|
HC SLEEVE ICED KNEE LARGE
|
Facility
IP
|
$259.14
|
|
| Hospital Charge Code |
41602162
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$194.36 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna Commercial |
$223.90
|
| Rate for Payer: Cash Price |
$160.67
|
| Rate for Payer: Cigna All Commercial |
$223.64
|
| Rate for Payer: CORVEL All Commercial |
$241.00
|
| Rate for Payer: Coventry All Commercial |
$228.04
|
| Rate for Payer: Encore All Commercial |
$238.54
|
| Rate for Payer: Frontpath All Commercial |
$238.41
|
| Rate for Payer: Humana ChoiceCare |
$223.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.23
|
| Rate for Payer: PHCS All Commercial |
$194.36
|
| Rate for Payer: PHP All Commercial |
$196.53
|
| Rate for Payer: Sagamore Health Network All Products |
$200.06
|
| Rate for Payer: Signature Care EPO |
$215.09
|
| Rate for Payer: Signature Care PPO |
$228.04
|
| Rate for Payer: United Healthcare Commercial |
$204.20
|
|
|
HC SLING GIV MOHR MED
|
Facility
OP
|
$354.69
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
41601888
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$329.86 |
| Rate for Payer: Aetna Commercial |
$299.36
|
| Rate for Payer: Aetna Medicare |
$117.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$203.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$221.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$134.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$128.75
|
| Rate for Payer: Cash Price |
$219.91
|
| Rate for Payer: Cash Price |
$219.91
|
| Rate for Payer: Centivo All Commercial |
$180.89
|
| Rate for Payer: Cigna All Commercial |
$306.10
|
| Rate for Payer: CORVEL All Commercial |
$329.86
|
| Rate for Payer: Coventry All Commercial |
$312.13
|
| Rate for Payer: Encore All Commercial |
$326.49
|
| Rate for Payer: Frontpath All Commercial |
$326.31
|
| Rate for Payer: Humana ChoiceCare |
$306.35
|
| Rate for Payer: Humana Medicare |
$180.89
|
| Rate for Payer: Lucent All Commercial |
$180.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$319.22
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$266.02
|
| Rate for Payer: PHP All Commercial |
$269.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$138.33
|
| Rate for Payer: Sagamore Health Network All Products |
$273.82
|
| Rate for Payer: Signature Care EPO |
$294.39
|
| Rate for Payer: Signature Care PPO |
$312.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$301.49
|
| Rate for Payer: United Healthcare Commercial |
$279.50
|
| Rate for Payer: United Healthcare Medicare |
$117.05
|
|
|
HC SLING GIV MOHR MED
|
Facility
IP
|
$354.69
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
41601888
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$266.02 |
| Max. Negotiated Rate |
$329.86 |
| Rate for Payer: Aetna Commercial |
$306.45
|
| Rate for Payer: Cash Price |
$219.91
|
| Rate for Payer: Cigna All Commercial |
$306.10
|
| Rate for Payer: CORVEL All Commercial |
$329.86
|
| Rate for Payer: Coventry All Commercial |
$312.13
|
| Rate for Payer: Encore All Commercial |
$326.49
|
| Rate for Payer: Frontpath All Commercial |
$326.31
|
| Rate for Payer: Humana ChoiceCare |
$306.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$319.22
|
| Rate for Payer: PHCS All Commercial |
$266.02
|
| Rate for Payer: PHP All Commercial |
$269.00
|
| Rate for Payer: Sagamore Health Network All Products |
$273.82
|
| Rate for Payer: Signature Care EPO |
$294.39
|
| Rate for Payer: Signature Care PPO |
$312.13
|
| Rate for Payer: United Healthcare Commercial |
$279.50
|
|
|
HC SLP STUDY 6/>YRS CPAP 4/> PARM <6 HRS RECORDING
|
Facility
IP
|
$6,877.84
|
|
|
Service Code
|
CPT 95811 52
|
| Hospital Charge Code |
01365811
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$5,158.38 |
| Max. Negotiated Rate |
$6,396.39 |
| Rate for Payer: Aetna Commercial |
$5,942.45
|
| Rate for Payer: Cash Price |
$4,264.26
|
| Rate for Payer: Cigna All Commercial |
