|
HC S FEM COMP 8 CR TRI R
|
Facility
OP
|
$10,703.99
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,954.71 |
| Rate for Payer: Aetna Commercial |
$9,034.17
|
| Rate for Payer: Aetna Medicare |
$3,532.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,532.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,147.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,691.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,062.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,885.55
|
| Rate for Payer: Cash Price |
$6,636.47
|
| Rate for Payer: Cash Price |
$6,636.47
|
| Rate for Payer: Centivo All Commercial |
$5,459.03
|
| Rate for Payer: Cigna All Commercial |
$9,237.54
|
| Rate for Payer: CORVEL All Commercial |
$9,954.71
|
| Rate for Payer: Coventry All Commercial |
$9,419.51
|
| Rate for Payer: Encore All Commercial |
$9,853.02
|
| Rate for Payer: Frontpath All Commercial |
$9,847.67
|
| Rate for Payer: Humana ChoiceCare |
$9,245.04
|
| Rate for Payer: Humana Medicare |
$5,459.03
|
| Rate for Payer: Lucent All Commercial |
$5,459.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,633.59
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,027.99
|
| Rate for Payer: PHP All Commercial |
$8,117.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,174.56
|
| Rate for Payer: Sagamore Health Network All Products |
$8,263.48
|
| Rate for Payer: Signature Care EPO |
$8,884.31
|
| Rate for Payer: Signature Care PPO |
$9,419.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,098.39
|
| Rate for Payer: United Healthcare Commercial |
$8,434.74
|
| Rate for Payer: United Healthcare Medicare |
$3,532.32
|
|
|
HC S FEM COMP 8 CR TRI R
|
Facility
IP
|
$10,703.99
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,027.99 |
| Max. Negotiated Rate |
$9,954.71 |
| Rate for Payer: Aetna Commercial |
$9,248.25
|
| Rate for Payer: Cash Price |
$6,636.47
|
| Rate for Payer: Cigna All Commercial |
$9,237.54
|
| Rate for Payer: CORVEL All Commercial |
$9,954.71
|
| Rate for Payer: Coventry All Commercial |
$9,419.51
|
| Rate for Payer: Encore All Commercial |
$9,853.02
|
| Rate for Payer: Frontpath All Commercial |
$9,847.67
|
| Rate for Payer: Humana ChoiceCare |
$9,245.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,633.59
|
| Rate for Payer: PHCS All Commercial |
$8,027.99
|
| Rate for Payer: PHP All Commercial |
$8,117.91
|
| Rate for Payer: Sagamore Health Network All Products |
$8,263.48
|
| Rate for Payer: Signature Care EPO |
$8,884.31
|
| Rate for Payer: Signature Care PPO |
$9,419.51
|
| Rate for Payer: United Healthcare Commercial |
$8,434.74
|
|
|
HC SGOT
|
Facility
IP
|
$48.25
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
63001101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$44.87 |
| Rate for Payer: Aetna Commercial |
$41.68
|
| Rate for Payer: Cash Price |
$29.91
|
| Rate for Payer: Cigna All Commercial |
$41.64
|
| Rate for Payer: CORVEL All Commercial |
$44.87
|
| Rate for Payer: Coventry All Commercial |
$42.46
|
| Rate for Payer: Encore All Commercial |
$44.41
|
| Rate for Payer: Frontpath All Commercial |
$44.39
|
| Rate for Payer: Humana ChoiceCare |
$41.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.42
|
| Rate for Payer: PHCS All Commercial |
$36.18
|
| Rate for Payer: PHP All Commercial |
$36.59
|
| Rate for Payer: Sagamore Health Network All Products |
$37.25
|
| Rate for Payer: Signature Care EPO |
$40.04
|
| Rate for Payer: Signature Care PPO |
$42.46
|
| Rate for Payer: United Healthcare Commercial |
$38.02
|
|
|
HC SGOT
|
Facility
OP
|
$48.25
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
63001101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$44.87 |
| Rate for Payer: Aetna Commercial |
$40.72
|
| Rate for Payer: Aetna Medicare |
$15.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.51
|
| Rate for Payer: Cash Price |
$29.91
|
