|
HC PIN/PLUG KIT DC 6725
|
Facility
IP
|
$337.50
|
|
| Hospital Charge Code |
41607374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.12 |
| Max. Negotiated Rate |
$313.88 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cigna All Commercial |
$291.26
|
| Rate for Payer: CORVEL All Commercial |
$313.88
|
| Rate for Payer: Coventry All Commercial |
$297.00
|
| Rate for Payer: Encore All Commercial |
$310.67
|
| Rate for Payer: Frontpath All Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$291.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.75
|
| Rate for Payer: PHCS All Commercial |
$253.12
|
| Rate for Payer: PHP All Commercial |
$255.96
|
| Rate for Payer: Sagamore Health Network All Products |
$260.55
|
| Rate for Payer: Signature Care EPO |
$280.12
|
| Rate for Payer: Signature Care PPO |
$297.00
|
| Rate for Payer: United Healthcare Commercial |
$265.95
|
|
|
HC PIN/PLUG KIT DC 6725
|
Facility
OP
|
$337.50
|
|
| Hospital Charge Code |
41607374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$313.88 |
| Rate for Payer: Aetna Commercial |
$284.85
|
| Rate for Payer: Aetna Medicare |
$111.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$210.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.51
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Centivo All Commercial |
$172.12
|
| Rate for Payer: Cigna All Commercial |
$291.26
|
| Rate for Payer: CORVEL All Commercial |
$313.88
|
| Rate for Payer: Coventry All Commercial |
$297.00
|
| Rate for Payer: Encore All Commercial |
$310.67
|
| Rate for Payer: Frontpath All Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$291.50
|
| Rate for Payer: Humana Medicare |
$172.12
|
| Rate for Payer: Lucent All Commercial |
$172.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$253.12
|
| Rate for Payer: PHP All Commercial |
$255.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.62
|
| Rate for Payer: Sagamore Health Network All Products |
$260.55
|
| Rate for Payer: Signature Care EPO |
$280.12
|
| Rate for Payer: Signature Care PPO |
$297.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$286.88
|
| Rate for Payer: United Healthcare Commercial |
$265.95
|
| Rate for Payer: United Healthcare Medicare |
$111.38
|
|
|
HC PIN/PLUG KIT DC 672625
|
Facility
OP
|
$337.50
|
|
| Hospital Charge Code |
41607375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$313.88 |
| Rate for Payer: Aetna Commercial |
$284.85
|
| Rate for Payer: Aetna Medicare |
$111.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$210.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.51
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Centivo All Commercial |
$172.12
|
| Rate for Payer: Cigna All Commercial |
$291.26
|
| Rate for Payer: CORVEL All Commercial |
$313.88
|
| Rate for Payer: Coventry All Commercial |
$297.00
|
| Rate for Payer: Encore All Commercial |
$310.67
|
| Rate for Payer: Frontpath All Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$291.50
|
| Rate for Payer: Humana Medicare |
$172.12
|
| Rate for Payer: Lucent All Commercial |
$172.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$253.12
|
| Rate for Payer: PHP All Commercial |
$255.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.62
|
| Rate for Payer: Sagamore Health Network All Products |
$260.55
|
| Rate for Payer: Signature Care EPO |
$280.12
|
| Rate for Payer: Signature Care PPO |
$297.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$286.88
|
| Rate for Payer: United Healthcare Commercial |
$265.95
|
| Rate for Payer: United Healthcare Medicare |
$111.38
|
|
|
HC PIN/PLUG KIT DC 672625
|
Facility
IP
|
$337.50
|
|
| Hospital Charge Code |
41607375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.12 |
| Max. Negotiated Rate |
$313.88 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cigna All Commercial |
$291.26
|
| Rate for Payer: CORVEL All Commercial |
$313.88
|
| Rate for Payer: Coventry All Commercial |
$297.00
|
| Rate for Payer: Encore All Commercial |
$310.67
|
| Rate for Payer: Frontpath All Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$291.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.75
