|
HC SN CEMENT AB MV RALLY
|
Facility
IP
|
$1,302.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.88 |
| Max. Negotiated Rate |
$1,211.32 |
| Rate for Payer: Aetna Commercial |
$1,125.36
|
| Rate for Payer: Cash Price |
$807.55
|
| Rate for Payer: Cigna All Commercial |
$1,124.06
|
| Rate for Payer: CORVEL All Commercial |
$1,211.32
|
| Rate for Payer: Coventry All Commercial |
$1,146.20
|
| Rate for Payer: Encore All Commercial |
$1,198.95
|
| Rate for Payer: Frontpath All Commercial |
$1,198.30
|
| Rate for Payer: Humana ChoiceCare |
$1,124.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,172.25
|
| Rate for Payer: PHCS All Commercial |
$976.88
|
| Rate for Payer: PHP All Commercial |
$987.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1,005.53
|
| Rate for Payer: Signature Care EPO |
$1,081.08
|
| Rate for Payer: Signature Care PPO |
$1,146.20
|
| Rate for Payer: United Healthcare Commercial |
$1,026.37
|
|
|
HC SN CEMENT AB VERSABOND
|
Facility
OP
|
$1,302.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.82 |
| Max. Negotiated Rate |
$1,211.32 |
| Rate for Payer: Aetna Commercial |
$1,099.31
|
| Rate for Payer: Aetna Medicare |
$429.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$429.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$748.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$814.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$494.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$472.81
|
| Rate for Payer: Cash Price |
$807.55
|
| Rate for Payer: Cash Price |
$807.55
|
| Rate for Payer: Centivo All Commercial |
$664.28
|
| Rate for Payer: Cigna All Commercial |
$1,124.06
|
| Rate for Payer: CORVEL All Commercial |
$1,211.32
|
| Rate for Payer: Coventry All Commercial |
$1,146.20
|
| Rate for Payer: Encore All Commercial |
$1,198.95
|
| Rate for Payer: Frontpath All Commercial |
$1,198.30
|
| Rate for Payer: Humana ChoiceCare |
$1,124.97
|
| Rate for Payer: Humana Medicare |
$664.28
|
| Rate for Payer: Lucent All Commercial |
$664.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,172.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$976.88
|
| Rate for Payer: PHP All Commercial |
$987.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$507.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,005.53
|
| Rate for Payer: Signature Care EPO |
$1,081.08
|
| Rate for Payer: Signature Care PPO |
$1,146.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,107.12
|
| Rate for Payer: United Healthcare Commercial |
$1,026.37
|
| Rate for Payer: United Healthcare Medicare |
$429.82
|
|
|
HC SN CEMENT AB VERSABOND
|
Facility
IP
|
$1,302.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.88 |
| Max. Negotiated Rate |
$1,211.32 |
| Rate for Payer: Aetna Commercial |
$1,125.36
|
| Rate for Payer: Cash Price |
$807.55
|
| Rate for Payer: Cigna All Commercial |
$1,124.06
|
| Rate for Payer: CORVEL All Commercial |
$1,211.32
|
| Rate for Payer: Coventry All Commercial |
$1,146.20
|
| Rate for Payer: Encore All Commercial |
$1,198.95
|
| Rate for Payer: Frontpath All Commercial |
$1,198.30
|
| Rate for Payer: Humana ChoiceCare |
$1,124.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,172.25
|
| Rate for Payer: PHCS All Commercial |
$976.88
|
| Rate for Payer: PHP All Commercial |
$987.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1,005.53
|
| Rate for Payer: Signature Care EPO |
$1,081.08
|
| Rate for Payer: Signature Care PPO |
$1,146.20
|
| Rate for Payer: United Healthcare Commercial |
$1,026.37
|
|
|
HC SN CEMENT VOR VACUUM SYSTEM
|
Facility
OP
|
$892.50
|
|
| Hospital Charge Code |
41601372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.52 |
| Max. Negotiated Rate |
$830.02 |
| Rate for Payer: Aetna Commercial |
$753.27
|
| Rate for Payer: Aetna Medicare |
$294.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$294.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$512.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$557.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$338.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$323.98
