|
HC SPLINT FINGER STAX #4
|
Facility
OP
|
$9.45
|
|
| Hospital Charge Code |
41601831
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$7.98
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.43
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Centivo All Commercial |
$4.82
|
| Rate for Payer: Cigna All Commercial |
$8.16
|
| Rate for Payer: CORVEL All Commercial |
$8.79
|
| Rate for Payer: Coventry All Commercial |
$8.32
|
| Rate for Payer: Encore All Commercial |
$8.70
|
| Rate for Payer: Frontpath All Commercial |
$8.69
|
| Rate for Payer: Humana ChoiceCare |
$8.16
|
| Rate for Payer: Humana Medicare |
$4.82
|
| Rate for Payer: Lucent All Commercial |
$4.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.50
|
| Rate for Payer: PHCS All Commercial |
$7.09
|
| Rate for Payer: PHP All Commercial |
$7.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.69
|
| Rate for Payer: Sagamore Health Network All Products |
$7.30
|
| Rate for Payer: Signature Care EPO |
$7.84
|
| Rate for Payer: Signature Care PPO |
$8.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.03
|
| Rate for Payer: United Healthcare Commercial |
$7.45
|
| Rate for Payer: United Healthcare Medicare |
$3.12
|
|
|
HC SPLINT FINGER STAX #4
|
Facility
IP
|
$9.45
|
|
| Hospital Charge Code |
41601831
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna All Commercial |
$8.16
|
| Rate for Payer: CORVEL All Commercial |
$8.79
|
| Rate for Payer: Coventry All Commercial |
$8.32
|
| Rate for Payer: Encore All Commercial |
$8.70
|
| Rate for Payer: Frontpath All Commercial |
$8.69
|
| Rate for Payer: Humana ChoiceCare |
$8.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.50
|
| Rate for Payer: PHCS All Commercial |
$7.09
|
| Rate for Payer: PHP All Commercial |
$7.17
|
| Rate for Payer: Sagamore Health Network All Products |
$7.30
|
| Rate for Payer: Signature Care EPO |
$7.84
|
| Rate for Payer: Signature Care PPO |
$8.32
|
| Rate for Payer: United Healthcare Commercial |
$7.45
|
|
|
HC SPLINT FINGER STAX #5
|
Facility
OP
|
$9.45
|
|
| Hospital Charge Code |
41601832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$7.98
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.43
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Centivo All Commercial |
$4.82
|
| Rate for Payer: Cigna All Commercial |
$8.16
|
| Rate for Payer: CORVEL All Commercial |
$8.79
|
| Rate for Payer: Coventry All Commercial |
$8.32
|
| Rate for Payer: Encore All Commercial |
$8.70
|
| Rate for Payer: Frontpath All Commercial |
$8.69
|
| Rate for Payer: Humana ChoiceCare |
$8.16
|
| Rate for Payer: Humana Medicare |
$4.82
|
| Rate for Payer: Lucent All Commercial |
$4.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.50
|
| Rate for Payer: PHCS All Commercial |
$7.09
|
| Rate for Payer: PHP All Commercial |
$7.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.69
|
| Rate for Payer: Sagamore Health Network All Products |
$7.30
|
| Rate for Payer: Signature Care EPO |
$7.84
|
| Rate for Payer: Signature Care PPO |
$8.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.03
|
| Rate for Payer: United Healthcare Commercial |
$7.45
|
| Rate for Payer: United Healthcare Medicare |
$3.12
|
|
|
HC SPLINT FINGER STAX #5
|
Facility
IP
|
$9.45
|
|
| Hospital Charge Code |
41601832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna All Commercial |
$8.16
|
| Rate for Payer: CORVEL All Commercial |
$8.79
|
| Rate for Payer: Coventry All Commercial |
$8.32
|
| Rate for Payer: Encore All Commercial |
$8.70
|
| Rate for Payer: Frontpath All Commercial |
$8.69
|
| Rate for Payer: Humana ChoiceCare |
$8.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.50
|
| Rate for Payer: PHCS All Commercial |
$7.09
|
| Rate for Payer: PHP All Commercial |
$7.17
