|
HC SN ENDOBUTTON CL ULT PAC 1.2
|
Facility
OP
|
$1,725.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,604.25 |
| Rate for Payer: Aetna Commercial |
$1,455.90
|
| Rate for Payer: Aetna Medicare |
$569.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$569.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$990.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,078.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$654.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$626.18
|
| Rate for Payer: Cash Price |
$1,069.50
|
| Rate for Payer: Cash Price |
$1,069.50
|
| Rate for Payer: Centivo All Commercial |
$879.75
|
| Rate for Payer: Cigna All Commercial |
$1,488.68
|
| Rate for Payer: CORVEL All Commercial |
$1,604.25
|
| Rate for Payer: Coventry All Commercial |
$1,518.00
|
| Rate for Payer: Encore All Commercial |
$1,587.86
|
| Rate for Payer: Frontpath All Commercial |
$1,587.00
|
| Rate for Payer: Humana ChoiceCare |
$1,489.88
|
| Rate for Payer: Humana Medicare |
$879.75
|
| Rate for Payer: Lucent All Commercial |
$879.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,552.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,293.75
|
| Rate for Payer: PHP All Commercial |
$1,308.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$672.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,331.70
|
| Rate for Payer: Signature Care EPO |
$1,431.75
|
| Rate for Payer: Signature Care PPO |
$1,518.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,466.25
|
| Rate for Payer: United Healthcare Commercial |
$1,359.30
|
| Rate for Payer: United Healthcare Medicare |
$569.25
|
|
|
HC SN ENDOBUTTON CL ULT PAC 1.2
|
Facility
IP
|
$1,725.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,293.75 |
| Max. Negotiated Rate |
$1,604.25 |
| Rate for Payer: Aetna Commercial |
$1,490.40
|
| Rate for Payer: Cash Price |
$1,069.50
|
| Rate for Payer: Cigna All Commercial |
$1,488.68
|
| Rate for Payer: CORVEL All Commercial |
$1,604.25
|
| Rate for Payer: Coventry All Commercial |
$1,518.00
|
| Rate for Payer: Encore All Commercial |
$1,587.86
|
| Rate for Payer: Frontpath All Commercial |
$1,587.00
|
| Rate for Payer: Humana ChoiceCare |
$1,489.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,552.50
|
| Rate for Payer: PHCS All Commercial |
$1,293.75
|
| Rate for Payer: PHP All Commercial |
$1,308.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,331.70
|
| Rate for Payer: Signature Care EPO |
$1,431.75
|
| Rate for Payer: Signature Care PPO |
$1,518.00
|
| Rate for Payer: United Healthcare Commercial |
$1,359.30
|
|
|
HC SNF ROOM
|
Facility
IP
|
$1,538.16
|
|
| Hospital Charge Code |
10010029
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,153.62 |
| Max. Negotiated Rate |
$5,584.50 |
| Rate for Payer: Aetna Commercial |
$1,328.97
|
| Rate for Payer: Aetna Medicare |
$3,285.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,285.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,777.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,613.50
|
| Rate for Payer: Cash Price |
$953.66
|
| Rate for Payer: Cash Price |
$953.66
|
| Rate for Payer: Centivo All Commercial |
$3,613.50
|
| Rate for Payer: Cigna All Commercial |
$1,327.43
|
| Rate for Payer: CORVEL All Commercial |
$1,430.49
|
| Rate for Payer: Coventry All Commercial |
$1,353.58
|
| Rate for Payer: Encore All Commercial |
$1,415.88
|
| Rate for Payer: Frontpath All Commercial |
$1,415.11
|
| Rate for Payer: Humana ChoiceCare |
$1,328.51
|
| Rate for Payer: Humana Medicare |
$3,285.00
|
| Rate for Payer: Lucent All Commercial |
$5,584.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,384.34
|
| Rate for Payer: PHCS All Commercial |
$1,153.62
|
| Rate for Payer: PHP All Commercial |
$1,166.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,187.46
|
| Rate for Payer: Signature Care EPO |
$1,276.67
|
| Rate for Payer: Signature Care PPO |
$1,353.58
|
| Rate for Payer: United Healthcare Commercial |
$1,212.07
|
| Rate for Payer: United Healthcare Medicare |
$3,285.00
|
|
|
HC SN GUIDE PIN 3.2 X 300 PT
|
Facility
OP
|
$571.20
|
|
| Hospital Charge Code |
41603170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$531.22 |
| Rate for Payer: Aetna Commercial |
$482.09
|
| Rate for Payer: Aetna Medicare |