|
| Rate for Payer: Cash Price |
$553.35
|
| Rate for Payer: Cash Price |
$553.35
|
| Rate for Payer: Centivo All Commercial |
$455.18
|
| Rate for Payer: Cigna All Commercial |
$770.23
|
| Rate for Payer: CORVEL All Commercial |
$830.02
|
| Rate for Payer: Coventry All Commercial |
$785.40
|
| Rate for Payer: Encore All Commercial |
$821.55
|
| Rate for Payer: Frontpath All Commercial |
$821.10
|
| Rate for Payer: Humana ChoiceCare |
$770.85
|
| Rate for Payer: Humana Medicare |
$455.18
|
| Rate for Payer: Lucent All Commercial |
$455.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$803.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$669.38
|
| Rate for Payer: PHP All Commercial |
$676.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$348.08
|
| Rate for Payer: Sagamore Health Network All Products |
$689.01
|
| Rate for Payer: Signature Care EPO |
$740.78
|
| Rate for Payer: Signature Care PPO |
$785.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$758.62
|
| Rate for Payer: United Healthcare Commercial |
$703.29
|
| Rate for Payer: United Healthcare Medicare |
$294.52
|
|
|
HC SN CEMENT VOR VACUUM SYSTEM
|
Facility
IP
|
$892.50
|
|
| Hospital Charge Code |
41601372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.38 |
| Max. Negotiated Rate |
$830.02 |
| Rate for Payer: Aetna Commercial |
$771.12
|
| Rate for Payer: Cash Price |
$553.35
|
| Rate for Payer: Cigna All Commercial |
$770.23
|
| Rate for Payer: CORVEL All Commercial |
$830.02
|
| Rate for Payer: Coventry All Commercial |
$785.40
|
| Rate for Payer: Encore All Commercial |
$821.55
|
| Rate for Payer: Frontpath All Commercial |
$821.10
|
| Rate for Payer: Humana ChoiceCare |
$770.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$803.25
|
| Rate for Payer: PHCS All Commercial |
$669.38
|
| Rate for Payer: PHP All Commercial |
$676.87
|
| Rate for Payer: Sagamore Health Network All Products |
$689.01
|
| Rate for Payer: Signature Care EPO |
$740.78
|
| Rate for Payer: Signature Care PPO |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$703.29
|
|
|
HC SN DRILL BIT 3.2 X 300 QC
|
Facility
IP
|
$1,372.75
|
|
| Hospital Charge Code |
41603171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,029.56 |
| Max. Negotiated Rate |
$1,276.66 |
| Rate for Payer: Aetna Commercial |
$1,186.06
|
| Rate for Payer: Cash Price |
$851.11
|
| Rate for Payer: Cigna All Commercial |
$1,184.68
|
| Rate for Payer: CORVEL All Commercial |
$1,276.66
|
| Rate for Payer: Coventry All Commercial |
$1,208.02
|
| Rate for Payer: Encore All Commercial |
$1,263.62
|
| Rate for Payer: Frontpath All Commercial |
$1,262.93
|
| Rate for Payer: Humana ChoiceCare |
$1,185.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,235.48
|
| Rate for Payer: PHCS All Commercial |
$1,029.56
|
| Rate for Payer: PHP All Commercial |
$1,041.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,059.76
|
| Rate for Payer: Signature Care EPO |
$1,139.38
|
| Rate for Payer: Signature Care PPO |
$1,208.02
|
| Rate for Payer: United Healthcare Commercial |
$1,081.73
|
|
|
HC SN DRILL BIT 3.2 X 300 QC
|
Facility
OP
|
$1,372.75
|
|
| Hospital Charge Code |
41603171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,276.66 |
| Rate for Payer: Aetna Commercial |
$1,158.60
|
| Rate for Payer: Aetna Medicare |
$453.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$453.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$788.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$858.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$520.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$498.31
|
| Rate for Payer: Cash Price |
$851.11
|
| Rate for Payer: Cash Price |
$851.11
|
| Rate for Payer: Centivo All Commercial |
$700.10
|
| Rate for Payer: Cigna All Commercial |
$1,184.68
|
| Rate for Payer: CORVEL All Commercial |
$1,276.66
|