| Rate for Payer: Cash Price |
$29.91
|
| Rate for Payer: Centivo All Commercial |
$24.61
|
| Rate for Payer: Cigna All Commercial |
$41.64
|
| Rate for Payer: CORVEL All Commercial |
$44.87
|
| Rate for Payer: Coventry All Commercial |
$42.46
|
| Rate for Payer: Encore All Commercial |
$44.41
|
| Rate for Payer: Frontpath All Commercial |
$44.39
|
| Rate for Payer: Humana ChoiceCare |
$41.67
|
| Rate for Payer: Humana Medicare |
$24.61
|
| Rate for Payer: Lucent All Commercial |
$24.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.42
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$36.18
|
| Rate for Payer: PHP All Commercial |
$36.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.82
|
| Rate for Payer: Sagamore Health Network All Products |
$37.25
|
| Rate for Payer: Signature Care EPO |
$40.04
|
| Rate for Payer: Signature Care PPO |
$42.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.01
|
| Rate for Payer: United Healthcare Commercial |
$38.02
|
| Rate for Payer: United Healthcare Medicare |
$15.92
|
|
|
HC SGPT
|
Facility
OP
|
$48.25
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
63001102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$44.87 |
| Rate for Payer: Aetna Commercial |
$40.72
|
| Rate for Payer: Aetna Medicare |
$15.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.51
|
| Rate for Payer: Cash Price |
$29.91
|
| Rate for Payer: Cash Price |
$29.91
|
| Rate for Payer: Centivo All Commercial |
$24.61
|
| Rate for Payer: Cigna All Commercial |
$41.64
|
| Rate for Payer: CORVEL All Commercial |
$44.87
|
| Rate for Payer: Coventry All Commercial |
$42.46
|
| Rate for Payer: Encore All Commercial |
$44.41
|
| Rate for Payer: Frontpath All Commercial |
$44.39
|
| Rate for Payer: Humana ChoiceCare |
$41.67
|
| Rate for Payer: Humana Medicare |
$24.61
|
| Rate for Payer: Lucent All Commercial |
$24.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.42
|
| Rate for Payer: Managed Health Services Medicaid |
$5.30
|
| Rate for Payer: MDWise Medicaid |
$5.30
|
| Rate for Payer: PHCS All Commercial |
$36.18
|
| Rate for Payer: PHP All Commercial |
$36.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.82
|
| Rate for Payer: Sagamore Health Network All Products |
$37.25
|
| Rate for Payer: Signature Care EPO |
$40.04
|
| Rate for Payer: Signature Care PPO |
$42.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.01
|
| Rate for Payer: United Healthcare Commercial |
$38.02
|
| Rate for Payer: United Healthcare Medicare |
$15.92
|
|
|
HC SGPT
|
Facility
IP
|
$48.25
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
63001102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$44.87 |
| Rate for Payer: Aetna Commercial |
$41.68
|
| Rate for Payer: Cash Price |
$29.91
|
| Rate for Payer: Cigna All Commercial |
$41.64
|
| Rate for Payer: CORVEL All Commercial |
$44.87
|
| Rate for Payer: Coventry All Commercial |
$42.46
|
| Rate for Payer: Encore All Commercial |
$44.41
|
| Rate for Payer: Frontpath All Commercial |
$44.39
|
| Rate for Payer: Humana ChoiceCare |
$41.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.42
|
| Rate for Payer: PHCS All Commercial |
$36.18
|
| Rate for Payer: PHP All Commercial |
$36.59
|
| Rate for Payer: Sagamore Health Network All Products |
$37.25
|
| Rate for Payer: Signature Care EPO |
$40.04
|
| Rate for Payer: Signature Care PPO |
$42.46
|
| Rate for Payer: United Healthcare Commercial |
$38.02
|
|
|
HC SHAVER RESECTOR 5.5
|
Facility
OP
|
$350.71
|
|
| Hospital Charge Code |
41606379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.73 |
| Max. Negotiated Rate |
$326.16 |
| Rate for Payer: Aetna Commercial |
$296.00
|
| Rate for Payer: Aetna Medicare |
$115.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$219.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$133.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.31
|
| Rate for Payer: Cash Price |
