|
HC PSA FREE & TOTAL
|
Facility
IP
|
$188.94
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
63001123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.71 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$163.25
|
| Rate for Payer: Cash Price |
$117.15
|
| Rate for Payer: Cigna All Commercial |
$163.06
|
| Rate for Payer: CORVEL All Commercial |
$175.72
|
| Rate for Payer: Coventry All Commercial |
$166.27
|
| Rate for Payer: Encore All Commercial |
$173.92
|
| Rate for Payer: Frontpath All Commercial |
$173.83
|
| Rate for Payer: Humana ChoiceCare |
$163.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.05
|
| Rate for Payer: PHCS All Commercial |
$141.71
|
| Rate for Payer: PHP All Commercial |
$143.30
|
| Rate for Payer: Sagamore Health Network All Products |
$145.87
|
| Rate for Payer: Signature Care EPO |
$156.82
|
| Rate for Payer: Signature Care PPO |
$166.27
|
| Rate for Payer: United Healthcare Commercial |
$148.89
|
|
|
HC PSA SCREEN
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
63001124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$135.04
|
| Rate for Payer: Aetna Medicare |
$52.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.08
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Centivo All Commercial |
$81.60
|
| Rate for Payer: Cigna All Commercial |
$138.08
|
| Rate for Payer: CORVEL All Commercial |
$148.80
|
| Rate for Payer: Coventry All Commercial |
$140.80
|
| Rate for Payer: Encore All Commercial |
$147.28
|
| Rate for Payer: Frontpath All Commercial |
$147.20
|
| Rate for Payer: Humana ChoiceCare |
$138.19
|
| Rate for Payer: Humana Medicare |
$81.60
|
| Rate for Payer: Lucent All Commercial |
$81.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Managed Health Services Medicaid |
$19.31
|
| Rate for Payer: MDWise Medicaid |
$19.31
|
| Rate for Payer: PHCS All Commercial |
$120.00
|
| Rate for Payer: PHP All Commercial |
$121.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.40
|
| Rate for Payer: Sagamore Health Network All Products |
$123.52
|
| Rate for Payer: Signature Care EPO |
$132.80
|
| Rate for Payer: Signature Care PPO |
$140.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.00
|
| Rate for Payer: United Healthcare Commercial |
$126.08
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
|
|
HC PSA SCREEN
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
63001124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$138.24
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cigna All Commercial |
$138.08
|
| Rate for Payer: CORVEL All Commercial |
$148.80
|
| Rate for Payer: Coventry All Commercial |
$140.80
|
| Rate for Payer: Encore All Commercial |
$147.28
|
| Rate for Payer: Frontpath All Commercial |
$147.20
|
| Rate for Payer: Humana ChoiceCare |
$138.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: PHCS All Commercial |
$120.00
|
| Rate for Payer: PHP All Commercial |
$121.34
|
| Rate for Payer: Sagamore Health Network All Products |
$123.52
|
| Rate for Payer: Signature Care EPO |
$132.80
|
| Rate for Payer: Signature Care PPO |
$140.80
|
| Rate for Payer: United Healthcare Commercial |
$126.08
|
|
|
HC PSA TOTAL
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
63001664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$135.04
|
| Rate for Payer: Aetna Medicare |
$52.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.08
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Centivo All Commercial |
$81.60
|
| Rate for Payer: Cigna All Commercial |
$138.08
|
| Rate for Payer: CORVEL All Commercial |
$148.80
|
| Rate for Payer: Coventry All Commercial |
$140.80
|
| Rate for Payer: Encore All Commercial |
$147.28
|
| Rate for Payer: Frontpath All Commercial |
$147.20
|
| Rate for Payer: Humana ChoiceCare |
$138.19
|
| Rate for Payer: Humana Medicare |
