|
HC STOCKING KNEE MEDIUM/REGULAR
|
Facility
IP
|
$33.74
|
|
| Hospital Charge Code |
41601104
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$31.38 |
| Rate for Payer: Aetna Commercial |
$29.15
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cigna All Commercial |
$29.12
|
| Rate for Payer: CORVEL All Commercial |
$31.38
|
| Rate for Payer: Coventry All Commercial |
$29.69
|
| Rate for Payer: Encore All Commercial |
$31.06
|
| Rate for Payer: Frontpath All Commercial |
$31.04
|
| Rate for Payer: Humana ChoiceCare |
$29.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.37
|
| Rate for Payer: PHCS All Commercial |
$25.30
|
| Rate for Payer: PHP All Commercial |
$25.59
|
| Rate for Payer: Sagamore Health Network All Products |
$26.05
|
| Rate for Payer: Signature Care EPO |
$28.00
|
| Rate for Payer: Signature Care PPO |
$29.69
|
| Rate for Payer: United Healthcare Commercial |
$26.59
|
|
|
HC STOCKING KNEE SMALL/LONG
|
Facility
IP
|
$22.52
|
|
| Hospital Charge Code |
41601105
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cigna All Commercial |
$19.43
|
| Rate for Payer: CORVEL All Commercial |
$20.94
|
| Rate for Payer: Coventry All Commercial |
$19.82
|
| Rate for Payer: Encore All Commercial |
$20.73
|
| Rate for Payer: Frontpath All Commercial |
$20.72
|
| Rate for Payer: Humana ChoiceCare |
$19.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.27
|
| Rate for Payer: PHCS All Commercial |
$16.89
|
| Rate for Payer: PHP All Commercial |
$17.08
|
| Rate for Payer: Sagamore Health Network All Products |
$17.39
|
| Rate for Payer: Signature Care EPO |
$18.69
|
| Rate for Payer: Signature Care PPO |
$19.82
|
| Rate for Payer: United Healthcare Commercial |
$17.75
|
|
|
HC STOCKING KNEE SMALL/LONG
|
Facility
OP
|
$22.52
|
|
| Hospital Charge Code |
41601105
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$19.01
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Centivo All Commercial |
$11.49
|
| Rate for Payer: Cigna All Commercial |
$19.43
|
| Rate for Payer: CORVEL All Commercial |
$20.94
|
| Rate for Payer: Coventry All Commercial |
$19.82
|
| Rate for Payer: Encore All Commercial |
$20.73
|
| Rate for Payer: Frontpath All Commercial |
$20.72
|
| Rate for Payer: Humana ChoiceCare |
$19.45
|
| Rate for Payer: Humana Medicare |
$11.49
|
| Rate for Payer: Lucent All Commercial |
$11.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.27
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$16.89
|
| Rate for Payer: PHP All Commercial |
$17.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.78
|
| Rate for Payer: Sagamore Health Network All Products |
$17.39
|
| Rate for Payer: Signature Care EPO |
$18.69
|
| Rate for Payer: Signature Care PPO |
$19.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$17.75
|
| Rate for Payer: United Healthcare Medicare |
$7.43
|
|
|
HC STOCKING KNEE SMALL/REGULAR
|
Facility
OP
|
$33.74
|
|
| Hospital Charge Code |
41601106
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$28.48
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.25
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Centivo All Commercial |
$17.21
|
| Rate for Payer: Cigna All Commercial |
$29.12
|
| Rate for Payer: CORVEL All Commercial |
$31.38
|
| Rate for Payer: Coventry All Commercial |
$29.69
|
| Rate for Payer: Encore All Commercial |
$31.06
|
| Rate for Payer: Frontpath All Commercial |
$31.04
|
| Rate for Payer: Humana ChoiceCare |
$29.14
|
| Rate for Payer: Humana Medicare |
$17.21
|
| Rate for Payer: Lucent All Commercial |
$17.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.37
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$25.30
|
| Rate for Payer: PHP All Commercial |
$25.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.16
|
| Rate for Payer: Sagamore Health Network All Products |
$26.05
|
| Rate for Payer: Signature Care EPO |
$28.00
|
| Rate for Payer: Signature Care PPO |
$29.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.68
|
| Rate for Payer: United Healthcare Commercial |
$26.59
|
| Rate for Payer: United Healthcare Medicare |
$11.13
|
|
|
HC STOCKING KNEE SMALL/REGULAR
|
Facility
IP
|
$33.74
|
|
| Hospital Charge Code |
41601106
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$31.38 |
| Rate for Payer: Aetna Commercial |
$29.15
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cigna All Commercial |