$217.44
|
| Rate for Payer: Cash Price |
$217.44
|
| Rate for Payer: Centivo All Commercial |
$178.86
|
| Rate for Payer: Cigna All Commercial |
$302.66
|
| Rate for Payer: CORVEL All Commercial |
$326.16
|
| Rate for Payer: Coventry All Commercial |
$308.62
|
| Rate for Payer: Encore All Commercial |
$322.83
|
| Rate for Payer: Frontpath All Commercial |
$322.65
|
| Rate for Payer: Humana ChoiceCare |
$302.91
|
| Rate for Payer: Humana Medicare |
$178.86
|
| Rate for Payer: Lucent All Commercial |
$178.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$263.03
|
| Rate for Payer: PHP All Commercial |
$265.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.78
|
| Rate for Payer: Sagamore Health Network All Products |
$270.75
|
| Rate for Payer: Signature Care EPO |
$291.09
|
| Rate for Payer: Signature Care PPO |
$308.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$298.10
|
| Rate for Payer: United Healthcare Commercial |
$276.36
|
| Rate for Payer: United Healthcare Medicare |
$115.73
|
|
|
HC SHAVER RESECTOR 5.5
|
Facility
IP
|
$350.71
|
|
| Hospital Charge Code |
41606379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.03 |
| Max. Negotiated Rate |
$326.16 |
| Rate for Payer: Aetna Commercial |
$303.01
|
| Rate for Payer: Cash Price |
$217.44
|
| Rate for Payer: Cigna All Commercial |
$302.66
|
| Rate for Payer: CORVEL All Commercial |
$326.16
|
| Rate for Payer: Coventry All Commercial |
$308.62
|
| Rate for Payer: Encore All Commercial |
$322.83
|
| Rate for Payer: Frontpath All Commercial |
$322.65
|
| Rate for Payer: Humana ChoiceCare |
$302.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.64
|
| Rate for Payer: PHCS All Commercial |
$263.03
|
| Rate for Payer: PHP All Commercial |
$265.98
|
| Rate for Payer: Sagamore Health Network All Products |
$270.75
|
| Rate for Payer: Signature Care EPO |
$291.09
|
| Rate for Payer: Signature Care PPO |
$308.62
|
| Rate for Payer: United Healthcare Commercial |
$276.36
|
|
|
HC SHAVER SMALL JOINT FULL RADIUS 2.5
|
Facility
OP
|
$388.02
|
|
| Hospital Charge Code |
41602175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$360.86 |
| Rate for Payer: Aetna Commercial |
$327.49
|
| Rate for Payer: Aetna Medicare |
$128.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$222.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$242.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.85
|
| Rate for Payer: Cash Price |
$240.57
|
| Rate for Payer: Cash Price |
$240.57
|
| Rate for Payer: Centivo All Commercial |
$197.89
|
| Rate for Payer: Cigna All Commercial |
$334.86
|
| Rate for Payer: CORVEL All Commercial |
$360.86
|
| Rate for Payer: Coventry All Commercial |
$341.46
|
| Rate for Payer: Encore All Commercial |
$357.17
|
| Rate for Payer: Frontpath All Commercial |
$356.98
|
| Rate for Payer: Humana ChoiceCare |
$335.13
|
| Rate for Payer: Humana Medicare |
$197.89
|
| Rate for Payer: Lucent All Commercial |
$197.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$349.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$291.02
|
| Rate for Payer: PHP All Commercial |
$294.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.33
|
| Rate for Payer: Sagamore Health Network All Products |
$299.55
|
| Rate for Payer: Signature Care EPO |
$322.06
|
| Rate for Payer: Signature Care PPO |
$341.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$329.82
|
| Rate for Payer: United Healthcare Commercial |
$305.76
|
| Rate for Payer: United Healthcare Medicare |
$128.05
|
|
|
HC SHAVER SMALL JOINT FULL RADIUS 2.5
|
Facility
IP
|
$388.02
|
|
| Hospital Charge Code |
41602175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.02 |
| Max. Negotiated Rate |
$360.86 |
| Rate for Payer: Aetna Commercial |
$335.25
|
| Rate for Payer: Cash Price |
$240.57
|
| Rate for Payer: Cigna All Commercial |
$334.86
|
| Rate for Payer: CORVEL All Commercial |
