|
HC STAPLER ENDO GIA
|
Facility
|
IP
|
$349.07
|
|
| Hospital Charge Code |
41602049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$324.64 |
| Rate for Payer: Aetna Commercial |
$301.60
|
| Rate for Payer: Cash Price |
$209.44
|
| Rate for Payer: Cigna All Commercial |
$301.25
|
| Rate for Payer: CORVEL All Commercial |
$324.64
|
| Rate for Payer: Coventry All Commercial |
$307.18
|
| Rate for Payer: Encore All Commercial |
$321.32
|
| Rate for Payer: Frontpath All Commercial |
$321.14
|
| Rate for Payer: Humana ChoiceCare |
$301.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$314.16
|
| Rate for Payer: PHCS All Commercial |
$261.80
|
| Rate for Payer: PHP All Commercial |
$264.73
|
| Rate for Payer: Sagamore Health Network All Products |
$269.48
|
| Rate for Payer: Signature Care EPO |
$289.73
|
| Rate for Payer: Signature Care PPO |
$307.18
|
| Rate for Payer: United Healthcare Commercial |
$275.07
|
|
|
HC STAPLER INSORB
|
Facility
|
IP
|
$338.33
|
|
| Hospital Charge Code |
41601401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$314.65 |
| Rate for Payer: Aetna Commercial |
$292.32
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cigna All Commercial |
$291.98
|
| Rate for Payer: CORVEL All Commercial |
$314.65
|
| Rate for Payer: Coventry All Commercial |
$297.73
|
| Rate for Payer: Encore All Commercial |
$311.43
|
| Rate for Payer: Frontpath All Commercial |
$311.26
|
| Rate for Payer: Humana ChoiceCare |
$292.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$304.50
|
| Rate for Payer: PHCS All Commercial |
$253.75
|
| Rate for Payer: PHP All Commercial |
$256.59
|
| Rate for Payer: Sagamore Health Network All Products |
$261.19
|
| Rate for Payer: Signature Care EPO |
$280.81
|
| Rate for Payer: Signature Care PPO |
$297.73
|
| Rate for Payer: United Healthcare Commercial |
$266.60
|
|
|
HC STAPLER INSORB
|
Facility
|
OP
|
$338.33
|
|
| Hospital Charge Code |
41601401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$314.65 |
| Rate for Payer: Aetna Commercial |
$285.55
|
| Rate for Payer: Aetna Medicare |
$108.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$194.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Centivo All Commercial |
$184.05
|
| Rate for Payer: Cigna All Commercial |
$291.98
|
| Rate for Payer: CORVEL All Commercial |
$314.65
|
| Rate for Payer: Coventry All Commercial |
$297.73
|
| Rate for Payer: Encore All Commercial |
$311.43
|
| Rate for Payer: Frontpath All Commercial |
$311.26
|
| Rate for Payer: Humana ChoiceCare |
$292.22
|
| Rate for Payer: Humana Medicare |
$108.27
|
| Rate for Payer: Lucent All Commercial |
$184.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$304.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$253.75
|
| Rate for Payer: PHP All Commercial |
$256.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.95
|
| Rate for Payer: Sagamore Health Network All Products |
$261.19
|
| Rate for Payer: Signature Care EPO |
$280.81
|
| Rate for Payer: Signature Care PPO |
$297.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.58
|
| Rate for Payer: United Healthcare Commercial |
$266.60
|
| Rate for Payer: United Healthcare Medicare |
$108.27
|
|
|
HC STAPLER PROX SKIN WIDE
|
Facility
|
IP
|
$42.70
|
|
| Hospital Charge Code |
41607917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.02 |
| Max. Negotiated Rate |
$39.71 |
| Rate for Payer: Aetna Commercial |
$36.89
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Cigna All Commercial |
$36.85
|
| Rate for Payer: CORVEL All Commercial |
$39.71
|
| Rate for Payer: Coventry All Commercial |
$37.58
|
| Rate for Payer: Encore All Commercial |
$39.31
|
| Rate for Payer: Frontpath All Commercial |
$39.28
|
| Rate for Payer: Humana ChoiceCare |
$36.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.43
|
| Rate for Payer: PHCS All Commercial |
$32.02
|
| Rate for Payer: PHP All Commercial |
$32.38
|
| Rate for Payer: Sagamore Health Network All Products |
$32.96
|
| Rate for Payer: Signature Care EPO |
$35.44
|
