|
HC SPLINT FINGER 4 PRONG MEDIUM
|
Facility
IP
|
$8.73
|
|
| Hospital Charge Code |
41601830
|
|
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 MEDIUM
|
Facility
OP
|
$8.73
|
|
| Hospital Charge Code |
41601830
|
|
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
|
|
|
HC SPLINT FINGER 4 PRONG SM
|
Facility
OP
|
$6.16
|
|
| Hospital Charge Code |
41603085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna Commercial |
$5.20
|
| Rate for Payer: Aetna Medicare |
$2.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.24
|
| Rate for Payer: Cash Price |
$3.82
|
| Rate for Payer: Centivo All Commercial |
$3.14
|
| Rate for Payer: Cigna All Commercial |
$5.32
|
| Rate for Payer: CORVEL All Commercial |
$5.73
|
| Rate for Payer: Coventry All Commercial |
$5.42
|
| Rate for Payer: Encore All Commercial |
$5.67
|
| Rate for Payer: Frontpath All Commercial |
$5.67
|
| Rate for Payer: Humana ChoiceCare |
$5.32
|
| Rate for Payer: Humana Medicare |
$3.14
|
| Rate for Payer: Lucent All Commercial |
$3.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.54
|
| Rate for Payer: PHCS All Commercial |
$4.62
|
| Rate for Payer: PHP All Commercial |
$4.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.40
|
| Rate for Payer: Sagamore Health Network All Products |
$4.76
|
| Rate for Payer: Signature Care EPO |
$5.11
|
| Rate for Payer: Signature Care PPO |
$5.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.24
|
| Rate for Payer: United Healthcare Commercial |
$4.85
|
| Rate for Payer: United Healthcare Medicare |
$2.03
|
|
|
HC SPLINT FINGER 4 PRONG SM
|
Facility
IP
|
$6.16
|
|
| Hospital Charge Code |
41603085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna Commercial |
$5.32
|
| Rate for Payer: Cash Price |
$3.82
|
| Rate for Payer: Cigna All Commercial |
$5.32
|
| Rate for Payer: CORVEL All Commercial |
$5.73
|
| Rate for Payer: Coventry All Commercial |
$5.42
|
| Rate for Payer: Encore All Commercial |
$5.67
|
| Rate for Payer: Frontpath All Commercial |
$5.67
|
| Rate for Payer: Humana ChoiceCare |
$5.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.54
|
| Rate for Payer: PHCS All Commercial |
$4.62
|
| Rate for Payer: PHP All Commercial |
$4.67
|
| Rate for Payer: Sagamore Health Network All Products |
$4.76
|
| Rate for Payer: Signature Care EPO |
$5.11
|
| Rate for Payer: Signature Care PPO |
$5.42
|
| Rate for Payer: United Healthcare Commercial |
$4.85
|
|
|
HC SPLINT FINGER ABD MED
|
Facility
OP
|
$20.93
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
41601843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$27.19 |
| Rate for Payer: Aetna Commercial |
$17.66
|
| Rate for Payer: Aetna Medicare |
$6.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.60
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Centivo All Commercial |
$10.67
|
| Rate for Payer: Cigna All Commercial |
$18.06
|
| Rate for Payer: CORVEL All Commercial |
$19.46
|
| Rate for Payer: Coventry All Commercial |
$18.42
|
| Rate for Payer: Encore All Commercial |
$19.27
|
| Rate for Payer: Frontpath All Commercial |
$19.26
|
| Rate for Payer: Humana ChoiceCare |
$18.08
|
| Rate for Payer: Humana Medicare |
$10.67
|
| Rate for Payer: Lucent All Commercial |
$10.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.84
|
| Rate for Payer: Managed Health Services Medicaid |
$27.19
|
| Rate for Payer: MDWise Medicaid |
$27.19
|
| Rate for Payer: PHCS All Commercial |
$15.70
|
| Rate for Payer: PHP All Commercial |
$15.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.16
|
| Rate for Payer: Sagamore Health Network All Products |
$16.16
|
| Rate for Payer: Signature Care EPO |
$17.37
|
| Rate for Payer: Signature Care PPO |
$18.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.79
|
| Rate for Payer: United Healthcare Commercial |
$16.49
|
| Rate for Payer: United Healthcare Medicare |
$6.91
|
|
|
HC SPLINT FINGER ABD MED
|
Facility
IP
|
$20.93
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
41601843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$19.46 |
| Rate for Payer: Aetna Commercial |
$18.08
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Cigna All Commercial |
$18.06
|
| Rate for Payer: CORVEL All Commercial |
$19.46
|
| Rate for Payer: Coventry All Commercial |
$18.42
|