$188.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$188.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$328.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$357.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$216.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$207.35
|
| Rate for Payer: Cash Price |
$354.14
|
| Rate for Payer: Cash Price |
$354.14
|
| Rate for Payer: Centivo All Commercial |
$291.31
|
| Rate for Payer: Cigna All Commercial |
$492.95
|
| Rate for Payer: CORVEL All Commercial |
$531.22
|
| Rate for Payer: Coventry All Commercial |
$502.66
|
| Rate for Payer: Encore All Commercial |
$525.79
|
| Rate for Payer: Frontpath All Commercial |
$525.50
|
| Rate for Payer: Humana ChoiceCare |
$493.35
|
| Rate for Payer: Humana Medicare |
$291.31
|
| Rate for Payer: Lucent All Commercial |
$291.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$514.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$428.40
|
| Rate for Payer: PHP All Commercial |
$433.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$222.77
|
| Rate for Payer: Sagamore Health Network All Products |
$440.97
|
| Rate for Payer: Signature Care EPO |
$474.10
|
| Rate for Payer: Signature Care PPO |
$502.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$485.52
|
| Rate for Payer: United Healthcare Commercial |
$450.11
|
| Rate for Payer: United Healthcare Medicare |
$188.50
|
|
|
HC SN GUIDE PIN 3.2 X 300 PT
|
Facility
IP
|
$571.20
|
|
| Hospital Charge Code |
41603170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$531.22 |
| Rate for Payer: Aetna Commercial |
$493.52
|
| Rate for Payer: Cash Price |
$354.14
|
| Rate for Payer: Cigna All Commercial |
$492.95
|
| Rate for Payer: CORVEL All Commercial |
$531.22
|
| Rate for Payer: Coventry All Commercial |
$502.66
|
| Rate for Payer: Encore All Commercial |
$525.79
|
| Rate for Payer: Frontpath All Commercial |
$525.50
|
| Rate for Payer: Humana ChoiceCare |
$493.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$514.08
|
| Rate for Payer: PHCS All Commercial |
$428.40
|
| Rate for Payer: PHP All Commercial |
$433.20
|
| Rate for Payer: Sagamore Health Network All Products |
$440.97
|
| Rate for Payer: Signature Care EPO |
$474.10
|
| Rate for Payer: Signature Care PPO |
$502.66
|
| Rate for Payer: United Healthcare Commercial |
$450.11
|
|
|
HC SN GUID PIN 3.2 X 300
|
Facility
OP
|
$264.39
|
|
| Hospital Charge Code |
41602937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.25 |
| Max. Negotiated Rate |
$245.88 |
| Rate for Payer: Aetna Commercial |
$223.15
|
| Rate for Payer: Aetna Medicare |
$87.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$151.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.97
|
| Rate for Payer: Cash Price |
$163.92
|
| Rate for Payer: Cash Price |
$163.92
|
| Rate for Payer: Centivo All Commercial |
$134.84
|
| Rate for Payer: Cigna All Commercial |
$228.17
|
| Rate for Payer: CORVEL All Commercial |
$245.88
|
| Rate for Payer: Coventry All Commercial |
$232.66
|
| Rate for Payer: Encore All Commercial |
$243.37
|
| Rate for Payer: Frontpath All Commercial |
$243.24
|
| Rate for Payer: Humana ChoiceCare |
$228.35
|
| Rate for Payer: Humana Medicare |
$134.84
|
| Rate for Payer: Lucent All Commercial |
$134.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$198.29
|
| Rate for Payer: PHP All Commercial |
$200.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.11
|
| Rate for Payer: Sagamore Health Network All Products |
$204.11
|
| Rate for Payer: Signature Care EPO |
$219.44
|
| Rate for Payer: Signature Care PPO |
$232.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$224.73
|
| Rate for Payer: United Healthcare Commercial |
$208.34
|
| Rate for Payer: United Healthcare Medicare |
$87.25
|
|
|
HC SN GUID PIN 3.2 X 300
|
Facility
IP
|
$264.39
|
|
| Hospital Charge Code |
41602937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.29 |
| Max. Negotiated Rate |
$245.88 |
| Rate for Payer: Aetna Commercial |
$228.43
|
| Rate for Payer: Cash Price |
$163.92
|
| Rate for Payer: Cigna All Commercial |
$228.17
|
| Rate for Payer: CORVEL All Commercial |
$245.88
|
| Rate for Payer: Coventry All Commercial |
$232.66
|
| Rate for Payer: Encore All Commercial |
$243.37
|
| Rate for Payer: Frontpath All Commercial |