|
| Rate for Payer: PHCS All Commercial |
$253.12
|
| Rate for Payer: PHP All Commercial |
$255.96
|
| Rate for Payer: Sagamore Health Network All Products |
$260.55
|
| Rate for Payer: Signature Care EPO |
$280.12
|
| Rate for Payer: Signature Care PPO |
$297.00
|
| Rate for Payer: United Healthcare Commercial |
$265.95
|
|
|
HC PIN/PLUG KIT DC 672637
|
Facility
IP
|
$337.50
|
|
| Hospital Charge Code |
41607376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.12 |
| Max. Negotiated Rate |
$313.88 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cigna All Commercial |
$291.26
|
| Rate for Payer: CORVEL All Commercial |
$313.88
|
| Rate for Payer: Coventry All Commercial |
$297.00
|
| Rate for Payer: Encore All Commercial |
$310.67
|
| Rate for Payer: Frontpath All Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$291.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.75
|
| Rate for Payer: PHCS All Commercial |
$253.12
|
| Rate for Payer: PHP All Commercial |
$255.96
|
| Rate for Payer: Sagamore Health Network All Products |
$260.55
|
| Rate for Payer: Signature Care EPO |
$280.12
|
| Rate for Payer: Signature Care PPO |
$297.00
|
| Rate for Payer: United Healthcare Commercial |
$265.95
|
|
|
HC PIN/PLUG KIT DC 672637
|
Facility
OP
|
$337.50
|
|
| Hospital Charge Code |
41607376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$313.88 |
| Rate for Payer: Aetna Commercial |
$284.85
|
| Rate for Payer: Aetna Medicare |
$111.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$210.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.51
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Centivo All Commercial |
$172.12
|
| Rate for Payer: Cigna All Commercial |
$291.26
|
| Rate for Payer: CORVEL All Commercial |
$313.88
|
| Rate for Payer: Coventry All Commercial |
$297.00
|
| Rate for Payer: Encore All Commercial |
$310.67
|
| Rate for Payer: Frontpath All Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$291.50
|
| Rate for Payer: Humana Medicare |
$172.12
|
| Rate for Payer: Lucent All Commercial |
$172.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$253.12
|
| Rate for Payer: PHP All Commercial |
$255.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.62
|
| Rate for Payer: Sagamore Health Network All Products |
$260.55
|
| Rate for Payer: Signature Care EPO |
$280.12
|
| Rate for Payer: Signature Care PPO |
$297.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$286.88
|
| Rate for Payer: United Healthcare Commercial |
$265.95
|
| Rate for Payer: United Healthcare Medicare |
$111.38
|
|
|
HC PINWORM EXAM
|
Facility
IP
|
$52.82
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
63001081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.61 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna Commercial |
$45.63
|
| Rate for Payer: Cash Price |
$32.75
|
| Rate for Payer: Cigna All Commercial |
$45.58
|
| Rate for Payer: CORVEL All Commercial |
$49.12
|
| Rate for Payer: Coventry All Commercial |
$46.48
|
| Rate for Payer: Encore All Commercial |
$48.62
|
| Rate for Payer: Frontpath All Commercial |
$48.59
|
| Rate for Payer: Humana ChoiceCare |
$45.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.53
|
| Rate for Payer: PHCS All Commercial |
$39.61
|
| Rate for Payer: PHP All Commercial |
$40.06
|
| Rate for Payer: Sagamore Health Network All Products |
$40.77
|
| Rate for Payer: Signature Care EPO |
$43.84
|
| Rate for Payer: Signature Care PPO |
$46.48
|
| Rate for Payer: United Healthcare Commercial |
$41.62
|
|
|
HC PINWORM EXAM
|
Facility
OP
|
$52.82
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
63001081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna Commercial |
$44.58
|
| Rate for Payer: Aetna Medicare |
$17.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.17
|
| Rate for Payer: Cash Price |
$32.75
|
| Rate for Payer: Cash Price |
$32.75
|
| Rate for Payer: Centivo All Commercial |
$26.94
|
| Rate for Payer: Cigna All Commercial |
$45.58
|
| Rate for Payer: CORVEL All Commercial |
$49.12
|
| Rate for Payer: Coventry All Commercial |
$46.48
|
| Rate for Payer: Encore All Commercial |
$48.62
|