$5,935.58
|
| Rate for Payer: CORVEL All Commercial |
$6,396.39
|
| Rate for Payer: Coventry All Commercial |
$6,052.50
|
| Rate for Payer: Encore All Commercial |
$6,331.05
|
| Rate for Payer: Frontpath All Commercial |
$6,327.61
|
| Rate for Payer: Humana ChoiceCare |
$5,940.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,190.06
|
| Rate for Payer: PHCS All Commercial |
$5,158.38
|
| Rate for Payer: PHP All Commercial |
$5,216.15
|
| Rate for Payer: Sagamore Health Network All Products |
$5,309.69
|
| Rate for Payer: Signature Care EPO |
$5,708.61
|
| Rate for Payer: Signature Care PPO |
$6,052.50
|
| Rate for Payer: United Healthcare Commercial |
$5,419.74
|
|
|
HC SLP STUDY 6/>YRS CPAP 4/> PARM <6 HRS RECORDING
|
Facility
OP
|
$6,877.84
|
|
|
Service Code
|
CPT 95811 52
|
| Hospital Charge Code |
01365811
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,269.69 |
| Max. Negotiated Rate |
$6,396.39 |
| Rate for Payer: Aetna Commercial |
$5,804.90
|
| Rate for Payer: Aetna Medicare |
$2,269.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,269.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,949.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,299.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,610.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,496.66
|
| Rate for Payer: Cash Price |
$4,264.26
|
| Rate for Payer: Centivo All Commercial |
$3,507.70
|
| Rate for Payer: Cigna All Commercial |
$5,935.58
|
| Rate for Payer: CORVEL All Commercial |
$6,396.39
|
| Rate for Payer: Coventry All Commercial |
$6,052.50
|
| Rate for Payer: Encore All Commercial |
$6,331.05
|
| Rate for Payer: Frontpath All Commercial |
$6,327.61
|
| Rate for Payer: Humana ChoiceCare |
$5,940.39
|
| Rate for Payer: Humana Medicare |
$3,507.70
|
| Rate for Payer: Lucent All Commercial |
$3,507.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,190.06
|
| Rate for Payer: PHCS All Commercial |
$5,158.38
|
| Rate for Payer: PHP All Commercial |
$5,216.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,682.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,309.69
|
| Rate for Payer: Signature Care EPO |
$5,708.61
|
| Rate for Payer: Signature Care PPO |
$6,052.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,846.16
|
| Rate for Payer: United Healthcare Commercial |
$5,419.74
|
| Rate for Payer: United Healthcare Medicare |
$2,269.69
|
|
|
HC SLP STUDY 6/>YRS CPAP 4/> PARM 6+ HRS RECORDING
|
Facility
IP
|
$6,877.84
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
01520011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$5,158.38 |
| Max. Negotiated Rate |
$6,396.39 |
| Rate for Payer: Aetna Commercial |
$5,942.45
|
| Rate for Payer: Cash Price |
$4,264.26
|
| Rate for Payer: Cigna All Commercial |
$5,935.58
|
| Rate for Payer: CORVEL All Commercial |
$6,396.39
|
| Rate for Payer: Coventry All Commercial |
$6,052.50
|
| Rate for Payer: Encore All Commercial |
$6,331.05
|
| Rate for Payer: Frontpath All Commercial |
$6,327.61
|
| Rate for Payer: Humana ChoiceCare |
$5,940.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,190.06
|
| Rate for Payer: PHCS All Commercial |
$5,158.38
|
| Rate for Payer: PHP All Commercial |
$5,216.15
|
| Rate for Payer: Sagamore Health Network All Products |
$5,309.69
|
| Rate for Payer: Signature Care EPO |
$5,708.61
|
| Rate for Payer: Signature Care PPO |
$6,052.50
|
| Rate for Payer: United Healthcare Commercial |
$5,419.74
|
|
|
HC SLP STUDY 6/>YRS CPAP 4/> PARM 6+ HRS RECORDING
|
Facility
OP
|
$6,877.84
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
01520011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$780.39 |
| Max. Negotiated Rate |
$6,396.39 |
| Rate for Payer: Aetna Commercial |
$5,804.90
|
| Rate for Payer: Aetna Medicare |
