthcare Commercial |
$941.27
|
|
|
HC MESH 3D MAX LIGHT MED LT
|
Facility
IP
|
$1,127.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.25 |
| Max. Negotiated Rate |
$1,048.11 |
| Rate for Payer: Aetna Commercial |
$973.73
|
| Rate for Payer: Cash Price |
$698.74
|
| Rate for Payer: Cigna All Commercial |
$972.60
|
| Rate for Payer: CORVEL All Commercial |
$1,048.11
|
| Rate for Payer: Coventry All Commercial |
$991.76
|
| Rate for Payer: Encore All Commercial |
$1,037.40
|
| Rate for Payer: Frontpath All Commercial |
$1,036.84
|
| Rate for Payer: Humana ChoiceCare |
$973.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,014.30
|
| Rate for Payer: PHCS All Commercial |
$845.25
|
| Rate for Payer: PHP All Commercial |
$854.72
|
| Rate for Payer: Sagamore Health Network All Products |
$870.04
|
| Rate for Payer: Signature Care EPO |
$935.41
|
| Rate for Payer: Signature Care PPO |
$991.76
|
| Rate for Payer: United Healthcare Commercial |
$888.08
|
|
|
HC MESH 3D MAX LIGHT MED LT
|
Facility
OP
|
$1,127.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.91 |
| Max. Negotiated Rate |
$1,048.11 |
| Rate for Payer: Aetna Commercial |
$951.19
|
| Rate for Payer: Aetna Medicare |
$371.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$371.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$647.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$704.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$427.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$409.10
|
| Rate for Payer: Cash Price |
$698.74
|
| Rate for Payer: Cash Price |
$698.74
|
| Rate for Payer: Centivo All Commercial |
$574.77
|
| Rate for Payer: Cigna All Commercial |
$972.60
|
| Rate for Payer: CORVEL All Commercial |
$1,048.11
|
| Rate for Payer: Coventry All Commercial |
$991.76
|
| Rate for Payer: Encore All Commercial |
$1,037.40
|
| Rate for Payer: Frontpath All Commercial |
$1,036.84
|
| Rate for Payer: Humana ChoiceCare |
$973.39
|
| Rate for Payer: Humana Medicare |
$574.77
|
| Rate for Payer: Lucent All Commercial |
$574.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,014.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$845.25
|
| Rate for Payer: PHP All Commercial |
$854.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$439.53
|
| Rate for Payer: Sagamore Health Network All Products |
$870.04
|
| Rate for Payer: Signature Care EPO |
$935.41
|
| Rate for Payer: Signature Care PPO |
$991.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$957.95
|
| Rate for Payer: United Healthcare Commercial |
$888.08
|
| Rate for Payer: United Healthcare Medicare |
$371.91
|
|
|
HC MESH 3D MAX LIGHT MED RT
|
Facility
OP
|
$1,127.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.91 |
| Max. Negotiated Rate |
$1,048.11 |
| Rate for Payer: Aetna Commercial |
$951.19
|
| Rate for Payer: Aetna Medicare |
$371.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$371.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$647.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$704.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$427.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$409.10
|
| Rate for Payer: Cash Price |
$698.74
|
| Rate for Payer: Cash Price |
$698.74
|
| Rate for Payer: Centivo All Commercial |
$574.77
|
| Rate for Payer: Cigna All Commercial |
$972.60
|
| Rate for Payer: CORVEL All Commercial |
$1,048.11
|
| Rate for Payer: Coventry All Commercial |
$991.76
|
| Rate for Payer: Encore All Commercial |
$1,037.40
|
| Rate for Payer: Frontpath All Commercial |
$1,036.84
|
| Rate for Payer: Humana ChoiceCare |
$973.39
|
| Rate for Payer: Humana Medicare |
$574.77
|
| Rate for Payer: Lucent All Commercial |
$574.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,014.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$845.25
|
| Rate for Payer: PHP All Commercial |
