|
HC SN K WIRE .062 4IN DT
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603107
|
|
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 .062 4IN DT
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603107
|
|
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 .062 6IN DT
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603108
|
|
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 .062 6IN DT
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603108
|
|
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 .062 X 4 IN ST
|
Facility
OP
|
$70.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$59.08
|
| Rate for Payer: Aetna Medicare |
$23.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.41
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Centivo All Commercial |
$35.70
|
| Rate for Payer: Cigna All Commercial |
$60.41
|
| Rate for Payer: CORVEL All Commercial |
$65.10
|
| Rate for Payer: Coventry All Commercial |
$61.60
|
| Rate for Payer: Encore All Commercial |
$64.44
|
| Rate for Payer: Frontpath All Commercial |
$64.40
|
| Rate for Payer: Humana ChoiceCare |
$60.46
|
| Rate for Payer: Humana Medicare |
$35.70
|
| Rate for Payer: Lucent All Commercial |
$35.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$52.50
|
| Rate for Payer: PHP All Commercial |
$53.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.30
|
| Rate for Payer: Sagamore Health Network All Products |
$54.04
|
| Rate for Payer: Signature Care EPO |
$58.10
|
| Rate for Payer: Signature Care PPO |
$61.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$55.16
|
| Rate for Payer: United Healthcare Medicare |
$23.10
|
|
|
HC SN K-WIRE .062 X 4 IN ST
|
Facility
IP
|
$70.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$60.48
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cigna All Commercial |
$60.41
|
| Rate for Payer: CORVEL All Commercial |
$65.10
|
| Rate for Payer: Coventry All Commercial |
$61.60
|
| Rate for Payer: Encore All Commercial |
$64.44
|
| Rate for Payer: Frontpath All Commercial |
$64.40
|
| Rate for Payer: Humana ChoiceCare |
$60.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: PHCS All Commercial |
$52.50
|
| Rate for Payer: PHP All Commercial |
$53.09
|
| Rate for Payer: Sagamore Health Network All Products |
$54.04
|
| Rate for Payer: Signature Care EPO |
$58.10
|
| Rate for Payer: Signature Care PPO |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$55.16
|
|
|
HC SN K WIRE PL 2.0MM
|
Facility
IP
|
$237.02
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.76 |
| Max. Negotiated Rate |
$220.43 |
| Rate for Payer: Aetna Commercial |
$204.79
|
| Rate for Payer: Cash Price |
$146.95
|
| Rate for Payer: Cigna All Commercial |
$204.55
|
| Rate for Payer: CORVEL All Commercial |
$220.43
|
| Rate for Payer: Coventry All Commercial |
$208.58
|
| Rate for Payer: Encore All Commercial |
$218.18
|
| Rate for Payer: Frontpath All Commercial |
$218.06
|
| Rate for Payer: Humana ChoiceCare |
$204.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.32
|
| Rate for Payer: PHCS All Commercial |
$177.76
|
| Rate for Payer: PHP All Commercial |
$179.76
|
| Rate for Payer: Sagamore Health Network All Products |
$182.98
|
| Rate for Payer: Signature Care EPO |
$196.73
|
| Rate for Payer: Signature Care PPO |
$208.58
|
| Rate for Payer: United Healthcare Commercial |
$186.77
|
|
|
HC SN K WIRE PL 2.0MM
|
Facility
OP
|
$237.02
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.22 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$200.04
|
| Rate for Payer: Aetna Medicare |
$78.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.04
|
| Rate for Payer: Cash Price |
$146.95
|
| Rate for Payer: Cash Price |
$146.95
|
| Rate for Payer: Centivo All Commercial |
$120.88
|
| Rate for Payer: Cigna All Commercial |
