|
HC SPLINT 3PT HINGED LEFT LG
|
Facility
IP
|
$538.65
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
41601812
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$403.99 |
| Max. Negotiated Rate |
$500.94 |
| Rate for Payer: Aetna Commercial |
$465.39
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Cigna All Commercial |
$464.85
|
| Rate for Payer: CORVEL All Commercial |
$500.94
|
| Rate for Payer: Coventry All Commercial |
$474.01
|
| Rate for Payer: Encore All Commercial |
$495.83
|
| Rate for Payer: Frontpath All Commercial |
$495.56
|
| Rate for Payer: Humana ChoiceCare |
$465.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$484.78
|
| Rate for Payer: PHCS All Commercial |
$403.99
|
| Rate for Payer: PHP All Commercial |
$408.51
|
| Rate for Payer: Sagamore Health Network All Products |
$415.84
|
| Rate for Payer: Signature Care EPO |
$447.08
|
| Rate for Payer: Signature Care PPO |
$474.01
|
| Rate for Payer: United Healthcare Commercial |
$424.46
|
|
|
HC SPLINT 3PT HINGED LEFT SMALL
|
Facility
OP
|
$538.65
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
41601802
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$500.94 |
| Rate for Payer: Aetna Commercial |
$454.62
|
| Rate for Payer: Aetna Medicare |
$177.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$309.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$204.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$195.53
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Centivo All Commercial |
$274.71
|
| Rate for Payer: Cigna All Commercial |
$464.85
|
| Rate for Payer: CORVEL All Commercial |
$500.94
|
| Rate for Payer: Coventry All Commercial |
$474.01
|
| Rate for Payer: Encore All Commercial |
$495.83
|
| Rate for Payer: Frontpath All Commercial |
$495.56
|
| Rate for Payer: Humana ChoiceCare |
$465.23
|
| Rate for Payer: Humana Medicare |
$274.71
|
| Rate for Payer: Lucent All Commercial |
$274.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$484.78
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$403.99
|
| Rate for Payer: PHP All Commercial |
$408.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.07
|
| Rate for Payer: Sagamore Health Network All Products |
$415.84
|
| Rate for Payer: Signature Care EPO |
$447.08
|
| Rate for Payer: Signature Care PPO |
$474.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$457.85
|
| Rate for Payer: United Healthcare Commercial |
$424.46
|
| Rate for Payer: United Healthcare Medicare |
$177.75
|
|
|
HC SPLINT 3PT HINGED LEFT SMALL
|
Facility
IP
|
$538.65
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
41601802
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$403.99 |
| Max. Negotiated Rate |
$500.94 |
| Rate for Payer: Aetna Commercial |
$465.39
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Cigna All Commercial |
$464.85
|
| Rate for Payer: CORVEL All Commercial |
$500.94
|
| Rate for Payer: Coventry All Commercial |
$474.01
|
| Rate for Payer: Encore All Commercial |
$495.83
|
| Rate for Payer: Frontpath All Commercial |
$495.56
|
| Rate for Payer: Humana ChoiceCare |
$465.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$484.78
|
| Rate for Payer: PHCS All Commercial |
$403.99
|
| Rate for Payer: PHP All Commercial |
$408.51
|
| Rate for Payer: Sagamore Health Network All Products |
$415.84
|
| Rate for Payer: Signature Care EPO |
$447.08
|
| Rate for Payer: Signature Care PPO |
$474.01
|
| Rate for Payer: United Healthcare Commercial |
$424.46
|
|
|
HC SPLINT 3PT HINGED RIGHT LG
|
Facility
IP
|
$538.65
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
41601813
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$403.99 |
| Max. Negotiated Rate |
$500.94 |
| Rate for Payer: Aetna Commercial |
$465.39
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Cigna All Commercial |
$464.85
|
| Rate for Payer: CORVEL All Commercial |
$500.94
|
| Rate for Payer: Coventry All Commercial |