|
| Rate for Payer: Sagamore Health Network All Products |
$7.30
|
| Rate for Payer: Signature Care EPO |
$7.84
|
| Rate for Payer: Signature Care PPO |
$8.32
|
| Rate for Payer: United Healthcare Commercial |
$7.45
|
|
|
HC SPLINT FINGER STAX #5 1/2
|
Facility
OP
|
$15.54
|
|
| Hospital Charge Code |
41601845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Aetna Commercial |
$13.12
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.64
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Centivo All Commercial |
$7.93
|
| Rate for Payer: Cigna All Commercial |
$13.41
|
| Rate for Payer: CORVEL All Commercial |
$14.45
|
| Rate for Payer: Coventry All Commercial |
$13.68
|
| Rate for Payer: Encore All Commercial |
$14.30
|
| Rate for Payer: Frontpath All Commercial |
$14.30
|
| Rate for Payer: Humana ChoiceCare |
$13.42
|
| Rate for Payer: Humana Medicare |
$7.93
|
| Rate for Payer: Lucent All Commercial |
$7.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.99
|
| Rate for Payer: PHCS All Commercial |
$11.66
|
| Rate for Payer: PHP All Commercial |
$11.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.06
|
| Rate for Payer: Sagamore Health Network All Products |
$12.00
|
| Rate for Payer: Signature Care EPO |
$12.90
|
| Rate for Payer: Signature Care PPO |
$13.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.21
|
| Rate for Payer: United Healthcare Commercial |
$12.25
|
| Rate for Payer: United Healthcare Medicare |
$5.13
|
|
|
HC SPLINT FINGER STAX #5 1/2
|
Facility
IP
|
$15.54
|
|
| Hospital Charge Code |
41601845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna All Commercial |
$13.41
|
| Rate for Payer: CORVEL All Commercial |
$14.45
|
| Rate for Payer: Coventry All Commercial |
$13.68
|
| Rate for Payer: Encore All Commercial |
$14.30
|
| Rate for Payer: Frontpath All Commercial |
$14.30
|
| Rate for Payer: Humana ChoiceCare |
$13.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.99
|
| Rate for Payer: PHCS All Commercial |
$11.66
|
| Rate for Payer: PHP All Commercial |
$11.79
|
| Rate for Payer: Sagamore Health Network All Products |
$12.00
|
| Rate for Payer: Signature Care EPO |
$12.90
|
| Rate for Payer: Signature Care PPO |
$13.68
|
| Rate for Payer: United Healthcare Commercial |
$12.25
|
|
|
HC SPLINT FINGER STAX #6
|
Facility
OP
|
$9.45
|
|
| Hospital Charge Code |
41601833
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$7.98
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.43
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Centivo All Commercial |
$4.82
|
| Rate for Payer: Cigna All Commercial |
$8.16
|
| Rate for Payer: CORVEL All Commercial |
$8.79
|
| Rate for Payer: Coventry All Commercial |
$8.32
|
| Rate for Payer: Encore All Commercial |
$8.70
|
| Rate for Payer: Frontpath All Commercial |
$8.69
|
| Rate for Payer: Humana ChoiceCare |
$8.16
|
| Rate for Payer: Humana Medicare |
$4.82
|
| Rate for Payer: Lucent All Commercial |
$4.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.50
|
| Rate for Payer: PHCS All Commercial |
$7.09
|
| Rate for Payer: PHP All Commercial |
$7.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.69
|
| Rate for Payer: Sagamore Health Network All Products |
$7.30
|
| Rate for Payer: Signature Care EPO |
$7.84
|
| Rate for Payer: Signature Care PPO |
$8.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.03
|
| Rate for Payer: United Healthcare Commercial |
$7.45
|
| Rate for Payer: United Healthcare Medicare |
$3.12
|
|
|
HC SPLINT FINGER STAX #6
|
Facility
IP
|
$9.45
|
|
| Hospital Charge Code |
41601833
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna All Commercial |
$8.16
|
| Rate for Payer: CORVEL All Commercial |
$8.79
|
| Rate for Payer: Coventry All Commercial |
$8.32
|