$360.86
|
| Rate for Payer: Coventry All Commercial |
$341.46
|
| Rate for Payer: Encore All Commercial |
$357.17
|
| Rate for Payer: Frontpath All Commercial |
$356.98
|
| Rate for Payer: Humana ChoiceCare |
$335.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$349.22
|
| Rate for Payer: PHCS All Commercial |
$291.02
|
| Rate for Payer: PHP All Commercial |
$294.27
|
| Rate for Payer: Sagamore Health Network All Products |
$299.55
|
| Rate for Payer: Signature Care EPO |
$322.06
|
| Rate for Payer: Signature Care PPO |
$341.46
|
| Rate for Payer: United Healthcare Commercial |
$305.76
|
|
|
HC SHAVER TOMCAT 3.5
|
Facility
IP
|
$343.25
|
|
| Hospital Charge Code |
41602167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.44 |
| Max. Negotiated Rate |
$319.22 |
| Rate for Payer: Aetna Commercial |
$296.57
|
| Rate for Payer: Cash Price |
$212.82
|
| Rate for Payer: Cigna All Commercial |
$296.22
|
| Rate for Payer: CORVEL All Commercial |
$319.22
|
| Rate for Payer: Coventry All Commercial |
$302.06
|
| Rate for Payer: Encore All Commercial |
$315.96
|
| Rate for Payer: Frontpath All Commercial |
$315.79
|
| Rate for Payer: Humana ChoiceCare |
$296.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$308.92
|
| Rate for Payer: PHCS All Commercial |
$257.44
|
| Rate for Payer: PHP All Commercial |
$260.32
|
| Rate for Payer: Sagamore Health Network All Products |
$264.99
|
| Rate for Payer: Signature Care EPO |
$284.90
|
| Rate for Payer: Signature Care PPO |
$302.06
|
| Rate for Payer: United Healthcare Commercial |
$270.48
|
|
|
HC SHAVER TOMCAT 3.5
|
Facility
OP
|
$343.25
|
|
| Hospital Charge Code |
41602167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.27 |
| Max. Negotiated Rate |
$319.22 |
| Rate for Payer: Aetna Commercial |
$289.70
|
| Rate for Payer: Aetna Medicare |
$113.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$197.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.60
|
| Rate for Payer: Cash Price |
$212.82
|
| Rate for Payer: Cash Price |
$212.82
|
| Rate for Payer: Centivo All Commercial |
$175.06
|
| Rate for Payer: Cigna All Commercial |
$296.22
|
| Rate for Payer: CORVEL All Commercial |
$319.22
|
| Rate for Payer: Coventry All Commercial |
$302.06
|
| Rate for Payer: Encore All Commercial |
$315.96
|
| Rate for Payer: Frontpath All Commercial |
$315.79
|
| Rate for Payer: Humana ChoiceCare |
$296.47
|
| Rate for Payer: Humana Medicare |
$175.06
|
| Rate for Payer: Lucent All Commercial |
$175.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$308.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$257.44
|
| Rate for Payer: PHP All Commercial |
$260.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$133.87
|
| Rate for Payer: Sagamore Health Network All Products |
$264.99
|
| Rate for Payer: Signature Care EPO |
$284.90
|
| Rate for Payer: Signature Care PPO |
$302.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$291.76
|
| Rate for Payer: United Healthcare Commercial |
$270.48
|
| Rate for Payer: United Healthcare Medicare |
$113.27
|
|
|
HC SHAVER TOMCAT 4.0
|
Facility
IP
|
$403.69
|
|
| Hospital Charge Code |
41601202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.77 |
| Max. Negotiated Rate |
$375.43 |
| Rate for Payer: Aetna Commercial |
$348.79
|
| Rate for Payer: Cash Price |
$250.29
|
| Rate for Payer: Cigna All Commercial |
$348.38
|
| Rate for Payer: CORVEL All Commercial |
$375.43
|
| Rate for Payer: Coventry All Commercial |
$355.25
|
| Rate for Payer: Encore All Commercial |
$371.60
|
| Rate for Payer: Frontpath All Commercial |
$371.39
|
| Rate for Payer: Humana ChoiceCare |
$348.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$363.32
|
| Rate for Payer: PHCS All Commercial |
$302.77
|
| Rate for Payer: PHP All Commercial |
$306.16
|
| Rate for Payer: Sagamore Health Network All Products |
$311.65
|
| Rate for Payer: Signature Care EPO |