$29.12
|
| Rate for Payer: CORVEL All Commercial |
$31.38
|
| Rate for Payer: Coventry All Commercial |
$29.69
|
| Rate for Payer: Encore All Commercial |
$31.06
|
| Rate for Payer: Frontpath All Commercial |
$31.04
|
| Rate for Payer: Humana ChoiceCare |
$29.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.37
|
| Rate for Payer: PHCS All Commercial |
$25.30
|
| Rate for Payer: PHP All Commercial |
$25.59
|
| Rate for Payer: Sagamore Health Network All Products |
$26.05
|
| Rate for Payer: Signature Care EPO |
$28.00
|
| Rate for Payer: Signature Care PPO |
$29.69
|
| Rate for Payer: United Healthcare Commercial |
$26.59
|
|
|
HC STOCKING KNEE X LARGE/LONG
|
Facility
OP
|
$24.93
|
|
| Hospital Charge Code |
41601107
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$21.04
|
| Rate for Payer: Aetna Medicare |
$8.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.05
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Centivo All Commercial |
$12.71
|
| Rate for Payer: Cigna All Commercial |
$21.51
|
| Rate for Payer: CORVEL All Commercial |
$23.18
|
| Rate for Payer: Coventry All Commercial |
$21.94
|
| Rate for Payer: Encore All Commercial |
$22.95
|
| Rate for Payer: Frontpath All Commercial |
$22.94
|
| Rate for Payer: Humana ChoiceCare |
$21.53
|
| Rate for Payer: Humana Medicare |
$12.71
|
| Rate for Payer: Lucent All Commercial |
$12.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.44
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$18.70
|
| Rate for Payer: PHP All Commercial |
$18.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.72
|
| Rate for Payer: Sagamore Health Network All Products |
$19.25
|
| Rate for Payer: Signature Care EPO |
$20.69
|
| Rate for Payer: Signature Care PPO |
$21.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.19
|
| Rate for Payer: United Healthcare Commercial |
$19.64
|
| Rate for Payer: United Healthcare Medicare |
$8.23
|
|
|
HC STOCKING KNEE X LARGE/LONG
|
Facility
IP
|
$24.93
|
|
| Hospital Charge Code |
41601107
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cigna All Commercial |
$21.51
|
| Rate for Payer: CORVEL All Commercial |
$23.18
|
| Rate for Payer: Coventry All Commercial |
$21.94
|
| Rate for Payer: Encore All Commercial |
$22.95
|
| Rate for Payer: Frontpath All Commercial |
$22.94
|
| Rate for Payer: Humana ChoiceCare |
$21.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.44
|
| Rate for Payer: PHCS All Commercial |
$18.70
|
| Rate for Payer: PHP All Commercial |
$18.91
|
| Rate for Payer: Sagamore Health Network All Products |
$19.25
|
| Rate for Payer: Signature Care EPO |
$20.69
|
| Rate for Payer: Signature Care PPO |
$21.94
|
| Rate for Payer: United Healthcare Commercial |
$19.64
|
|
|
HC STOCKING KNEE X LARGE/REGULAR
|
Facility
OP
|
$33.74
|
|
| Hospital Charge Code |
41601108
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$28.48
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.25
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Centivo All Commercial |
$17.21
|
| Rate for Payer: Cigna All Commercial |
$29.12
|
| Rate for Payer: CORVEL All Commercial |
$31.38
|
| Rate for Payer: Coventry All Commercial |
$29.69
|
| Rate for Payer: Encore All Commercial |
$31.06
|
| Rate for Payer: Frontpath All Commercial |
$31.04
|
| Rate for Payer: Humana ChoiceCare |
$29.14
|
| Rate for Payer: Humana Medicare |
$17.21
|
| Rate for Payer: Lucent All Commercial |
$17.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.37
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$25.30
|
| Rate for Payer: PHP All Commercial |
$25.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.16
|
| Rate for Payer: Sagamore Health Network All Products |
$26.05
|
| Rate for Payer: Signature Care EPO |
$28.00
|
| Rate for Payer: Signature Care PPO |
$29.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.68
|
| Rate for Payer: United Healthcare Commercial |
$26.59
|
| Rate for Payer: United Healthcare Medicare |
$11.13
|
|
|
HC STOCKING KNEE X LARGE/REGULAR
|
Facility
IP
|
$33.74
|
|
| Hospital Charge Code |
41601108
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$31.38 |
| Rate for Payer: Aetna Commercial |
$29.15
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cigna All Commercial |
$29.12
|
| Rate for Payer: CORVEL All Commercial |
$31.38
|
| Rate for Payer: Coventry All Commercial |
$29.69
|