| Rate for Payer: Encore All Commercial |
$8.70
|
| Rate for Payer: Frontpath All Commercial |
$8.69
|
| Rate for Payer: Humana ChoiceCare |
$8.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.50
|
| Rate for Payer: PHCS All Commercial |
$7.09
|
| Rate for Payer: PHP All Commercial |
$7.17
|
| Rate for Payer: Sagamore Health Network All Products |
$7.30
|
| Rate for Payer: Signature Care EPO |
$7.84
|
| Rate for Payer: Signature Care PPO |
$8.32
|
| Rate for Payer: United Healthcare Commercial |
$7.45
|
|
|
HC SPLINT FINGER STAX #7
|
Facility
OP
|
$10.01
|
|
| Hospital Charge Code |
41601837
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.45
|
| Rate for Payer: Aetna Medicare |
$3.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.63
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Centivo All Commercial |
$5.11
|
| Rate for Payer: Cigna All Commercial |
$8.64
|
| Rate for Payer: CORVEL All Commercial |
$9.31
|
| Rate for Payer: Coventry All Commercial |
$8.81
|
| Rate for Payer: Encore All Commercial |
$9.21
|
| Rate for Payer: Frontpath All Commercial |
$9.21
|
| Rate for Payer: Humana ChoiceCare |
$8.65
|
| Rate for Payer: Humana Medicare |
$5.11
|
| Rate for Payer: Lucent All Commercial |
$5.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.01
|
| Rate for Payer: PHCS All Commercial |
$7.51
|
| Rate for Payer: PHP All Commercial |
$7.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.90
|
| Rate for Payer: Sagamore Health Network All Products |
$7.73
|
| Rate for Payer: Signature Care EPO |
$8.31
|
| Rate for Payer: Signature Care PPO |
$8.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.51
|
| Rate for Payer: United Healthcare Commercial |
$7.89
|
| Rate for Payer: United Healthcare Medicare |
$3.30
|
|
|
HC SPLINT FINGER STAX #7
|
Facility
IP
|
$10.01
|
|
| Hospital Charge Code |
41601837
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.65
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cigna All Commercial |
$8.64
|
| Rate for Payer: CORVEL All Commercial |
$9.31
|
| Rate for Payer: Coventry All Commercial |
$8.81
|
| Rate for Payer: Encore All Commercial |
$9.21
|
| Rate for Payer: Frontpath All Commercial |
$9.21
|
| Rate for Payer: Humana ChoiceCare |
$8.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.01
|
| Rate for Payer: PHCS All Commercial |
$7.51
|
| Rate for Payer: PHP All Commercial |
$7.59
|
| Rate for Payer: Sagamore Health Network All Products |
$7.73
|
| Rate for Payer: Signature Care EPO |
$8.31
|
| Rate for Payer: Signature Care PPO |
$8.81
|
| Rate for Payer: United Healthcare Commercial |
$7.89
|
|
|
HC SPLINT FLEX ALL
|
Facility
IP
|
$67.83
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
41601847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.87 |
| Max. Negotiated Rate |
$63.08 |
| Rate for Payer: Aetna Commercial |
$58.61
|
| Rate for Payer: Cash Price |
$42.06
|
| Rate for Payer: Cigna All Commercial |
$58.54
|
| Rate for Payer: CORVEL All Commercial |
$63.08
|
| Rate for Payer: Coventry All Commercial |
$59.69
|
| Rate for Payer: Encore All Commercial |
$62.44
|
| Rate for Payer: Frontpath All Commercial |
$62.40
|
| Rate for Payer: Humana ChoiceCare |
$58.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.05
|
| Rate for Payer: PHCS All Commercial |
$50.87
|
| Rate for Payer: PHP All Commercial |
$51.44
|
| Rate for Payer: Sagamore Health Network All Products |
$52.36
|
| Rate for Payer: Signature Care EPO |
$56.30
|
| Rate for Payer: Signature Care PPO |
$59.69
|
| Rate for Payer: United Healthcare Commercial |
$53.45
|
|
|
HC SPLINT FLEX ALL
|
Facility
OP
|
$67.83
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
41601847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.38 |
| Max. Negotiated Rate |
$63.08 |
