|
HC PLATE OBLIQUE LEFT 5 HOLE
|
Facility
IP
|
$391.51
|
|
| Hospital Charge Code |
41601969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.63 |
| Max. Negotiated Rate |
$364.10 |
| Rate for Payer: Aetna Commercial |
$338.26
|
| Rate for Payer: Cash Price |
$242.74
|
| Rate for Payer: Cigna All Commercial |
$337.87
|
| Rate for Payer: CORVEL All Commercial |
$364.10
|
| Rate for Payer: Coventry All Commercial |
$344.53
|
| Rate for Payer: Encore All Commercial |
$360.38
|
| Rate for Payer: Frontpath All Commercial |
$360.19
|
| Rate for Payer: Humana ChoiceCare |
$338.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$352.36
|
| Rate for Payer: PHCS All Commercial |
$293.63
|
| Rate for Payer: PHP All Commercial |
$296.92
|
| Rate for Payer: Sagamore Health Network All Products |
$302.25
|
| Rate for Payer: Signature Care EPO |
$324.95
|
| Rate for Payer: Signature Care PPO |
$344.53
|
| Rate for Payer: United Healthcare Commercial |
$308.51
|
|
|
HC PLATE POW LOCK T 4 MM
|
Facility
OP
|
$3,544.20
|
|
| Hospital Charge Code |
41601287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC PLATE POW LOCK T 4 MM
|
Facility
IP
|
$3,544.20
|
|
| Hospital Charge Code |
41601287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC PLATE POW LOCK T 5 MM
|
Facility
OP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC PLATE POW LOCK T 5 MM
|
Facility
IP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC PLATE POW LOCK T 6 MM
|
Facility
OP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC PLATE POW LOCK T 6 MM
|
Facility
IP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC PLATE POW LOCK TI 2 MM
|
Facility
IP
|
$3,544.20
|
|
| Hospital Charge Code |
41601288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC PLATE POW LOCK TI 2 MM
|
Facility
OP
|
$3,544.20
|
|
| Hospital Charge Code |
41601288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC PLATE POW LOCK TI 3 MM
|
Facility
OP
|
$3,544.20
|
|
| Hospital Charge Code |
41601289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC PLATE POW LOCK TI 3 MM
|
Facility
IP
|
$3,544.20
|
|
| Hospital Charge Code |
41601289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC PLATE TACK
|
Facility
OP
|
$539.00
|
|
| Hospital Charge Code |
41602636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$501.27 |
| Rate for Payer: Aetna Commercial |
$454.92
|
| Rate for Payer: Aetna Medicare |
$177.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$309.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$204.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$195.66
|
| Rate for Payer: Cash Price |
$334.18
|
| Rate for Payer: Cash Price |
$334.18
|
| Rate for Payer: Centivo All Commercial |
$274.89
|
| Rate for Payer: Cigna All Commercial |
$465.16
|
| Rate for Payer: CORVEL All Commercial |
$501.27
|
| Rate for Payer: Coventry All Commercial |
$474.32
|
| Rate for Payer: Encore All Commercial |
$496.15
|
| Rate for Payer: Frontpath All Commercial |
$495.88
|
| Rate for Payer: Humana ChoiceCare |
$465.53
|
| Rate for Payer: Humana Medicare |
$274.89
|
| Rate for Payer: Lucent All Commercial |
$274.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$404.25
|
| Rate for Payer: PHP All Commercial |
$408.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.21
|
| Rate for Payer: Sagamore Health Network All Products |
$416.11
|
| Rate for Payer: Signature Care EPO |
$447.37
|
| Rate for Payer: Signature Care PPO |
$474.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$458.15
|
| Rate for Payer: United Healthcare Commercial |
$424.73
|
| Rate for Payer: United Healthcare Medicare |
$177.87
|
|
|
HC PLATE TACK
|
Facility
IP
|
$539.00
|
|
| Hospital Charge Code |
41602636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$404.25 |
| Max. Negotiated Rate |
$501.27 |
| Rate for Payer: Aetna Commercial |
$465.70
|
| Rate for Payer: Cash Price |
$334.18
|
| Rate for Payer: Cigna All Commercial |
$465.16
|
| Rate for Payer: CORVEL All Commercial |
$501.27
|