| Rate for Payer: Signature Care PPO |
$37.58
|
| Rate for Payer: United Healthcare Commercial |
$33.65
|
|
|
HC STAPLER PROX SKIN WIDE
|
Facility
|
OP
|
$42.70
|
|
| Hospital Charge Code |
41607917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$39.71 |
| Rate for Payer: Aetna Commercial |
$36.04
|
| Rate for Payer: Aetna Medicare |
$13.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.03
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Centivo All Commercial |
$23.23
|
| Rate for Payer: Cigna All Commercial |
$36.85
|
| Rate for Payer: CORVEL All Commercial |
$39.71
|
| Rate for Payer: Coventry All Commercial |
$37.58
|
| Rate for Payer: Encore All Commercial |
$39.31
|
| Rate for Payer: Frontpath All Commercial |
$39.28
|
| Rate for Payer: Humana ChoiceCare |
$36.88
|
| Rate for Payer: Humana Medicare |
$13.66
|
| Rate for Payer: Lucent All Commercial |
$23.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.43
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$32.02
|
| Rate for Payer: PHP All Commercial |
$32.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.65
|
| Rate for Payer: Sagamore Health Network All Products |
$32.96
|
| Rate for Payer: Signature Care EPO |
$35.44
|
| Rate for Payer: Signature Care PPO |
$37.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.30
|
| Rate for Payer: United Healthcare Commercial |
$33.65
|
| Rate for Payer: United Healthcare Medicare |
$13.66
|
|
|
HC STAPLER SKIN 5-SHOT
|
Facility
|
OP
|
$30.19
|
|
| Hospital Charge Code |
41601100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$25.48
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.63
|
| Rate for Payer: Cash Price |
$18.11
|
| Rate for Payer: Cash Price |
$18.11
|
| Rate for Payer: Centivo All Commercial |
$16.42
|
| Rate for Payer: Cigna All Commercial |
$26.05
|
| Rate for Payer: CORVEL All Commercial |
$28.08
|
| Rate for Payer: Coventry All Commercial |
$26.57
|
| Rate for Payer: Encore All Commercial |
$27.79
|
| Rate for Payer: Frontpath All Commercial |
$27.77
|
| Rate for Payer: Humana ChoiceCare |
$26.08
|
| Rate for Payer: Humana Medicare |
$9.66
|
| Rate for Payer: Lucent All Commercial |
$16.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.17
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$22.64
|
| Rate for Payer: PHP All Commercial |
$22.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.77
|
| Rate for Payer: Sagamore Health Network All Products |
$23.31
|
| Rate for Payer: Signature Care EPO |
$25.06
|
| Rate for Payer: Signature Care PPO |
$26.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.66
|
| Rate for Payer: United Healthcare Commercial |
$23.79
|
| Rate for Payer: United Healthcare Medicare |
$9.66
|
|
|
HC STAPLER SKIN 5-SHOT
|
Facility
|
IP
|
$30.19
|
|
| Hospital Charge Code |
41601100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Aetna Commercial |
$26.08
|
| Rate for Payer: Cash Price |
$18.11
|
| Rate for Payer: Cigna All Commercial |
$26.05
|
| Rate for Payer: CORVEL All Commercial |
$28.08
|
| Rate for Payer: Coventry All Commercial |
$26.57
|
| Rate for Payer: Encore All Commercial |
$27.79
|
| Rate for Payer: Frontpath All Commercial |
$27.77
|
| Rate for Payer: Humana ChoiceCare |
$26.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.17
|
| Rate for Payer: PHCS All Commercial |
$22.64
|
| Rate for Payer: PHP All Commercial |
$22.90
|
| Rate for Payer: Sagamore Health Network All Products |
$23.31
|
| Rate for Payer: Signature Care EPO |
$25.06
|
| Rate for Payer: Signature Care PPO |
$26.57
|
| Rate for Payer: United Healthcare Commercial |
$23.79
|
|
|
HC STAPLER SKIN VISTA PRECISE 35W
|
Facility
|
OP
|
$73.12
|
|
| Hospital Charge Code |
41605569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.67 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$61.71
|
| Rate for Payer: Aetna Medicare |
$23.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.74
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Centivo All Commercial |
$39.78
|
| Rate for Payer: Cigna All Commercial |
$63.10
|