$204.55
|
| Rate for Payer: CORVEL All Commercial |
$220.43
|
| Rate for Payer: Coventry All Commercial |
$208.58
|
| Rate for Payer: Encore All Commercial |
$218.18
|
| Rate for Payer: Frontpath All Commercial |
$218.06
|
| Rate for Payer: Humana ChoiceCare |
$204.71
|
| Rate for Payer: Humana Medicare |
$120.88
|
| Rate for Payer: Lucent All Commercial |
$120.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$177.76
|
| Rate for Payer: PHP All Commercial |
$179.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.44
|
| Rate for Payer: Sagamore Health Network All Products |
$182.98
|
| Rate for Payer: Signature Care EPO |
$196.73
|
| Rate for Payer: Signature Care PPO |
$208.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$201.47
|
| Rate for Payer: United Healthcare Commercial |
$186.77
|
| Rate for Payer: United Healthcare Medicare |
$78.22
|
|
|
HC SN PASSING DRILL TIP 2.4X381
|
Facility
IP
|
$631.82
|
|
| Hospital Charge Code |
41603392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.86 |
| Max. Negotiated Rate |
$587.59 |
| Rate for Payer: Aetna Commercial |
$545.89
|
| Rate for Payer: Cash Price |
$391.73
|
| Rate for Payer: Cigna All Commercial |
$545.26
|
| Rate for Payer: CORVEL All Commercial |
$587.59
|
| Rate for Payer: Coventry All Commercial |
$556.00
|
| Rate for Payer: Encore All Commercial |
$581.59
|
| Rate for Payer: Frontpath All Commercial |
$581.27
|
| Rate for Payer: Humana ChoiceCare |
$545.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$568.64
|
| Rate for Payer: PHCS All Commercial |
$473.86
|
| Rate for Payer: PHP All Commercial |
$479.17
|
| Rate for Payer: Sagamore Health Network All Products |
$487.77
|
| Rate for Payer: Signature Care EPO |
$524.41
|
| Rate for Payer: Signature Care PPO |
$556.00
|
| Rate for Payer: United Healthcare Commercial |
$497.87
|
|
|
HC SN PASSING DRILL TIP 2.4X381
|
Facility
OP
|
$631.82
|
|
| Hospital Charge Code |
41603392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$587.59 |
| Rate for Payer: Aetna Commercial |
$533.26
|
| Rate for Payer: Aetna Medicare |
$208.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$208.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$362.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$394.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$239.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$229.35
|
| Rate for Payer: Cash Price |
$391.73
|
| Rate for Payer: Cash Price |
$391.73
|
| Rate for Payer: Centivo All Commercial |
$322.23
|
| Rate for Payer: Cigna All Commercial |
$545.26
|
| Rate for Payer: CORVEL All Commercial |
$587.59
|
| Rate for Payer: Coventry All Commercial |
$556.00
|
| Rate for Payer: Encore All Commercial |
$581.59
|
| Rate for Payer: Frontpath All Commercial |
$581.27
|
| Rate for Payer: Humana ChoiceCare |
$545.70
|
| Rate for Payer: Humana Medicare |
$322.23
|
| Rate for Payer: Lucent All Commercial |
$322.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$568.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$473.86
|
| Rate for Payer: PHP All Commercial |
$479.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$246.41
|
| Rate for Payer: Sagamore Health Network All Products |
$487.77
|
| Rate for Payer: Signature Care EPO |
$524.41
|
| Rate for Payer: Signature Care PPO |
$556.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$537.05
|
| Rate for Payer: United Healthcare Commercial |
$497.87
|
| Rate for Payer: United Healthcare Medicare |
$208.50
|
|
|
HC SN PLATE PL 4.5 3 HOLE RT 93
|
Facility
OP
|
$5,975.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,557.55 |
| Rate for Payer: Aetna Commercial |
$5,043.63
|
| Rate for Payer: Aetna Medicare |