| Rate for Payer: Frontpath All Commercial |
$48.59
|
| Rate for Payer: Humana ChoiceCare |
$45.62
|
| Rate for Payer: Humana Medicare |
$26.94
|
| Rate for Payer: Lucent All Commercial |
$26.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.53
|
| Rate for Payer: Managed Health Services Medicaid |
$4.27
|
| Rate for Payer: MDWise Medicaid |
$4.27
|
| Rate for Payer: PHCS All Commercial |
$39.61
|
| Rate for Payer: PHP All Commercial |
$40.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.60
|
| Rate for Payer: Sagamore Health Network All Products |
$40.77
|
| Rate for Payer: Signature Care EPO |
$43.84
|
| Rate for Payer: Signature Care PPO |
$46.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44.89
|
| Rate for Payer: United Healthcare Commercial |
$41.62
|
| Rate for Payer: United Healthcare Medicare |
$17.43
|
|
|
HC PK CUTTING FORCEPS 5MM, 33CM
|
Facility
OP
|
$1,980.00
|
|
| Hospital Charge Code |
41602181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,841.40 |
| Rate for Payer: Aetna Commercial |
$1,671.12
|
| Rate for Payer: Aetna Medicare |
$653.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$653.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,137.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,237.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$751.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$718.74
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Centivo All Commercial |
$1,009.80
|
| Rate for Payer: Cigna All Commercial |
$1,708.74
|
| Rate for Payer: CORVEL All Commercial |
$1,841.40
|
| Rate for Payer: Coventry All Commercial |
$1,742.40
|
| Rate for Payer: Encore All Commercial |
$1,822.59
|
| Rate for Payer: Frontpath All Commercial |
$1,821.60
|
| Rate for Payer: Humana ChoiceCare |
$1,710.13
|
| Rate for Payer: Humana Medicare |
$1,009.80
|
| Rate for Payer: Lucent All Commercial |
$1,009.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,782.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,485.00
|
| Rate for Payer: PHP All Commercial |
$1,501.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$772.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,528.56
|
| Rate for Payer: Signature Care EPO |
$1,643.40
|
| Rate for Payer: Signature Care PPO |
$1,742.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,683.00
|
| Rate for Payer: United Healthcare Commercial |
$1,560.24
|
| Rate for Payer: United Healthcare Medicare |
$653.40
|
|
|
HC PK CUTTING FORCEPS 5MM, 33CM
|
Facility
IP
|
$1,980.00
|
|
| Hospital Charge Code |
41602181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,485.00 |
| Max. Negotiated Rate |
$1,841.40 |
| Rate for Payer: Aetna Commercial |
$1,710.72
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cigna All Commercial |
$1,708.74
|
| Rate for Payer: CORVEL All Commercial |
$1,841.40
|
| Rate for Payer: Coventry All Commercial |
$1,742.40
|
| Rate for Payer: Encore All Commercial |
$1,822.59
|
| Rate for Payer: Frontpath All Commercial |
$1,821.60
|
| Rate for Payer: Humana ChoiceCare |
$1,710.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,782.00
|
| Rate for Payer: PHCS All Commercial |
$1,485.00
|
| Rate for Payer: PHP All Commercial |
$1,501.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1,528.56
|
| Rate for Payer: Signature Care EPO |
$1,643.40
|
| Rate for Payer: Signature Care PPO |
$1,742.40
|
| Rate for Payer: United Healthcare Commercial |
$1,560.24
|
|
|
HC P K-WIRE 1.6X150
|
Facility
OP
|
$612.50
|
|
|
Service Code
|
CPT C1716
|
| Hospital Charge Code |
41608017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$569.62 |
| Rate for Payer: Aetna Commercial |
$516.95
|
| Rate for Payer: Aetna Medicare |
$202.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$351.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$382.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$232.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$222.34
|
| Rate for Payer: Cash Price |
$379.75
|
| Rate for Payer: Cash Price |
$379.75
|
| Rate for Payer: Centivo All Commercial |
$312.38
|
| Rate for Payer: Cigna All Commercial |
$528.59
|