$474.01
|
| Rate for Payer: Encore All Commercial |
$495.83
|
| Rate for Payer: Frontpath All Commercial |
$495.56
|
| Rate for Payer: Humana ChoiceCare |
$465.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$484.78
|
| Rate for Payer: PHCS All Commercial |
$403.99
|
| Rate for Payer: PHP All Commercial |
$408.51
|
| Rate for Payer: Sagamore Health Network All Products |
$415.84
|
| Rate for Payer: Signature Care EPO |
$447.08
|
| Rate for Payer: Signature Care PPO |
$474.01
|
| Rate for Payer: United Healthcare Commercial |
$424.46
|
|
|
HC SPLINT 3PT HINGED RIGHT LG
|
Facility
OP
|
$538.65
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
41601813
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$500.94 |
| Rate for Payer: Aetna Commercial |
$454.62
|
| Rate for Payer: Aetna Medicare |
$177.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$309.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$204.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$195.53
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Centivo All Commercial |
$274.71
|
| Rate for Payer: Cigna All Commercial |
$464.85
|
| Rate for Payer: CORVEL All Commercial |
$500.94
|
| Rate for Payer: Coventry All Commercial |
$474.01
|
| Rate for Payer: Encore All Commercial |
$495.83
|
| Rate for Payer: Frontpath All Commercial |
$495.56
|
| Rate for Payer: Humana ChoiceCare |
$465.23
|
| Rate for Payer: Humana Medicare |
$274.71
|
| Rate for Payer: Lucent All Commercial |
$274.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$484.78
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$403.99
|
| Rate for Payer: PHP All Commercial |
$408.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.07
|
| Rate for Payer: Sagamore Health Network All Products |
$415.84
|
| Rate for Payer: Signature Care EPO |
$447.08
|
| Rate for Payer: Signature Care PPO |
$474.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$457.85
|
| Rate for Payer: United Healthcare Commercial |
$424.46
|
| Rate for Payer: United Healthcare Medicare |
$177.75
|
|
|
HC SPLINT 3PT HINGED RIGHT SMALL
|
Facility
IP
|
$538.65
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
41601803
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$403.99 |
| Max. Negotiated Rate |
$500.94 |
| Rate for Payer: Aetna Commercial |
$465.39
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Cigna All Commercial |
$464.85
|
| Rate for Payer: CORVEL All Commercial |
$500.94
|
| Rate for Payer: Coventry All Commercial |
$474.01
|
| Rate for Payer: Encore All Commercial |
$495.83
|
| Rate for Payer: Frontpath All Commercial |
$495.56
|
| Rate for Payer: Humana ChoiceCare |
$465.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$484.78
|
| Rate for Payer: PHCS All Commercial |
$403.99
|
| Rate for Payer: PHP All Commercial |
$408.51
|
| Rate for Payer: Sagamore Health Network All Products |
$415.84
|
| Rate for Payer: Signature Care EPO |
$447.08
|
| Rate for Payer: Signature Care PPO |
$474.01
|
| Rate for Payer: United Healthcare Commercial |
$424.46
|
|
|
HC SPLINT 3PT HINGED RIGHT SMALL
|
Facility
OP
|
$538.65
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
41601803
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$500.94 |
| Rate for Payer: Aetna Commercial |
$454.62
|
| Rate for Payer: Aetna Medicare |
$177.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$309.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$204.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$195.53
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Cash Price |
$333.96
|
| Rate for Payer: Centivo All Commercial |
$274.71
|
| Rate for Payer: Cigna All Commercial |
$464.85
|
| Rate for Payer: CORVEL All Commercial |
$500.94
|
| Rate for Payer: Coventry All Commercial |
$474.01
|
| Rate for Payer: Encore All Commercial |
$495.83
|
| Rate for Payer: Frontpath All Commercial |
$495.56
|