$335.06
|
| Rate for Payer: Signature Care PPO |
$355.25
|
| Rate for Payer: United Healthcare Commercial |
$318.11
|
|
|
HC SHAVER TOMCAT 4.0
|
Facility
OP
|
$403.69
|
|
| Hospital Charge Code |
41601202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$375.43 |
| Rate for Payer: Aetna Commercial |
$340.71
|
| Rate for Payer: Aetna Medicare |
$133.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$133.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$231.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.54
|
| Rate for Payer: Cash Price |
$250.29
|
| Rate for Payer: Cash Price |
$250.29
|
| Rate for Payer: Centivo All Commercial |
$205.88
|
| Rate for Payer: Cigna All Commercial |
$348.38
|
| Rate for Payer: CORVEL All Commercial |
$375.43
|
| Rate for Payer: Coventry All Commercial |
$355.25
|
| Rate for Payer: Encore All Commercial |
$371.60
|
| Rate for Payer: Frontpath All Commercial |
$371.39
|
| Rate for Payer: Humana ChoiceCare |
$348.67
|
| Rate for Payer: Humana Medicare |
$205.88
|
| Rate for Payer: Lucent All Commercial |
$205.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$363.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$302.77
|
| Rate for Payer: PHP All Commercial |
$306.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$157.44
|
| Rate for Payer: Sagamore Health Network All Products |
$311.65
|
| Rate for Payer: Signature Care EPO |
$335.06
|
| Rate for Payer: Signature Care PPO |
$355.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$343.14
|
| Rate for Payer: United Healthcare Commercial |
$318.11
|
| Rate for Payer: United Healthcare Medicare |
$133.22
|
|
|
HC SHAVER TOMCAT 4.0 ANG
|
Facility
OP
|
$390.85
|
|
| Hospital Charge Code |
41603087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$363.49 |
| Rate for Payer: Aetna Commercial |
$329.88
|
| Rate for Payer: Aetna Medicare |
$128.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$224.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.88
|
| Rate for Payer: Cash Price |
$242.33
|
| Rate for Payer: Cash Price |
$242.33
|
| Rate for Payer: Centivo All Commercial |
$199.33
|
| Rate for Payer: Cigna All Commercial |
$337.30
|
| Rate for Payer: CORVEL All Commercial |
$363.49
|
| Rate for Payer: Coventry All Commercial |
$343.95
|
| Rate for Payer: Encore All Commercial |
$359.78
|
| Rate for Payer: Frontpath All Commercial |
$359.58
|
| Rate for Payer: Humana ChoiceCare |
$337.58
|
| Rate for Payer: Humana Medicare |
$199.33
|
| Rate for Payer: Lucent All Commercial |
$199.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$293.14
|
| Rate for Payer: PHP All Commercial |
$296.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.43
|
| Rate for Payer: Sagamore Health Network All Products |
$301.74
|
| Rate for Payer: Signature Care EPO |
$324.41
|
| Rate for Payer: Signature Care PPO |
$343.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$332.22
|
| Rate for Payer: United Healthcare Commercial |
$307.99
|
| Rate for Payer: United Healthcare Medicare |
$128.98
|
|
|
HC SHAVER TOMCAT 4.0 ANG
|
Facility
IP
|
$390.85
|
|
| Hospital Charge Code |
41603087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.14 |
| Max. Negotiated Rate |
$363.49 |
| Rate for Payer: Aetna Commercial |
$337.69
|
| Rate for Payer: Cash Price |
$242.33
|
| Rate for Payer: Cigna All Commercial |
$337.30
|
| Rate for Payer: CORVEL All Commercial |
$363.49
|
| Rate for Payer: Coventry All Commercial |
$343.95
|
| Rate for Payer: Encore All Commercial |
$359.78
|
| Rate for Payer: Frontpath All Commercial |
$359.58
|
| Rate for Payer: Humana ChoiceCare |
$337.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.76
|
| Rate for Payer: PHCS All Commercial |
$293.14
|
| Rate for Payer: PHP All Commercial |
$296.42
|
| Rate for Payer: Sagamore Health Network All Products |
$301.74
|
| Rate for Payer: Signature Care EPO |