$243.24
|
| Rate for Payer: Humana ChoiceCare |
$228.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.95
|
| Rate for Payer: PHCS All Commercial |
$198.29
|
| Rate for Payer: PHP All Commercial |
$200.51
|
| Rate for Payer: Sagamore Health Network All Products |
$204.11
|
| Rate for Payer: Signature Care EPO |
$219.44
|
| Rate for Payer: Signature Care PPO |
$232.66
|
| Rate for Payer: United Healthcare Commercial |
$208.34
|
|
|
HC SN HEWSON SUTURE RETRIEVER
|
Facility
IP
|
$983.30
|
|
| Hospital Charge Code |
41603952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$737.48 |
| Max. Negotiated Rate |
$914.47 |
| Rate for Payer: Aetna Commercial |
$849.57
|
| Rate for Payer: Cash Price |
$609.65
|
| Rate for Payer: Cigna All Commercial |
$848.59
|
| Rate for Payer: CORVEL All Commercial |
$914.47
|
| Rate for Payer: Coventry All Commercial |
$865.30
|
| Rate for Payer: Encore All Commercial |
$905.13
|
| Rate for Payer: Frontpath All Commercial |
$904.64
|
| Rate for Payer: Humana ChoiceCare |
$849.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$884.97
|
| Rate for Payer: PHCS All Commercial |
$737.48
|
| Rate for Payer: PHP All Commercial |
$745.73
|
| Rate for Payer: Sagamore Health Network All Products |
$759.11
|
| Rate for Payer: Signature Care EPO |
$816.14
|
| Rate for Payer: Signature Care PPO |
$865.30
|
| Rate for Payer: United Healthcare Commercial |
$774.84
|
|
|
HC SN HEWSON SUTURE RETRIEVER
|
Facility
OP
|
$983.30
|
|
| Hospital Charge Code |
41603952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$914.47 |
| Rate for Payer: Aetna Commercial |
$829.91
|
| Rate for Payer: Aetna Medicare |
$324.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$324.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$564.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$614.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$373.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$356.94
|
| Rate for Payer: Cash Price |
$609.65
|
| Rate for Payer: Cash Price |
$609.65
|
| Rate for Payer: Centivo All Commercial |
$501.48
|
| Rate for Payer: Cigna All Commercial |
$848.59
|
| Rate for Payer: CORVEL All Commercial |
$914.47
|
| Rate for Payer: Coventry All Commercial |
$865.30
|
| Rate for Payer: Encore All Commercial |
$905.13
|
| Rate for Payer: Frontpath All Commercial |
$904.64
|
| Rate for Payer: Humana ChoiceCare |
$849.28
|
| Rate for Payer: Humana Medicare |
$501.48
|
| Rate for Payer: Lucent All Commercial |
$501.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$884.97
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$737.48
|
| Rate for Payer: PHP All Commercial |
$745.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$383.49
|
| Rate for Payer: Sagamore Health Network All Products |
$759.11
|
| Rate for Payer: Signature Care EPO |
$816.14
|
| Rate for Payer: Signature Care PPO |
$865.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$835.80
|
| Rate for Payer: United Healthcare Commercial |
$774.84
|
| Rate for Payer: United Healthcare Medicare |
$324.49
|
|
|
HC SN INVIS DISTAL CENTRALIZER 10
|
Facility
OP
|
$1,275.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.75 |
| Max. Negotiated Rate |
$1,185.75 |
| Rate for Payer: Aetna Commercial |
$1,076.10
|
| Rate for Payer: Aetna Medicare |
$420.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$420.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$732.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$797.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$483.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$462.82
|
| Rate for Payer: Cash Price |
$790.50
|
| Rate for Payer: Cash Price |
$790.50
|
| Rate for Payer: Centivo All Commercial |
$650.25
|
| Rate for Payer: Cigna All Commercial |
$1,100.32
|
| Rate for Payer: CORVEL All Commercial |
$1,185.75
|
| Rate for Payer: Coventry All Commercial |
$1,122.00
|
| Rate for Payer: Encore All Commercial |
$1,173.64
|
| Rate for Payer: Frontpath All Commercial |
$1,173.00
|
| Rate for Payer: Humana ChoiceCare |
$1,101.22
|
| Rate for Payer: Humana Medicare |
$650.25
|
| Rate for Payer: Lucent All Commercial |
$650.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,147.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$956.25