$2,269.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,269.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,949.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,299.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$780.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,610.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,496.66
|
| Rate for Payer: Cash Price |
$4,264.26
|
| Rate for Payer: Cash Price |
$4,264.26
|
| Rate for Payer: Centivo All Commercial |
$3,507.70
|
| Rate for Payer: Cigna All Commercial |
$5,935.58
|
| Rate for Payer: CORVEL All Commercial |
$6,396.39
|
| Rate for Payer: Coventry All Commercial |
$6,052.50
|
| Rate for Payer: Encore All Commercial |
$6,331.05
|
| Rate for Payer: Frontpath All Commercial |
$6,327.61
|
| Rate for Payer: Humana ChoiceCare |
$5,940.39
|
| Rate for Payer: Humana Medicare |
$3,507.70
|
| Rate for Payer: Lucent All Commercial |
$3,507.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,190.06
|
| Rate for Payer: Managed Health Services Medicaid |
$780.39
|
| Rate for Payer: MDWise Medicaid |
$780.39
|
| Rate for Payer: PHCS All Commercial |
$5,158.38
|
| Rate for Payer: PHP All Commercial |
$5,216.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,682.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,309.69
|
| Rate for Payer: Signature Care EPO |
$5,708.61
|
| Rate for Payer: Signature Care PPO |
$6,052.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,846.16
|
| Rate for Payer: United Healthcare Commercial |
$5,419.74
|
| Rate for Payer: United Healthcare Medicare |
$2,269.69
|
|
|
HC SMART LUNG CT SCAN
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
01660125
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$315.51 |
| Rate for Payer: Aetna Commercial |
$139.26
|
| Rate for Payer: Aetna Medicare |
$54.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$315.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.90
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Centivo All Commercial |
$84.15
|
| Rate for Payer: Cigna All Commercial |
$142.40
|
| Rate for Payer: CORVEL All Commercial |
$153.45
|
| Rate for Payer: Coventry All Commercial |
$145.20
|
| Rate for Payer: Encore All Commercial |
$151.88
|
| Rate for Payer: Frontpath All Commercial |
$151.80
|
| Rate for Payer: Humana ChoiceCare |
$142.51
|
| Rate for Payer: Humana Medicare |
$84.15
|
| Rate for Payer: Lucent All Commercial |
$84.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.50
|
| Rate for Payer: Managed Health Services Medicaid |
$315.51
|
| Rate for Payer: MDWise Medicaid |
$315.51
|
| Rate for Payer: PHCS All Commercial |
$123.75
|
| Rate for Payer: PHP All Commercial |
$125.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.35
|
| Rate for Payer: Sagamore Health Network All Products |
$127.38
|
| Rate for Payer: Signature Care EPO |
$136.95
|
| Rate for Payer: Signature Care PPO |
$145.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.25
|
| Rate for Payer: United Healthcare Commercial |
$130.02
|
| Rate for Payer: United Healthcare Medicare |
$54.45
|
|
|
HC SMART LUNG CT SCAN
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
01660125
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$153.45 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna All Commercial |
$142.40
|
| Rate for Payer: CORVEL All Commercial |
$153.45
|
| Rate for Payer: Coventry All Commercial |
$145.20
|
| Rate for Payer: Encore All Commercial |
$151.88
|
| Rate for Payer: Frontpath All Commercial |
$151.80
|
| Rate for Payer: Humana ChoiceCare |
$142.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.50
|
| Rate for Payer: PHCS All Commercial |
$123.75
|
| Rate for Payer: PHP All Commercial |
$125.14
|
| Rate for Payer: Sagamore Health Network All Products |
$127.38
|
| Rate for Payer: Signature Care EPO |
$136.95
|
| Rate for Payer: Signature Care PPO |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$130.02
|
|
|
HC SMOOTH MUSC AB TITER
|
Facility
OP
|
$194.36