$324.41
|
| Rate for Payer: Signature Care PPO |
$343.95
|
| Rate for Payer: United Healthcare Commercial |
$307.99
|
|
|
HC SHAVER TOMCAT 5.0
|
Facility
IP
|
$334.24
|
|
| Hospital Charge Code |
41603086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.68 |
| Max. Negotiated Rate |
$310.84 |
| Rate for Payer: Aetna Commercial |
$288.78
|
| Rate for Payer: Cash Price |
$207.23
|
| Rate for Payer: Cigna All Commercial |
$288.45
|
| Rate for Payer: CORVEL All Commercial |
$310.84
|
| Rate for Payer: Coventry All Commercial |
$294.13
|
| Rate for Payer: Encore All Commercial |
$307.67
|
| Rate for Payer: Frontpath All Commercial |
$307.50
|
| Rate for Payer: Humana ChoiceCare |
$288.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.82
|
| Rate for Payer: PHCS All Commercial |
$250.68
|
| Rate for Payer: PHP All Commercial |
$253.49
|
| Rate for Payer: Sagamore Health Network All Products |
$258.03
|
| Rate for Payer: Signature Care EPO |
$277.42
|
| Rate for Payer: Signature Care PPO |
$294.13
|
| Rate for Payer: United Healthcare Commercial |
$263.38
|
|
|
HC SHAVER TOMCAT 5.0
|
Facility
OP
|
$334.24
|
|
| Hospital Charge Code |
41603086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.30 |
| Max. Negotiated Rate |
$310.84 |
| Rate for Payer: Aetna Commercial |
$282.10
|
| Rate for Payer: Aetna Medicare |
$110.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$191.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$208.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.33
|
| Rate for Payer: Cash Price |
$207.23
|
| Rate for Payer: Cash Price |
$207.23
|
| Rate for Payer: Centivo All Commercial |
$170.46
|
| Rate for Payer: Cigna All Commercial |
$288.45
|
| Rate for Payer: CORVEL All Commercial |
$310.84
|
| Rate for Payer: Coventry All Commercial |
$294.13
|
| Rate for Payer: Encore All Commercial |
$307.67
|
| Rate for Payer: Frontpath All Commercial |
$307.50
|
| Rate for Payer: Humana ChoiceCare |
$288.68
|
| Rate for Payer: Humana Medicare |
$170.46
|
| Rate for Payer: Lucent All Commercial |
$170.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$250.68
|
| Rate for Payer: PHP All Commercial |
$253.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.35
|
| Rate for Payer: Sagamore Health Network All Products |
$258.03
|
| Rate for Payer: Signature Care EPO |
$277.42
|
| Rate for Payer: Signature Care PPO |
$294.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$284.10
|
| Rate for Payer: United Healthcare Commercial |
$263.38
|
| Rate for Payer: United Healthcare Medicare |
$110.30
|
|
|
HC SHOE ORTHOWEDGE SMALL
|
Facility
OP
|
$129.50
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
41602315
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.74 |
| Max. Negotiated Rate |
$120.44 |
| Rate for Payer: Aetna Commercial |
$109.30
|
| Rate for Payer: Aetna Medicare |
$42.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$74.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.01
|
| Rate for Payer: Cash Price |
$80.29
|
| Rate for Payer: Centivo All Commercial |
$66.04
|
| Rate for Payer: Cigna All Commercial |
$111.76
|
| Rate for Payer: CORVEL All Commercial |
$120.44
|
| Rate for Payer: Coventry All Commercial |
$113.96
|
| Rate for Payer: Encore All Commercial |
$119.20
|
| Rate for Payer: Frontpath All Commercial |
$119.14
|
| Rate for Payer: Humana ChoiceCare |
$111.85
|
| Rate for Payer: Humana Medicare |
$66.04
|
| Rate for Payer: Lucent All Commercial |
$66.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.55
|
| Rate for Payer: PHCS All Commercial |
$97.12
|
| Rate for Payer: PHP All Commercial |
$98.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.50
|
| Rate for Payer: Sagamore Health Network All Products |
$99.97
|
| Rate for Payer: Signature Care EPO |
$107.48
|
| Rate for Payer: Signature Care PPO |
$113.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.08