| Rate for Payer: Humana ChoiceCare |
$465.23
|
| Rate for Payer: Humana Medicare |
$274.71
|
| Rate for Payer: Lucent All Commercial |
$274.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$484.78
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$403.99
|
| Rate for Payer: PHP All Commercial |
$408.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.07
|
| Rate for Payer: Sagamore Health Network All Products |
$415.84
|
| Rate for Payer: Signature Care EPO |
$447.08
|
| Rate for Payer: Signature Care PPO |
$474.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$457.85
|
| Rate for Payer: United Healthcare Commercial |
$424.46
|
| Rate for Payer: United Healthcare Medicare |
$177.75
|
|
|
HC SPLINT ADULT COMFY DEVIATION
|
Facility
IP
|
$587.65
|
|
| Hospital Charge Code |
41602205
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$440.74 |
| Max. Negotiated Rate |
$546.51 |
| Rate for Payer: Aetna Commercial |
$507.73
|
| Rate for Payer: Cash Price |
$364.34
|
| Rate for Payer: Cigna All Commercial |
$507.14
|
| Rate for Payer: CORVEL All Commercial |
$546.51
|
| Rate for Payer: Coventry All Commercial |
$517.13
|
| Rate for Payer: Encore All Commercial |
$540.93
|
| Rate for Payer: Frontpath All Commercial |
$540.64
|
| Rate for Payer: Humana ChoiceCare |
$507.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$528.88
|
| Rate for Payer: PHCS All Commercial |
$440.74
|
| Rate for Payer: PHP All Commercial |
$445.67
|
| Rate for Payer: Sagamore Health Network All Products |
$453.67
|
| Rate for Payer: Signature Care EPO |
$487.75
|
| Rate for Payer: Signature Care PPO |
$517.13
|
| Rate for Payer: United Healthcare Commercial |
$463.07
|
|
|
HC SPLINT ADULT COMFY DEVIATION
|
Facility
OP
|
$587.65
|
|
| Hospital Charge Code |
41602205
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$546.51 |
| Rate for Payer: Aetna Commercial |
$495.98
|
| Rate for Payer: Aetna Medicare |
$193.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$337.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$367.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$223.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$213.32
|
| Rate for Payer: Cash Price |
$364.34
|
| Rate for Payer: Cash Price |
$364.34
|
| Rate for Payer: Centivo All Commercial |
$299.70
|
| Rate for Payer: Cigna All Commercial |
$507.14
|
| Rate for Payer: CORVEL All Commercial |
$546.51
|
| Rate for Payer: Coventry All Commercial |
$517.13
|
| Rate for Payer: Encore All Commercial |
$540.93
|
| Rate for Payer: Frontpath All Commercial |
$540.64
|
| Rate for Payer: Humana ChoiceCare |
$507.55
|
| Rate for Payer: Humana Medicare |
$299.70
|
| Rate for Payer: Lucent All Commercial |
$299.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$528.88
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$440.74
|
| Rate for Payer: PHP All Commercial |
$445.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$229.18
|
| Rate for Payer: Sagamore Health Network All Products |
$453.67
|
| Rate for Payer: Signature Care EPO |
$487.75
|
| Rate for Payer: Signature Care PPO |
$517.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$499.50
|
| Rate for Payer: United Healthcare Commercial |
$463.07
|
| Rate for Payer: United Healthcare Medicare |
$193.92
|
|
|
HC SPLINT AIR SOFT RESTING SMALL
|
Facility
IP
|
$763.98
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41601801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$572.98 |
| Max. Negotiated Rate |
$710.50 |
| Rate for Payer: Aetna Commercial |
$660.08
|
| Rate for Payer: Cash Price |
$473.67
|
| Rate for Payer: Cigna All Commercial |
$659.31
|
| Rate for Payer: CORVEL All Commercial |
$710.50
|
| Rate for Payer: Coventry All Commercial |
$672.30
|
| Rate for Payer: Encore All Commercial |
$703.24
|
| Rate for Payer: Frontpath All Commercial |
$702.86
|
| Rate for Payer: Humana ChoiceCare |
$659.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$687.58