| Rate for Payer: CORVEL All Commercial |
$569.62
|
| Rate for Payer: Coventry All Commercial |
$539.00
|
| Rate for Payer: Encore All Commercial |
$563.81
|
| Rate for Payer: Frontpath All Commercial |
$563.50
|
| Rate for Payer: Humana ChoiceCare |
$529.02
|
| Rate for Payer: Humana Medicare |
$312.38
|
| Rate for Payer: Lucent All Commercial |
$312.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$459.38
|
| Rate for Payer: PHP All Commercial |
$464.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$238.88
|
| Rate for Payer: Sagamore Health Network All Products |
$472.85
|
| Rate for Payer: Signature Care EPO |
$508.38
|
| Rate for Payer: Signature Care PPO |
$539.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$520.62
|
| Rate for Payer: United Healthcare Commercial |
$482.65
|
| Rate for Payer: United Healthcare Medicare |
$202.12
|
|
|
HC P K-WIRE 1.6X150
|
Facility
IP
|
$612.50
|
|
|
Service Code
|
CPT C1716
|
| Hospital Charge Code |
41608017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.38 |
| Max. Negotiated Rate |
$569.62 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Cash Price |
$379.75
|
| Rate for Payer: Cigna All Commercial |
$528.59
|
| Rate for Payer: CORVEL All Commercial |
$569.62
|
| Rate for Payer: Coventry All Commercial |
$539.00
|
| Rate for Payer: Encore All Commercial |
$563.81
|
| Rate for Payer: Frontpath All Commercial |
$563.50
|
| Rate for Payer: Humana ChoiceCare |
$529.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.25
|
| Rate for Payer: PHCS All Commercial |
$459.38
|
| Rate for Payer: PHP All Commercial |
$464.52
|
| Rate for Payer: Sagamore Health Network All Products |
$472.85
|
| Rate for Payer: Signature Care EPO |
$508.38
|
| Rate for Payer: Signature Care PPO |
$539.00
|
| Rate for Payer: United Healthcare Commercial |
$482.65
|
|
|
HC P K-WIRE .8X70
|
Facility
IP
|
$612.50
|
|
|
Service Code
|
CPT C1716
|
| Hospital Charge Code |
41608016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.38 |
| Max. Negotiated Rate |
$569.62 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Cash Price |
$379.75
|
| Rate for Payer: Cigna All Commercial |
$528.59
|
| Rate for Payer: CORVEL All Commercial |
$569.62
|
| Rate for Payer: Coventry All Commercial |
$539.00
|
| Rate for Payer: Encore All Commercial |
$563.81
|
| Rate for Payer: Frontpath All Commercial |
$563.50
|
| Rate for Payer: Humana ChoiceCare |
$529.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.25
|
| Rate for Payer: PHCS All Commercial |
$459.38
|
| Rate for Payer: PHP All Commercial |
$464.52
|
| Rate for Payer: Sagamore Health Network All Products |
$472.85
|
| Rate for Payer: Signature Care EPO |
$508.38
|
| Rate for Payer: Signature Care PPO |
$539.00
|
| Rate for Payer: United Healthcare Commercial |
$482.65
|
|
|
HC P K-WIRE .8X70
|
Facility
OP
|
$612.50
|
|
|
Service Code
|
CPT C1716
|
| Hospital Charge Code |
41608016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$569.62 |
| Rate for Payer: Aetna Commercial |
$516.95
|
| Rate for Payer: Aetna Medicare |
$202.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$351.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$382.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$232.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$222.34
|
| Rate for Payer: Cash Price |
$379.75
|
| Rate for Payer: Cash Price |
$379.75
|
| Rate for Payer: Centivo All Commercial |
$312.38
|
| Rate for Payer: Cigna All Commercial |
$528.59
|
| Rate for Payer: CORVEL All Commercial |
$569.62
|
| Rate for Payer: Coventry All Commercial |
$539.00
|
| Rate for Payer: Encore All Commercial |
$563.81
|
| Rate for Payer: Frontpath All Commercial |
$563.50
|
| Rate for Payer: Humana ChoiceCare |
$529.02
|
| Rate for Payer: Humana Medicare |
$312.38
|
| Rate for Payer: Lucent All Commercial |
$312.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$459.38
|
| Rate for Payer: PHP All Commercial |
$464.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$238.88
|
| Rate for Payer: Sagamore Health Network All Products |
$472.85
|
| Rate for Payer: Signature Care EPO |
$508.38
|
| Rate for Payer: Signature Care PPO |