$1,972.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,972.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,431.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,735.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,267.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,169.24
|
| Rate for Payer: Cash Price |
$3,705.03
|
| Rate for Payer: Cash Price |
$3,705.03
|
| Rate for Payer: Centivo All Commercial |
$3,047.69
|
| Rate for Payer: Cigna All Commercial |
$5,157.17
|
| Rate for Payer: CORVEL All Commercial |
$5,557.55
|
| Rate for Payer: Coventry All Commercial |
$5,258.76
|
| Rate for Payer: Encore All Commercial |
$5,500.78
|
| Rate for Payer: Frontpath All Commercial |
$5,497.79
|
| Rate for Payer: Humana ChoiceCare |
$5,161.35
|
| Rate for Payer: Humana Medicare |
$3,047.69
|
| Rate for Payer: Lucent All Commercial |
$3,047.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,378.27
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,481.90
|
| Rate for Payer: PHP All Commercial |
$4,532.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,330.59
|
| Rate for Payer: Sagamore Health Network All Products |
$4,613.36
|
| Rate for Payer: Signature Care EPO |
$4,959.96
|
| Rate for Payer: Signature Care PPO |
$5,258.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,079.48
|
| Rate for Payer: United Healthcare Commercial |
$4,708.98
|
| Rate for Payer: United Healthcare Medicare |
$1,972.03
|
|
|
HC SN PLATE PL 4.5 3 HOLE RT 93
|
Facility
IP
|
$5,975.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,481.90 |
| Max. Negotiated Rate |
$5,557.55 |
| Rate for Payer: Aetna Commercial |
$5,163.14
|
| Rate for Payer: Cash Price |
$3,705.03
|
| Rate for Payer: Cigna All Commercial |
$5,157.17
|
| Rate for Payer: CORVEL All Commercial |
$5,557.55
|
| Rate for Payer: Coventry All Commercial |
$5,258.76
|
| Rate for Payer: Encore All Commercial |
$5,500.78
|
| Rate for Payer: Frontpath All Commercial |
$5,497.79
|
| Rate for Payer: Humana ChoiceCare |
$5,161.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,378.27
|
| Rate for Payer: PHCS All Commercial |
$4,481.90
|
| Rate for Payer: PHP All Commercial |
$4,532.09
|
| Rate for Payer: Sagamore Health Network All Products |
$4,613.36
|
| Rate for Payer: Signature Care EPO |
$4,959.96
|
| Rate for Payer: Signature Care PPO |
$5,258.76
|
| Rate for Payer: United Healthcare Commercial |
$4,708.98
|
|
|
HC SN PL DRILL BIT 2.7 155 CANN
|
Facility
IP
|
$2,010.42
|
|
| Hospital Charge Code |
41601373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,507.82 |
| Max. Negotiated Rate |
$1,869.69 |
| Rate for Payer: Aetna Commercial |
$1,737.00
|
| Rate for Payer: Cash Price |
$1,246.46
|
| Rate for Payer: Cigna All Commercial |
$1,734.99
|
| Rate for Payer: CORVEL All Commercial |
$1,869.69
|
| Rate for Payer: Coventry All Commercial |
$1,769.17
|
| Rate for Payer: Encore All Commercial |
$1,850.59
|
| Rate for Payer: Frontpath All Commercial |
$1,849.59
|
| Rate for Payer: Humana ChoiceCare |
$1,736.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,809.38
|
| Rate for Payer: PHCS All Commercial |
$1,507.82
|
| Rate for Payer: PHP All Commercial |
$1,524.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,552.04
|
| Rate for Payer: Signature Care EPO |
$1,668.65
|
| Rate for Payer: Signature Care PPO |
$1,769.17
|
| Rate for Payer: United Healthcare Commercial |
$1,584.21
|
|
|
HC SN PL DRILL BIT 2.7 155 CANN
|
Facility
OP
|
$2,010.42
|
|
| Hospital Charge Code |
41601373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,869.69 |
| Rate for Payer: Aetna Commercial |
$1,696.79
|
| Rate for Payer: Aetna Medicare |
$663.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$663.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,154.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,256.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$762.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$729.78