|
| Rate for Payer: PHP All Commercial |
$966.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$497.25
|
| Rate for Payer: Sagamore Health Network All Products |
$984.30
|
| Rate for Payer: Signature Care EPO |
$1,058.25
|
| Rate for Payer: Signature Care PPO |
$1,122.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,083.75
|
| Rate for Payer: United Healthcare Commercial |
$1,004.70
|
| Rate for Payer: United Healthcare Medicare |
$420.75
|
|
|
HC SN INVIS DISTAL CENTRALIZER 10
|
Facility
IP
|
$1,275.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.25 |
| Max. Negotiated Rate |
$1,185.75 |
| Rate for Payer: Aetna Commercial |
$1,101.60
|
| Rate for Payer: Cash Price |
$790.50
|
| Rate for Payer: Cigna All Commercial |
$1,100.32
|
| Rate for Payer: CORVEL All Commercial |
$1,185.75
|
| Rate for Payer: Coventry All Commercial |
$1,122.00
|
| Rate for Payer: Encore All Commercial |
$1,173.64
|
| Rate for Payer: Frontpath All Commercial |
$1,173.00
|
| Rate for Payer: Humana ChoiceCare |
$1,101.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,147.50
|
| Rate for Payer: PHCS All Commercial |
$956.25
|
| Rate for Payer: PHP All Commercial |
$966.96
|
| Rate for Payer: Sagamore Health Network All Products |
$984.30
|
| Rate for Payer: Signature Care EPO |
$1,058.25
|
| Rate for Payer: Signature Care PPO |
$1,122.00
|
| Rate for Payer: United Healthcare Commercial |
$1,004.70
|
|
|
HC SN INVIS DISTAL CENTRALIZER 12
|
Facility
OP
|
$1,355.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.15 |
| Max. Negotiated Rate |
$1,260.15 |
| Rate for Payer: Aetna Commercial |
$1,143.62
|
| Rate for Payer: Aetna Medicare |
$447.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$447.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$778.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$847.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$514.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$491.86
|
| Rate for Payer: Cash Price |
$840.10
|
| Rate for Payer: Cash Price |
$840.10
|
| Rate for Payer: Centivo All Commercial |
$691.05
|
| Rate for Payer: Cigna All Commercial |
$1,169.36
|
| Rate for Payer: CORVEL All Commercial |
$1,260.15
|
| Rate for Payer: Coventry All Commercial |
$1,192.40
|
| Rate for Payer: Encore All Commercial |
$1,247.28
|
| Rate for Payer: Frontpath All Commercial |
$1,246.60
|
| Rate for Payer: Humana ChoiceCare |
$1,170.31
|
| Rate for Payer: Humana Medicare |
$691.05
|
| Rate for Payer: Lucent All Commercial |
$691.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,219.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,016.25
|
| Rate for Payer: PHP All Commercial |
$1,027.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$528.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,046.06
|
| Rate for Payer: Signature Care EPO |
$1,124.65
|
| Rate for Payer: Signature Care PPO |
$1,192.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,151.75
|
| Rate for Payer: United Healthcare Commercial |
$1,067.74
|
| Rate for Payer: United Healthcare Medicare |
$447.15
|
|
|
HC SN INVIS DISTAL CENTRALIZER 12
|
Facility
IP
|
$1,355.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.25 |
| Max. Negotiated Rate |
$1,260.15 |
| Rate for Payer: Aetna Commercial |
$1,170.72
|
| Rate for Payer: Cash Price |
$840.10
|
| Rate for Payer: Cigna All Commercial |
$1,169.36
|
| Rate for Payer: CORVEL All Commercial |
$1,260.15
|
| Rate for Payer: Coventry All Commercial |
$1,192.40
|
| Rate for Payer: Encore All Commercial |
$1,247.28
|
| Rate for Payer: Frontpath All Commercial |
$1,246.60
|
| Rate for Payer: Humana ChoiceCare |
$1,170.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,219.50
|
| Rate for Payer: PHCS All Commercial |
$1,016.25
|
| Rate for Payer: PHP All Commercial |
$1,027.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1,046.06
|
| Rate for Payer: Signature Care EPO |
$1,124.65
|
| Rate for Payer: Signature Care PPO |
$1,192.40
|
| Rate for Payer: United Healthcare Commercial |
$1,067.74
|
|
|
HC SN INVIS DISTAL CENTRALIZER 8
|
Facility
OP
|
$1,355.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.15 |
| Max. Negotiated Rate |
$1,260.15 |
| Rate for Payer: Aetna Commercial |
$1,143.62
|
| Rate for Payer: Aetna Medicare |