$539.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$520.62
|
| Rate for Payer: United Healthcare Commercial |
$482.65
|
| Rate for Payer: United Healthcare Medicare |
$202.12
|
|
|
HC PLATE CLOVERLEAF 4 HOLE
|
Facility
OP
|
$479.50
|
|
| Hospital Charge Code |
41602115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.24 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$404.70
|
| Rate for Payer: Aetna Medicare |
$158.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$275.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$299.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$181.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.06
|
| Rate for Payer: Cash Price |
$297.29
|
| Rate for Payer: Cash Price |
$297.29
|
| Rate for Payer: Centivo All Commercial |
$244.54
|
| Rate for Payer: Cigna All Commercial |
$413.81
|
| Rate for Payer: CORVEL All Commercial |
$445.94
|
| Rate for Payer: Coventry All Commercial |
$421.96
|
| Rate for Payer: Encore All Commercial |
$441.38
|
| Rate for Payer: Frontpath All Commercial |
$441.14
|
| Rate for Payer: Humana ChoiceCare |
$414.14
|
| Rate for Payer: Humana Medicare |
$244.54
|
| Rate for Payer: Lucent All Commercial |
$244.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$359.62
|
| Rate for Payer: PHP All Commercial |
$363.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.00
|
| Rate for Payer: Sagamore Health Network All Products |
$370.17
|
| Rate for Payer: Signature Care EPO |
$397.98
|
| Rate for Payer: Signature Care PPO |
$421.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$407.58
|
| Rate for Payer: United Healthcare Commercial |
$377.85
|
| Rate for Payer: United Healthcare Medicare |
$158.24
|
|
|
HC PLATE CLOVERLEAF 4 HOLE
|
Facility
IP
|
$479.50
|
|
| Hospital Charge Code |
41602115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.62 |
| Max. Negotiated Rate |
$445.94 |
| Rate for Payer: Aetna Commercial |
$414.29
|
| Rate for Payer: Cash Price |
$297.29
|
| Rate for Payer: Cigna All Commercial |
$413.81
|
| Rate for Payer: CORVEL All Commercial |
$445.94
|
| Rate for Payer: Coventry All Commercial |
$421.96
|
| Rate for Payer: Encore All Commercial |
$441.38
|
| Rate for Payer: Frontpath All Commercial |
$441.14
|
| Rate for Payer: Humana ChoiceCare |
$414.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.55
|
| Rate for Payer: PHCS All Commercial |
$359.62
|
| Rate for Payer: PHP All Commercial |
$363.65
|
| Rate for Payer: Sagamore Health Network All Products |
$370.17
|
| Rate for Payer: Signature Care EPO |
$397.98
|
| Rate for Payer: Signature Care PPO |
$421.96
|
| Rate for Payer: United Healthcare Commercial |
$377.85
|
|
|
HC PLATE CLOVERLEAF 8 HOLE
|
Facility
IP
|
$518.00
|
|
| Hospital Charge Code |
41602114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$388.50 |
| Max. Negotiated Rate |
$481.74 |
| Rate for Payer: Aetna Commercial |
$447.55
|
| Rate for Payer: Cash Price |
$321.16
|
| Rate for Payer: Cigna All Commercial |
$447.03
|
| Rate for Payer: CORVEL All Commercial |
$481.74
|
| Rate for Payer: Coventry All Commercial |
$455.84
|
| Rate for Payer: Encore All Commercial |
$476.82
|
| Rate for Payer: Frontpath All Commercial |
$476.56
|
| Rate for Payer: Humana ChoiceCare |
$447.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.20
|
| Rate for Payer: PHCS All Commercial |
$388.50
|
| Rate for Payer: PHP All Commercial |
$392.85
|
| Rate for Payer: Sagamore Health Network All Products |
$399.90
|
| Rate for Payer: Signature Care EPO |
$429.94
|
| Rate for Payer: Signature Care PPO |
$455.84
|
| Rate for Payer: United Healthcare Commercial |
$408.18
|
|
|
HC PLATE CLOVERLEAF 8 HOLE
|
Facility
OP
|
$518.00
|
|
| Hospital Charge Code |
41602114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.94 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$437.19
|
| Rate for Payer: Aetna Medicare |
$170.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$297.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$323.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.03
|
| Rate for Payer: Cash Price |
$321.16
|
| Rate for Payer: Cash Price |
$321.16