$854.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$439.53
|
| Rate for Payer: Sagamore Health Network All Products |
$870.04
|
| Rate for Payer: Signature Care EPO |
$935.41
|
| Rate for Payer: Signature Care PPO |
$991.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$957.95
|
| Rate for Payer: United Healthcare Commercial |
$888.08
|
| Rate for Payer: United Healthcare Medicare |
$371.91
|
|
|
HC MESH 3D MAX LIGHT MED RT
|
Facility
IP
|
$1,127.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.25 |
| Max. Negotiated Rate |
$1,048.11 |
| Rate for Payer: Aetna Commercial |
$973.73
|
| Rate for Payer: Cash Price |
$698.74
|
| Rate for Payer: Cigna All Commercial |
$972.60
|
| Rate for Payer: CORVEL All Commercial |
$1,048.11
|
| Rate for Payer: Coventry All Commercial |
$991.76
|
| Rate for Payer: Encore All Commercial |
$1,037.40
|
| Rate for Payer: Frontpath All Commercial |
$1,036.84
|
| Rate for Payer: Humana ChoiceCare |
$973.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,014.30
|
| Rate for Payer: PHCS All Commercial |
$845.25
|
| Rate for Payer: PHP All Commercial |
$854.72
|
| Rate for Payer: Sagamore Health Network All Products |
$870.04
|
| Rate for Payer: Signature Care EPO |
$935.41
|
| Rate for Payer: Signature Care PPO |
$991.76
|
| Rate for Payer: United Healthcare Commercial |
$888.08
|
|
|
HC MESH 3D MAX LIGHT XL LT
|
Facility
OP
|
$1,318.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41601076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.94 |
| Max. Negotiated Rate |
$1,225.74 |
| Rate for Payer: Aetna Commercial |
$1,112.39
|
| Rate for Payer: Aetna Medicare |
$434.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$434.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$756.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$823.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$500.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$478.43
|
| Rate for Payer: Cash Price |
$817.16
|
| Rate for Payer: Cash Price |
$817.16
|
| Rate for Payer: Centivo All Commercial |
$672.18
|
| Rate for Payer: Cigna All Commercial |
$1,137.43
|
| Rate for Payer: CORVEL All Commercial |
$1,225.74
|
| Rate for Payer: Coventry All Commercial |
$1,159.84
|
| Rate for Payer: Encore All Commercial |
$1,213.22
|
| Rate for Payer: Frontpath All Commercial |
$1,212.56
|
| Rate for Payer: Humana ChoiceCare |
$1,138.36
|
| Rate for Payer: Humana Medicare |
$672.18
|
| Rate for Payer: Lucent All Commercial |
$672.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,186.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$988.50
|
| Rate for Payer: PHP All Commercial |
$999.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$514.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,017.50
|
| Rate for Payer: Signature Care EPO |
$1,093.94
|
| Rate for Payer: Signature Care PPO |
$1,159.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,120.30
|
| Rate for Payer: United Healthcare Commercial |
$1,038.58
|
| Rate for Payer: United Healthcare Medicare |
$434.94
|
|
|
HC MESH 3D MAX LIGHT XL LT
|
Facility
IP
|
$1,318.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41601076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.50 |
| Max. Negotiated Rate |
$1,225.74 |
| Rate for Payer: Aetna Commercial |
$1,138.75
|
| Rate for Payer: Cash Price |
$817.16
|
| Rate for Payer: Cigna All Commercial |
$1,137.43
|
| Rate for Payer: CORVEL All Commercial |
$1,225.74
|
| Rate for Payer: Coventry All Commercial |
$1,159.84
|
| Rate for Payer: Encore All Commercial |
$1,213.22
|
| Rate for Payer: Frontpath All Commercial |
$1,212.56
|
| Rate for Payer: Humana ChoiceCare |
$1,138.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,186.20
|
| Rate for Payer: PHCS All Commercial |
$988.50
|
| Rate for Payer: PHP All Commercial |
$999.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,017.50