$81.60
|
| Rate for Payer: Lucent All Commercial |
$81.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Managed Health Services Medicaid |
$18.39
|
| Rate for Payer: MDWise Medicaid |
$18.39
|
| Rate for Payer: PHCS All Commercial |
$120.00
|
| Rate for Payer: PHP All Commercial |
$121.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.40
|
| Rate for Payer: Sagamore Health Network All Products |
$123.52
|
| Rate for Payer: Signature Care EPO |
$132.80
|
| Rate for Payer: Signature Care PPO |
$140.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.00
|
| Rate for Payer: United Healthcare Commercial |
$126.08
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
|
|
HC PSA TOTAL
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
63001664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$138.24
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cigna All Commercial |
$138.08
|
| Rate for Payer: CORVEL All Commercial |
$148.80
|
| Rate for Payer: Coventry All Commercial |
$140.80
|
| Rate for Payer: Encore All Commercial |
$147.28
|
| Rate for Payer: Frontpath All Commercial |
$147.20
|
| Rate for Payer: Humana ChoiceCare |
$138.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: PHCS All Commercial |
$120.00
|
| Rate for Payer: PHP All Commercial |
$121.34
|
| Rate for Payer: Sagamore Health Network All Products |
$123.52
|
| Rate for Payer: Signature Care EPO |
$132.80
|
| Rate for Payer: Signature Care PPO |
$140.80
|
| Rate for Payer: United Healthcare Commercial |
$126.08
|
|
|
HC P SCREW 2.5X14 HD CANN
|
Facility
OP
|
$2,364.41
|
|
|
Service Code
|
CPT C1716
|
| Hospital Charge Code |
41608019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,198.90 |
| Rate for Payer: Aetna Commercial |
$1,995.56
|
| Rate for Payer: Aetna Medicare |
$780.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$780.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,357.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,477.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$897.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$858.28
|
| Rate for Payer: Cash Price |
$1,465.93
|
| Rate for Payer: Cash Price |
$1,465.93
|
| Rate for Payer: Centivo All Commercial |
$1,205.85
|
| Rate for Payer: Cigna All Commercial |
$2,040.49
|
| Rate for Payer: CORVEL All Commercial |
$2,198.90
|
| Rate for Payer: Coventry All Commercial |
$2,080.68
|
| Rate for Payer: Encore All Commercial |
$2,176.44
|
| Rate for Payer: Frontpath All Commercial |
$2,175.26
|
| Rate for Payer: Humana ChoiceCare |
$2,042.14
|
| Rate for Payer: Humana Medicare |
$1,205.85
|
| Rate for Payer: Lucent All Commercial |
$1,205.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,127.97
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,773.31
|
| Rate for Payer: PHP All Commercial |
$1,793.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$922.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,825.32
|
| Rate for Payer: Signature Care EPO |
$1,962.46
|
| Rate for Payer: Signature Care PPO |
$2,080.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,009.75
|
| Rate for Payer: United Healthcare Commercial |
$1,863.16
|
| Rate for Payer: United Healthcare Medicare |
$780.26
|
|
|
HC P SCREW 2.5X14 HD CANN
|
Facility
IP
|
$2,364.41
|
|
|
Service Code
|
CPT C1716
|
| Hospital Charge Code |
41608019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.31 |
| Max. Negotiated Rate |
$2,198.90 |
| Rate for Payer: Aetna Commercial |
$2,042.85
|
| Rate for Payer: Cash Price |
$1,465.93
|
| Rate for Payer: Cigna All Commercial |
$2,040.49
|
| Rate for Payer: CORVEL All Commercial |
$2,198.90
|
| Rate for Payer: Coventry All Commercial |
$2,080.68
|
| Rate for Payer: Encore All Commercial |
$2,176.44
|
| Rate for Payer: Frontpath All Commercial |
$2,175.26
|