|
| Rate for Payer: United Healthcare Commercial |
$102.05
|
| Rate for Payer: United Healthcare Medicare |
$42.74
|
|
|
HC SHOE ORTHOWEDGE SMALL
|
Facility
IP
|
$129.50
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
41602315
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.12 |
| Max. Negotiated Rate |
$120.44 |
| Rate for Payer: Aetna Commercial |
$111.89
|
| Rate for Payer: Cash Price |
$80.29
|
| Rate for Payer: Cigna All Commercial |
$111.76
|
| Rate for Payer: CORVEL All Commercial |
$120.44
|
| Rate for Payer: Coventry All Commercial |
$113.96
|
| Rate for Payer: Encore All Commercial |
$119.20
|
| Rate for Payer: Frontpath All Commercial |
$119.14
|
| Rate for Payer: Humana ChoiceCare |
$111.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.55
|
| Rate for Payer: PHCS All Commercial |
$97.12
|
| Rate for Payer: PHP All Commercial |
$98.21
|
| Rate for Payer: Sagamore Health Network All Products |
$99.97
|
| Rate for Payer: Signature Care EPO |
$107.48
|
| Rate for Payer: Signature Care PPO |
$113.96
|
| Rate for Payer: United Healthcare Commercial |
$102.05
|
|
|
HC SHOULDER ARTHROGRAM BI
|
Facility
OP
|
$1,846.73
|
|
|
Service Code
|
CPT 73040 50
|
| Hospital Charge Code |
21616073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$609.42 |
| Max. Negotiated Rate |
$1,717.46 |
| Rate for Payer: Aetna Commercial |
$1,558.64
|
| Rate for Payer: Aetna Medicare |
$609.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$609.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,060.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,154.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$700.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$670.36
|
| Rate for Payer: Cash Price |
$1,144.97
|
| Rate for Payer: Centivo All Commercial |
$941.83
|
| Rate for Payer: Cigna All Commercial |
$1,593.73
|
| Rate for Payer: CORVEL All Commercial |
$1,717.46
|
| Rate for Payer: Coventry All Commercial |
$1,625.12
|
| Rate for Payer: Encore All Commercial |
$1,699.92
|
| Rate for Payer: Frontpath All Commercial |
$1,698.99
|
| Rate for Payer: Humana ChoiceCare |
$1,595.02
|
| Rate for Payer: Humana Medicare |
$941.83
|
| Rate for Payer: Lucent All Commercial |
$941.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,662.06
|
| Rate for Payer: PHCS All Commercial |
$1,385.05
|
| Rate for Payer: PHP All Commercial |
$1,400.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$720.22
|
| Rate for Payer: Sagamore Health Network All Products |
$1,425.68
|
| Rate for Payer: Signature Care EPO |
$1,532.79
|
| Rate for Payer: Signature Care PPO |
$1,625.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,569.72
|
| Rate for Payer: United Healthcare Commercial |
$1,455.22
|
| Rate for Payer: United Healthcare Medicare |
$609.42
|
|
|
HC SHOULDER ARTHROGRAM BI
|
Facility
IP
|
$1,846.73
|
|
|
Service Code
|
CPT 73040 50
|
| Hospital Charge Code |
21616073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,385.05 |
| Max. Negotiated Rate |
$1,717.46 |
| Rate for Payer: Aetna Commercial |
$1,595.58
|
| Rate for Payer: Cash Price |
$1,144.97
|
| Rate for Payer: Cigna All Commercial |
$1,593.73
|
| Rate for Payer: CORVEL All Commercial |
$1,717.46
|
| Rate for Payer: Coventry All Commercial |
$1,625.12
|
| Rate for Payer: Encore All Commercial |
$1,699.92
|
| Rate for Payer: Frontpath All Commercial |
$1,698.99
|
| Rate for Payer: Humana ChoiceCare |
$1,595.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,662.06
|
| Rate for Payer: PHCS All Commercial |
$1,385.05
|
| Rate for Payer: PHP All Commercial |
$1,400.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,425.68
|
| Rate for Payer: Signature Care EPO |
$1,532.79
|
| Rate for Payer: Signature Care PPO |
$1,625.12
|
| Rate for Payer: United Healthcare Commercial |
$1,455.22
|
|
|
HC SHOULDER ARTHROGRAM LT
|
Facility
IP
|
$924.49
|
|