| Rate for Payer: Coventry All Commercial |
$1,208.02
|
| Rate for Payer: Encore All Commercial |
$1,263.62
|
| Rate for Payer: Frontpath All Commercial |
$1,262.93
|
| Rate for Payer: Humana ChoiceCare |
$1,185.64
|
| Rate for Payer: Humana Medicare |
$700.10
|
| Rate for Payer: Lucent All Commercial |
$700.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,235.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,029.56
|
| Rate for Payer: PHP All Commercial |
$1,041.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$535.37
|
| Rate for Payer: Sagamore Health Network All Products |
$1,059.76
|
| Rate for Payer: Signature Care EPO |
$1,139.38
|
| Rate for Payer: Signature Care PPO |
$1,208.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,166.84
|
| Rate for Payer: United Healthcare Commercial |
$1,081.73
|
| Rate for Payer: United Healthcare Medicare |
$453.01
|
|
|
HC SN DRILL BIT 5.0 CANN
|
Facility
IP
|
$2,512.26
|
|
| Hospital Charge Code |
41603168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,884.20 |
| Max. Negotiated Rate |
$2,336.40 |
| Rate for Payer: Aetna Commercial |
$2,170.59
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cigna All Commercial |
$2,168.08
|
| Rate for Payer: CORVEL All Commercial |
$2,336.40
|
| Rate for Payer: Coventry All Commercial |
$2,210.79
|
| Rate for Payer: Encore All Commercial |
$2,312.54
|
| Rate for Payer: Frontpath All Commercial |
$2,311.28
|
| Rate for Payer: Humana ChoiceCare |
$2,169.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,261.03
|
| Rate for Payer: PHCS All Commercial |
$1,884.20
|
| Rate for Payer: PHP All Commercial |
$1,905.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,939.46
|
| Rate for Payer: Signature Care EPO |
$2,085.18
|
| Rate for Payer: Signature Care PPO |
$2,210.79
|
| Rate for Payer: United Healthcare Commercial |
$1,979.66
|
|
|
HC SN DRILL BIT 5.0 CANN
|
Facility
OP
|
$2,512.26
|
|
| Hospital Charge Code |
41603168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,336.40 |
| Rate for Payer: Aetna Commercial |
$2,120.35
|
| Rate for Payer: Aetna Medicare |
$829.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$829.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,442.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,570.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$953.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$911.95
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Centivo All Commercial |
$1,281.25
|
| Rate for Payer: Cigna All Commercial |
$2,168.08
|
| Rate for Payer: CORVEL All Commercial |
$2,336.40
|
| Rate for Payer: Coventry All Commercial |
$2,210.79
|
| Rate for Payer: Encore All Commercial |
$2,312.54
|
| Rate for Payer: Frontpath All Commercial |
$2,311.28
|
| Rate for Payer: Humana ChoiceCare |
$2,169.84
|
| Rate for Payer: Humana Medicare |
$1,281.25
|
| Rate for Payer: Lucent All Commercial |
$1,281.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,261.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,884.20
|
| Rate for Payer: PHP All Commercial |
$1,905.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$979.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,939.46
|
| Rate for Payer: Signature Care EPO |
$2,085.18
|
| Rate for Payer: Signature Care PPO |
$2,210.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,135.42
|
| Rate for Payer: United Healthcare Commercial |
$1,979.66
|
| Rate for Payer: United Healthcare Medicare |
$829.05
|
|
|
HC SN DRILL BIT 5.2 CANN
|
Facility
OP
|
$2,235.02
|
|
| Hospital Charge Code |
41602936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,078.57 |
| Rate for Payer: Aetna Commercial |
$1,886.36
|
| Rate for Payer: Aetna Medicare |
$737.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$737.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,283.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,397.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$848.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$811.31