| Rate for Payer: Humana ChoiceCare |
$2,042.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,127.97
|
| Rate for Payer: PHCS All Commercial |
$1,773.31
|
| Rate for Payer: PHP All Commercial |
$1,793.17
|
| Rate for Payer: Sagamore Health Network All Products |
$1,825.32
|
| Rate for Payer: Signature Care EPO |
$1,962.46
|
| Rate for Payer: Signature Care PPO |
$2,080.68
|
| Rate for Payer: United Healthcare Commercial |
$1,863.16
|
|
|
HC P SCREW 2X12 PT CANN
|
Facility
OP
|
$1,912.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,778.62 |
| Rate for Payer: Aetna Commercial |
$1,614.15
|
| Rate for Payer: Aetna Medicare |
$631.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$631.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,098.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,195.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$725.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$694.24
|
| Rate for Payer: Cash Price |
$1,185.75
|
| Rate for Payer: Cash Price |
$1,185.75
|
| Rate for Payer: Centivo All Commercial |
$975.38
|
| Rate for Payer: Cigna All Commercial |
$1,650.49
|
| Rate for Payer: CORVEL All Commercial |
$1,778.62
|
| Rate for Payer: Coventry All Commercial |
$1,683.00
|
| Rate for Payer: Encore All Commercial |
$1,760.46
|
| Rate for Payer: Frontpath All Commercial |
$1,759.50
|
| Rate for Payer: Humana ChoiceCare |
$1,651.83
|
| Rate for Payer: Humana Medicare |
$975.38
|
| Rate for Payer: Lucent All Commercial |
$975.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,721.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,434.38
|
| Rate for Payer: PHP All Commercial |
$1,450.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$745.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,476.45
|
| Rate for Payer: Signature Care EPO |
$1,587.38
|
| Rate for Payer: Signature Care PPO |
$1,683.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,625.62
|
| Rate for Payer: United Healthcare Commercial |
$1,507.05
|
| Rate for Payer: United Healthcare Medicare |
$631.12
|
|
|
HC P SCREW 2X12 PT CANN
|
Facility
IP
|
$1,912.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.38 |
| Max. Negotiated Rate |
$1,778.62 |
| Rate for Payer: Aetna Commercial |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,185.75
|
| Rate for Payer: Cigna All Commercial |
$1,650.49
|
| Rate for Payer: CORVEL All Commercial |
$1,778.62
|
| Rate for Payer: Coventry All Commercial |
$1,683.00
|
| Rate for Payer: Encore All Commercial |
$1,760.46
|
| Rate for Payer: Frontpath All Commercial |
$1,759.50
|
| Rate for Payer: Humana ChoiceCare |
$1,651.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,721.25
|
| Rate for Payer: PHCS All Commercial |
$1,434.38
|
| Rate for Payer: PHP All Commercial |
$1,450.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,476.45
|
| Rate for Payer: Signature Care EPO |
$1,587.38
|
| Rate for Payer: Signature Care PPO |
$1,683.00
|
| Rate for Payer: United Healthcare Commercial |
$1,507.05
|
|
|
HC PSEUDOCHOLINE INHIB
|
Facility
IP
|
$104.18
|
|
|
Service Code
|
CPT 82638
|
| Hospital Charge Code |
63001529
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$96.89 |
| Rate for Payer: Aetna Commercial |
$90.01
|
| Rate for Payer: Cash Price |
$64.59
|
| Rate for Payer: Cigna All Commercial |
$89.91
|
| Rate for Payer: CORVEL All Commercial |
$96.89
|
| Rate for Payer: Coventry All Commercial |
$91.68
|
| Rate for Payer: Encore All Commercial |
$95.90
|
| Rate for Payer: Frontpath All Commercial |
$95.85
|
| Rate for Payer: Humana ChoiceCare |
$89.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.76
|
| Rate for Payer: PHCS All Commercial |
$78.14
|
| Rate for Payer: PHP All Commercial |
$79.01
|
| Rate for Payer: Sagamore Health Network All Products |
$80.43
|
| Rate for Payer: Signature Care EPO |