| Rate for Payer: CORVEL All Commercial |
$68.00
|
| Rate for Payer: Coventry All Commercial |
$64.35
|
| Rate for Payer: Encore All Commercial |
$67.31
|
| Rate for Payer: Frontpath All Commercial |
$67.27
|
| Rate for Payer: Humana ChoiceCare |
$63.15
|
| Rate for Payer: Humana Medicare |
$23.40
|
| Rate for Payer: Lucent All Commercial |
$39.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.81
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$54.84
|
| Rate for Payer: PHP All Commercial |
$55.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.52
|
| Rate for Payer: Sagamore Health Network All Products |
$56.45
|
| Rate for Payer: Signature Care EPO |
$60.69
|
| Rate for Payer: Signature Care PPO |
$64.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.15
|
| Rate for Payer: United Healthcare Commercial |
$57.62
|
| Rate for Payer: United Healthcare Medicare |
$23.40
|
|
|
HC STAPLER SKIN VISTA PRECISE 35W
|
Facility
|
IP
|
$73.12
|
|
| Hospital Charge Code |
41605569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$63.18
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Cigna All Commercial |
$63.10
|
| Rate for Payer: CORVEL All Commercial |
$68.00
|
| Rate for Payer: Coventry All Commercial |
$64.35
|
| Rate for Payer: Encore All Commercial |
$67.31
|
| Rate for Payer: Frontpath All Commercial |
$67.27
|
| Rate for Payer: Humana ChoiceCare |
$63.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.81
|
| Rate for Payer: PHCS All Commercial |
$54.84
|
| Rate for Payer: PHP All Commercial |
$55.45
|
| Rate for Payer: Sagamore Health Network All Products |
$56.45
|
| Rate for Payer: Signature Care EPO |
$60.69
|
| Rate for Payer: Signature Care PPO |
$64.35
|
| Rate for Payer: United Healthcare Commercial |
$57.62
|
|
|
HC STEREOSCOPIC X-RAY GUIDANCE
|
Facility
|
OP
|
$848.64
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
1540421
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$263.08 |
| Max. Negotiated Rate |
$789.24 |
| Rate for Payer: Aetna Commercial |
$716.25
|
| Rate for Payer: Aetna Medicare |
$271.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$263.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$487.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$298.72
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Centivo All Commercial |
$461.66
|
| Rate for Payer: Cigna All Commercial |
$732.38
|
| Rate for Payer: CORVEL All Commercial |
$789.24
|
| Rate for Payer: Coventry All Commercial |
$746.80
|
| Rate for Payer: Encore All Commercial |
$781.17
|
| Rate for Payer: Frontpath All Commercial |
$780.75
|
| Rate for Payer: Humana ChoiceCare |
$732.97
|
| Rate for Payer: Humana Medicare |
$271.56
|
| Rate for Payer: Lucent All Commercial |
$461.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.78
|
| Rate for Payer: PHCS All Commercial |
$636.48
|
| Rate for Payer: PHP All Commercial |
$643.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.97
|
| Rate for Payer: Sagamore Health Network All Products |
$655.15
|
| Rate for Payer: Signature Care EPO |
$704.37
|
| Rate for Payer: Signature Care PPO |
$746.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$721.34
|
| Rate for Payer: United Healthcare Commercial |
$668.73
|
| Rate for Payer: United Healthcare Medicare |
$271.56
|
|
|
HC STEREOSCOPIC X-RAY GUIDANCE
|
Facility
|
IP
|
$848.64
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
1540421
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$636.48 |
| Max. Negotiated Rate |
$789.24 |
| Rate for Payer: Aetna Commercial |
$733.22
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Cigna All Commercial |
$732.38
|
| Rate for Payer: CORVEL All Commercial |
$789.24
|
| Rate for Payer: Coventry All Commercial |
$746.80
|
| Rate for Payer: Encore All Commercial |
$781.17
|
| Rate for Payer: Frontpath All Commercial |
$780.75
|
| Rate for Payer: Humana ChoiceCare |
$732.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.78
|
| Rate for Payer: PHCS All Commercial |
$636.48
|
| Rate for Payer: PHP All Commercial |