|
| Rate for Payer: PHCS All Commercial |
$572.98
|
| Rate for Payer: PHP All Commercial |
$579.40
|
| Rate for Payer: Sagamore Health Network All Products |
$589.79
|
| Rate for Payer: Signature Care EPO |
$634.10
|
| Rate for Payer: Signature Care PPO |
$672.30
|
| Rate for Payer: United Healthcare Commercial |
$602.02
|
|
|
HC SPLINT AIR SOFT RESTING SMALL
|
Facility
OP
|
$763.98
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41601801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.88 |
| Max. Negotiated Rate |
$710.50 |
| Rate for Payer: Aetna Commercial |
$644.80
|
| Rate for Payer: Aetna Medicare |
$252.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$252.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$438.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$477.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$161.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$289.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$277.32
|
| Rate for Payer: Cash Price |
$473.67
|
| Rate for Payer: Cash Price |
$473.67
|
| Rate for Payer: Centivo All Commercial |
$389.63
|
| Rate for Payer: Cigna All Commercial |
$659.31
|
| Rate for Payer: CORVEL All Commercial |
$710.50
|
| Rate for Payer: Coventry All Commercial |
$672.30
|
| Rate for Payer: Encore All Commercial |
$703.24
|
| Rate for Payer: Frontpath All Commercial |
$702.86
|
| Rate for Payer: Humana ChoiceCare |
$659.85
|
| Rate for Payer: Humana Medicare |
$389.63
|
| Rate for Payer: Lucent All Commercial |
$389.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$687.58
|
| Rate for Payer: Managed Health Services Medicaid |
$161.88
|
| Rate for Payer: MDWise Medicaid |
$161.88
|
| Rate for Payer: PHCS All Commercial |
$572.98
|
| Rate for Payer: PHP All Commercial |
$579.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$297.95
|
| Rate for Payer: Sagamore Health Network All Products |
$589.79
|
| Rate for Payer: Signature Care EPO |
$634.10
|
| Rate for Payer: Signature Care PPO |
$672.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$649.38
|
| Rate for Payer: United Healthcare Commercial |
$602.02
|
| Rate for Payer: United Healthcare Medicare |
$252.11
|
|
|
HC SPLINT BASEBALL DEROYAL LARGE
|
Facility
OP
|
$14.55
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601427
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$12.28
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.28
|
| Rate for Payer: Cash Price |
$9.02
|
| Rate for Payer: Cash Price |
$9.02
|
| Rate for Payer: Centivo All Commercial |
$7.42
|
| Rate for Payer: Cigna All Commercial |
$12.56
|
| Rate for Payer: CORVEL All Commercial |
$13.53
|
| Rate for Payer: Coventry All Commercial |
$12.80
|
| Rate for Payer: Encore All Commercial |
$13.39
|
| Rate for Payer: Frontpath All Commercial |
$13.39
|
| Rate for Payer: Humana ChoiceCare |
$12.57
|
| Rate for Payer: Humana Medicare |
$7.42
|
| Rate for Payer: Lucent All Commercial |
$7.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.10
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$10.91
|
| Rate for Payer: PHP All Commercial |
$11.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.67
|
| Rate for Payer: Sagamore Health Network All Products |
$11.23
|
| Rate for Payer: Signature Care EPO |
$12.08
|
| Rate for Payer: Signature Care PPO |
$12.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.37
|
| Rate for Payer: United Healthcare Commercial |
$11.47
|
| Rate for Payer: United Healthcare Medicare |
$4.80
|
|
|
HC SPLINT BASEBALL DEROYAL LARGE
|
Facility
IP
|
$14.55
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601427
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$13.53 |
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Cash Price |
$9.02
|
| Rate for Payer: Cigna All Commercial |
$12.56
|
| Rate for Payer: CORVEL All Commercial |
$13.53
|
| Rate for Payer: Coventry All Commercial |