$86.47
|
| Rate for Payer: Signature Care PPO |
$91.68
|
| Rate for Payer: United Healthcare Commercial |
$82.10
|
|
|
HC PSEUDOCHOLINE INHIB
|
Facility
OP
|
$104.18
|
|
|
Service Code
|
CPT 82638
|
| Hospital Charge Code |
63001529
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$96.89 |
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Aetna Medicare |
$34.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.82
|
| Rate for Payer: Cash Price |
$64.59
|
| Rate for Payer: Cash Price |
$64.59
|
| Rate for Payer: Centivo All Commercial |
$53.13
|
| Rate for Payer: Cigna All Commercial |
$89.91
|
| Rate for Payer: CORVEL All Commercial |
$96.89
|
| Rate for Payer: Coventry All Commercial |
$91.68
|
| Rate for Payer: Encore All Commercial |
$95.90
|
| Rate for Payer: Frontpath All Commercial |
$95.85
|
| Rate for Payer: Humana ChoiceCare |
$89.98
|
| Rate for Payer: Humana Medicare |
$53.13
|
| Rate for Payer: Lucent All Commercial |
$53.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.76
|
| Rate for Payer: Managed Health Services Medicaid |
$12.25
|
| Rate for Payer: MDWise Medicaid |
$12.25
|
| Rate for Payer: PHCS All Commercial |
$78.14
|
| Rate for Payer: PHP All Commercial |
$79.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.63
|
| Rate for Payer: Sagamore Health Network All Products |
$80.43
|
| Rate for Payer: Signature Care EPO |
$86.47
|
| Rate for Payer: Signature Care PPO |
$91.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88.56
|
| Rate for Payer: United Healthcare Commercial |
$82.10
|
| Rate for Payer: United Healthcare Medicare |
$34.38
|
|
|
HC PSEUDOCHOLINE TOTAL
|
Facility
IP
|
$80.19
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
63001492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.14 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna Commercial |
$69.29
|
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Cigna All Commercial |
$69.21
|
| Rate for Payer: CORVEL All Commercial |
$74.58
|
| Rate for Payer: Coventry All Commercial |
$70.57
|
| Rate for Payer: Encore All Commercial |
$73.82
|
| Rate for Payer: Frontpath All Commercial |
$73.78
|
| Rate for Payer: Humana ChoiceCare |
$69.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.17
|
| Rate for Payer: PHCS All Commercial |
$60.14
|
| Rate for Payer: PHP All Commercial |
$60.82
|
| Rate for Payer: Sagamore Health Network All Products |
$61.91
|
| Rate for Payer: Signature Care EPO |
$66.56
|
| Rate for Payer: Signature Care PPO |
$70.57
|
| Rate for Payer: United Healthcare Commercial |
$63.19
|
|
|
HC PSEUDOCHOLINE TOTAL
|
Facility
OP
|
$80.19
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
63001492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna Commercial |
$67.68
|
| Rate for Payer: Aetna Medicare |
$26.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.11
|
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Centivo All Commercial |
$40.90
|
| Rate for Payer: Cigna All Commercial |
$69.21
|
| Rate for Payer: CORVEL All Commercial |
$74.58
|
| Rate for Payer: Coventry All Commercial |
$70.57
|
| Rate for Payer: Encore All Commercial |
$73.82
|
| Rate for Payer: Frontpath All Commercial |
$73.78
|
| Rate for Payer: Humana ChoiceCare |
$69.26
|
| Rate for Payer: Humana Medicare |
$40.90
|
| Rate for Payer: Lucent All Commercial |
$40.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.17
|
| Rate for Payer: Managed Health Services Medicaid |
$7.87
|
| Rate for Payer: MDWise Medicaid |
$7.87
|
| Rate for Payer: PHCS All Commercial |
$60.14
|
| Rate for Payer: PHP All Commercial |
$60.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.28
|
| Rate for Payer: Sagamore Health Network All Products |
$61.91
|
| Rate for Payer: Signature Care EPO |
$66.56
|
| Rate for Payer: Signature Care PPO |