| Rate for Payer: Coventry All Commercial |
$474.32
|
| Rate for Payer: Encore All Commercial |
$496.15
|
| Rate for Payer: Frontpath All Commercial |
$495.88
|
| Rate for Payer: Humana ChoiceCare |
$465.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.10
|
| Rate for Payer: PHCS All Commercial |
$404.25
|
| Rate for Payer: PHP All Commercial |
$408.78
|
| Rate for Payer: Sagamore Health Network All Products |
$416.11
|
| Rate for Payer: Signature Care EPO |
$447.37
|
| Rate for Payer: Signature Care PPO |
$474.32
|
| Rate for Payer: United Healthcare Commercial |
$424.73
|
|
|
HC PLATE X MED 3.0MM
|
Facility
OP
|
$3,168.00
|
|
| Hospital Charge Code |
41601290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,946.24 |
| Rate for Payer: Aetna Commercial |
$2,673.79
|
| Rate for Payer: Aetna Medicare |
$1,045.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,045.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,819.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,980.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,202.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,149.98
|
| Rate for Payer: Cash Price |
$1,964.16
|
| Rate for Payer: Cash Price |
$1,964.16
|
| Rate for Payer: Centivo All Commercial |
$1,615.68
|
| Rate for Payer: Cigna All Commercial |
$2,733.98
|
| Rate for Payer: CORVEL All Commercial |
$2,946.24
|
| Rate for Payer: Coventry All Commercial |
$2,787.84
|
| Rate for Payer: Encore All Commercial |
$2,916.14
|
| Rate for Payer: Frontpath All Commercial |
$2,914.56
|
| Rate for Payer: Humana ChoiceCare |
$2,736.20
|
| Rate for Payer: Humana Medicare |
$1,615.68
|
| Rate for Payer: Lucent All Commercial |
$1,615.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,851.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,376.00
|
| Rate for Payer: PHP All Commercial |
$2,402.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,235.52
|
| Rate for Payer: Sagamore Health Network All Products |
$2,445.70
|
| Rate for Payer: Signature Care EPO |
$2,629.44
|
| Rate for Payer: Signature Care PPO |
$2,787.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,692.80
|
| Rate for Payer: United Healthcare Commercial |
$2,496.38
|
| Rate for Payer: United Healthcare Medicare |
$1,045.44
|
|
|
HC PLATE X MED 3.0MM
|
Facility
IP
|
$3,168.00
|
|
| Hospital Charge Code |
41601290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.00 |
| Max. Negotiated Rate |
$2,946.24 |
| Rate for Payer: Aetna Commercial |
$2,737.15
|
| Rate for Payer: Cash Price |
$1,964.16
|
| Rate for Payer: Cigna All Commercial |
$2,733.98
|
| Rate for Payer: CORVEL All Commercial |
$2,946.24
|
| Rate for Payer: Coventry All Commercial |
$2,787.84
|
| Rate for Payer: Encore All Commercial |
$2,916.14
|
| Rate for Payer: Frontpath All Commercial |
$2,914.56
|
| Rate for Payer: Humana ChoiceCare |
$2,736.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,851.20
|
| Rate for Payer: PHCS All Commercial |
$2,376.00
|
| Rate for Payer: PHP All Commercial |
$2,402.61
|
| Rate for Payer: Sagamore Health Network All Products |
$2,445.70
|
| Rate for Payer: Signature Care EPO |
$2,629.44
|
| Rate for Payer: Signature Care PPO |
$2,787.84
|
| Rate for Payer: United Healthcare Commercial |
$2,496.38
|
|
|
HC PLATE X SM 2.4 MM
|
Facility
IP
|
$2,752.20
|
|
| Hospital Charge Code |
41601291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.15 |
| Max. Negotiated Rate |
$2,559.55 |
| Rate for Payer: Aetna Commercial |
$2,377.90
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Cigna All Commercial |
$2,375.15
|
| Rate for Payer: CORVEL All Commercial |
$2,559.55
|
| Rate for Payer: Coventry All Commercial |
$2,421.94
|
| Rate for Payer: Encore All Commercial |
$2,533.40
|
| Rate for Payer: Frontpath All Commercial |
$2,532.02
|
| Rate for Payer: Humana ChoiceCare |
$2,377.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,476.98
|
| Rate for Payer: PHCS All Commercial |
$2,064.15
|
| Rate for Payer: PHP All Commercial |
$2,087.27
|