|
| Rate for Payer: Signature Care EPO |
$1,093.94
|
| Rate for Payer: Signature Care PPO |
$1,159.84
|
| Rate for Payer: United Healthcare Commercial |
$1,038.58
|
|
|
HC MESH 3D MAX LIGHT XL RT
|
Facility
IP
|
$1,318.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41601077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.50 |
| Max. Negotiated Rate |
$1,225.74 |
| Rate for Payer: Aetna Commercial |
$1,138.75
|
| Rate for Payer: Cash Price |
$817.16
|
| Rate for Payer: Cigna All Commercial |
$1,137.43
|
| Rate for Payer: CORVEL All Commercial |
$1,225.74
|
| Rate for Payer: Coventry All Commercial |
$1,159.84
|
| Rate for Payer: Encore All Commercial |
$1,213.22
|
| Rate for Payer: Frontpath All Commercial |
$1,212.56
|
| Rate for Payer: Humana ChoiceCare |
$1,138.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,186.20
|
| Rate for Payer: PHCS All Commercial |
$988.50
|
| Rate for Payer: PHP All Commercial |
$999.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,017.50
|
| Rate for Payer: Signature Care EPO |
$1,093.94
|
| Rate for Payer: Signature Care PPO |
$1,159.84
|
| Rate for Payer: United Healthcare Commercial |
$1,038.58
|
|
|
HC MESH 3D MAX LIGHT XL RT
|
Facility
OP
|
$1,318.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41601077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.94 |
| Max. Negotiated Rate |
$1,225.74 |
| Rate for Payer: Aetna Commercial |
$1,112.39
|
| Rate for Payer: Aetna Medicare |
$434.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$434.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$756.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$823.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$500.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$478.43
|
| Rate for Payer: Cash Price |
$817.16
|
| Rate for Payer: Cash Price |
$817.16
|
| Rate for Payer: Centivo All Commercial |
$672.18
|
| Rate for Payer: Cigna All Commercial |
$1,137.43
|
| Rate for Payer: CORVEL All Commercial |
$1,225.74
|
| Rate for Payer: Coventry All Commercial |
$1,159.84
|
| Rate for Payer: Encore All Commercial |
$1,213.22
|
| Rate for Payer: Frontpath All Commercial |
$1,212.56
|
| Rate for Payer: Humana ChoiceCare |
$1,138.36
|
| Rate for Payer: Humana Medicare |
$672.18
|
| Rate for Payer: Lucent All Commercial |
$672.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,186.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$988.50
|
| Rate for Payer: PHP All Commercial |
$999.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$514.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,017.50
|
| Rate for Payer: Signature Care EPO |
$1,093.94
|
| Rate for Payer: Signature Care PPO |
$1,159.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,120.30
|
| Rate for Payer: United Healthcare Commercial |
$1,038.58
|
| Rate for Payer: United Healthcare Medicare |
$434.94
|
|
|
HC MESH BARD SOFT 12X12
|
Facility
IP
|
$917.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41601809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.75 |
| Max. Negotiated Rate |
$852.81 |
| Rate for Payer: Aetna Commercial |
$792.29
|
| Rate for Payer: Cash Price |
$568.54
|
| Rate for Payer: Cigna All Commercial |
$791.37
|
| Rate for Payer: CORVEL All Commercial |
$852.81
|
| Rate for Payer: Coventry All Commercial |
$806.96
|
| Rate for Payer: Encore All Commercial |
$844.10
|
| Rate for Payer: Frontpath All Commercial |
$843.64
|
| Rate for Payer: Humana ChoiceCare |
$792.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$825.30
|
| Rate for Payer: PHCS All Commercial |
$687.75
|
| Rate for Payer: PHP All Commercial |
$695.45
|
| Rate for Payer: Sagamore Health Network All Products |
$707.92
|
| Rate for Payer: Signature Care EPO |
$761.11
|
| Rate for Payer: Signature Care PPO |
$806.96
|
| Rate for Payer: United Healthcare Commercial |
$722.60
|
|