| Rate for Payer: Aetna Commercial |
$57.25
|
| Rate for Payer: Aetna Medicare |
$22.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$51.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.62
|
| Rate for Payer: Cash Price |
$42.06
|
| Rate for Payer: Cash Price |
$42.06
|
| Rate for Payer: Centivo All Commercial |
$34.59
|
| Rate for Payer: Cigna All Commercial |
$58.54
|
| Rate for Payer: CORVEL All Commercial |
$63.08
|
| Rate for Payer: Coventry All Commercial |
$59.69
|
| Rate for Payer: Encore All Commercial |
$62.44
|
| Rate for Payer: Frontpath All Commercial |
$62.40
|
| Rate for Payer: Humana ChoiceCare |
$58.58
|
| Rate for Payer: Humana Medicare |
$34.59
|
| Rate for Payer: Lucent All Commercial |
$34.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.05
|
| Rate for Payer: Managed Health Services Medicaid |
$51.55
|
| Rate for Payer: MDWise Medicaid |
$51.55
|
| Rate for Payer: PHCS All Commercial |
$50.87
|
| Rate for Payer: PHP All Commercial |
$51.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.45
|
| Rate for Payer: Sagamore Health Network All Products |
$52.36
|
| Rate for Payer: Signature Care EPO |
$56.30
|
| Rate for Payer: Signature Care PPO |
$59.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$57.66
|
| Rate for Payer: United Healthcare Commercial |
$53.45
|
| Rate for Payer: United Healthcare Medicare |
$22.38
|
|
|
HC SPLINT GUTTER 4 INCH
|
Facility
IP
|
$4.86
|
|
| Hospital Charge Code |
41601834
|
|
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 GUTTER 4 INCH
|
Facility
OP
|
$4.86
|
|
| Hospital Charge Code |
41601834
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$4.52 |
| 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 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: 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: 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 HAND FINGER THUMB COMFY ADULT SM BLUE
|
Facility
OP
|
$476.49
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41603890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.24 |
| Max. Negotiated Rate |
$443.14 |
| Rate for Payer: Aetna Commercial |
$402.16
|
| Rate for Payer: Aetna Medicare |
$157.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$273.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$297.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$161.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.97
|
| Rate for Payer: Cash Price |
$295.42
|
| Rate for Payer: Cash Price |
$295.42
|
| Rate for Payer: Centivo All Commercial |
$243.01
|
| Rate for Payer: Cigna All Commercial |
$411.21
|
| Rate for Payer: CORVEL All Commercial |
$443.14
|
| Rate for Payer: Coventry All Commercial |
$419.31
|
| Rate for Payer: Encore All Commercial |
$438.61
|
| Rate for Payer: Frontpath All Commercial |
$438.37
|
| Rate for Payer: Humana ChoiceCare |
$411.54
|
| Rate for Payer: Humana Medicare |
$243.01
|
| Rate for Payer: Lucent All Commercial |
$243.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.84
|
| Rate for Payer: Managed Health Services Medicaid |
$161.88
|
| Rate for Payer: MDWise Medicaid |
$161.88
|
| Rate for Payer: PHCS All Commercial |
$357.37
|
| Rate for Payer: PHP All Commercial |
$361.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.83
|
| Rate for Payer: Sagamore Health Network All Products |
$367.85
|
| Rate for Payer: Signature Care EPO |
$395.49
|
| Rate for Payer: Signature Care PPO |
$419.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.02
|
| Rate for Payer: United Healthcare Commercial |
$375.47
|
| Rate for Payer: United Healthcare Medicare |
$157.24
|
|
|
HC SPLINT HAND FINGER THUMB COMFY ADULT SM BLUE
|
Facility
IP
|
$476.49
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41603890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$357.37 |