$70.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.16
|
| Rate for Payer: United Healthcare Commercial |
$63.19
|
| Rate for Payer: United Healthcare Medicare |
$26.46
|
|
|
HC P SUTURE ANCHOR PEEK 4.75X15
|
Facility
OP
|
$2,548.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,370.38 |
| Rate for Payer: Aetna Commercial |
$2,151.19
|
| Rate for Payer: Aetna Medicare |
$841.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$841.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,463.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,593.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$967.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$925.21
|
| Rate for Payer: Cash Price |
$1,580.26
|
| Rate for Payer: Cash Price |
$1,580.26
|
| Rate for Payer: Centivo All Commercial |
$1,299.89
|
| Rate for Payer: Cigna All Commercial |
$2,199.61
|
| Rate for Payer: CORVEL All Commercial |
$2,370.38
|
| Rate for Payer: Coventry All Commercial |
$2,242.94
|
| Rate for Payer: Encore All Commercial |
$2,346.17
|
| Rate for Payer: Frontpath All Commercial |
$2,344.90
|
| Rate for Payer: Humana ChoiceCare |
$2,201.40
|
| Rate for Payer: Humana Medicare |
$1,299.89
|
| Rate for Payer: Lucent All Commercial |
$1,299.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,293.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,911.60
|
| Rate for Payer: PHP All Commercial |
$1,933.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$994.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,967.67
|
| Rate for Payer: Signature Care EPO |
$2,115.50
|
| Rate for Payer: Signature Care PPO |
$2,242.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,166.48
|
| Rate for Payer: United Healthcare Commercial |
$2,008.45
|
| Rate for Payer: United Healthcare Medicare |
$841.10
|
|
|
HC P SUTURE ANCHOR PEEK 4.75X15
|
Facility
IP
|
$2,548.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,911.60 |
| Max. Negotiated Rate |
$2,370.38 |
| Rate for Payer: Aetna Commercial |
$2,202.16
|
| Rate for Payer: Cash Price |
$1,580.26
|
| Rate for Payer: Cigna All Commercial |
$2,199.61
|
| Rate for Payer: CORVEL All Commercial |
$2,370.38
|
| Rate for Payer: Coventry All Commercial |
$2,242.94
|
| Rate for Payer: Encore All Commercial |
$2,346.17
|
| Rate for Payer: Frontpath All Commercial |
$2,344.90
|
| Rate for Payer: Humana ChoiceCare |
$2,201.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,293.92
|
| Rate for Payer: PHCS All Commercial |
$1,911.60
|
| Rate for Payer: PHP All Commercial |
$1,933.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,967.67
|
| Rate for Payer: Signature Care EPO |
$2,115.50
|
| Rate for Payer: Signature Care PPO |
$2,242.94
|
| Rate for Payer: United Healthcare Commercial |
$2,008.45
|
|
|
HC P SUTURE ANCHOR PEEK 5.5X15
|
Facility
OP
|
$2,548.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,370.38 |
| Rate for Payer: Aetna Commercial |
$2,151.19
|
| Rate for Payer: Aetna Medicare |
$841.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$841.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,463.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,593.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$967.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$925.21
|
| Rate for Payer: Cash Price |
$1,580.26
|
| Rate for Payer: Cash Price |
$1,580.26
|
| Rate for Payer: Centivo All Commercial |
$1,299.89
|
| Rate for Payer: Cigna All Commercial |
$2,199.61
|
| Rate for Payer: CORVEL All Commercial |
$2,370.38
|
| Rate for Payer: Coventry All Commercial |
$2,242.94
|
| Rate for Payer: Encore All Commercial |
$2,346.17
|
| Rate for Payer: Frontpath All Commercial |
$2,344.90
|
| Rate for Payer: Humana ChoiceCare |
$2,201.40
|
| Rate for Payer: Humana Medicare |
$1,299.89
|
| Rate for Payer: Lucent All Commercial |