|
| Rate for Payer: Cash Price |
$1,385.71
|
| Rate for Payer: Cash Price |
$1,385.71
|
| Rate for Payer: Centivo All Commercial |
$1,139.86
|
| Rate for Payer: Cigna All Commercial |
$1,928.82
|
| Rate for Payer: CORVEL All Commercial |
$2,078.57
|
| Rate for Payer: Coventry All Commercial |
$1,966.82
|
| Rate for Payer: Encore All Commercial |
$2,057.34
|
| Rate for Payer: Frontpath All Commercial |
$2,056.22
|
| Rate for Payer: Humana ChoiceCare |
$1,930.39
|
| Rate for Payer: Humana Medicare |
$1,139.86
|
| Rate for Payer: Lucent All Commercial |
$1,139.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,011.52
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,676.26
|
| Rate for Payer: PHP All Commercial |
$1,695.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$871.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,725.44
|
| Rate for Payer: Signature Care EPO |
$1,855.07
|
| Rate for Payer: Signature Care PPO |
$1,966.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,899.77
|
| Rate for Payer: United Healthcare Commercial |
$1,761.20
|
| Rate for Payer: United Healthcare Medicare |
$737.56
|
|
|
HC SN DRILL BIT 5.2 CANN
|
Facility
IP
|
$2,235.02
|
|
| Hospital Charge Code |
41602936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,676.26 |
| Max. Negotiated Rate |
$2,078.57 |
| Rate for Payer: Aetna Commercial |
$1,931.06
|
| Rate for Payer: Cash Price |
$1,385.71
|
| Rate for Payer: Cigna All Commercial |
$1,928.82
|
| Rate for Payer: CORVEL All Commercial |
$2,078.57
|
| Rate for Payer: Coventry All Commercial |
$1,966.82
|
| Rate for Payer: Encore All Commercial |
$2,057.34
|
| Rate for Payer: Frontpath All Commercial |
$2,056.22
|
| Rate for Payer: Humana ChoiceCare |
$1,930.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,011.52
|
| Rate for Payer: PHCS All Commercial |
$1,676.26
|
| Rate for Payer: PHP All Commercial |
$1,695.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,725.44
|
| Rate for Payer: Signature Care EPO |
$1,855.07
|
| Rate for Payer: Signature Care PPO |
$1,966.82
|
| Rate for Payer: United Healthcare Commercial |
$1,761.20
|
|
|
HC SN DRILL BIT 5.5 CANN
|
Facility
IP
|
$2,512.26
|
|
| Hospital Charge Code |
41603169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,884.20 |
| Max. Negotiated Rate |
$2,336.40 |
| Rate for Payer: Aetna Commercial |
$2,170.59
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cigna All Commercial |
$2,168.08
|
| Rate for Payer: CORVEL All Commercial |
$2,336.40
|
| Rate for Payer: Coventry All Commercial |
$2,210.79
|
| Rate for Payer: Encore All Commercial |
$2,312.54
|
| Rate for Payer: Frontpath All Commercial |
$2,311.28
|
| Rate for Payer: Humana ChoiceCare |
$2,169.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,261.03
|
| Rate for Payer: PHCS All Commercial |
$1,884.20
|
| Rate for Payer: PHP All Commercial |
$1,905.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,939.46
|
| Rate for Payer: Signature Care EPO |
$2,085.18
|
| Rate for Payer: Signature Care PPO |
$2,210.79
|
| Rate for Payer: United Healthcare Commercial |
$1,979.66
|
|
|
HC SN DRILL BIT 5.5 CANN
|
Facility
OP
|
$2,512.26
|
|
| Hospital Charge Code |
41603169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,336.40 |
| Rate for Payer: Aetna Commercial |
$2,120.35
|
| Rate for Payer: Aetna Medicare |
$829.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$829.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,442.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,570.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$953.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$911.95
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Centivo All Commercial |
$1,281.25
|
| Rate for Payer: Cigna All Commercial |
$2,168.08
|
| Rate for Payer: CORVEL All Commercial |
$2,336.40
|
| Rate for Payer: Coventry All Commercial |
$2,210.79
|
| Rate for Payer: Encore All Commercial |
$2,312.54
|
| Rate for Payer: Frontpath All Commercial |