| Max. Negotiated Rate |
$443.14 |
| Rate for Payer: Aetna Commercial |
$411.69
|
| Rate for Payer: Cash Price |
$295.42
|
| Rate for Payer: Cigna All Commercial |
$411.21
|
| Rate for Payer: CORVEL All Commercial |
$443.14
|
| Rate for Payer: Coventry All Commercial |
$419.31
|
| Rate for Payer: Encore All Commercial |
$438.61
|
| Rate for Payer: Frontpath All Commercial |
$438.37
|
| Rate for Payer: Humana ChoiceCare |
$411.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.84
|
| Rate for Payer: PHCS All Commercial |
$357.37
|
| Rate for Payer: PHP All Commercial |
$361.37
|
| Rate for Payer: Sagamore Health Network All Products |
$367.85
|
| Rate for Payer: Signature Care EPO |
$395.49
|
| Rate for Payer: Signature Care PPO |
$419.31
|
| Rate for Payer: United Healthcare Commercial |
$375.47
|
|
|
HC SPLINT HAND THUMB COMFY ADULT SMALL
|
Facility
OP
|
$289.52
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41602163
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.54 |
| Max. Negotiated Rate |
$269.25 |
| Rate for Payer: Aetna Commercial |
$244.35
|
| Rate for Payer: Aetna Medicare |
$95.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$166.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$180.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$161.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$109.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.10
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Centivo All Commercial |
$147.66
|
| Rate for Payer: Cigna All Commercial |
$249.86
|
| Rate for Payer: CORVEL All Commercial |
$269.25
|
| Rate for Payer: Coventry All Commercial |
$254.78
|
| Rate for Payer: Encore All Commercial |
$266.50
|
| Rate for Payer: Frontpath All Commercial |
$266.36
|
| Rate for Payer: Humana ChoiceCare |
$250.06
|
| Rate for Payer: Humana Medicare |
$147.66
|
| Rate for Payer: Lucent All Commercial |
$147.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.57
|
| Rate for Payer: Managed Health Services Medicaid |
$161.88
|
| Rate for Payer: MDWise Medicaid |
$161.88
|
| Rate for Payer: PHCS All Commercial |
$217.14
|
| Rate for Payer: PHP All Commercial |
$219.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$112.91
|
| Rate for Payer: Sagamore Health Network All Products |
$223.51
|
| Rate for Payer: Signature Care EPO |
$240.30
|
| Rate for Payer: Signature Care PPO |
$254.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$246.09
|
| Rate for Payer: United Healthcare Commercial |
$228.14
|
| Rate for Payer: United Healthcare Medicare |
$95.54
|
|
|
HC SPLINT HAND THUMB COMFY ADULT SMALL
|
Facility
IP
|
$289.52
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
41602163
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.14 |
| Max. Negotiated Rate |
$269.25 |
| Rate for Payer: Aetna Commercial |
$250.15
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna All Commercial |
$249.86
|
| Rate for Payer: CORVEL All Commercial |
$269.25
|
| Rate for Payer: Coventry All Commercial |
$254.78
|
| Rate for Payer: Encore All Commercial |
$266.50
|
| Rate for Payer: Frontpath All Commercial |
$266.36
|
| Rate for Payer: Humana ChoiceCare |
$250.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.57
|
| Rate for Payer: PHCS All Commercial |
$217.14
|
| Rate for Payer: PHP All Commercial |
$219.57
|
| Rate for Payer: Sagamore Health Network All Products |
$223.51
|
| Rate for Payer: Signature Care EPO |
$240.30
|
| Rate for Payer: Signature Care PPO |
$254.78
|
| Rate for Payer: United Healthcare Commercial |
$228.14
|
|
|
HC SPLINT KNUCKLE BEND REV L
|
Facility
OP
|
$106.69
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
41602338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$99.22 |