| Rate for Payer: Sagamore Health Network All Products |
$2,124.70
|
| Rate for Payer: Signature Care EPO |
$2,284.33
|
| Rate for Payer: Signature Care PPO |
$2,421.94
|
| Rate for Payer: United Healthcare Commercial |
$2,168.73
|
|
|
HC PLATE X SM 2.4 MM
|
Facility
OP
|
$2,752.20
|
|
| Hospital Charge Code |
41601291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,559.55 |
| Rate for Payer: Aetna Commercial |
$2,322.86
|
| Rate for Payer: Aetna Medicare |
$908.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$908.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,580.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,720.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,044.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$999.05
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Cash Price |
$1,706.36
|
| Rate for Payer: Centivo All Commercial |
$1,403.62
|
| Rate for Payer: Cigna All Commercial |
$2,375.15
|
| Rate for Payer: CORVEL All Commercial |
$2,559.55
|
| Rate for Payer: Coventry All Commercial |
$2,421.94
|
| Rate for Payer: Encore All Commercial |
$2,533.40
|
| Rate for Payer: Frontpath All Commercial |
$2,532.02
|
| Rate for Payer: Humana ChoiceCare |
$2,377.08
|
| Rate for Payer: Humana Medicare |
$1,403.62
|
| Rate for Payer: Lucent All Commercial |
$1,403.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,476.98
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,064.15
|
| Rate for Payer: PHP All Commercial |
$2,087.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,073.36
|
| Rate for Payer: Sagamore Health Network All Products |
$2,124.70
|
| Rate for Payer: Signature Care EPO |
$2,284.33
|
| Rate for Payer: Signature Care PPO |
$2,421.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,339.37
|
| Rate for Payer: United Healthcare Commercial |
$2,168.73
|
| Rate for Payer: United Healthcare Medicare |
$908.23
|
|
|
HC PLCMT BREAST DEV FIRST LES W/ MAMMO GUID
|
Facility
OP
|
$2,465.14
|
|
| Hospital Charge Code |
01619281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$813.49 |
| Max. Negotiated Rate |
$2,292.58 |
| Rate for Payer: Aetna Commercial |
$2,080.57
|
| Rate for Payer: Aetna Medicare |
$813.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$813.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,415.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,540.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$935.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$894.84
|
| Rate for Payer: Cash Price |
$1,528.38
|
| Rate for Payer: Centivo All Commercial |
$1,257.22
|
| Rate for Payer: Cigna All Commercial |
$2,127.41
|
| Rate for Payer: CORVEL All Commercial |
$2,292.58
|
| Rate for Payer: Coventry All Commercial |
$2,169.32
|
| Rate for Payer: Encore All Commercial |
$2,269.16
|
| Rate for Payer: Frontpath All Commercial |
$2,267.93
|
| Rate for Payer: Humana ChoiceCare |
$2,129.14
|
| Rate for Payer: Humana Medicare |
$1,257.22
|
| Rate for Payer: Lucent All Commercial |
$1,257.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,218.62
|
| Rate for Payer: PHCS All Commercial |
$1,848.85
|
| Rate for Payer: PHP All Commercial |
$1,869.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$961.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,903.08
|
| Rate for Payer: Signature Care EPO |
$2,046.06
|
| Rate for Payer: Signature Care PPO |
$2,169.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,095.37
|
| Rate for Payer: United Healthcare Commercial |
$1,942.53
|
| Rate for Payer: United Healthcare Medicare |
$813.49
|
|
|
HC PLCMT BREAST DEV FIRST LES W/ MAMMO GUID
|
Facility
IP
|
$2,465.14
|
|
| Hospital Charge Code |
01619281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,848.85 |
| Max. Negotiated Rate |
$2,292.58 |
| Rate for Payer: Aetna Commercial |
$2,129.88
|
| Rate for Payer: Cash Price |
$1,528.38
|
| Rate for Payer: Cigna All Commercial |
$2,127.41
|
| Rate for Payer: CORVEL All Commercial |
$2,292.58
|
| Rate for Payer: Coventry All Commercial |
$2,169.32