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$180.76 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$64.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.55
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Centivo All Commercial |
$99.12
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.76
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Humana Medicare |
$99.12
|
| Rate for Payer: Lucent All Commercial |
$99.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.80
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.21
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
| Rate for Payer: United Healthcare Medicare |
$64.14
|
|
|
HC SMOOTH MUSC AB TITER
|
Facility
IP
|
$194.36
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
63001025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.77 |
| Max. Negotiated Rate |
$180.76 |
| Rate for Payer: Aetna Commercial |
$167.93
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna All Commercial |
$167.73
|
| Rate for Payer: CORVEL All Commercial |
$180.76
|
| Rate for Payer: Coventry All Commercial |
$171.04
|
| Rate for Payer: Encore All Commercial |
$178.91
|
| Rate for Payer: Frontpath All Commercial |
$178.81
|
| Rate for Payer: Humana ChoiceCare |
$167.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.92
|
| Rate for Payer: PHCS All Commercial |
$145.77
|
| Rate for Payer: PHP All Commercial |
$147.40
|
| Rate for Payer: Sagamore Health Network All Products |
$150.05
|
| Rate for Payer: Signature Care EPO |
$161.32
|
| Rate for Payer: Signature Care PPO |
$171.04
|
| Rate for Payer: United Healthcare Commercial |
$153.16
|
|
|
HC SN ACC 2.0 CABLE FOR GRIP/PLATES
|
Facility
OP
|
$1,844.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,715.01 |
| Rate for Payer: Aetna Commercial |
$1,556.42
|
| Rate for Payer: Aetna Medicare |
$608.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$608.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,059.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,152.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$699.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$669.41
|
| Rate for Payer: Cash Price |
$1,143.34
|
| Rate for Payer: Cash Price |
$1,143.34
|
| Rate for Payer: Centivo All Commercial |
$940.49
|
| Rate for Payer: Cigna All Commercial |
$1,591.46
|
| Rate for Payer: CORVEL All Commercial |
$1,715.01
|
| Rate for Payer: Coventry All Commercial |
$1,622.81
|
| Rate for Payer: Encore All Commercial |
$1,697.49
|
| Rate for Payer: Frontpath All Commercial |
$1,696.57
|
| Rate for Payer: Humana ChoiceCare |
$1,592.75
|
| Rate for Payer: Humana Medicare |
$940.49
|
| Rate for Payer: Lucent All Commercial |
$940.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,659.69
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,383.08
|
| Rate for Payer: PHP All Commercial |
$1,398.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$719.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,423.65
|
| Rate for Payer: Signature Care EPO |
$1,530.60
|
| Rate for Payer: Signature Care PPO |
$1,622.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,567.48
|
| Rate for Payer: United Healthcare Commercial |
$1,453.15
|
| Rate for Payer: United Healthcare Medicare |
$608.55
|
|
|
HC SN ACC 2.0 CABLE FOR GRIP/PLATES
|
Facility
IP
|
$1,844.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.08 |
| Max. Negotiated Rate |
$1,715.01 |
| Rate for Payer: Aetna Commercial |
$1,593.30
|
| Rate for Payer: Cash Price |
$1,143.34
|
| Rate for Payer: Cigna All Commercial |
$1,591.46
|
| Rate for Payer: CORVEL All Commercial |
$1,715.01
|
| Rate for Payer: Coventry All Commercial |
$1,622.81
|
| Rate for Payer: Encore All Commercial |
$1,697.49
|
| Rate for Payer: Frontpath All Commercial |
$1,696.57
|
| Rate for Payer: Humana ChoiceCare |
$1,592.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,659.69
|
| Rate for Payer: PHCS All Commercial |
$1,383.08
|
| Rate for Payer: PHP All Commercial |