|
| Rate for Payer: Cash Price |
$1,246.46
|
| Rate for Payer: Cash Price |
$1,246.46
|
| Rate for Payer: Centivo All Commercial |
$1,025.31
|
| Rate for Payer: Cigna All Commercial |
$1,734.99
|
| Rate for Payer: CORVEL All Commercial |
$1,869.69
|
| Rate for Payer: Coventry All Commercial |
$1,769.17
|
| Rate for Payer: Encore All Commercial |
$1,850.59
|
| Rate for Payer: Frontpath All Commercial |
$1,849.59
|
| Rate for Payer: Humana ChoiceCare |
$1,736.40
|
| Rate for Payer: Humana Medicare |
$1,025.31
|
| Rate for Payer: Lucent All Commercial |
$1,025.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,809.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,507.82
|
| Rate for Payer: PHP All Commercial |
$1,524.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$784.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,552.04
|
| Rate for Payer: Signature Care EPO |
$1,668.65
|
| Rate for Payer: Signature Care PPO |
$1,769.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,708.86
|
| Rate for Payer: United Healthcare Commercial |
$1,584.21
|
| Rate for Payer: United Healthcare Medicare |
$663.44
|
|
|
HC SN PL DRILL BIT 2.7 QC
|
Facility
OP
|
$667.94
|
|
| Hospital Charge Code |
41601374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$621.18 |
| Rate for Payer: Aetna Commercial |
$563.74
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$220.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$383.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$417.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$253.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$242.46
|
| Rate for Payer: Cash Price |
$414.12
|
| Rate for Payer: Cash Price |
$414.12
|
| Rate for Payer: Centivo All Commercial |
$340.65
|
| Rate for Payer: Cigna All Commercial |
$576.43
|
| Rate for Payer: CORVEL All Commercial |
$621.18
|
| Rate for Payer: Coventry All Commercial |
$587.79
|
| Rate for Payer: Encore All Commercial |
$614.84
|
| Rate for Payer: Frontpath All Commercial |
$614.50
|
| Rate for Payer: Humana ChoiceCare |
$576.90
|
| Rate for Payer: Humana Medicare |
$340.65
|
| Rate for Payer: Lucent All Commercial |
$340.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$601.15
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$500.96
|
| Rate for Payer: PHP All Commercial |
$506.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$260.50
|
| Rate for Payer: Sagamore Health Network All Products |
$515.65
|
| Rate for Payer: Signature Care EPO |
$554.39
|
| Rate for Payer: Signature Care PPO |
$587.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$567.75
|
| Rate for Payer: United Healthcare Commercial |
$526.34
|
| Rate for Payer: United Healthcare Medicare |
$220.42
|
|
|
HC SN PL DRILL BIT 2.7 QC
|
Facility
IP
|
$667.94
|
|
| Hospital Charge Code |
41601374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$500.96 |
| Max. Negotiated Rate |
$621.18 |
| Rate for Payer: Aetna Commercial |
$577.10
|
| Rate for Payer: Cash Price |
$414.12
|
| Rate for Payer: Cigna All Commercial |
$576.43
|
| Rate for Payer: CORVEL All Commercial |
$621.18
|
| Rate for Payer: Coventry All Commercial |
$587.79
|
| Rate for Payer: Encore All Commercial |
$614.84
|
| Rate for Payer: Frontpath All Commercial |
$614.50
|
| Rate for Payer: Humana ChoiceCare |
$576.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$601.15
|
| Rate for Payer: PHCS All Commercial |
$500.96
|
| Rate for Payer: PHP All Commercial |
$506.57
|
| Rate for Payer: Sagamore Health Network All Products |
$515.65
|
| Rate for Payer: Signature Care EPO |
$554.39
|
| Rate for Payer: Signature Care PPO |
$587.79
|
| Rate for Payer: United Healthcare Commercial |
$526.34
|
|
|
HC SN PL DRILL BIT 2.7 SHORT QC
|
Facility
OP
|
$638.26
|
|
| Hospital Charge Code |