|
| Rate for Payer: Encore All Commercial |
$2,269.16
|
| Rate for Payer: Frontpath All Commercial |
$2,267.93
|
| Rate for Payer: Humana ChoiceCare |
$2,129.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,218.62
|
| Rate for Payer: PHCS All Commercial |
$1,848.85
|
| Rate for Payer: PHP All Commercial |
$1,869.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,903.08
|
| Rate for Payer: Signature Care EPO |
$2,046.06
|
| Rate for Payer: Signature Care PPO |
$2,169.32
|
| Rate for Payer: United Healthcare Commercial |
$1,942.53
|
|
|
HC PLEURX DRAINAGE KIT 1000ML
|
Facility
IP
|
$523.11
|
|
| Hospital Charge Code |
41602209
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$392.33 |
| Max. Negotiated Rate |
$486.49 |
| Rate for Payer: Aetna Commercial |
$451.97
|
| Rate for Payer: Cash Price |
$324.33
|
| Rate for Payer: Cigna All Commercial |
$451.44
|
| Rate for Payer: CORVEL All Commercial |
$486.49
|
| Rate for Payer: Coventry All Commercial |
$460.34
|
| Rate for Payer: Encore All Commercial |
$481.52
|
| Rate for Payer: Frontpath All Commercial |
$481.26
|
| Rate for Payer: Humana ChoiceCare |
$451.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$470.80
|
| Rate for Payer: PHCS All Commercial |
$392.33
|
| Rate for Payer: PHP All Commercial |
$396.73
|
| Rate for Payer: Sagamore Health Network All Products |
$403.84
|
| Rate for Payer: Signature Care EPO |
$434.18
|
| Rate for Payer: Signature Care PPO |
$460.34
|
| Rate for Payer: United Healthcare Commercial |
$412.21
|
|
|
HC PLEURX DRAINAGE KIT 1000ML
|
Facility
OP
|
$523.11
|
|
| Hospital Charge Code |
41602209
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$486.49 |
| Rate for Payer: Aetna Commercial |
$441.50
|
| Rate for Payer: Aetna Medicare |
$172.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$172.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$300.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$327.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.89
|
| Rate for Payer: Cash Price |
$324.33
|
| Rate for Payer: Cash Price |
$324.33
|
| Rate for Payer: Centivo All Commercial |
$266.79
|
| Rate for Payer: Cigna All Commercial |
$451.44
|
| Rate for Payer: CORVEL All Commercial |
$486.49
|
| Rate for Payer: Coventry All Commercial |
$460.34
|
| Rate for Payer: Encore All Commercial |
$481.52
|
| Rate for Payer: Frontpath All Commercial |
$481.26
|
| Rate for Payer: Humana ChoiceCare |
$451.81
|
| Rate for Payer: Humana Medicare |
$266.79
|
| Rate for Payer: Lucent All Commercial |
$266.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$470.80
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$392.33
|
| Rate for Payer: PHP All Commercial |
$396.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$204.01
|
| Rate for Payer: Sagamore Health Network All Products |
$403.84
|
| Rate for Payer: Signature Care EPO |
$434.18
|
| Rate for Payer: Signature Care PPO |
$460.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$444.64
|
| Rate for Payer: United Healthcare Commercial |
$412.21
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
|
|
HC PLEURX DRAINAGE KIT 500ML
|
Facility
OP
|
$523.11
|
|
| Hospital Charge Code |
41602212
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$486.49 |
| Rate for Payer: Aetna Commercial |
$441.50
|
| Rate for Payer: Aetna Medicare |
$172.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$172.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$300.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$327.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.89
|
| Rate for Payer: Cash Price |
$324.33
|
| Rate for Payer: Cash Price |
$324.33
|
| Rate for Payer: Centivo All Commercial |
$266.79
|
| Rate for Payer: Cigna All Commercial |
$451.44
|
| Rate for Payer: CORVEL All Commercial |
$486.49
|
| Rate for Payer: Coventry All Commercial |
$460.34
|
| Rate for Payer: Encore All Commercial |
$481.52
|
| Rate for Payer: Frontpath All Commercial |
$481.26
|
| Rate for Payer: Humana ChoiceCare |