$12.80
|
| Rate for Payer: Encore All Commercial |
$13.39
|
| Rate for Payer: Frontpath All Commercial |
$13.39
|
| Rate for Payer: Humana ChoiceCare |
$12.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.10
|
| Rate for Payer: PHCS All Commercial |
$10.91
|
| Rate for Payer: PHP All Commercial |
$11.03
|
| Rate for Payer: Sagamore Health Network All Products |
$11.23
|
| Rate for Payer: Signature Care EPO |
$12.08
|
| Rate for Payer: Signature Care PPO |
$12.80
|
| Rate for Payer: United Healthcare Commercial |
$11.47
|
|
|
HC SPLINT BASEBALL DEROYAL MEDIUM
|
Facility
OP
|
$15.14
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601426
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$12.78
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.50
|
| Rate for Payer: Cash Price |
$9.39
|
| Rate for Payer: Cash Price |
$9.39
|
| Rate for Payer: Centivo All Commercial |
$7.72
|
| Rate for Payer: Cigna All Commercial |
$13.07
|
| Rate for Payer: CORVEL All Commercial |
$14.08
|
| Rate for Payer: Coventry All Commercial |
$13.32
|
| Rate for Payer: Encore All Commercial |
$13.94
|
| Rate for Payer: Frontpath All Commercial |
$13.93
|
| Rate for Payer: Humana ChoiceCare |
$13.08
|
| Rate for Payer: Humana Medicare |
$7.72
|
| Rate for Payer: Lucent All Commercial |
$7.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.63
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$11.36
|
| Rate for Payer: PHP All Commercial |
$11.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.90
|
| Rate for Payer: Sagamore Health Network All Products |
$11.69
|
| Rate for Payer: Signature Care EPO |
$12.57
|
| Rate for Payer: Signature Care PPO |
$13.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$11.93
|
| Rate for Payer: United Healthcare Medicare |
$5.00
|
|
|
HC SPLINT BASEBALL DEROYAL MEDIUM
|
Facility
IP
|
$15.14
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601426
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Aetna Commercial |
$13.08
|
| Rate for Payer: Cash Price |
$9.39
|
| Rate for Payer: Cigna All Commercial |
$13.07
|
| Rate for Payer: CORVEL All Commercial |
$14.08
|
| Rate for Payer: Coventry All Commercial |
$13.32
|
| Rate for Payer: Encore All Commercial |
$13.94
|
| Rate for Payer: Frontpath All Commercial |
$13.93
|
| Rate for Payer: Humana ChoiceCare |
$13.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.63
|
| Rate for Payer: PHCS All Commercial |
$11.36
|
| Rate for Payer: PHP All Commercial |
$11.48
|
| Rate for Payer: Sagamore Health Network All Products |
$11.69
|
| Rate for Payer: Signature Care EPO |
$12.57
|
| Rate for Payer: Signature Care PPO |
$13.32
|
| Rate for Payer: United Healthcare Commercial |
$11.93
|
|
|
HC SPLINT COMFORTER ULNAR DEVIATION LT
|
Facility
OP
|
$532.21
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41601806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.88 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$449.19
|
| Rate for Payer: Aetna Medicare |
$175.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$305.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$332.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$161.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.19
|
| Rate for Payer: Cash Price |
$329.97
|
| Rate for Payer: Cash Price |
$329.97
|
| Rate for Payer: Centivo All Commercial |
$271.43
|
| Rate for Payer: Cigna All Commercial |
$459.30
|
| Rate for Payer: CORVEL All Commercial |
$494.96
|
| Rate for Payer: Coventry All Commercial |
$468.34
|
| Rate for Payer: Encore All Commercial |
$489.90
|
| Rate for Payer: Frontpath All Commercial |
$489.63
|
| Rate for Payer: Humana ChoiceCare |
$459.67
|
| Rate for Payer: Humana Medicare |
$271.43
|
| Rate for Payer: Lucent All Commercial |
$271.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.99
|
| Rate for Payer: Managed Health Services Medicaid |
$161.88
|