| Rate for Payer: Aetna Commercial |
$90.05
|
| Rate for Payer: Aetna Medicare |
$35.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$71.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.73
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Centivo All Commercial |
$54.41
|
| Rate for Payer: Cigna All Commercial |
$92.07
|
| Rate for Payer: CORVEL All Commercial |
$99.22
|
| Rate for Payer: Coventry All Commercial |
$93.89
|
| Rate for Payer: Encore All Commercial |
$98.21
|
| Rate for Payer: Frontpath All Commercial |
$98.15
|
| Rate for Payer: Humana ChoiceCare |
$92.15
|
| Rate for Payer: Humana Medicare |
$54.41
|
| Rate for Payer: Lucent All Commercial |
$54.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.02
|
| Rate for Payer: Managed Health Services Medicaid |
$71.68
|
| Rate for Payer: MDWise Medicaid |
$71.68
|
| Rate for Payer: PHCS All Commercial |
$80.02
|
| Rate for Payer: PHP All Commercial |
$80.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.61
|
| Rate for Payer: Sagamore Health Network All Products |
$82.36
|
| Rate for Payer: Signature Care EPO |
$88.55
|
| Rate for Payer: Signature Care PPO |
$93.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.69
|
| Rate for Payer: United Healthcare Commercial |
$84.07
|
| Rate for Payer: United Healthcare Medicare |
$35.21
|
|
|
HC SPLINT KNUCKLE BEND REV L
|
Facility
IP
|
$106.69
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
41602338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.02 |
| Max. Negotiated Rate |
$99.22 |
| Rate for Payer: Aetna Commercial |
$92.18
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna All Commercial |
$92.07
|
| Rate for Payer: CORVEL All Commercial |
$99.22
|
| Rate for Payer: Coventry All Commercial |
$93.89
|
| Rate for Payer: Encore All Commercial |
$98.21
|
| Rate for Payer: Frontpath All Commercial |
$98.15
|
| Rate for Payer: Humana ChoiceCare |
$92.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.02
|
| Rate for Payer: PHCS All Commercial |
$80.02
|
| Rate for Payer: PHP All Commercial |
$80.91
|
| Rate for Payer: Sagamore Health Network All Products |
$82.36
|
| Rate for Payer: Signature Care EPO |
$88.55
|
| Rate for Payer: Signature Care PPO |
$93.89
|
| Rate for Payer: United Healthcare Commercial |
$84.07
|
|
|
HC SPLINT; LONG ARM-OT-LT
|
Facility
IP
|
$343.94
|
|
|
Service Code
|
CPT 29105 GO
|
| Hospital Charge Code |
01738073
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$257.96 |
| Max. Negotiated Rate |
$319.87 |
| Rate for Payer: Aetna Commercial |
$297.17
|
| Rate for Payer: Cash Price |
$213.25
|
| Rate for Payer: Cigna All Commercial |
$296.82
|
| Rate for Payer: CORVEL All Commercial |
$319.87
|
| Rate for Payer: Coventry All Commercial |
$302.67
|
| Rate for Payer: Encore All Commercial |
$316.60
|
| Rate for Payer: Frontpath All Commercial |
$316.43
|
| Rate for Payer: Humana ChoiceCare |
$297.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.55
|
| Rate for Payer: PHCS All Commercial |
$257.96
|
| Rate for Payer: PHP All Commercial |
$260.85
|
| Rate for Payer: Sagamore Health Network All Products |
$265.52
|
| Rate for Payer: Signature Care EPO |
$285.47
|
| Rate for Payer: Signature Care PPO |
$302.67
|
| Rate for Payer: United Healthcare Commercial |
$271.03
|
|
|
HC SPLINT; LONG ARM-OT-LT
|
Facility
OP
|
$343.94
|
|
|
Service Code
|
CPT 29105 GO
|
| Hospital Charge Code |
01738073
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$113.50 |
| Max. Negotiated Rate |
$319.87 |
| Rate for Payer: Aetna Commercial |
$290.29
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$197.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$215.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.85
|
| Rate for Payer: Cash Price |
$213.25
|