| Rate for Payer: Encore All Commercial |
$19.27
|
| Rate for Payer: Frontpath All Commercial |
$19.26
|
| Rate for Payer: Humana ChoiceCare |
$18.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.84
|
| Rate for Payer: PHCS All Commercial |
$15.70
|
| Rate for Payer: PHP All Commercial |
$15.87
|
| Rate for Payer: Sagamore Health Network All Products |
$16.16
|
| Rate for Payer: Signature Care EPO |
$17.37
|
| Rate for Payer: Signature Care PPO |
$18.42
|
| Rate for Payer: United Healthcare Commercial |
$16.49
|
|
|
HC SPLINT FINGER FOAM 3 INCH
|
Facility
OP
|
$4.86
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$4.10
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.76
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Centivo All Commercial |
$2.48
|
| Rate for Payer: Cigna All Commercial |
$4.19
|
| Rate for Payer: CORVEL All Commercial |
$4.52
|
| Rate for Payer: Coventry All Commercial |
$4.28
|
| Rate for Payer: Encore All Commercial |
$4.47
|
| Rate for Payer: Frontpath All Commercial |
$4.47
|
| Rate for Payer: Humana ChoiceCare |
$4.20
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Lucent All Commercial |
$2.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.37
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$3.64
|
| Rate for Payer: PHP All Commercial |
$3.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.90
|
| Rate for Payer: Sagamore Health Network All Products |
$3.75
|
| Rate for Payer: Signature Care EPO |
$4.03
|
| Rate for Payer: Signature Care PPO |
$4.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.13
|
| Rate for Payer: United Healthcare Commercial |
$3.83
|
| Rate for Payer: United Healthcare Medicare |
$1.60
|
|
|
HC SPLINT FINGER FOAM 3 INCH
|
Facility
IP
|
$4.86
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cigna All Commercial |
$4.19
|
| Rate for Payer: CORVEL All Commercial |
$4.52
|
| Rate for Payer: Coventry All Commercial |
$4.28
|
| Rate for Payer: Encore All Commercial |
$4.47
|
| Rate for Payer: Frontpath All Commercial |
$4.47
|
| Rate for Payer: Humana ChoiceCare |
$4.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.37
|
| Rate for Payer: PHCS All Commercial |
$3.64
|
| Rate for Payer: PHP All Commercial |
$3.69
|
| Rate for Payer: Sagamore Health Network All Products |
$3.75
|
| Rate for Payer: Signature Care EPO |
$4.03
|
| Rate for Payer: Signature Care PPO |
$4.28
|
| Rate for Payer: United Healthcare Commercial |
$3.83
|
|
|
HC SPLINT FINGER FOAM 6 INCH
|
Facility
OP
|
$4.86
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601095
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$4.10
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.76
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Centivo All Commercial |
$2.48
|
| Rate for Payer: Cigna All Commercial |
$4.19
|
| Rate for Payer: CORVEL All Commercial |
$4.52
|
| Rate for Payer: Coventry All Commercial |
$4.28
|
| Rate for Payer: Encore All Commercial |
$4.47
|
| Rate for Payer: Frontpath All Commercial |
$4.47
|
| Rate for Payer: Humana ChoiceCare |
$4.20
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Lucent All Commercial |
$2.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.37
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$3.64
|
| Rate for Payer: PHP All Commercial |
$3.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.90
|
| Rate for Payer: Sagamore Health Network All Products |
$3.75
|
| Rate for Payer: Signature Care EPO |
$4.03
|
| Rate for Payer: Signature Care PPO |
$4.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.13
|
| Rate for Payer: United Healthcare Commercial |
$3.83
|
| Rate for Payer: United Healthcare Medicare |
$1.60
|
|
|
HC SPLINT FINGER FOAM 6 INCH
|
Facility
IP
|
$4.86
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601095
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cigna All Commercial |
$4.19
|
| Rate for Payer: CORVEL All Commercial |
$4.52
|
| Rate for Payer: Coventry All Commercial |
$4.28
|
| Rate for Payer: Encore All Commercial |
$4.47
|
| Rate for Payer: Frontpath All Commercial |
$4.47
|
| Rate for Payer: Humana ChoiceCare |
$4.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.37
|
| Rate for Payer: PHCS All Commercial |
$3.64
|
| Rate for Payer: PHP All Commercial |
$3.69