$1,299.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,293.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,911.60
|
| Rate for Payer: PHP All Commercial |
$1,933.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$994.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,967.67
|
| Rate for Payer: Signature Care EPO |
$2,115.50
|
| Rate for Payer: Signature Care PPO |
$2,242.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,166.48
|
| Rate for Payer: United Healthcare Commercial |
$2,008.45
|
| Rate for Payer: United Healthcare Medicare |
$841.10
|
|
|
HC P SUTURE ANCHOR PEEK 5.5X15
|
Facility
IP
|
$2,548.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,911.60 |
| Max. Negotiated Rate |
$2,370.38 |
| Rate for Payer: Aetna Commercial |
$2,202.16
|
| Rate for Payer: Cash Price |
$1,580.26
|
| Rate for Payer: Cigna All Commercial |
$2,199.61
|
| Rate for Payer: CORVEL All Commercial |
$2,370.38
|
| Rate for Payer: Coventry All Commercial |
$2,242.94
|
| Rate for Payer: Encore All Commercial |
$2,346.17
|
| Rate for Payer: Frontpath All Commercial |
$2,344.90
|
| Rate for Payer: Humana ChoiceCare |
$2,201.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,293.92
|
| Rate for Payer: PHCS All Commercial |
$1,911.60
|
| Rate for Payer: PHP All Commercial |
$1,933.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,967.67
|
| Rate for Payer: Signature Care EPO |
$2,115.50
|
| Rate for Payer: Signature Care PPO |
$2,242.94
|
| Rate for Payer: United Healthcare Commercial |
$2,008.45
|
|
|
HC PT EVAL HIGH COMPLEX 45 MIN
|
Facility
IP
|
$480.42
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
01727163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$360.32 |
| Max. Negotiated Rate |
$446.79 |
| Rate for Payer: Aetna Commercial |
$415.08
|
| Rate for Payer: Cash Price |
$297.86
|
| Rate for Payer: Cigna All Commercial |
$414.60
|
| Rate for Payer: CORVEL All Commercial |
$446.79
|
| Rate for Payer: Coventry All Commercial |
$422.77
|
| Rate for Payer: Encore All Commercial |
$442.23
|
| Rate for Payer: Frontpath All Commercial |
$441.99
|
| Rate for Payer: Humana ChoiceCare |
$414.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.38
|
| Rate for Payer: PHCS All Commercial |
$360.32
|
| Rate for Payer: PHP All Commercial |
$364.35
|
| Rate for Payer: Sagamore Health Network All Products |
$370.88
|
| Rate for Payer: Signature Care EPO |
$398.75
|
| Rate for Payer: Signature Care PPO |
$422.77
|
| Rate for Payer: United Healthcare Commercial |
$378.57
|
|
|
HC PT EVAL HIGH COMPLEX 45 MIN
|
Facility
OP
|
$480.42
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
01727163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$158.54 |
| Max. Negotiated Rate |
$446.79 |
| Rate for Payer: Aetna Commercial |
$405.47
|
| Rate for Payer: Aetna Medicare |
$158.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$275.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$300.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.39
|
| Rate for Payer: Cash Price |
$297.86
|
| Rate for Payer: Centivo All Commercial |
$245.01
|
| Rate for Payer: Cigna All Commercial |
$414.60
|
| Rate for Payer: CORVEL All Commercial |
$446.79
|
| Rate for Payer: Coventry All Commercial |
$422.77
|
| Rate for Payer: Encore All Commercial |
$442.23
|
| Rate for Payer: Frontpath All Commercial |
$441.99
|
| Rate for Payer: Humana ChoiceCare |
$414.94
|
| Rate for Payer: Humana Medicare |
$245.01
|
| Rate for Payer: Lucent All Commercial |
$245.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.38
|
| Rate for Payer: PHCS All Commercial |
$360.32
|
| Rate for Payer: PHP All Commercial |
$364.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.36
|
| Rate for Payer: Sagamore Health Network All Products |
$370.88
|
| Rate for Payer: Signature Care EPO |