41602512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$593.58 |
| Rate for Payer: Aetna Commercial |
$538.69
|
| Rate for Payer: Aetna Medicare |
$210.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$210.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$366.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$398.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$242.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.69
|
| Rate for Payer: Cash Price |
$395.72
|
| Rate for Payer: Cash Price |
$395.72
|
| Rate for Payer: Centivo All Commercial |
$325.51
|
| Rate for Payer: Cigna All Commercial |
$550.82
|
| Rate for Payer: CORVEL All Commercial |
$593.58
|
| Rate for Payer: Coventry All Commercial |
$561.67
|
| Rate for Payer: Encore All Commercial |
$587.52
|
| Rate for Payer: Frontpath All Commercial |
$587.20
|
| Rate for Payer: Humana ChoiceCare |
$551.27
|
| Rate for Payer: Humana Medicare |
$325.51
|
| Rate for Payer: Lucent All Commercial |
$325.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$574.43
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$478.70
|
| Rate for Payer: PHP All Commercial |
$484.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$248.92
|
| Rate for Payer: Sagamore Health Network All Products |
$492.74
|
| Rate for Payer: Signature Care EPO |
$529.76
|
| Rate for Payer: Signature Care PPO |
$561.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$542.52
|
| Rate for Payer: United Healthcare Commercial |
$502.95
|
| Rate for Payer: United Healthcare Medicare |
$210.63
|
|
|
HC SN PL DRILL BIT 2.7 SHORT QC
|
Facility
IP
|
$638.26
|
|
| Hospital Charge Code |
41602512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.70 |
| Max. Negotiated Rate |
$593.58 |
| Rate for Payer: Aetna Commercial |
$551.46
|
| Rate for Payer: Cash Price |
$395.72
|
| Rate for Payer: Cigna All Commercial |
$550.82
|
| Rate for Payer: CORVEL All Commercial |
$593.58
|
| Rate for Payer: Coventry All Commercial |
$561.67
|
| Rate for Payer: Encore All Commercial |
$587.52
|
| Rate for Payer: Frontpath All Commercial |
$587.20
|
| Rate for Payer: Humana ChoiceCare |
$551.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$574.43
|
| Rate for Payer: PHCS All Commercial |
$478.70
|
| Rate for Payer: PHP All Commercial |
$484.06
|
| Rate for Payer: Sagamore Health Network All Products |
$492.74
|
| Rate for Payer: Signature Care EPO |
$529.76
|
| Rate for Payer: Signature Care PPO |
$561.67
|
| Rate for Payer: United Healthcare Commercial |
$502.95
|
|
|
HC SN PL DRILL BIT 3.5 SHORT QC
|
Facility
IP
|
$881.86
|
|
| Hospital Charge Code |
41602513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.40 |
| Max. Negotiated Rate |
$820.13 |
| Rate for Payer: Aetna Commercial |
$761.93
|
| Rate for Payer: Cash Price |
$546.75
|
| Rate for Payer: Cigna All Commercial |
$761.05
|
| Rate for Payer: CORVEL All Commercial |
$820.13
|
| Rate for Payer: Coventry All Commercial |
$776.04
|
| Rate for Payer: Encore All Commercial |
$811.75
|
| Rate for Payer: Frontpath All Commercial |
$811.31
|
| Rate for Payer: Humana ChoiceCare |
$761.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$793.67
|
| Rate for Payer: PHCS All Commercial |
$661.40
|
| Rate for Payer: PHP All Commercial |
$668.80
|
| Rate for Payer: Sagamore Health Network All Products |
$680.80
|
| Rate for Payer: Signature Care EPO |
$731.94
|
| Rate for Payer: Signature Care PPO |
$776.04
|
| Rate for Payer: United Healthcare Commercial |
$694.91
|
|
|
HC SN PL DRILL BIT 3.5 SHORT QC
|
Facility
OP
|
$881.86
|
|
| Hospital Charge Code |
41602513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$820.13 |
| Rate for Payer: Aetna Commercial |
$744.29
|
| Rate for Payer: Aetna Medicare |