$1,398.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,423.65
|
| Rate for Payer: Signature Care EPO |
$1,530.60
|
| Rate for Payer: Signature Care PPO |
$1,622.81
|
| Rate for Payer: United Healthcare Commercial |
$1,453.15
|
|
|
HC SN ACC 2.0 CABLE W/CLAMP 71
|
Facility
IP
|
$1,876.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,407.38 |
| Max. Negotiated Rate |
$1,745.14 |
| Rate for Payer: Aetna Commercial |
$1,621.30
|
| Rate for Payer: Cash Price |
$1,163.43
|
| Rate for Payer: Cigna All Commercial |
$1,619.42
|
| Rate for Payer: CORVEL All Commercial |
$1,745.14
|
| Rate for Payer: Coventry All Commercial |
$1,651.32
|
| Rate for Payer: Encore All Commercial |
$1,727.32
|
| Rate for Payer: Frontpath All Commercial |
$1,726.38
|
| Rate for Payer: Humana ChoiceCare |
$1,620.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,688.85
|
| Rate for Payer: PHCS All Commercial |
$1,407.38
|
| Rate for Payer: PHP All Commercial |
$1,423.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,448.66
|
| Rate for Payer: Signature Care EPO |
$1,557.50
|
| Rate for Payer: Signature Care PPO |
$1,651.32
|
| Rate for Payer: United Healthcare Commercial |
$1,478.68
|
|
|
HC SN ACC 2.0 CABLE W/CLAMP 71
|
Facility
OP
|
$1,876.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,745.14 |
| Rate for Payer: Aetna Commercial |
$1,583.77
|
| Rate for Payer: Aetna Medicare |
$619.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$619.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,077.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,173.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$712.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$681.17
|
| Rate for Payer: Cash Price |
$1,163.43
|
| Rate for Payer: Cash Price |
$1,163.43
|
| Rate for Payer: Centivo All Commercial |
$957.02
|
| Rate for Payer: Cigna All Commercial |
$1,619.42
|
| Rate for Payer: CORVEL All Commercial |
$1,745.14
|
| Rate for Payer: Coventry All Commercial |
$1,651.32
|
| Rate for Payer: Encore All Commercial |
$1,727.32
|
| Rate for Payer: Frontpath All Commercial |
$1,726.38
|
| Rate for Payer: Humana ChoiceCare |
$1,620.73
|
| Rate for Payer: Humana Medicare |
$957.02
|
| Rate for Payer: Lucent All Commercial |
$957.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,688.85
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,407.38
|
| Rate for Payer: PHP All Commercial |
$1,423.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$731.84
|
| Rate for Payer: Sagamore Health Network All Products |
$1,448.66
|
| Rate for Payer: Signature Care EPO |
$1,557.50
|
| Rate for Payer: Signature Care PPO |
$1,651.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,595.02
|
| Rate for Payer: United Healthcare Commercial |
$1,478.68
|
| Rate for Payer: United Healthcare Medicare |
$619.24
|
|
|
HC SN ACC 2.0 COCR CABLE W/CLAMP
|
Facility
OP
|
$1,844.10
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,715.01 |
| Rate for Payer: Aetna Commercial |
$1,556.42
|
| Rate for Payer: Aetna Medicare |
$608.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$608.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,059.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,152.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$699.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$669.41
|
| Rate for Payer: Cash Price |
$1,143.34
|
| Rate for Payer: Cash Price |
$1,143.34
|
| Rate for Payer: Centivo All Commercial |
$940.49
|
| Rate for Payer: Cigna All Commercial |
$1,591.46
|
| Rate for Payer: CORVEL All Commercial |
$1,715.01
|
| Rate for Payer: Coventry All Commercial |
$1,622.81
|
| Rate for Payer: Encore All Commercial |
$1,697.49
|
| Rate for Payer: Frontpath All Commercial |
$1,696.57
|
| Rate for Payer: Humana ChoiceCare |
$1,592.75
|
| Rate for Payer: Humana Medicare |
$940.49
|
| Rate for Payer: Lucent All Commercial |
$940.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,659.69