$643.61
|
| Rate for Payer: Sagamore Health Network All Products |
$655.15
|
| Rate for Payer: Signature Care EPO |
$704.37
|
| Rate for Payer: Signature Care PPO |
$746.80
|
| Rate for Payer: United Healthcare Commercial |
$668.73
|
|
|
HC STEREOSCOPIC X-RAY GUIDANCE
|
Facility
|
IP
|
$848.64
|
|
|
Service Code
|
CPT G6002
|
| Hospital Charge Code |
1540421
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$636.48 |
| Max. Negotiated Rate |
$789.24 |
| Rate for Payer: Aetna Commercial |
$733.22
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Cigna All Commercial |
$732.38
|
| Rate for Payer: CORVEL All Commercial |
$789.24
|
| Rate for Payer: Coventry All Commercial |
$746.80
|
| Rate for Payer: Encore All Commercial |
$781.17
|
| Rate for Payer: Frontpath All Commercial |
$780.75
|
| Rate for Payer: Humana ChoiceCare |
$732.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.78
|
| Rate for Payer: PHCS All Commercial |
$636.48
|
| Rate for Payer: PHP All Commercial |
$643.61
|
| Rate for Payer: Sagamore Health Network All Products |
$655.15
|
| Rate for Payer: Signature Care EPO |
$704.37
|
| Rate for Payer: Signature Care PPO |
$746.80
|
| Rate for Payer: United Healthcare Commercial |
$668.73
|
|
|
HC STEREOSCOPIC X-RAY GUIDANCE
|
Facility
|
OP
|
$848.64
|
|
|
Service Code
|
CPT G6002
|
| Hospital Charge Code |
1540421
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$263.08 |
| Max. Negotiated Rate |
$789.24 |
| Rate for Payer: Aetna Commercial |
$716.25
|
| Rate for Payer: Aetna Medicare |
$271.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$263.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$487.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$298.72
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Centivo All Commercial |
$461.66
|
| Rate for Payer: Cigna All Commercial |
$732.38
|
| Rate for Payer: CORVEL All Commercial |
$789.24
|
| Rate for Payer: Coventry All Commercial |
$746.80
|
| Rate for Payer: Encore All Commercial |
$781.17
|
| Rate for Payer: Frontpath All Commercial |
$780.75
|
| Rate for Payer: Humana ChoiceCare |
$732.97
|
| Rate for Payer: Humana Medicare |
$271.56
|
| Rate for Payer: Lucent All Commercial |
$461.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.78
|
| Rate for Payer: PHCS All Commercial |
$636.48
|
| Rate for Payer: PHP All Commercial |
$643.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.97
|
| Rate for Payer: Sagamore Health Network All Products |
$655.15
|
| Rate for Payer: Signature Care EPO |
$704.37
|
| Rate for Payer: Signature Care PPO |
$746.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$721.34
|
| Rate for Payer: United Healthcare Commercial |
$668.73
|
| Rate for Payer: United Healthcare Medicare |
$271.56
|
|
|
HC STERIFLATE INFLATION DEVICE
|
Facility
|
IP
|
$273.98
|
|
| Hospital Charge Code |
41608202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.49 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$236.72
|
| Rate for Payer: Cash Price |
$164.39
|
| Rate for Payer: Cigna All Commercial |
$236.44
|
| Rate for Payer: CORVEL All Commercial |
$254.80
|
| Rate for Payer: Coventry All Commercial |
$241.10
|
| Rate for Payer: Encore All Commercial |
$252.20
|
| Rate for Payer: Frontpath All Commercial |
$252.06
|
| Rate for Payer: Humana ChoiceCare |
$236.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.58
|
| Rate for Payer: PHCS All Commercial |
$205.49
|
| Rate for Payer: PHP All Commercial |
$207.79
|
| Rate for Payer: Sagamore Health Network All Products |
$211.51
|
| Rate for Payer: Signature Care EPO |
$227.40
|
| Rate for Payer: Signature Care PPO |
$241.10
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
|
|
HC STERIFLATE INFLATION DEVICE
|
Facility
|
OP
|
$273.98
|
|
| Hospital Charge Code |
41608202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$231.24
|
| Rate for Payer: Aetna Medicare |
$87.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$157.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.44
|
| Rate for Payer: Cash Price |