|
Service Code
|
CPT 73040 LT
|
| Hospital Charge Code |
01616073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$693.37 |
| Max. Negotiated Rate |
$859.77 |
| Rate for Payer: Aetna Commercial |
$798.76
|
| Rate for Payer: Cash Price |
$573.18
|
| Rate for Payer: Cigna All Commercial |
$797.83
|
| Rate for Payer: CORVEL All Commercial |
$859.77
|
| Rate for Payer: Coventry All Commercial |
$813.55
|
| Rate for Payer: Encore All Commercial |
$850.99
|
| Rate for Payer: Frontpath All Commercial |
$850.53
|
| Rate for Payer: Humana ChoiceCare |
$798.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$832.04
|
| Rate for Payer: PHCS All Commercial |
$693.37
|
| Rate for Payer: PHP All Commercial |
$701.13
|
| Rate for Payer: Sagamore Health Network All Products |
$713.70
|
| Rate for Payer: Signature Care EPO |
$767.32
|
| Rate for Payer: Signature Care PPO |
$813.55
|
| Rate for Payer: United Healthcare Commercial |
$728.50
|
|
|
HC SHOULDER ARTHROGRAM LT
|
Facility
OP
|
$924.49
|
|
|
Service Code
|
CPT 73040 LT
|
| Hospital Charge Code |
01616073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.08 |
| Max. Negotiated Rate |
$859.77 |
| Rate for Payer: Aetna Commercial |
$780.27
|
| Rate for Payer: Aetna Medicare |
$305.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$305.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.59
|
| Rate for Payer: Cash Price |
$573.18
|
| Rate for Payer: Centivo All Commercial |
$471.49
|
| Rate for Payer: Cigna All Commercial |
$797.83
|
| Rate for Payer: CORVEL All Commercial |
$859.77
|
| Rate for Payer: Coventry All Commercial |
$813.55
|
| Rate for Payer: Encore All Commercial |
$850.99
|
| Rate for Payer: Frontpath All Commercial |
$850.53
|
| Rate for Payer: Humana ChoiceCare |
$798.48
|
| Rate for Payer: Humana Medicare |
$471.49
|
| Rate for Payer: Lucent All Commercial |
$471.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$832.04
|
| Rate for Payer: PHCS All Commercial |
$693.37
|
| Rate for Payer: PHP All Commercial |
$701.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.55
|
| Rate for Payer: Sagamore Health Network All Products |
$713.70
|
| Rate for Payer: Signature Care EPO |
$767.32
|
| Rate for Payer: Signature Care PPO |
$813.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.81
|
| Rate for Payer: United Healthcare Commercial |
$728.50
|
| Rate for Payer: United Healthcare Medicare |
$305.08
|
|
|
HC SHOULDER ARTHROGRAM RT
|
Facility
OP
|
$924.49
|
|
|
Service Code
|
CPT 73040 RT
|
| Hospital Charge Code |
11616073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.08 |
| Max. Negotiated Rate |
$859.77 |
| Rate for Payer: Aetna Commercial |
$780.27
|
| Rate for Payer: Aetna Medicare |
$305.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$305.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.59
|
| Rate for Payer: Cash Price |
$573.18
|
| Rate for Payer: Centivo All Commercial |
$471.49
|
| Rate for Payer: Cigna All Commercial |
$797.83
|
| Rate for Payer: CORVEL All Commercial |
$859.77
|
| Rate for Payer: Coventry All Commercial |
$813.55
|
| Rate for Payer: Encore All Commercial |
$850.99
|
| Rate for Payer: Frontpath All Commercial |
$850.53
|
| Rate for Payer: Humana ChoiceCare |
$798.48
|
| Rate for Payer: Humana Medicare |
$471.49
|
| Rate for Payer: Lucent All Commercial |
$471.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$832.04
|
| Rate for Payer: PHCS All Commercial |
$693.37
|
| Rate for Payer: PHP All Commercial |
$701.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.55
|
| Rate for Payer: Sagamore Health Network All Products |
$713.70
|
| Rate for Payer: Signature Care EPO |
$767.32
|
| Rate for Payer: Signature Care PPO |
$813.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.81
|
| Rate for Payer: United Healthcare Commercial |
$728.50
|
| Rate for Payer: United Healthcare Medicare |
$305.08
|
|