$447.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$447.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$778.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$847.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$514.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$491.86
|
| Rate for Payer: Cash Price |
$840.10
|
| Rate for Payer: Cash Price |
$840.10
|
| Rate for Payer: Centivo All Commercial |
$691.05
|
| Rate for Payer: Cigna All Commercial |
$1,169.36
|
| Rate for Payer: CORVEL All Commercial |
$1,260.15
|
| Rate for Payer: Coventry All Commercial |
$1,192.40
|
| Rate for Payer: Encore All Commercial |
$1,247.28
|
| Rate for Payer: Frontpath All Commercial |
$1,246.60
|
| Rate for Payer: Humana ChoiceCare |
$1,170.31
|
| Rate for Payer: Humana Medicare |
$691.05
|
| Rate for Payer: Lucent All Commercial |
$691.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,219.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,016.25
|
| Rate for Payer: PHP All Commercial |
$1,027.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$528.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,046.06
|
| Rate for Payer: Signature Care EPO |
$1,124.65
|
| Rate for Payer: Signature Care PPO |
$1,192.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,151.75
|
| Rate for Payer: United Healthcare Commercial |
$1,067.74
|
| Rate for Payer: United Healthcare Medicare |
$447.15
|
|
|
HC SN INVIS DISTAL CENTRALIZER 8
|
Facility
IP
|
$1,355.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.25 |
| Max. Negotiated Rate |
$1,260.15 |
| Rate for Payer: Aetna Commercial |
$1,170.72
|
| Rate for Payer: Cash Price |
$840.10
|
| Rate for Payer: Cigna All Commercial |
$1,169.36
|
| Rate for Payer: CORVEL All Commercial |
$1,260.15
|
| Rate for Payer: Coventry All Commercial |
$1,192.40
|
| Rate for Payer: Encore All Commercial |
$1,247.28
|
| Rate for Payer: Frontpath All Commercial |
$1,246.60
|
| Rate for Payer: Humana ChoiceCare |
$1,170.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,219.50
|
| Rate for Payer: PHCS All Commercial |
$1,016.25
|
| Rate for Payer: PHP All Commercial |
$1,027.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1,046.06
|
| Rate for Payer: Signature Care EPO |
$1,124.65
|
| Rate for Payer: Signature Care PPO |
$1,192.40
|
| Rate for Payer: United Healthcare Commercial |
$1,067.74
|
|
|
HC SN KIT TOTAL HIP PREP-IM
|
Facility
OP
|
$2,335.00
|
|
| Hospital Charge Code |
41602468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,171.55 |
| Rate for Payer: Aetna Commercial |
$1,970.74
|
| Rate for Payer: Aetna Medicare |
$770.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$770.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,340.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,459.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$886.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$847.60
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Centivo All Commercial |
$1,190.85
|
| Rate for Payer: Cigna All Commercial |
$2,015.10
|
| Rate for Payer: CORVEL All Commercial |
$2,171.55
|
| Rate for Payer: Coventry All Commercial |
$2,054.80
|
| Rate for Payer: Encore All Commercial |
$2,149.37
|
| Rate for Payer: Frontpath All Commercial |
$2,148.20
|
| Rate for Payer: Humana ChoiceCare |
$2,016.74
|
| Rate for Payer: Humana Medicare |
$1,190.85
|
| Rate for Payer: Lucent All Commercial |
$1,190.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,101.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,751.25
|
| Rate for Payer: PHP All Commercial |
$1,770.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$910.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,802.62
|
| Rate for Payer: Signature Care EPO |
$1,938.05
|
| Rate for Payer: Signature Care PPO |
$2,054.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,984.75
|
| Rate for Payer: United Healthcare Commercial |
$1,839.98
|
| Rate for Payer: United Healthcare Medicare |
$770.55
|
|
|
HC SN KIT TOTAL HIP PREP-IM
|
Facility
IP
|
$2,335.00
|
|
| Hospital Charge Code |
41602468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,751.25 |
| Max. Negotiated Rate |
$2,171.55 |
| Rate for Payer: Aetna Commercial |
$2,017.44
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Cigna All Commercial |