$164.39
|
| Rate for Payer: Cash Price |
$164.39
|
| Rate for Payer: Centivo All Commercial |
$149.05
|
| Rate for Payer: Cigna All Commercial |
$236.44
|
| Rate for Payer: CORVEL All Commercial |
$254.80
|
| Rate for Payer: Coventry All Commercial |
$241.10
|
| Rate for Payer: Encore All Commercial |
$252.20
|
| Rate for Payer: Frontpath All Commercial |
$252.06
|
| Rate for Payer: Humana ChoiceCare |
$236.64
|
| Rate for Payer: Humana Medicare |
$87.67
|
| Rate for Payer: Lucent All Commercial |
$149.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.58
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$205.49
|
| Rate for Payer: PHP All Commercial |
$207.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.85
|
| Rate for Payer: Sagamore Health Network All Products |
$211.51
|
| Rate for Payer: Signature Care EPO |
$227.40
|
| Rate for Payer: Signature Care PPO |
$241.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.88
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
| Rate for Payer: United Healthcare Medicare |
$87.67
|
|
|
HC S TIBIAL BRG 3X13 TRI
|
Facility
|
IP
|
$4,865.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,649.10 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,203.77
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Cigna All Commercial |
$4,198.90
|
| Rate for Payer: CORVEL All Commercial |
$4,524.89
|
| Rate for Payer: Coventry All Commercial |
$4,281.61
|
| Rate for Payer: Encore All Commercial |
$4,478.67
|
| Rate for Payer: Frontpath All Commercial |
$4,476.23
|
| Rate for Payer: Humana ChoiceCare |
$4,202.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.14
|
| Rate for Payer: Signature Care EPO |
$4,038.34
|
| Rate for Payer: Signature Care PPO |
$4,281.61
|
| Rate for Payer: United Healthcare Commercial |
$3,833.99
|
|
|
HC S TIBIAL BRG 3X13 TRI
|
Facility
|
OP
|
$4,865.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,106.46
|
| Rate for Payer: Aetna Medicare |
$1,556.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,508.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,794.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,041.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,790.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,712.65
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Centivo All Commercial |
$2,646.82
|
| Rate for Payer: Cigna All Commercial |
$4,198.90
|
| Rate for Payer: CORVEL All Commercial |
$4,524.89
|
| Rate for Payer: Coventry All Commercial |
$4,281.61
|
| Rate for Payer: Encore All Commercial |
$4,478.67
|
| Rate for Payer: Frontpath All Commercial |
$4,476.23
|
| Rate for Payer: Humana ChoiceCare |
$4,202.31
|
| Rate for Payer: Humana Medicare |
$1,556.95
|
| Rate for Payer: Lucent All Commercial |
$2,646.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,897.53
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.14
|
| Rate for Payer: Signature Care EPO |
$4,038.34
|
| Rate for Payer: Signature Care PPO |
$4,281.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,135.65
|
| Rate for Payer: United Healthcare Commercial |
$3,833.99
|
| Rate for Payer: United Healthcare Medicare |
$1,556.95
|
|
|
HC S TIBIAL BRG 3X9 TRI
|
Facility
|
IP
|
$4,865.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,649.10 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,203.77
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Cigna All Commercial |
$4,198.90
|
| Rate for Payer: CORVEL All Commercial |
$4,524.89
|
| Rate for Payer: Coventry All Commercial |
$4,281.61
|
| Rate for Payer: Encore All Commercial |
$4,478.67
|
| Rate for Payer: Frontpath All Commercial |
$4,476.23
|
| Rate for Payer: Humana ChoiceCare |
$4,202.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.14
|
| Rate for Payer: Signature Care EPO |
$4,038.34
|
| Rate for Payer: Signature Care PPO |
$4,281.61
|
| Rate for Payer: United Healthcare Commercial |
$3,833.99
|
|
|
HC S TIBIAL BRG 3X9 TRI
|
Facility
|
OP
|
$4,865.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,106.46