|
| Rate for Payer: Sagamore Health Network All Products |
$3.75
|
| Rate for Payer: Signature Care EPO |
$4.03
|
| Rate for Payer: Signature Care PPO |
$4.28
|
| Rate for Payer: United Healthcare Commercial |
$3.83
|
|
|
HC SPLINT FINGER FOAM MED
|
Facility
OP
|
$6.37
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601428
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$5.38
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.31
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Centivo All Commercial |
$3.25
|
| Rate for Payer: Cigna All Commercial |
$5.50
|
| Rate for Payer: CORVEL All Commercial |
$5.92
|
| Rate for Payer: Coventry All Commercial |
$5.61
|
| Rate for Payer: Encore All Commercial |
$5.86
|
| Rate for Payer: Frontpath All Commercial |
$5.86
|
| Rate for Payer: Humana ChoiceCare |
$5.50
|
| Rate for Payer: Humana Medicare |
$3.25
|
| Rate for Payer: Lucent All Commercial |
$3.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.73
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$4.78
|
| Rate for Payer: PHP All Commercial |
$4.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.48
|
| Rate for Payer: Sagamore Health Network All Products |
$4.92
|
| Rate for Payer: Signature Care EPO |
$5.29
|
| Rate for Payer: Signature Care PPO |
$5.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.41
|
| Rate for Payer: United Healthcare Commercial |
$5.02
|
| Rate for Payer: United Healthcare Medicare |
$2.10
|
|
|
HC SPLINT FINGER FOAM MED
|
Facility
IP
|
$6.37
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601428
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Aetna Commercial |
$5.50
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cigna All Commercial |
$5.50
|
| Rate for Payer: CORVEL All Commercial |
$5.92
|
| Rate for Payer: Coventry All Commercial |
$5.61
|
| Rate for Payer: Encore All Commercial |
$5.86
|
| Rate for Payer: Frontpath All Commercial |
$5.86
|
| Rate for Payer: Humana ChoiceCare |
$5.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.73
|
| Rate for Payer: PHCS All Commercial |
$4.78
|
| Rate for Payer: PHP All Commercial |
$4.83
|
| Rate for Payer: Sagamore Health Network All Products |
$4.92
|
| Rate for Payer: Signature Care EPO |
$5.29
|
| Rate for Payer: Signature Care PPO |
$5.61
|
| Rate for Payer: United Healthcare Commercial |
$5.02
|
|
|
HC SPLINT FINGER FOAM XLG
|
Facility
IP
|
$5.22
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601096
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$4.51
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna All Commercial |
$4.50
|
| Rate for Payer: CORVEL All Commercial |
$4.85
|
| Rate for Payer: Coventry All Commercial |
$4.59
|
| Rate for Payer: Encore All Commercial |
$4.81
|
| Rate for Payer: Frontpath All Commercial |
$4.80
|
| Rate for Payer: Humana ChoiceCare |
$4.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.70
|
| Rate for Payer: PHCS All Commercial |
$3.92
|
| Rate for Payer: PHP All Commercial |
$3.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4.03
|
| Rate for Payer: Signature Care EPO |
$4.33
|
| Rate for Payer: Signature Care PPO |
$4.59
|
| Rate for Payer: United Healthcare Commercial |
$4.11
|
|
|
HC SPLINT FINGER FOAM XLG
|
Facility
OP
|
$5.22
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
41601096
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$27.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.89
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Centivo All Commercial |
$2.66
|
| Rate for Payer: Cigna All Commercial |
$4.50
|
| Rate for Payer: CORVEL All Commercial |
$4.85
|
| Rate for Payer: Coventry All Commercial |
$4.59
|
| Rate for Payer: Encore All Commercial |
$4.81
|
| Rate for Payer: Frontpath All Commercial |
$4.80
|
| Rate for Payer: Humana ChoiceCare |
$4.51
|
| Rate for Payer: Humana Medicare |
$2.66
|
| Rate for Payer: Lucent All Commercial |
$2.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.70
|
| Rate for Payer: Managed Health Services Medicaid |
$27.48
|
| Rate for Payer: MDWise Medicaid |
$27.48
|
| Rate for Payer: PHCS All Commercial |
$3.92
|
| Rate for Payer: PHP All Commercial |
$3.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.04
|
| Rate for Payer: Sagamore Health Network All Products |