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,383.08
|
| Rate for Payer: PHP All Commercial |
$1,398.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$719.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,423.65
|
| Rate for Payer: Signature Care EPO |
$1,530.60
|
| Rate for Payer: Signature Care PPO |
$1,622.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,567.48
|
| Rate for Payer: United Healthcare Commercial |
$1,453.15
|
| Rate for Payer: United Healthcare Medicare |
$608.55
|
|
|
HC SN ACC 2.0 COCR CABLE W/CLAMP
|
Facility
IP
|
$1,844.10
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.08 |
| Max. Negotiated Rate |
$1,715.01 |
| Rate for Payer: Aetna Commercial |
$1,593.30
|
| Rate for Payer: Cash Price |
$1,143.34
|
| Rate for Payer: Cigna All Commercial |
$1,591.46
|
| Rate for Payer: CORVEL All Commercial |
$1,715.01
|
| Rate for Payer: Coventry All Commercial |
$1,622.81
|
| Rate for Payer: Encore All Commercial |
$1,697.49
|
| Rate for Payer: Frontpath All Commercial |
$1,696.57
|
| Rate for Payer: Humana ChoiceCare |
$1,592.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,659.69
|
| Rate for Payer: PHCS All Commercial |
$1,383.08
|
| Rate for Payer: PHP All Commercial |
$1,398.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,423.65
|
| Rate for Payer: Signature Care EPO |
$1,530.60
|
| Rate for Payer: Signature Care PPO |
$1,622.81
|
| Rate for Payer: United Healthcare Commercial |
$1,453.15
|
|
|
HC S NAIL 11X380 T2 SC
|
Facility
OP
|
$9,866.92
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,176.24 |
| Rate for Payer: Aetna Commercial |
$8,327.68
|
| Rate for Payer: Aetna Medicare |
$3,256.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,256.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,666.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,167.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,744.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,581.69
|
| Rate for Payer: Cash Price |
$6,117.49
|
| Rate for Payer: Cash Price |
$6,117.49
|
| Rate for Payer: Centivo All Commercial |
$5,032.13
|
| Rate for Payer: Cigna All Commercial |
$8,515.15
|
| Rate for Payer: CORVEL All Commercial |
$9,176.24
|
| Rate for Payer: Coventry All Commercial |
$8,682.89
|
| Rate for Payer: Encore All Commercial |
$9,082.50
|
| Rate for Payer: Frontpath All Commercial |
$9,077.57
|
| Rate for Payer: Humana ChoiceCare |
$8,522.06
|
| Rate for Payer: Humana Medicare |
$5,032.13
|
| Rate for Payer: Lucent All Commercial |
$5,032.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,880.23
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,400.19
|
| Rate for Payer: PHP All Commercial |
$7,483.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,848.10
|
| Rate for Payer: Sagamore Health Network All Products |
$7,617.26
|
| Rate for Payer: Signature Care EPO |
$8,189.54
|
| Rate for Payer: Signature Care PPO |
$8,682.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,386.88
|
| Rate for Payer: United Healthcare Commercial |
$7,775.13
|
| Rate for Payer: United Healthcare Medicare |
$3,256.08
|
|
|
HC S NAIL 11X380 T2 SC
|
Facility
IP
|
$9,866.92
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,400.19 |
| Max. Negotiated Rate |
$9,176.24 |
| Rate for Payer: Aetna Commercial |
$8,525.02
|
| Rate for Payer: Cash Price |
$6,117.49
|
| Rate for Payer: Cigna All Commercial |
$8,515.15
|
| Rate for Payer: CORVEL All Commercial |
$9,176.24
|
| Rate for Payer: Coventry All Commercial |
$8,682.89
|
| Rate for Payer: Encore All Commercial |
$9,082.50
|
| Rate for Payer: Frontpath All Commercial |
$9,077.57
|
| Rate for Payer: Humana ChoiceCare |
$8,522.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,880.23
|
| Rate for Payer: PHCS All Commercial |
$7,400.19
|
| Rate for Payer: PHP All Commercial |
$7,483.07
|
| Rate for Payer: Sagamore Health Network All Products |
$7,617.26
|
| Rate for Payer: Signature Care EPO |