$451.81
|
| Rate for Payer: Humana Medicare |
$266.79
|
| Rate for Payer: Lucent All Commercial |
$266.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$470.80
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$392.33
|
| Rate for Payer: PHP All Commercial |
$396.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$204.01
|
| Rate for Payer: Sagamore Health Network All Products |
$403.84
|
| Rate for Payer: Signature Care EPO |
$434.18
|
| Rate for Payer: Signature Care PPO |
$460.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$444.64
|
| Rate for Payer: United Healthcare Commercial |
$412.21
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
|
|
HC PLEURX DRAINAGE KIT 500ML
|
Facility
IP
|
$523.11
|
|
| Hospital Charge Code |
41602212
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$392.33 |
| Max. Negotiated Rate |
$486.49 |
| Rate for Payer: Aetna Commercial |
$451.97
|
| Rate for Payer: Cash Price |
$324.33
|
| Rate for Payer: Cigna All Commercial |
$451.44
|
| Rate for Payer: CORVEL All Commercial |
$486.49
|
| Rate for Payer: Coventry All Commercial |
$460.34
|
| Rate for Payer: Encore All Commercial |
$481.52
|
| Rate for Payer: Frontpath All Commercial |
$481.26
|
| Rate for Payer: Humana ChoiceCare |
$451.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$470.80
|
| Rate for Payer: PHCS All Commercial |
$392.33
|
| Rate for Payer: PHP All Commercial |
$396.73
|
| Rate for Payer: Sagamore Health Network All Products |
$403.84
|
| Rate for Payer: Signature Care EPO |
$434.18
|
| Rate for Payer: Signature Care PPO |
$460.34
|
| Rate for Payer: United Healthcare Commercial |
$412.21
|
|
|
HC PLMT BREAST DEV EA ADD LES W/ MAMMO GUID
|
Facility
OP
|
$993.99
|
|
| Hospital Charge Code |
01619282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.02 |
| Max. Negotiated Rate |
$924.41 |
| Rate for Payer: Aetna Commercial |
$838.93
|
| Rate for Payer: Aetna Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.82
|
| Rate for Payer: Cash Price |
$616.27
|
| Rate for Payer: Centivo All Commercial |
$506.93
|
| Rate for Payer: Cigna All Commercial |
$857.81
|
| Rate for Payer: CORVEL All Commercial |
$924.41
|
| Rate for Payer: Coventry All Commercial |
$874.71
|
| Rate for Payer: Encore All Commercial |
$914.97
|
| Rate for Payer: Frontpath All Commercial |
$914.47
|
| Rate for Payer: Humana ChoiceCare |
$858.51
|
| Rate for Payer: Humana Medicare |
$506.93
|
| Rate for Payer: Lucent All Commercial |
$506.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.59
|
| Rate for Payer: PHCS All Commercial |
$745.49
|
| Rate for Payer: PHP All Commercial |
$753.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.66
|
| Rate for Payer: Sagamore Health Network All Products |
$767.36
|
| Rate for Payer: Signature Care EPO |
$825.01
|
| Rate for Payer: Signature Care PPO |
$874.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.89
|
| Rate for Payer: United Healthcare Commercial |
$783.26
|
| Rate for Payer: United Healthcare Medicare |
$328.02
|
|
|
HC PLMT BREAST DEV EA ADD LES W/ MAMMO GUID
|
Facility
IP
|
$993.99
|
|
| Hospital Charge Code |
01619282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.49 |
| Max. Negotiated Rate |
$924.41 |
| Rate for Payer: Aetna Commercial |
$858.81
|
| Rate for Payer: Cash Price |
$616.27
|
| Rate for Payer: Cigna All Commercial |
$857.81
|
| Rate for Payer: CORVEL All Commercial |
$924.41
|
| Rate for Payer: Coventry All Commercial |
$874.71
|
| Rate for Payer: Encore All Commercial |
$914.97
|
| Rate for Payer: Frontpath All Commercial |
$914.47
|
| Rate for Payer: Humana ChoiceCare |
$858.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.59
|
| Rate for Payer: PHCS All Commercial |
$745.49
|
| Rate for Payer: PHP All Commercial |
$753.84
|
| Rate for Payer: Sagamore Health Network All Products |
$767.36
|
| Rate for Payer: Signature Care EPO |
$825.01
|
| Rate for Payer: Signature Care PPO |
$874.71
|
| Rate for Payer: United Healthcare Commercial |
$783.26
|
|