$291.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$291.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$506.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$551.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$334.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$320.12
|
| Rate for Payer: Cash Price |
$546.75
|
| Rate for Payer: Cash Price |
$546.75
|
| Rate for Payer: Centivo All Commercial |
$449.75
|
| Rate for Payer: Cigna All Commercial |
$761.05
|
| Rate for Payer: CORVEL All Commercial |
$820.13
|
| Rate for Payer: Coventry All Commercial |
$776.04
|
| Rate for Payer: Encore All Commercial |
$811.75
|
| Rate for Payer: Frontpath All Commercial |
$811.31
|
| Rate for Payer: Humana ChoiceCare |
$761.66
|
| Rate for Payer: Humana Medicare |
$449.75
|
| Rate for Payer: Lucent All Commercial |
$449.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$793.67
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$661.40
|
| Rate for Payer: PHP All Commercial |
$668.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$343.93
|
| Rate for Payer: Sagamore Health Network All Products |
$680.80
|
| Rate for Payer: Signature Care EPO |
$731.94
|
| Rate for Payer: Signature Care PPO |
$776.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$749.58
|
| Rate for Payer: United Healthcare Commercial |
$694.91
|
| Rate for Payer: United Healthcare Medicare |
$291.01
|
|
|
HC SN PL GUIDE PIN 1.3 X 140
|
Facility
OP
|
$416.22
|
|
| Hospital Charge Code |
41602522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$387.08 |
| Rate for Payer: Aetna Commercial |
$351.29
|
| Rate for Payer: Aetna Medicare |
$137.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.09
|
| Rate for Payer: Cash Price |
$258.06
|
| Rate for Payer: Cash Price |
$258.06
|
| Rate for Payer: Centivo All Commercial |
$212.27
|
| Rate for Payer: Cigna All Commercial |
$359.20
|
| Rate for Payer: CORVEL All Commercial |
$387.08
|
| Rate for Payer: Coventry All Commercial |
$366.27
|
| Rate for Payer: Encore All Commercial |
$383.13
|
| Rate for Payer: Frontpath All Commercial |
$382.92
|
| Rate for Payer: Humana ChoiceCare |
$359.49
|
| Rate for Payer: Humana Medicare |
$212.27
|
| Rate for Payer: Lucent All Commercial |
$212.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$312.16
|
| Rate for Payer: PHP All Commercial |
$315.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.33
|
| Rate for Payer: Sagamore Health Network All Products |
$321.32
|
| Rate for Payer: Signature Care EPO |
$345.46
|
| Rate for Payer: Signature Care PPO |
$366.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.79
|
| Rate for Payer: United Healthcare Commercial |
$327.98
|
| Rate for Payer: United Healthcare Medicare |
$137.35
|
|
|
HC SN PL GUIDE PIN 1.3 X 140
|
Facility
IP
|
$416.22
|
|
| Hospital Charge Code |
41602522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.16 |
| Max. Negotiated Rate |
$387.08 |
| Rate for Payer: Aetna Commercial |
$359.61
|
| Rate for Payer: Cash Price |
$258.06
|
| Rate for Payer: Cigna All Commercial |
$359.20
|
| Rate for Payer: CORVEL All Commercial |
$387.08
|
| Rate for Payer: Coventry All Commercial |
$366.27
|
| Rate for Payer: Encore All Commercial |
$383.13
|
| Rate for Payer: Frontpath All Commercial |
$382.92
|
| Rate for Payer: Humana ChoiceCare |
$359.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.60
|
| Rate for Payer: PHCS All Commercial |
$312.16
|
| Rate for Payer: PHP All Commercial |
$315.66
|
| Rate for Payer: Sagamore Health Network All Products |
$321.32
|
| Rate for Payer: Signature Care EPO |
$345.46
|
| Rate for Payer: Signature Care PPO |
$366.27
|
| Rate for Payer: United Healthcare Commercial |
$327.98
|
|
|
HC SN PL K-WIRE 1.25
|
Facility
OP
|
$237.02
|
|
| Hospital Charge Code |
41602520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.22 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$200.04