$8,189.54
|
| Rate for Payer: Signature Care PPO |
$8,682.89
|
| Rate for Payer: United Healthcare Commercial |
$7,775.13
|
|
|
HC SN ANCHOR HEALICOIL 4.75
|
Facility
OP
|
$2,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,990.20 |
| Rate for Payer: Aetna Commercial |
$1,806.16
|
| Rate for Payer: Aetna Medicare |
$706.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$706.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,229.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,337.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$812.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$776.82
|
| Rate for Payer: Cash Price |
$1,326.80
|
| Rate for Payer: Cash Price |
$1,326.80
|
| Rate for Payer: Centivo All Commercial |
$1,091.40
|
| Rate for Payer: Cigna All Commercial |
$1,846.82
|
| Rate for Payer: CORVEL All Commercial |
$1,990.20
|
| Rate for Payer: Coventry All Commercial |
$1,883.20
|
| Rate for Payer: Encore All Commercial |
$1,969.87
|
| Rate for Payer: Frontpath All Commercial |
$1,968.80
|
| Rate for Payer: Humana ChoiceCare |
$1,848.32
|
| Rate for Payer: Humana Medicare |
$1,091.40
|
| Rate for Payer: Lucent All Commercial |
$1,091.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,926.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,605.00
|
| Rate for Payer: PHP All Commercial |
$1,622.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$834.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,652.08
|
| Rate for Payer: Signature Care EPO |
$1,776.20
|
| Rate for Payer: Signature Care PPO |
$1,883.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,819.00
|
| Rate for Payer: United Healthcare Commercial |
$1,686.32
|
| Rate for Payer: United Healthcare Medicare |
$706.20
|
|
|
HC SN ANCHOR HEALICOIL 4.75
|
Facility
IP
|
$2,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,605.00 |
| Max. Negotiated Rate |
$1,990.20 |
| Rate for Payer: Aetna Commercial |
$1,848.96
|
| Rate for Payer: Cash Price |
$1,326.80
|
| Rate for Payer: Cigna All Commercial |
$1,846.82
|
| Rate for Payer: CORVEL All Commercial |
$1,990.20
|
| Rate for Payer: Coventry All Commercial |
$1,883.20
|
| Rate for Payer: Encore All Commercial |
$1,969.87
|
| Rate for Payer: Frontpath All Commercial |
$1,968.80
|
| Rate for Payer: Humana ChoiceCare |
$1,848.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,926.00
|
| Rate for Payer: PHCS All Commercial |
$1,605.00
|
| Rate for Payer: PHP All Commercial |
$1,622.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,652.08
|
| Rate for Payer: Signature Care EPO |
$1,776.20
|
| Rate for Payer: Signature Care PPO |
$1,883.20
|
| Rate for Payer: United Healthcare Commercial |
$1,686.32
|
|
|
HC SN ANCHOR HEALICOIL 5.5
|
Facility
OP
|
$2,410.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,241.30 |
| Rate for Payer: Aetna Commercial |
$2,034.04
|
| Rate for Payer: Aetna Medicare |
$795.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$795.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,384.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,506.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$914.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$874.83
|
| Rate for Payer: Cash Price |
$1,494.20
|
| Rate for Payer: Cash Price |
$1,494.20
|
| Rate for Payer: Centivo All Commercial |
$1,229.10
|
| Rate for Payer: Cigna All Commercial |
$2,079.83
|
| Rate for Payer: CORVEL All Commercial |
$2,241.30
|
| Rate for Payer: Coventry All Commercial |
$2,120.80
|
| Rate for Payer: Encore All Commercial |
$2,218.40
|
| Rate for Payer: Frontpath All Commercial |
$2,217.20
|
| Rate for Payer: Humana ChoiceCare |
$2,081.52
|
| Rate for Payer: Humana Medicare |
$1,229.10
|
| Rate for Payer: Lucent All Commercial |
$1,229.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,169.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,807.50
|
| Rate for Payer: PHP All Commercial |