$2,015.10
|
| Rate for Payer: CORVEL All Commercial |
$2,171.55
|
| Rate for Payer: Coventry All Commercial |
$2,054.80
|
| Rate for Payer: Encore All Commercial |
$2,149.37
|
| Rate for Payer: Frontpath All Commercial |
$2,148.20
|
| Rate for Payer: Humana ChoiceCare |
$2,016.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,101.50
|
| Rate for Payer: PHCS All Commercial |
$1,751.25
|
| Rate for Payer: PHP All Commercial |
$1,770.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,802.62
|
| Rate for Payer: Signature Care EPO |
$1,938.05
|
| Rate for Payer: Signature Care PPO |
$2,054.80
|
| Rate for Payer: United Healthcare Commercial |
$1,839.98
|
|
|
HC SN K WIRE .045 4IN DT
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$354.48
|
| Rate for Payer: Aetna Medicare |
$138.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.46
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Centivo All Commercial |
$214.20
|
| Rate for Payer: Cigna All Commercial |
$362.46
|
| Rate for Payer: CORVEL All Commercial |
$390.60
|
| Rate for Payer: Coventry All Commercial |
$369.60
|
| Rate for Payer: Encore All Commercial |
$386.61
|
| Rate for Payer: Frontpath All Commercial |
$386.40
|
| Rate for Payer: Humana ChoiceCare |
$362.75
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Lucent All Commercial |
$214.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$315.00
|
| Rate for Payer: PHP All Commercial |
$318.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$163.80
|
| Rate for Payer: Sagamore Health Network All Products |
$324.24
|
| Rate for Payer: Signature Care EPO |
$348.60
|
| Rate for Payer: Signature Care PPO |
$369.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.00
|
| Rate for Payer: United Healthcare Commercial |
$330.96
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
|
|
HC SN K WIRE .045 4IN DT
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Aetna Commercial |
$362.88
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna All Commercial |
$362.46
|
| Rate for Payer: CORVEL All Commercial |
$390.60
|
| Rate for Payer: Coventry All Commercial |
$369.60
|
| Rate for Payer: Encore All Commercial |
$386.61
|
| Rate for Payer: Frontpath All Commercial |
$386.40
|
| Rate for Payer: Humana ChoiceCare |
$362.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: PHCS All Commercial |
$315.00
|
| Rate for Payer: PHP All Commercial |
$318.53
|
| Rate for Payer: Sagamore Health Network All Products |
$324.24
|
| Rate for Payer: Signature Care EPO |
$348.60
|
| Rate for Payer: Signature Care PPO |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$330.96
|
|
|
HC SN K WIRE .045 6IN DT
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Aetna Commercial |
$362.88
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna All Commercial |
$362.46
|
| Rate for Payer: CORVEL All Commercial |
$390.60
|
| Rate for Payer: Coventry All Commercial |
$369.60
|
| Rate for Payer: Encore All Commercial |
$386.61
|
| Rate for Payer: Frontpath All Commercial |
$386.40
|
| Rate for Payer: Humana ChoiceCare |
$362.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: PHCS All Commercial |
$315.00
|
| Rate for Payer: PHP All Commercial |
$318.53
|
| Rate for Payer: Sagamore Health Network All Products |
$324.24
|
| Rate for Payer: Signature Care EPO |
$348.60
|
| Rate for Payer: Signature Care PPO |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$330.96
|
|
|
HC SN K WIRE .045 6IN DT
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$354.48
|
| Rate for Payer: Aetna Medicare |
$138.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.46
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Centivo All Commercial |
$214.20
|
| Rate for Payer: Cigna All Commercial |
$362.46
|
| Rate for Payer: CORVEL All Commercial |
$390.60
|
| Rate for Payer: Coventry All Commercial |
$369.60
|
| Rate for Payer: Encore All Commercial |
$386.61
|
| Rate for Payer: Frontpath All Commercial |
$386.40
|
| Rate for Payer: Humana ChoiceCare |
$362.75
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Lucent All Commercial |
$214.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$315.00
|
| Rate for Payer: PHP All Commercial |
$318.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$163.80