|
| Rate for Payer: Centivo All Commercial |
$264.18
|
| Rate for Payer: Cigna All Commercial |
$447.03
|
| Rate for Payer: CORVEL All Commercial |
$481.74
|
| Rate for Payer: Coventry All Commercial |
$455.84
|
| Rate for Payer: Encore All Commercial |
$476.82
|
| Rate for Payer: Frontpath All Commercial |
$476.56
|
| Rate for Payer: Humana ChoiceCare |
$447.40
|
| Rate for Payer: Humana Medicare |
$264.18
|
| Rate for Payer: Lucent All Commercial |
$264.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$388.50
|
| Rate for Payer: PHP All Commercial |
$392.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.02
|
| Rate for Payer: Sagamore Health Network All Products |
$399.90
|
| Rate for Payer: Signature Care EPO |
$429.94
|
| Rate for Payer: Signature Care PPO |
$455.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$440.30
|
| Rate for Payer: United Healthcare Commercial |
$408.18
|
| Rate for Payer: United Healthcare Medicare |
$170.94
|
|
|
HC PLATE EPIPHYSIS L/R 5 HOLE
|
Facility
IP
|
$385.77
|
|
| Hospital Charge Code |
41601964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.33 |
| Max. Negotiated Rate |
$358.77 |
| Rate for Payer: Aetna Commercial |
$333.31
|
| Rate for Payer: Cash Price |
$239.18
|
| Rate for Payer: Cigna All Commercial |
$332.92
|
| Rate for Payer: CORVEL All Commercial |
$358.77
|
| Rate for Payer: Coventry All Commercial |
$339.48
|
| Rate for Payer: Encore All Commercial |
$355.10
|
| Rate for Payer: Frontpath All Commercial |
$354.91
|
| Rate for Payer: Humana ChoiceCare |
$333.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$347.19
|
| Rate for Payer: PHCS All Commercial |
$289.33
|
| Rate for Payer: PHP All Commercial |
$292.57
|
| Rate for Payer: Sagamore Health Network All Products |
$297.81
|
| Rate for Payer: Signature Care EPO |
$320.19
|
| Rate for Payer: Signature Care PPO |
$339.48
|
| Rate for Payer: United Healthcare Commercial |
$303.99
|
|
|
HC PLATE EPIPHYSIS L/R 5 HOLE
|
Facility
OP
|
$385.77
|
|
| Hospital Charge Code |
41601964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.30 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$325.59
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$127.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$221.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$241.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.03
|
| Rate for Payer: Cash Price |
$239.18
|
| Rate for Payer: Cash Price |
$239.18
|
| Rate for Payer: Centivo All Commercial |
$196.74
|
| Rate for Payer: Cigna All Commercial |
$332.92
|
| Rate for Payer: CORVEL All Commercial |
$358.77
|
| Rate for Payer: Coventry All Commercial |
$339.48
|
| Rate for Payer: Encore All Commercial |
$355.10
|
| Rate for Payer: Frontpath All Commercial |
$354.91
|
| Rate for Payer: Humana ChoiceCare |
$333.19
|
| Rate for Payer: Humana Medicare |
$196.74
|
| Rate for Payer: Lucent All Commercial |
$196.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$347.19
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$289.33
|
| Rate for Payer: PHP All Commercial |
$292.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.45
|
| Rate for Payer: Sagamore Health Network All Products |
$297.81
|
| Rate for Payer: Signature Care EPO |
$320.19
|
| Rate for Payer: Signature Care PPO |
$339.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.90
|
| Rate for Payer: United Healthcare Commercial |
$303.99
|
| Rate for Payer: United Healthcare Medicare |
$127.30
|
|
|
HC PLATELET CONCENTRATE LR
|
Facility
IP
|
$186.80
|
|
|
Service Code
|
CPT P9031
|
| Hospital Charge Code |
01371003
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$140.10 |
| Max. Negotiated Rate |
$173.73 |
| Rate for Payer: Aetna Commercial |
$161.40
|
| Rate for Payer: Cash Price |
$115.82
|
| Rate for Payer: Cigna All Commercial |
$161.21
|
| Rate for Payer: CORVEL All Commercial |
$173.73
|
| Rate for Payer: Coventry All Commercial |
$164.39
|
| Rate for Payer: Encore All Commercial |
$171.95
|
| Rate for Payer: Frontpath All Commercial |
$171.86
|
| Rate for Payer: Humana ChoiceCare |
$161.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.12