| Rate for Payer: MDWise Medicaid |
$161.88
|
| Rate for Payer: PHCS All Commercial |
$399.16
|
| Rate for Payer: PHP All Commercial |
$403.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$207.56
|
| Rate for Payer: Sagamore Health Network All Products |
$410.87
|
| Rate for Payer: Signature Care EPO |
$441.73
|
| Rate for Payer: Signature Care PPO |
$468.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$452.38
|
| Rate for Payer: United Healthcare Commercial |
$419.38
|
| Rate for Payer: United Healthcare Medicare |
$175.63
|
|
|
HC SPLINT COMFORTER ULNAR DEVIATION LT
|
Facility
IP
|
$532.21
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41601806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$399.16 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$459.83
|
| Rate for Payer: Cash Price |
$329.97
|
| Rate for Payer: Cigna All Commercial |
$459.30
|
| Rate for Payer: CORVEL All Commercial |
$494.96
|
| Rate for Payer: Coventry All Commercial |
$468.34
|
| Rate for Payer: Encore All Commercial |
$489.90
|
| Rate for Payer: Frontpath All Commercial |
$489.63
|
| Rate for Payer: Humana ChoiceCare |
$459.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.99
|
| Rate for Payer: PHCS All Commercial |
$399.16
|
| Rate for Payer: PHP All Commercial |
$403.63
|
| Rate for Payer: Sagamore Health Network All Products |
$410.87
|
| Rate for Payer: Signature Care EPO |
$441.73
|
| Rate for Payer: Signature Care PPO |
$468.34
|
| Rate for Payer: United Healthcare Commercial |
$419.38
|
|
|
HC SPLINT COMFORTER ULNAR DEVIATION RT
|
Facility
IP
|
$532.21
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41601805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$399.16 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$459.83
|
| Rate for Payer: Cash Price |
$329.97
|
| Rate for Payer: Cigna All Commercial |
$459.30
|
| Rate for Payer: CORVEL All Commercial |
$494.96
|
| Rate for Payer: Coventry All Commercial |
$468.34
|
| Rate for Payer: Encore All Commercial |
$489.90
|
| Rate for Payer: Frontpath All Commercial |
$489.63
|
| Rate for Payer: Humana ChoiceCare |
$459.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.99
|
| Rate for Payer: PHCS All Commercial |
$399.16
|
| Rate for Payer: PHP All Commercial |
$403.63
|
| Rate for Payer: Sagamore Health Network All Products |
$410.87
|
| Rate for Payer: Signature Care EPO |
$441.73
|
| Rate for Payer: Signature Care PPO |
$468.34
|
| Rate for Payer: United Healthcare Commercial |
$419.38
|
|
|
HC SPLINT COMFORTER ULNAR DEVIATION RT
|
Facility
OP
|
$532.21
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41601805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.88 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$449.19
|
| Rate for Payer: Aetna Medicare |
$175.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$305.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$332.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$161.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.19
|
| Rate for Payer: Cash Price |
$329.97
|
| Rate for Payer: Cash Price |
$329.97
|
| Rate for Payer: Centivo All Commercial |
$271.43
|
| Rate for Payer: Cigna All Commercial |
$459.30
|
| Rate for Payer: CORVEL All Commercial |
$494.96
|
| Rate for Payer: Coventry All Commercial |
$468.34
|
| Rate for Payer: Encore All Commercial |
$489.90
|
| Rate for Payer: Frontpath All Commercial |
$489.63
|
| Rate for Payer: Humana ChoiceCare |
$459.67
|
| Rate for Payer: Humana Medicare |
$271.43
|
| Rate for Payer: Lucent All Commercial |
$271.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.99
|
| Rate for Payer: Managed Health Services Medicaid |
$161.88
|
| Rate for Payer: MDWise Medicaid |
$161.88
|
| Rate for Payer: PHCS All Commercial |
$399.16
|
| Rate for Payer: PHP All Commercial |
$403.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$207.56
|
| Rate for Payer: Sagamore Health Network All Products |