|
| Rate for Payer: Aetna Medicare |
$78.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.04
|
| Rate for Payer: Cash Price |
$146.95
|
| Rate for Payer: Cash Price |
$146.95
|
| Rate for Payer: Centivo All Commercial |
$120.88
|
| Rate for Payer: Cigna All Commercial |
$204.55
|
| Rate for Payer: CORVEL All Commercial |
$220.43
|
| Rate for Payer: Coventry All Commercial |
$208.58
|
| Rate for Payer: Encore All Commercial |
$218.18
|
| Rate for Payer: Frontpath All Commercial |
$218.06
|
| Rate for Payer: Humana ChoiceCare |
$204.71
|
| Rate for Payer: Humana Medicare |
$120.88
|
| Rate for Payer: Lucent All Commercial |
$120.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$177.76
|
| Rate for Payer: PHP All Commercial |
$179.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.44
|
| Rate for Payer: Sagamore Health Network All Products |
$182.98
|
| Rate for Payer: Signature Care EPO |
$196.73
|
| Rate for Payer: Signature Care PPO |
$208.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$201.47
|
| Rate for Payer: United Healthcare Commercial |
$186.77
|
| Rate for Payer: United Healthcare Medicare |
$78.22
|
|
|
HC SN PL K-WIRE 1.25
|
Facility
IP
|
$237.02
|
|
| Hospital Charge Code |
41602520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.76 |
| Max. Negotiated Rate |
$220.43 |
| Rate for Payer: Aetna Commercial |
$204.79
|
| Rate for Payer: Cash Price |
$146.95
|
| Rate for Payer: Cigna All Commercial |
$204.55
|
| Rate for Payer: CORVEL All Commercial |
$220.43
|
| Rate for Payer: Coventry All Commercial |
$208.58
|
| Rate for Payer: Encore All Commercial |
$218.18
|
| Rate for Payer: Frontpath All Commercial |
$218.06
|
| Rate for Payer: Humana ChoiceCare |
$204.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.32
|
| Rate for Payer: PHCS All Commercial |
$177.76
|
| Rate for Payer: PHP All Commercial |
$179.76
|
| Rate for Payer: Sagamore Health Network All Products |
$182.98
|
| Rate for Payer: Signature Care EPO |
$196.73
|
| Rate for Payer: Signature Care PPO |
$208.58
|
| Rate for Payer: United Healthcare Commercial |
$186.77
|
|
|
HC SN PL PLATE 3.5 10-H COMP
|
Facility
OP
|
$810.88
|
|
| Hospital Charge Code |
41601778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.59 |
| Max. Negotiated Rate |
$754.12 |
| Rate for Payer: Aetna Commercial |
$684.38
|
| Rate for Payer: Aetna Medicare |
$267.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$267.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$465.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$506.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$307.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$294.35
|
| Rate for Payer: Cash Price |
$502.75
|
| Rate for Payer: Cash Price |
$502.75
|
| Rate for Payer: Centivo All Commercial |
$413.55
|
| Rate for Payer: Cigna All Commercial |
$699.79
|
| Rate for Payer: CORVEL All Commercial |
$754.12
|
| Rate for Payer: Coventry All Commercial |
$713.57
|
| Rate for Payer: Encore All Commercial |
$746.42
|
| Rate for Payer: Frontpath All Commercial |
$746.01
|
| Rate for Payer: Humana ChoiceCare |
$700.36
|
| Rate for Payer: Humana Medicare |
$413.55
|
| Rate for Payer: Lucent All Commercial |
$413.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$729.79
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$608.16
|
| Rate for Payer: PHP All Commercial |
$614.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$316.24
|
| Rate for Payer: Sagamore Health Network All Products |
$626.00
|
| Rate for Payer: Signature Care EPO |
$673.03
|
| Rate for Payer: Signature Care PPO |
$713.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$689.25
|
| Rate for Payer: United Healthcare Commercial |
$638.97
|
| Rate for Payer: United Healthcare Medicare |
$267.59
|
|