| Rate for Payer: Centivo All Commercial |
$175.41
|
| Rate for Payer: Cigna All Commercial |
$296.82
|
| Rate for Payer: CORVEL All Commercial |
$319.87
|
| Rate for Payer: Coventry All Commercial |
$302.67
|
| Rate for Payer: Encore All Commercial |
$316.60
|
| Rate for Payer: Frontpath All Commercial |
$316.43
|
| Rate for Payer: Humana ChoiceCare |
$297.06
|
| Rate for Payer: Humana Medicare |
$175.41
|
| Rate for Payer: Lucent All Commercial |
$175.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.55
|
| Rate for Payer: PHCS All Commercial |
$257.96
|
| Rate for Payer: PHP All Commercial |
$260.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$134.14
|
| Rate for Payer: Sagamore Health Network All Products |
$265.52
|
| Rate for Payer: Signature Care EPO |
$285.47
|
| Rate for Payer: Signature Care PPO |
$302.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$292.35
|
| Rate for Payer: United Healthcare Commercial |
$271.03
|
| Rate for Payer: United Healthcare Medicare |
$113.50
|
|
|
HC SPLINT; LONG ARM-PT
|
Facility
IP
|
$330.71
|
|
|
Service Code
|
CPT 29105 GP
|
| Hospital Charge Code |
01728100
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$248.04 |
| Max. Negotiated Rate |
$307.56 |
| Rate for Payer: Aetna Commercial |
$285.74
|
| Rate for Payer: Cash Price |
$205.04
|
| Rate for Payer: Cigna All Commercial |
$285.41
|
| Rate for Payer: CORVEL All Commercial |
$307.56
|
| Rate for Payer: Coventry All Commercial |
$291.03
|
| Rate for Payer: Encore All Commercial |
$304.42
|
| Rate for Payer: Frontpath All Commercial |
$304.26
|
| Rate for Payer: Humana ChoiceCare |
$285.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.64
|
| Rate for Payer: PHCS All Commercial |
$248.04
|
| Rate for Payer: PHP All Commercial |
$250.81
|
| Rate for Payer: Sagamore Health Network All Products |
$255.31
|
| Rate for Payer: Signature Care EPO |
$274.49
|
| Rate for Payer: Signature Care PPO |
$291.03
|
| Rate for Payer: United Healthcare Commercial |
$260.60
|
|
|
HC SPLINT; LONG ARM-PT
|
Facility
OP
|
$330.71
|
|
|
Service Code
|
CPT 29105 GP
|
| Hospital Charge Code |
01728100
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$109.14 |
| Max. Negotiated Rate |
$307.56 |
| Rate for Payer: Aetna Commercial |
$279.12
|
| Rate for Payer: Aetna Medicare |
$109.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$109.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$189.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$206.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.05
|
| Rate for Payer: Cash Price |
$205.04
|
| Rate for Payer: Centivo All Commercial |
$168.66
|
| Rate for Payer: Cigna All Commercial |
$285.41
|
| Rate for Payer: CORVEL All Commercial |
$307.56
|
| Rate for Payer: Coventry All Commercial |
$291.03
|
| Rate for Payer: Encore All Commercial |
$304.42
|
| Rate for Payer: Frontpath All Commercial |
$304.26
|
| Rate for Payer: Humana ChoiceCare |
$285.64
|
| Rate for Payer: Humana Medicare |
$168.66
|
| Rate for Payer: Lucent All Commercial |
$168.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.64
|
| Rate for Payer: PHCS All Commercial |
$248.04
|
| Rate for Payer: PHP All Commercial |
$250.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.98
|
| Rate for Payer: Sagamore Health Network All Products |
$255.31
|
| Rate for Payer: Signature Care EPO |
$274.49
|
| Rate for Payer: Signature Care PPO |
$291.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$281.11
|
| Rate for Payer: United Healthcare Commercial |
$260.60
|
| Rate for Payer: United Healthcare Medicare |
$109.14
|
|
|
HC SPLINT; L THUMB DYNAMIC-OT
|
Facility
OP
|
$260.27
|
|
|
Service Code
|
CPT 29131 GO,FA
|
| Hospital Charge Code |
01738071
|
|
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
|
|