|
| Rate for Payer: Aetna Medicare |
$1,556.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,508.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,794.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,041.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,790.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,712.65
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Centivo All Commercial |
$2,646.82
|
| Rate for Payer: Cigna All Commercial |
$4,198.90
|
| Rate for Payer: CORVEL All Commercial |
$4,524.89
|
| Rate for Payer: Coventry All Commercial |
$4,281.61
|
| Rate for Payer: Encore All Commercial |
$4,478.67
|
| Rate for Payer: Frontpath All Commercial |
$4,476.23
|
| Rate for Payer: Humana ChoiceCare |
$4,202.31
|
| Rate for Payer: Humana Medicare |
$1,556.95
|
| Rate for Payer: Lucent All Commercial |
$2,646.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,897.53
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.14
|
| Rate for Payer: Signature Care EPO |
$4,038.34
|
| Rate for Payer: Signature Care PPO |
$4,281.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,135.65
|
| Rate for Payer: United Healthcare Commercial |
$3,833.99
|
| Rate for Payer: United Healthcare Medicare |
$1,556.95
|
|
|
HC S TIBIAL BRG 5X10 TRI
|
Facility
|
OP
|
$4,865.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,106.46
|
| Rate for Payer: Aetna Medicare |
$1,556.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,508.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,794.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,041.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,790.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,712.65
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Centivo All Commercial |
$2,646.82
|
| Rate for Payer: Cigna All Commercial |
$4,198.90
|
| Rate for Payer: CORVEL All Commercial |
$4,524.89
|
| Rate for Payer: Coventry All Commercial |
$4,281.61
|
| Rate for Payer: Encore All Commercial |
$4,478.67
|
| Rate for Payer: Frontpath All Commercial |
$4,476.23
|
| Rate for Payer: Humana ChoiceCare |
$4,202.31
|
| Rate for Payer: Humana Medicare |
$1,556.95
|
| Rate for Payer: Lucent All Commercial |
$2,646.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,897.53
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.14
|
| Rate for Payer: Signature Care EPO |
$4,038.34
|
| Rate for Payer: Signature Care PPO |
$4,281.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,135.65
|
| Rate for Payer: United Healthcare Commercial |
$3,833.99
|
| Rate for Payer: United Healthcare Medicare |
$1,556.95
|
|
|
HC S TIBIAL BRG 5X10 TRI
|
Facility
|
IP
|
$4,865.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,649.10 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,203.77
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Cigna All Commercial |
$4,198.90
|
| Rate for Payer: CORVEL All Commercial |
$4,524.89
|
| Rate for Payer: Coventry All Commercial |
$4,281.61
|
| Rate for Payer: Encore All Commercial |
$4,478.67
|
| Rate for Payer: Frontpath All Commercial |
$4,476.23
|
| Rate for Payer: Humana ChoiceCare |
$4,202.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.14
|
| Rate for Payer: Signature Care EPO |
$4,038.34
|
| Rate for Payer: Signature Care PPO |
$4,281.61
|
| Rate for Payer: United Healthcare Commercial |
$3,833.99
|
|
|
HC S TIBIAL BRG 7X11 TRI
|
Facility
|
OP
|
$4,865.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,106.46
|
| Rate for Payer: Aetna Medicare |
$1,556.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,508.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,794.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,041.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,790.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,712.65
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Centivo All Commercial |
$2,646.82
|
| Rate for Payer: Cigna All Commercial |
$4,198.90
|
| Rate for Payer: CORVEL All Commercial |
$4,524.89
|
| Rate for Payer: Coventry All Commercial |