$4.03
|
| Rate for Payer: Signature Care EPO |
$4.33
|
| Rate for Payer: Signature Care PPO |
$4.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.44
|
| Rate for Payer: United Healthcare Commercial |
$4.11
|
| Rate for Payer: United Healthcare Medicare |
$1.72
|
|
|
HC SPLINT; FINGER L 2 DYNAMIC-OT
|
Facility
OP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F1
|
| Hospital Charge Code |
11738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.89 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$219.67
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.48
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Centivo All Commercial |
$132.74
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Humana Medicare |
$132.74
|
| Rate for Payer: Lucent All Commercial |
$132.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.51
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.23
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
| Rate for Payer: United Healthcare Medicare |
$85.89
|
|
|
HC SPLINT; FINGER L 2 DYNAMIC-OT
|
Facility
IP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F1
|
| Hospital Charge Code |
11738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$195.21 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$224.88
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
|
|
HC SPLINT; FINGER L 2 STATIC-OT
|
Facility
IP
|
$291.72
|
|
|
Service Code
|
CPT 29130 GO,F1
|
| Hospital Charge Code |
11738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$218.79 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna Commercial |
$252.05
|
| Rate for Payer: Cash Price |
$180.87
|
| Rate for Payer: Cigna All Commercial |
$251.75
|
| Rate for Payer: CORVEL All Commercial |
$271.30
|
| Rate for Payer: Coventry All Commercial |
$256.71
|
| Rate for Payer: Encore All Commercial |
$268.53
|
| Rate for Payer: Frontpath All Commercial |
$268.38
|
| Rate for Payer: Humana ChoiceCare |
$251.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$262.55
|
| Rate for Payer: PHCS All Commercial |
$218.79
|
| Rate for Payer: PHP All Commercial |
$221.24
|
| Rate for Payer: Sagamore Health Network All Products |
$225.21
|
| Rate for Payer: Signature Care EPO |
$242.13
|
| Rate for Payer: Signature Care PPO |
$256.71
|
| Rate for Payer: United Healthcare Commercial |
$229.88
|
|
|
HC SPLINT; FINGER L 2 STATIC-OT
|
Facility
OP
|
$291.72
|
|
|
Service Code
|
CPT 29130 GO,F1
|
| Hospital Charge Code |
11738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$96.27 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna Commercial |
$246.21
|
| Rate for Payer: Aetna Medicare |
$96.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$167.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.89
|
| Rate for Payer: Cash Price |
$180.87
|
| Rate for Payer: Centivo All Commercial |
$148.78
|
| Rate for Payer: Cigna All Commercial |
$251.75
|
| Rate for Payer: CORVEL All Commercial |
$271.30
|
| Rate for Payer: Coventry All Commercial |
$256.71
|
| Rate for Payer: Encore All Commercial |
$268.53
|
| Rate for Payer: Frontpath All Commercial |
$268.38
|
| Rate for Payer: Humana ChoiceCare |
$251.96
|
| Rate for Payer: Humana Medicare |
$148.78
|
| Rate for Payer: Lucent All Commercial |
$148.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$262.55
|
| Rate for Payer: PHCS All Commercial |
$218.79
|
| Rate for Payer: PHP All Commercial |
$221.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.77
|
| Rate for Payer: Sagamore Health Network All Products |
$225.21
|
| Rate for Payer: Signature Care EPO |
$242.13
|
| Rate for Payer: Signature Care PPO |
$256.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$247.96
|
| Rate for Payer: United Healthcare Commercial |
$229.88
|
| Rate for Payer: United Healthcare Medicare |
$96.27
|
|
|
HC SPLINT; FINGER L 3 DYNAMIC-OT
|
Facility
OP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F2
|
| Hospital Charge Code |
21738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.89 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$219.67
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.48
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Centivo All Commercial |
$132.74
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Humana Medicare |