|
| Rate for Payer: PHCS All Commercial |
$140.10
|
| Rate for Payer: PHP All Commercial |
$141.67
|
| Rate for Payer: Sagamore Health Network All Products |
$144.21
|
| Rate for Payer: Signature Care EPO |
$155.05
|
| Rate for Payer: Signature Care PPO |
$164.39
|
| Rate for Payer: United Healthcare Commercial |
$147.20
|
|
|
HC PLATELET CONCENTRATE LR
|
Facility
OP
|
$186.80
|
|
|
Service Code
|
CPT P9031
|
| Hospital Charge Code |
01371003
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$157.66
|
| Rate for Payer: Aetna Medicare |
$61.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$116.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.81
|
| Rate for Payer: Cash Price |
$115.82
|
| Rate for Payer: Cash Price |
$115.82
|
| Rate for Payer: Centivo All Commercial |
$95.27
|
| Rate for Payer: Cigna All Commercial |
$161.21
|
| Rate for Payer: CORVEL All Commercial |
$173.73
|
| Rate for Payer: Coventry All Commercial |
$164.39
|
| Rate for Payer: Encore All Commercial |
$171.95
|
| Rate for Payer: Frontpath All Commercial |
$171.86
|
| Rate for Payer: Humana ChoiceCare |
$161.34
|
| Rate for Payer: Humana Medicare |
$95.27
|
| Rate for Payer: Lucent All Commercial |
$95.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.12
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$140.10
|
| Rate for Payer: PHP All Commercial |
$141.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.85
|
| Rate for Payer: Sagamore Health Network All Products |
$144.21
|
| Rate for Payer: Signature Care EPO |
$155.05
|
| Rate for Payer: Signature Care PPO |
$164.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158.78
|
| Rate for Payer: United Healthcare Commercial |
$147.20
|
| Rate for Payer: United Healthcare Medicare |
$61.64
|
|
|
HC PLATELET COUNT AUTO
|
Facility
OP
|
$57.22
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001228
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$48.30
|
| Rate for Payer: Aetna Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.77
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Centivo All Commercial |
$29.18
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Humana Medicare |
$29.18
|
| Rate for Payer: Lucent All Commercial |
$29.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: Managed Health Services Medicaid |
$4.48
|
| Rate for Payer: MDWise Medicaid |
$4.48
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.32
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
| Rate for Payer: United Healthcare Medicare |
$18.88
|
|
|
HC PLATELET COUNT AUTO
|
Facility
IP
|
$57.22
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001228
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
|
|
HC PLATELET COUNT AUTO
|
Facility
OP
|
$46.95
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
63001227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$43.66 |
| Rate for Payer: Aetna Commercial |
$39.63
|
| Rate for Payer: Aetna Medicare |
$15.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.04
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Centivo All Commercial |
$23.94
|
| Rate for Payer: Cigna All Commercial |
$40.52
|
| Rate for Payer: CORVEL All Commercial |
$43.66
|
| Rate for Payer: Coventry All Commercial |
$41.32
|
| Rate for Payer: Encore All Commercial |
$43.22
|
| Rate for Payer: Frontpath All Commercial |
$43.19
|
| Rate for Payer: Humana ChoiceCare |
$40.55
|
| Rate for Payer: Humana Medicare |
$23.94
|
| Rate for Payer: Lucent All Commercial |
$23.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.26
|
| Rate for Payer: Managed Health Services Medicaid |
$4.48
|
| Rate for Payer: MDWise Medicaid |
$4.48
|
| Rate for Payer: PHCS All Commercial |
$35.21
|
| Rate for Payer: PHP All Commercial |
$35.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.31
|
| Rate for Payer: Sagamore Health Network All Products |
$36.25
|
| Rate for Payer: Signature Care EPO |
$38.97
|
| Rate for Payer: Signature Care PPO |
$41.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.91
|
| Rate for Payer: United Healthcare Commercial |
$37.00
|
| Rate for Payer: United Healthcare Medicare |
$15.49
|
|