$398.75
|
| Rate for Payer: Signature Care PPO |
$422.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$408.36
|
| Rate for Payer: United Healthcare Commercial |
$378.57
|
| Rate for Payer: United Healthcare Medicare |
$158.54
|
|
|
HC PT EVAL LOW COMPLEX 20 MIN
|
Facility
OP
|
$269.28
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
01727161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$88.86 |
| Max. Negotiated Rate |
$250.43 |
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Medicare |
$88.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.75
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Centivo All Commercial |
$137.33
|
| Rate for Payer: Cigna All Commercial |
$232.39
|
| Rate for Payer: CORVEL All Commercial |
$250.43
|
| Rate for Payer: Coventry All Commercial |
$236.97
|
| Rate for Payer: Encore All Commercial |
$247.87
|
| Rate for Payer: Frontpath All Commercial |
$247.74
|
| Rate for Payer: Humana ChoiceCare |
$232.58
|
| Rate for Payer: Humana Medicare |
$137.33
|
| Rate for Payer: Lucent All Commercial |
$137.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.35
|
| Rate for Payer: PHCS All Commercial |
$201.96
|
| Rate for Payer: PHP All Commercial |
$204.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.02
|
| Rate for Payer: Sagamore Health Network All Products |
$207.88
|
| Rate for Payer: Signature Care EPO |
$223.50
|
| Rate for Payer: Signature Care PPO |
$236.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$228.89
|
| Rate for Payer: United Healthcare Commercial |
$212.19
|
| Rate for Payer: United Healthcare Medicare |
$88.86
|
|
|
HC PT EVAL LOW COMPLEX 20 MIN
|
Facility
IP
|
$269.28
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
01727161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$201.96 |
| Max. Negotiated Rate |
$250.43 |
| Rate for Payer: Aetna Commercial |
$232.66
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna All Commercial |
$232.39
|
| Rate for Payer: CORVEL All Commercial |
$250.43
|
| Rate for Payer: Coventry All Commercial |
$236.97
|
| Rate for Payer: Encore All Commercial |
$247.87
|
| Rate for Payer: Frontpath All Commercial |
$247.74
|
| Rate for Payer: Humana ChoiceCare |
$232.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.35
|
| Rate for Payer: PHCS All Commercial |
$201.96
|
| Rate for Payer: PHP All Commercial |
$204.22
|
| Rate for Payer: Sagamore Health Network All Products |
$207.88
|
| Rate for Payer: Signature Care EPO |
$223.50
|
| Rate for Payer: Signature Care PPO |
$236.97
|
| Rate for Payer: United Healthcare Commercial |
$212.19
|
|
|
HC PT EVAL MOD COMPLEX 30 MIN
|
Facility
OP
|
$408.82
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
01727162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$134.91 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Aetna Commercial |
$345.04
|
| Rate for Payer: Aetna Medicare |
$134.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$234.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.40
|
| Rate for Payer: Cash Price |
$253.47
|
| Rate for Payer: Centivo All Commercial |
$208.50
|
| Rate for Payer: Cigna All Commercial |
$352.81
|
| Rate for Payer: CORVEL All Commercial |
$380.20
|
| Rate for Payer: Coventry All Commercial |
$359.76
|
| Rate for Payer: Encore All Commercial |
$376.32
|
| Rate for Payer: Frontpath All Commercial |
$376.11
|
| Rate for Payer: Humana ChoiceCare |
$353.09
|
| Rate for Payer: Humana Medicare |
$208.50
|
| Rate for Payer: Lucent All Commercial |
$208.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.93
|
| Rate for Payer: PHCS All Commercial |
$306.61
|
| Rate for Payer: PHP All Commercial |
$310.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.44
|
| Rate for Payer: Sagamore Health Network All Products |
$315.61
|