$1,827.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$939.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,860.52
|
| Rate for Payer: Signature Care EPO |
$2,000.30
|
| Rate for Payer: Signature Care PPO |
$2,120.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,048.50
|
| Rate for Payer: United Healthcare Commercial |
$1,899.08
|
| Rate for Payer: United Healthcare Medicare |
$795.30
|
|
|
HC SN ANCHOR HEALICOIL 5.5
|
Facility
IP
|
$2,410.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.50 |
| Max. Negotiated Rate |
$2,241.30 |
| Rate for Payer: Aetna Commercial |
$2,082.24
|
| Rate for Payer: Cash Price |
$1,494.20
|
| Rate for Payer: Cigna All Commercial |
$2,079.83
|
| Rate for Payer: CORVEL All Commercial |
$2,241.30
|
| Rate for Payer: Coventry All Commercial |
$2,120.80
|
| Rate for Payer: Encore All Commercial |
$2,218.40
|
| Rate for Payer: Frontpath All Commercial |
$2,217.20
|
| Rate for Payer: Humana ChoiceCare |
$2,081.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,169.00
|
| Rate for Payer: PHCS All Commercial |
$1,807.50
|
| Rate for Payer: PHP All Commercial |
$1,827.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,860.52
|
| Rate for Payer: Signature Care EPO |
$2,000.30
|
| Rate for Payer: Signature Care PPO |
$2,120.80
|
| Rate for Payer: United Healthcare Commercial |
$1,899.08
|
|
|
HC SN ANCHOR HEALICOIL 5.5 TRIPLE
|
Facility
OP
|
$2,410.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,241.30 |
| Rate for Payer: Aetna Commercial |
$2,034.04
|
| Rate for Payer: Aetna Medicare |
$795.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$795.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,384.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,506.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$914.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$874.83
|
| Rate for Payer: Cash Price |
$1,494.20
|
| Rate for Payer: Cash Price |
$1,494.20
|
| Rate for Payer: Centivo All Commercial |
$1,229.10
|
| Rate for Payer: Cigna All Commercial |
$2,079.83
|
| Rate for Payer: CORVEL All Commercial |
$2,241.30
|
| Rate for Payer: Coventry All Commercial |
$2,120.80
|
| Rate for Payer: Encore All Commercial |
$2,218.40
|
| Rate for Payer: Frontpath All Commercial |
$2,217.20
|
| Rate for Payer: Humana ChoiceCare |
$2,081.52
|
| Rate for Payer: Humana Medicare |
$1,229.10
|
| Rate for Payer: Lucent All Commercial |
$1,229.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,169.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,807.50
|
| Rate for Payer: PHP All Commercial |
$1,827.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$939.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,860.52
|
| Rate for Payer: Signature Care EPO |
$2,000.30
|
| Rate for Payer: Signature Care PPO |
$2,120.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,048.50
|
| Rate for Payer: United Healthcare Commercial |
$1,899.08
|
| Rate for Payer: United Healthcare Medicare |
$795.30
|
|
|
HC SN ANCHOR HEALICOIL 5.5 TRIPLE
|
Facility
IP
|
$2,410.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.50 |
| Max. Negotiated Rate |
$2,241.30 |
| Rate for Payer: Aetna Commercial |
$2,082.24
|
| Rate for Payer: Cash Price |
$1,494.20
|
| Rate for Payer: Cigna All Commercial |
$2,079.83
|
| Rate for Payer: CORVEL All Commercial |
$2,241.30
|
| Rate for Payer: Coventry All Commercial |
$2,120.80
|
| Rate for Payer: Encore All Commercial |
$2,218.40
|
| Rate for Payer: Frontpath All Commercial |
$2,217.20
|
| Rate for Payer: Humana ChoiceCare |
$2,081.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,169.00
|
| Rate for Payer: PHCS All Commercial |
$1,807.50
|
| Rate for Payer: PHP All Commercial |
$1,827.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,860.52
|
| Rate for Payer: Signature Care EPO |
$2,000.30
|
| Rate for Payer: Signature Care PPO |
$2,120.80
|
| Rate for Payer: United Healthcare Commercial |
$1,899.08
|
|