$2,311.28
|
| Rate for Payer: Humana ChoiceCare |
$2,169.84
|
| Rate for Payer: Humana Medicare |
$1,281.25
|
| Rate for Payer: Lucent All Commercial |
$1,281.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,261.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,884.20
|
| Rate for Payer: PHP All Commercial |
$1,905.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$979.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,939.46
|
| Rate for Payer: Signature Care EPO |
$2,085.18
|
| Rate for Payer: Signature Care PPO |
$2,210.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,135.42
|
| Rate for Payer: United Healthcare Commercial |
$1,979.66
|
| Rate for Payer: United Healthcare Medicare |
$829.05
|
|
|
HC SN DRILL BIT PL 3.5
|
Facility
IP
|
$993.86
|
|
| Hospital Charge Code |
41603264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$745.40 |
| Max. Negotiated Rate |
$924.29 |
| Rate for Payer: Aetna Commercial |
$858.70
|
| Rate for Payer: Cash Price |
$616.19
|
| Rate for Payer: Cigna All Commercial |
$857.70
|
| Rate for Payer: CORVEL All Commercial |
$924.29
|
| Rate for Payer: Coventry All Commercial |
$874.60
|
| Rate for Payer: Encore All Commercial |
$914.85
|
| Rate for Payer: Frontpath All Commercial |
$914.35
|
| Rate for Payer: Humana ChoiceCare |
$858.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.47
|
| Rate for Payer: PHCS All Commercial |
$745.40
|
| Rate for Payer: PHP All Commercial |
$753.74
|
| Rate for Payer: Sagamore Health Network All Products |
$767.26
|
| Rate for Payer: Signature Care EPO |
$824.90
|
| Rate for Payer: Signature Care PPO |
$874.60
|
| Rate for Payer: United Healthcare Commercial |
$783.16
|
|
|
HC SN DRILL BIT PL 3.5
|
Facility
OP
|
$993.86
|
|
| Hospital Charge Code |
41603264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$924.29 |
| Rate for Payer: Aetna Commercial |
$838.82
|
| Rate for Payer: Aetna Medicare |
$327.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$327.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.77
|
| Rate for Payer: Cash Price |
$616.19
|
| Rate for Payer: Cash Price |
$616.19
|
| Rate for Payer: Centivo All Commercial |
$506.87
|
| Rate for Payer: Cigna All Commercial |
$857.70
|
| Rate for Payer: CORVEL All Commercial |
$924.29
|
| Rate for Payer: Coventry All Commercial |
$874.60
|
| Rate for Payer: Encore All Commercial |
$914.85
|
| Rate for Payer: Frontpath All Commercial |
$914.35
|
| Rate for Payer: Humana ChoiceCare |
$858.40
|
| Rate for Payer: Humana Medicare |
$506.87
|
| Rate for Payer: Lucent All Commercial |
$506.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$745.40
|
| Rate for Payer: PHP All Commercial |
$753.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.61
|
| Rate for Payer: Sagamore Health Network All Products |
$767.26
|
| Rate for Payer: Signature Care EPO |
$824.90
|
| Rate for Payer: Signature Care PPO |
$874.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.78
|
| Rate for Payer: United Healthcare Commercial |
$783.16
|
| Rate for Payer: United Healthcare Medicare |
$327.97
|
|
|
HC SN DRILL BIT PL 4.5
|
Facility
OP
|
$993.86
|
|
| Hospital Charge Code |
41603265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$924.29 |
| Rate for Payer: Aetna Commercial |
$838.82
|
| Rate for Payer: Aetna Medicare |
$327.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$327.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.77
|
| Rate for Payer: Cash Price |
$616.19
|
| Rate for Payer: Cash Price |
$616.19
|
| Rate for Payer: Centivo All Commercial |
$506.87
|
| Rate for Payer: Cigna All Commercial |
$857.70
|
| Rate for Payer: CORVEL All Commercial |
$924.29
|
| Rate for Payer: Coventry All Commercial |
$874.60
|
| Rate for Payer: Encore All Commercial |
$914.85
|
| Rate for Payer: Frontpath All Commercial |
$914.35
|
| Rate for Payer: Humana ChoiceCare |
$858.40
|
| Rate for Payer: Humana Medicare |
$506.87
|
| Rate for Payer: Lucent All Commercial |