| Rate for Payer: Signature Care EPO |
$339.32
|
| Rate for Payer: Signature Care PPO |
$359.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$347.49
|
| Rate for Payer: United Healthcare Commercial |
$322.15
|
| Rate for Payer: United Healthcare Medicare |
$134.91
|
|
|
HC PT EVAL MOD COMPLEX 30 MIN
|
Facility
IP
|
$408.82
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
01727162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$306.61 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Aetna Commercial |
$353.22
|
| Rate for Payer: Cash Price |
$253.47
|
| Rate for Payer: Cigna All Commercial |
$352.81
|
| Rate for Payer: CORVEL All Commercial |
$380.20
|
| Rate for Payer: Coventry All Commercial |
$359.76
|
| Rate for Payer: Encore All Commercial |
$376.32
|
| Rate for Payer: Frontpath All Commercial |
$376.11
|
| Rate for Payer: Humana ChoiceCare |
$353.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.93
|
| Rate for Payer: PHCS All Commercial |
$306.61
|
| Rate for Payer: PHP All Commercial |
$310.05
|
| Rate for Payer: Sagamore Health Network All Products |
$315.61
|
| Rate for Payer: Signature Care EPO |
$339.32
|
| Rate for Payer: Signature Care PPO |
$359.76
|
| Rate for Payer: United Healthcare Commercial |
$322.15
|
|
|
HC PTH C TERMINAL
|
Facility
IP
|
$237.59
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
63001648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$178.19 |
| Max. Negotiated Rate |
$220.96 |
| Rate for Payer: Aetna Commercial |
$205.28
|
| Rate for Payer: Cash Price |
$147.31
|
| Rate for Payer: Cigna All Commercial |
$205.04
|
| Rate for Payer: CORVEL All Commercial |
$220.96
|
| Rate for Payer: Coventry All Commercial |
$209.08
|
| Rate for Payer: Encore All Commercial |
$218.70
|
| Rate for Payer: Frontpath All Commercial |
$218.58
|
| Rate for Payer: Humana ChoiceCare |
$205.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.83
|
| Rate for Payer: PHCS All Commercial |
$178.19
|
| Rate for Payer: PHP All Commercial |
$180.19
|
| Rate for Payer: Sagamore Health Network All Products |
$183.42
|
| Rate for Payer: Signature Care EPO |
$197.20
|
| Rate for Payer: Signature Care PPO |
$209.08
|
| Rate for Payer: United Healthcare Commercial |
$187.22
|
|
|
HC PTH C TERMINAL
|
Facility
OP
|
$237.59
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
63001648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$220.96 |
| Rate for Payer: Aetna Commercial |
$200.52
|
| Rate for Payer: Aetna Medicare |
$78.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$109.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.24
|
| Rate for Payer: Cash Price |
$147.31
|
| Rate for Payer: Cash Price |
$147.31
|
| Rate for Payer: Centivo All Commercial |
$121.17
|
| Rate for Payer: Cigna All Commercial |
$205.04
|
| Rate for Payer: CORVEL All Commercial |
$220.96
|
| Rate for Payer: Coventry All Commercial |
$209.08
|
| Rate for Payer: Encore All Commercial |
$218.70
|
| Rate for Payer: Frontpath All Commercial |
$218.58
|
| Rate for Payer: Humana ChoiceCare |
$205.21
|
| Rate for Payer: Humana Medicare |
$121.17
|
| Rate for Payer: Lucent All Commercial |
$121.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.83
|
| Rate for Payer: Managed Health Services Medicaid |
$41.28
|
| Rate for Payer: MDWise Medicaid |
$41.28
|
| Rate for Payer: PHCS All Commercial |
$178.19
|
| Rate for Payer: PHP All Commercial |
$180.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.66
|
| Rate for Payer: Sagamore Health Network All Products |
$183.42
|
| Rate for Payer: Signature Care EPO |
$197.20
|
| Rate for Payer: Signature Care PPO |
$209.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$201.95
|
| Rate for Payer: United Healthcare Commercial |
$187.22
|
| Rate for Payer: United Healthcare Medicare |
$78.40
|
|