|
| Rate for Payer: Sagamore Health Network All Products |
$324.24
|
| Rate for Payer: Signature Care EPO |
$348.60
|
| Rate for Payer: Signature Care PPO |
$369.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.00
|
| Rate for Payer: United Healthcare Commercial |
$330.96
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
|
|
HC SN K WIRE .054 4IN DT
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Aetna Commercial |
$362.88
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna All Commercial |
$362.46
|
| Rate for Payer: CORVEL All Commercial |
$390.60
|
| Rate for Payer: Coventry All Commercial |
$369.60
|
| Rate for Payer: Encore All Commercial |
$386.61
|
| Rate for Payer: Frontpath All Commercial |
$386.40
|
| Rate for Payer: Humana ChoiceCare |
$362.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: PHCS All Commercial |
$315.00
|
| Rate for Payer: PHP All Commercial |
$318.53
|
| Rate for Payer: Sagamore Health Network All Products |
$324.24
|
| Rate for Payer: Signature Care EPO |
$348.60
|
| Rate for Payer: Signature Care PPO |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$330.96
|
|
|
HC SN K WIRE .054 4IN DT
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$354.48
|
| Rate for Payer: Aetna Medicare |
$138.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.46
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Centivo All Commercial |
$214.20
|
| Rate for Payer: Cigna All Commercial |
$362.46
|
| Rate for Payer: CORVEL All Commercial |
$390.60
|
| Rate for Payer: Coventry All Commercial |
$369.60
|
| Rate for Payer: Encore All Commercial |
$386.61
|
| Rate for Payer: Frontpath All Commercial |
$386.40
|
| Rate for Payer: Humana ChoiceCare |
$362.75
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Lucent All Commercial |
$214.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$315.00
|
| Rate for Payer: PHP All Commercial |
$318.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$163.80
|
| Rate for Payer: Sagamore Health Network All Products |
$324.24
|
| Rate for Payer: Signature Care EPO |
$348.60
|
| Rate for Payer: Signature Care PPO |
$369.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.00
|
| Rate for Payer: United Healthcare Commercial |
$330.96
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
|
|
HC SN K WIRE .054 6IN DT
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$354.48
|
| Rate for Payer: Aetna Medicare |
$138.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.46
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Centivo All Commercial |
$214.20
|
| Rate for Payer: Cigna All Commercial |
$362.46
|
| Rate for Payer: CORVEL All Commercial |
$390.60
|
| Rate for Payer: Coventry All Commercial |
$369.60
|
| Rate for Payer: Encore All Commercial |
$386.61
|
| Rate for Payer: Frontpath All Commercial |
$386.40
|
| Rate for Payer: Humana ChoiceCare |
$362.75
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Lucent All Commercial |
$214.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$315.00
|
| Rate for Payer: PHP All Commercial |
$318.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$163.80
|
| Rate for Payer: Sagamore Health Network All Products |
$324.24
|
| Rate for Payer: Signature Care EPO |
$348.60
|
| Rate for Payer: Signature Care PPO |
$369.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.00
|
| Rate for Payer: United Healthcare Commercial |
$330.96
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
|
|
HC SN K WIRE .054 6IN DT
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Aetna Commercial |
$362.88
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna All Commercial |
$362.46
|
| Rate for Payer: CORVEL All Commercial |
$390.60
|
| Rate for Payer: Coventry All Commercial |
$369.60
|
| Rate for Payer: Encore All Commercial |
$386.61
|
| Rate for Payer: Frontpath All Commercial |
$386.40
|
| Rate for Payer: Humana ChoiceCare |
$362.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: PHCS All Commercial |
$315.00
|
| Rate for Payer: PHP All Commercial |
$318.53
|
| Rate for Payer: Sagamore Health Network All Products |
$324.24
|
| Rate for Payer: Signature Care EPO |
$348.60
|
| Rate for Payer: Signature Care PPO |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$330.96
|
|