$506.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$745.40
|
| Rate for Payer: PHP All Commercial |
$753.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.61
|
| Rate for Payer: Sagamore Health Network All Products |
$767.26
|
| Rate for Payer: Signature Care EPO |
$824.90
|
| Rate for Payer: Signature Care PPO |
$874.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.78
|
| Rate for Payer: United Healthcare Commercial |
$783.16
|
| Rate for Payer: United Healthcare Medicare |
$327.97
|
|
|
HC SN DRILL BIT PL 4.5
|
Facility
IP
|
$993.86
|
|
| Hospital Charge Code |
41603265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$745.40 |
| Max. Negotiated Rate |
$924.29 |
| Rate for Payer: Aetna Commercial |
$858.70
|
| Rate for Payer: Cash Price |
$616.19
|
| Rate for Payer: Cigna All Commercial |
$857.70
|
| Rate for Payer: CORVEL All Commercial |
$924.29
|
| Rate for Payer: Coventry All Commercial |
$874.60
|
| Rate for Payer: Encore All Commercial |
$914.85
|
| Rate for Payer: Frontpath All Commercial |
$914.35
|
| Rate for Payer: Humana ChoiceCare |
$858.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.47
|
| Rate for Payer: PHCS All Commercial |
$745.40
|
| Rate for Payer: PHP All Commercial |
$753.74
|
| Rate for Payer: Sagamore Health Network All Products |
$767.26
|
| Rate for Payer: Signature Care EPO |
$824.90
|
| Rate for Payer: Signature Care PPO |
$874.60
|
| Rate for Payer: United Healthcare Commercial |
$783.16
|
|
|
HC SN DRILL BIT SHORT 5.0 CANN
|
Facility
OP
|
$2,934.00
|
|
| Hospital Charge Code |
41603172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,728.62 |
| Rate for Payer: Aetna Commercial |
$2,476.30
|
| Rate for Payer: Aetna Medicare |
$968.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$968.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,685.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,834.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,113.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,065.04
|
| Rate for Payer: Cash Price |
$1,819.08
|
| Rate for Payer: Cash Price |
$1,819.08
|
| Rate for Payer: Centivo All Commercial |
$1,496.34
|
| Rate for Payer: Cigna All Commercial |
$2,532.04
|
| Rate for Payer: CORVEL All Commercial |
$2,728.62
|
| Rate for Payer: Coventry All Commercial |
$2,581.92
|
| Rate for Payer: Encore All Commercial |
$2,700.75
|
| Rate for Payer: Frontpath All Commercial |
$2,699.28
|
| Rate for Payer: Humana ChoiceCare |
$2,534.10
|
| Rate for Payer: Humana Medicare |
$1,496.34
|
| Rate for Payer: Lucent All Commercial |
$1,496.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,640.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,200.50
|
| Rate for Payer: PHP All Commercial |
$2,225.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,144.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,265.05
|
| Rate for Payer: Signature Care EPO |
$2,435.22
|
| Rate for Payer: Signature Care PPO |
$2,581.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,493.90
|
| Rate for Payer: United Healthcare Commercial |
$2,311.99
|
| Rate for Payer: United Healthcare Medicare |
$968.22
|
|
|
HC SN DRILL BIT SHORT 5.0 CANN
|
Facility
IP
|
$2,934.00
|
|
| Hospital Charge Code |
41603172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,200.50 |
| Max. Negotiated Rate |
$2,728.62 |
| Rate for Payer: Aetna Commercial |
$2,534.98
|
| Rate for Payer: Cash Price |
$1,819.08
|
| Rate for Payer: Cigna All Commercial |
$2,532.04
|
| Rate for Payer: CORVEL All Commercial |
$2,728.62
|
| Rate for Payer: Coventry All Commercial |
$2,581.92
|
| Rate for Payer: Encore All Commercial |
$2,700.75
|
| Rate for Payer: Frontpath All Commercial |
$2,699.28
|
| Rate for Payer: Humana ChoiceCare |
$2,534.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,640.60
|
| Rate for Payer: PHCS All Commercial |
$2,200.50
|
| Rate for Payer: PHP All Commercial |
$2,225.15
|
| Rate for Payer: Sagamore Health Network All Products |
$2,265.05