$410.87
|
| Rate for Payer: Signature Care EPO |
$441.73
|
| Rate for Payer: Signature Care PPO |
$468.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$452.38
|
| Rate for Payer: United Healthcare Commercial |
$419.38
|
| Rate for Payer: United Healthcare Medicare |
$175.63
|
|
|
HC SPLINT COMFY AIR HAND ROLL
|
Facility
IP
|
$388.50
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41601804
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.38 |
| Max. Negotiated Rate |
$361.30 |
| Rate for Payer: Aetna Commercial |
$335.66
|
| Rate for Payer: Cash Price |
$240.87
|
| Rate for Payer: Cigna All Commercial |
$335.28
|
| Rate for Payer: CORVEL All Commercial |
$361.30
|
| Rate for Payer: Coventry All Commercial |
$341.88
|
| Rate for Payer: Encore All Commercial |
$357.61
|
| Rate for Payer: Frontpath All Commercial |
$357.42
|
| Rate for Payer: Humana ChoiceCare |
$335.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$349.65
|
| Rate for Payer: PHCS All Commercial |
$291.38
|
| Rate for Payer: PHP All Commercial |
$294.64
|
| Rate for Payer: Sagamore Health Network All Products |
$299.92
|
| Rate for Payer: Signature Care EPO |
$322.46
|
| Rate for Payer: Signature Care PPO |
$341.88
|
| Rate for Payer: United Healthcare Commercial |
$306.14
|
|
|
HC SPLINT COMFY AIR HAND ROLL
|
Facility
OP
|
$388.50
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41601804
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$361.30 |
| Rate for Payer: Aetna Commercial |
$327.89
|
| Rate for Payer: Aetna Medicare |
$128.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$223.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$242.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$161.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.03
|
| Rate for Payer: Cash Price |
$240.87
|
| Rate for Payer: Cash Price |
$240.87
|
| Rate for Payer: Centivo All Commercial |
$198.14
|
| Rate for Payer: Cigna All Commercial |
$335.28
|
| Rate for Payer: CORVEL All Commercial |
$361.30
|
| Rate for Payer: Coventry All Commercial |
$341.88
|
| Rate for Payer: Encore All Commercial |
$357.61
|
| Rate for Payer: Frontpath All Commercial |
$357.42
|
| Rate for Payer: Humana ChoiceCare |
$335.55
|
| Rate for Payer: Humana Medicare |
$198.14
|
| Rate for Payer: Lucent All Commercial |
$198.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$349.65
|
| Rate for Payer: Managed Health Services Medicaid |
$161.88
|
| Rate for Payer: MDWise Medicaid |
$161.88
|
| Rate for Payer: PHCS All Commercial |
$291.38
|
| Rate for Payer: PHP All Commercial |
$294.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.52
|
| Rate for Payer: Sagamore Health Network All Products |
$299.92
|
| Rate for Payer: Signature Care EPO |
$322.46
|
| Rate for Payer: Signature Care PPO |
$341.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$330.22
|
| Rate for Payer: United Healthcare Commercial |
$306.14
|
| Rate for Payer: United Healthcare Medicare |
$128.20
|
|
|
HC SPLINT COMFY C GRIP ADULT MD L
|
Facility
OP
|
$455.21
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41607483
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$423.35 |
| Rate for Payer: Aetna Commercial |
$384.20
|
| Rate for Payer: Aetna Medicare |
$150.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$261.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$284.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$161.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.24
|
| Rate for Payer: Cash Price |
$282.23
|
| Rate for Payer: Cash Price |
$282.23
|
| Rate for Payer: Centivo All Commercial |
$232.16
|
| Rate for Payer: Cigna All Commercial |
$392.85
|
| Rate for Payer: CORVEL All Commercial |
$423.35
|
| Rate for Payer: Coventry All Commercial |
$400.58
|
| Rate for Payer: Encore All Commercial |
$419.02
|
| Rate for Payer: Frontpath All Commercial |
$418.79
|