$4,281.61
|
| Rate for Payer: Encore All Commercial |
$4,478.67
|
| Rate for Payer: Frontpath All Commercial |
$4,476.23
|
| Rate for Payer: Humana ChoiceCare |
$4,202.31
|
| Rate for Payer: Humana Medicare |
$1,556.95
|
| Rate for Payer: Lucent All Commercial |
$2,646.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,897.53
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.14
|
| Rate for Payer: Signature Care EPO |
$4,038.34
|
| Rate for Payer: Signature Care PPO |
$4,281.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,135.65
|
| Rate for Payer: United Healthcare Commercial |
$3,833.99
|
| Rate for Payer: United Healthcare Medicare |
$1,556.95
|
|
|
HC S TIBIAL BRG 7X11 TRI
|
Facility
|
IP
|
$4,865.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,649.10 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,203.77
|
| Rate for Payer: Cash Price |
$2,919.28
|
| Rate for Payer: Cigna All Commercial |
$4,198.90
|
| Rate for Payer: CORVEL All Commercial |
$4,524.89
|
| Rate for Payer: Coventry All Commercial |
$4,281.61
|
| Rate for Payer: Encore All Commercial |
$4,478.67
|
| Rate for Payer: Frontpath All Commercial |
$4,476.23
|
| Rate for Payer: Humana ChoiceCare |
$4,202.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.14
|
| Rate for Payer: Signature Care EPO |
$4,038.34
|
| Rate for Payer: Signature Care PPO |
$4,281.61
|
| Rate for Payer: United Healthcare Commercial |
$3,833.99
|
|
|
HC S TIBIAL COMP 3 TRI
|
Facility
|
IP
|
$5,838.55
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,378.91 |
| Max. Negotiated Rate |
$5,429.85 |
| Rate for Payer: Aetna Commercial |
$5,044.51
|
| Rate for Payer: Cash Price |
$3,503.13
|
| Rate for Payer: Cigna All Commercial |
$5,038.67
|
| Rate for Payer: CORVEL All Commercial |
$5,429.85
|
| Rate for Payer: Coventry All Commercial |
$5,137.92
|
| Rate for Payer: Encore All Commercial |
$5,374.39
|
| Rate for Payer: Frontpath All Commercial |
$5,371.47
|
| Rate for Payer: Humana ChoiceCare |
$5,042.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,254.69
|
| Rate for Payer: PHCS All Commercial |
$4,378.91
|
| Rate for Payer: PHP All Commercial |
$4,427.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4,507.36
|
| Rate for Payer: Signature Care EPO |
$4,846.00
|
| Rate for Payer: Signature Care PPO |
$5,137.92
|
| Rate for Payer: United Healthcare Commercial |
$4,600.78
|
|
|
HC S TIBIAL COMP 3 TRI
|
Facility
|
OP
|
$5,838.55
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,429.85 |
| Rate for Payer: Aetna Commercial |
$4,927.74
|
| Rate for Payer: Aetna Medicare |
$1,868.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,809.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,353.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,649.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,148.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,055.17
|
| Rate for Payer: Cash Price |
$3,503.13
|
| Rate for Payer: Cash Price |
$3,503.13
|
| Rate for Payer: Centivo All Commercial |
$3,176.17
|
| Rate for Payer: Cigna All Commercial |
$5,038.67
|
| Rate for Payer: CORVEL All Commercial |
$5,429.85
|
| Rate for Payer: Coventry All Commercial |
$5,137.92
|
| Rate for Payer: Encore All Commercial |
$5,374.39
|
| Rate for Payer: Frontpath All Commercial |
$5,371.47
|
| Rate for Payer: Humana ChoiceCare |
$5,042.76
|
| Rate for Payer: Humana Medicare |
$1,868.34
|
| Rate for Payer: Lucent All Commercial |
$3,176.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,254.69
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,378.91
|
| Rate for Payer: PHP All Commercial |
$4,427.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,277.03
|
| Rate for Payer: Sagamore Health Network All Products |
$4,507.36
|
| Rate for Payer: Signature Care EPO |
$4,846.00
|
| Rate for Payer: Signature Care PPO |
$5,137.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,962.77
|
| Rate for Payer: United Healthcare Commercial |
$4,600.78
|
| Rate for Payer: United Healthcare Medicare |
$1,868.34
|
|