|
| Rate for Payer: Signature Care EPO |
$2,435.22
|
| Rate for Payer: Signature Care PPO |
$2,581.92
|
| Rate for Payer: United Healthcare Commercial |
$2,311.99
|
|
|
HC SN ENDOBUTTON CL ULT 20
|
Facility
OP
|
$1,438.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.74 |
| Max. Negotiated Rate |
$1,337.90 |
| Rate for Payer: Aetna Commercial |
$1,214.18
|
| Rate for Payer: Aetna Medicare |
$474.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$474.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$826.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$899.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$545.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$522.21
|
| Rate for Payer: Cash Price |
$891.93
|
| Rate for Payer: Cash Price |
$891.93
|
| Rate for Payer: Centivo All Commercial |
$733.69
|
| Rate for Payer: Cigna All Commercial |
$1,241.51
|
| Rate for Payer: CORVEL All Commercial |
$1,337.90
|
| Rate for Payer: Coventry All Commercial |
$1,265.97
|
| Rate for Payer: Encore All Commercial |
$1,324.23
|
| Rate for Payer: Frontpath All Commercial |
$1,323.51
|
| Rate for Payer: Humana ChoiceCare |
$1,242.52
|
| Rate for Payer: Humana Medicare |
$733.69
|
| Rate for Payer: Lucent All Commercial |
$733.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,294.74
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,078.95
|
| Rate for Payer: PHP All Commercial |
$1,091.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$561.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,110.60
|
| Rate for Payer: Signature Care EPO |
$1,194.04
|
| Rate for Payer: Signature Care PPO |
$1,265.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,222.81
|
| Rate for Payer: United Healthcare Commercial |
$1,133.62
|
| Rate for Payer: United Healthcare Medicare |
$474.74
|
|
|
HC SN ENDOBUTTON CL ULT 20
|
Facility
IP
|
$1,438.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.95 |
| Max. Negotiated Rate |
$1,337.90 |
| Rate for Payer: Aetna Commercial |
$1,242.95
|
| Rate for Payer: Cash Price |
$891.93
|
| Rate for Payer: Cigna All Commercial |
$1,241.51
|
| Rate for Payer: CORVEL All Commercial |
$1,337.90
|
| Rate for Payer: Coventry All Commercial |
$1,265.97
|
| Rate for Payer: Encore All Commercial |
$1,324.23
|
| Rate for Payer: Frontpath All Commercial |
$1,323.51
|
| Rate for Payer: Humana ChoiceCare |
$1,242.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,294.74
|
| Rate for Payer: PHCS All Commercial |
$1,078.95
|
| Rate for Payer: PHP All Commercial |
$1,091.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,110.60
|
| Rate for Payer: Signature Care EPO |
$1,194.04
|
| Rate for Payer: Signature Care PPO |
$1,265.97
|
| Rate for Payer: United Healthcare Commercial |
$1,133.62
|
|
|
HC SN ENDOBUTTON CL ULT 25
|
Facility
IP
|
$1,438.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.95 |
| Max. Negotiated Rate |
$1,337.90 |
| Rate for Payer: Aetna Commercial |
$1,242.95
|
| Rate for Payer: Cash Price |
$891.93
|
| Rate for Payer: Cigna All Commercial |
$1,241.51
|
| Rate for Payer: CORVEL All Commercial |
$1,337.90
|
| Rate for Payer: Coventry All Commercial |
$1,265.97
|
| Rate for Payer: Encore All Commercial |
$1,324.23
|
| Rate for Payer: Frontpath All Commercial |
$1,323.51
|
| Rate for Payer: Humana ChoiceCare |
$1,242.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,294.74
|
| Rate for Payer: PHCS All Commercial |
$1,078.95
|
| Rate for Payer: PHP All Commercial |
$1,091.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,110.60
|
| Rate for Payer: Signature Care EPO |
$1,194.04
|
| Rate for Payer: Signature Care PPO |
$1,265.97
|
| Rate for Payer: United Healthcare Commercial |
$1,133.62
|
|
|
HC SN ENDOBUTTON CL ULT 25
|
Facility
OP
|
$1,438.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.74 |
| Max. Negotiated Rate |
$1,337.90 |
| Rate for Payer: Aetna Commercial |
$1,214.18
|
| Rate for Payer: Aetna Medicare |