$132.74
|
| Rate for Payer: Lucent All Commercial |
$132.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.51
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.23
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
| Rate for Payer: United Healthcare Medicare |
$85.89
|
|
|
HC SPLINT; FINGER L 3 DYNAMIC-OT
|
Facility
IP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F2
|
| Hospital Charge Code |
21738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$195.21 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$224.88
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
|
|
HC SPLINT; FINGER L 3 STATIC-OT
|
Facility
IP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F2
|
| Hospital Charge Code |
21738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$235.35 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$271.13
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
|
|
HC SPLINT; FINGER L 3 STATIC-OT
|
Facility
OP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F2
|
| Hospital Charge Code |
21738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.55 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$264.85
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.91
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Centivo All Commercial |
$160.04
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Humana Medicare |
$160.04
|
| Rate for Payer: Lucent All Commercial |
$160.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.38
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$266.73
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
| Rate for Payer: United Healthcare Medicare |
$103.55
|
|
|
HC SPLINT; FINGER L 4 DYNAMIC-OT
|
Facility
IP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F3
|
| Hospital Charge Code |
31738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$195.21 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$224.88
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
|
|
HC SPLINT; FINGER L 4 DYNAMIC-OT
|
Facility
OP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,F3
|
| Hospital Charge Code |
31738071
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.89 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$219.67
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.48
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Centivo All Commercial |
$132.74
|
| Rate for Payer: Cigna All Commercial |
$224.62
|
| Rate for Payer: CORVEL All Commercial |
$242.05
|
| Rate for Payer: Coventry All Commercial |
$229.04
|
| Rate for Payer: Encore All Commercial |
$239.58
|
| Rate for Payer: Frontpath All Commercial |
$239.45
|
| Rate for Payer: Humana ChoiceCare |
$224.80
|
| Rate for Payer: Humana Medicare |
$132.74
|
| Rate for Payer: Lucent All Commercial |
$132.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.25
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: PHP All Commercial |
$197.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.51
|
| Rate for Payer: Sagamore Health Network All Products |
$200.93
|
| Rate for Payer: Signature Care EPO |
$216.03
|
| Rate for Payer: Signature Care PPO |
$229.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.23
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
| Rate for Payer: United Healthcare Medicare |
$85.89
|
|
|
HC SPLINT; FINGER L 4 STATIC-OT
|
Facility
IP
|
$313.80
|
|
|
Service Code
|
CPT 29130 GO,F3
|
| Hospital Charge Code |
31738072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$235.35 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$271.13
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cigna All Commercial |
$270.81
|
| Rate for Payer: CORVEL All Commercial |
$291.84
|
| Rate for Payer: Coventry All Commercial |
$276.15
|
| Rate for Payer: Encore All Commercial |
$288.86
|
| Rate for Payer: Frontpath All Commercial |
$288.70
|
| Rate for Payer: Humana ChoiceCare |
$271.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.42
|
| Rate for Payer: PHCS All Commercial |
$235.35
|
| Rate for Payer: PHP All Commercial |
$237.99
|
| Rate for Payer: Sagamore Health Network All Products |
$242.26
|
| Rate for Payer: Signature Care EPO |
$260.46
|
| Rate for Payer: Signature Care PPO |
$276.15
|
| Rate for Payer: United Healthcare Commercial |
$247.28
|
|