| Rate for Payer: Humana ChoiceCare |
$393.16
|
| Rate for Payer: Humana Medicare |
$232.16
|
| Rate for Payer: Lucent All Commercial |
$232.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.69
|
| Rate for Payer: Managed Health Services Medicaid |
$161.88
|
| Rate for Payer: MDWise Medicaid |
$161.88
|
| Rate for Payer: PHCS All Commercial |
$341.41
|
| Rate for Payer: PHP All Commercial |
$345.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$177.53
|
| Rate for Payer: Sagamore Health Network All Products |
$351.42
|
| Rate for Payer: Signature Care EPO |
$377.82
|
| Rate for Payer: Signature Care PPO |
$400.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$386.93
|
| Rate for Payer: United Healthcare Commercial |
$358.71
|
| Rate for Payer: United Healthcare Medicare |
$150.22
|
|
|
HC SPLINT COMFY C GRIP ADULT MD L
|
Facility
IP
|
$455.21
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41607483
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$341.41 |
| Max. Negotiated Rate |
$423.35 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Cash Price |
$282.23
|
| Rate for Payer: Cigna All Commercial |
$392.85
|
| Rate for Payer: CORVEL All Commercial |
$423.35
|
| Rate for Payer: Coventry All Commercial |
$400.58
|
| Rate for Payer: Encore All Commercial |
$419.02
|
| Rate for Payer: Frontpath All Commercial |
$418.79
|
| Rate for Payer: Humana ChoiceCare |
$393.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.69
|
| Rate for Payer: PHCS All Commercial |
$341.41
|
| Rate for Payer: PHP All Commercial |
$345.23
|
| Rate for Payer: Sagamore Health Network All Products |
$351.42
|
| Rate for Payer: Signature Care EPO |
$377.82
|
| Rate for Payer: Signature Care PPO |
$400.58
|
| Rate for Payer: United Healthcare Commercial |
$358.71
|
|
|
HC SPLINT FINGER 4 PRONG LARGE
|
Facility
IP
|
$8.73
|
|
| Hospital Charge Code |
41601829
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Aetna Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cigna All Commercial |
$7.53
|
| Rate for Payer: CORVEL All Commercial |
$8.12
|
| Rate for Payer: Coventry All Commercial |
$7.68
|
| Rate for Payer: Encore All Commercial |
$8.04
|
| Rate for Payer: Frontpath All Commercial |
$8.03
|
| Rate for Payer: Humana ChoiceCare |
$7.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.86
|
| Rate for Payer: PHCS All Commercial |
$6.55
|
| Rate for Payer: PHP All Commercial |
$6.62
|
| Rate for Payer: Sagamore Health Network All Products |
$6.74
|
| Rate for Payer: Signature Care EPO |
$7.25
|
| Rate for Payer: Signature Care PPO |
$7.68
|
| Rate for Payer: United Healthcare Commercial |
$6.88
|
|
|
HC SPLINT FINGER 4 PRONG LARGE
|
Facility
OP
|
$8.73
|
|
| Hospital Charge Code |
41601829
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Aetna Commercial |
$7.37
|
| Rate for Payer: Aetna Medicare |
$2.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.17
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Centivo All Commercial |
$4.45
|
| Rate for Payer: Cigna All Commercial |
$7.53
|
| Rate for Payer: CORVEL All Commercial |
$8.12
|
| Rate for Payer: Coventry All Commercial |
$7.68
|
| Rate for Payer: Encore All Commercial |
$8.04
|
| Rate for Payer: Frontpath All Commercial |
$8.03
|
| Rate for Payer: Humana ChoiceCare |
$7.54
|
| Rate for Payer: Humana Medicare |
$4.45
|
| Rate for Payer: Lucent All Commercial |
$4.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.86
|
| Rate for Payer: PHCS All Commercial |
$6.55
|
| Rate for Payer: PHP All Commercial |
$6.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.40
|
| Rate for Payer: Sagamore Health Network All Products |
$6.74
|
| Rate for Payer: Signature Care EPO |
$7.25
|
| Rate for Payer: Signature Care PPO |
$7.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.42
|
| Rate for Payer: United Healthcare Commercial |
$6.88
|
| Rate for Payer: United Healthcare Medicare |
$2.88
|
|