$474.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$474.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$826.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$899.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$545.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$522.21
|
| Rate for Payer: Cash Price |
$891.93
|
| Rate for Payer: Cash Price |
$891.93
|
| Rate for Payer: Centivo All Commercial |
$733.69
|
| Rate for Payer: Cigna All Commercial |
$1,241.51
|
| Rate for Payer: CORVEL All Commercial |
$1,337.90
|
| Rate for Payer: Coventry All Commercial |
$1,265.97
|
| Rate for Payer: Encore All Commercial |
$1,324.23
|
| Rate for Payer: Frontpath All Commercial |
$1,323.51
|
| Rate for Payer: Humana ChoiceCare |
$1,242.52
|
| Rate for Payer: Humana Medicare |
$733.69
|
| Rate for Payer: Lucent All Commercial |
$733.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,294.74
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,078.95
|
| Rate for Payer: PHP All Commercial |
$1,091.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$561.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,110.60
|
| Rate for Payer: Signature Care EPO |
$1,194.04
|
| Rate for Payer: Signature Care PPO |
$1,265.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,222.81
|
| Rate for Payer: United Healthcare Commercial |
$1,133.62
|
| Rate for Payer: United Healthcare Medicare |
$474.74
|
|
|
HC SN ENDOBUTTON CL ULT 30
|
Facility
IP
|
$1,438.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.95 |
| Max. Negotiated Rate |
$1,337.90 |
| Rate for Payer: Aetna Commercial |
$1,242.95
|
| Rate for Payer: Cash Price |
$891.93
|
| Rate for Payer: Cigna All Commercial |
$1,241.51
|
| Rate for Payer: CORVEL All Commercial |
$1,337.90
|
| Rate for Payer: Coventry All Commercial |
$1,265.97
|
| Rate for Payer: Encore All Commercial |
$1,324.23
|
| Rate for Payer: Frontpath All Commercial |
$1,323.51
|
| Rate for Payer: Humana ChoiceCare |
$1,242.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,294.74
|
| Rate for Payer: PHCS All Commercial |
$1,078.95
|
| Rate for Payer: PHP All Commercial |
$1,091.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,110.60
|
| Rate for Payer: Signature Care EPO |
$1,194.04
|
| Rate for Payer: Signature Care PPO |
$1,265.97
|
| Rate for Payer: United Healthcare Commercial |
$1,133.62
|
|
|
HC SN ENDOBUTTON CL ULT 30
|
Facility
OP
|
$1,438.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.74 |
| Max. Negotiated Rate |
$1,337.90 |
| Rate for Payer: Aetna Commercial |
$1,214.18
|
| Rate for Payer: Aetna Medicare |
$474.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$474.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$826.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$899.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$545.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$522.21
|
| Rate for Payer: Cash Price |
$891.93
|
| Rate for Payer: Cash Price |
$891.93
|
| Rate for Payer: Centivo All Commercial |
$733.69
|
| Rate for Payer: Cigna All Commercial |
$1,241.51
|
| Rate for Payer: CORVEL All Commercial |
$1,337.90
|
| Rate for Payer: Coventry All Commercial |
$1,265.97
|
| Rate for Payer: Encore All Commercial |
$1,324.23
|
| Rate for Payer: Frontpath All Commercial |
$1,323.51
|
| Rate for Payer: Humana ChoiceCare |
$1,242.52
|
| Rate for Payer: Humana Medicare |
$733.69
|
| Rate for Payer: Lucent All Commercial |
$733.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,294.74
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,078.95
|
| Rate for Payer: PHP All Commercial |
$1,091.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$561.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,110.60
|
| Rate for Payer: Signature Care EPO |
$1,194.04
|
| Rate for Payer: Signature Care PPO |
$1,265.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,222.81
|
| Rate for Payer: United Healthcare Commercial |
$1,133.62
|
| Rate for Payer: United Healthcare Medicare |
$474.74
|
|