| Rate for Payer: Encore All Commercial |
$31.06
|
| Rate for Payer: Frontpath All Commercial |
$31.04
|
| Rate for Payer: Humana ChoiceCare |
$29.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.37
|
| Rate for Payer: PHCS All Commercial |
$25.30
|
| Rate for Payer: PHP All Commercial |
$25.59
|
| Rate for Payer: Sagamore Health Network All Products |
$26.05
|
| Rate for Payer: Signature Care EPO |
$28.00
|
| Rate for Payer: Signature Care PPO |
$29.69
|
| Rate for Payer: United Healthcare Commercial |
$26.59
|
|
|
HC STOCKING KNEE XX LARGE/LONG
|
Facility
OP
|
$39.51
|
|
| Hospital Charge Code |
41601109
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$33.35
|
| Rate for Payer: Aetna Medicare |
$13.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.34
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Centivo All Commercial |
$20.15
|
| Rate for Payer: Cigna All Commercial |
$34.10
|
| Rate for Payer: CORVEL All Commercial |
$36.74
|
| Rate for Payer: Coventry All Commercial |
$34.77
|
| Rate for Payer: Encore All Commercial |
$36.37
|
| Rate for Payer: Frontpath All Commercial |
$36.35
|
| Rate for Payer: Humana ChoiceCare |
$34.12
|
| Rate for Payer: Humana Medicare |
$20.15
|
| Rate for Payer: Lucent All Commercial |
$20.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.56
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$29.63
|
| Rate for Payer: PHP All Commercial |
$29.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.41
|
| Rate for Payer: Sagamore Health Network All Products |
$30.50
|
| Rate for Payer: Signature Care EPO |
$32.79
|
| Rate for Payer: Signature Care PPO |
$34.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.58
|
| Rate for Payer: United Healthcare Commercial |
$31.13
|
| Rate for Payer: United Healthcare Medicare |
$13.04
|
|
|
HC STOCKING KNEE XX LARGE/LONG
|
Facility
IP
|
$39.51
|
|
| Hospital Charge Code |
41601109
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.63 |
| Max. Negotiated Rate |
$36.74 |
| Rate for Payer: Aetna Commercial |
$34.14
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna All Commercial |
$34.10
|
| Rate for Payer: CORVEL All Commercial |
$36.74
|
| Rate for Payer: Coventry All Commercial |
$34.77
|
| Rate for Payer: Encore All Commercial |
$36.37
|
| Rate for Payer: Frontpath All Commercial |
$36.35
|
| Rate for Payer: Humana ChoiceCare |
$34.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.56
|
| Rate for Payer: PHCS All Commercial |
$29.63
|
| Rate for Payer: PHP All Commercial |
$29.96
|
| Rate for Payer: Sagamore Health Network All Products |
$30.50
|
| Rate for Payer: Signature Care EPO |
$32.79
|
| Rate for Payer: Signature Care PPO |
$34.77
|
| Rate for Payer: United Healthcare Commercial |
$31.13
|
|
|
HC STOCKING KNEE XX LARGE/REGULAR
|
Facility
IP
|
$43.72
|
|
| Hospital Charge Code |
41601110
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.79 |
| Max. Negotiated Rate |
$40.66 |
| Rate for Payer: Aetna Commercial |
$37.77
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cigna All Commercial |
$37.73
|
| Rate for Payer: CORVEL All Commercial |
$40.66
|
| Rate for Payer: Coventry All Commercial |
$38.47
|
| Rate for Payer: Encore All Commercial |
$40.24
|
| Rate for Payer: Frontpath All Commercial |
$40.22
|
| Rate for Payer: Humana ChoiceCare |
$37.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.35
|
| Rate for Payer: PHCS All Commercial |
$32.79
|
| Rate for Payer: PHP All Commercial |
$33.16
|
| Rate for Payer: Sagamore Health Network All Products |
$33.75
|
| Rate for Payer: Signature Care EPO |
$36.29
|
| Rate for Payer: Signature Care PPO |
$38.47
|
| Rate for Payer: United Healthcare Commercial |
$34.45
|
|
|
HC STOCKING KNEE XX LARGE/REGULAR
|
Facility
OP
|
$43.72
|
|
| Hospital Charge Code |
41601110
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$36.90
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.87
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Centivo All Commercial |
$22.30
|
| Rate for Payer: Cigna All Commercial |
$37.73
|
| Rate for Payer: CORVEL All Commercial |
$40.66
|
| Rate for Payer: Coventry All Commercial |
$38.47
|
| Rate for Payer: Encore All Commercial |
$40.24
|
| Rate for Payer: Frontpath All Commercial |
$40.22
|
| Rate for Payer: Humana ChoiceCare |
$37.76
|
| Rate for Payer: Humana Medicare |
$22.30
|
| Rate for Payer: Lucent All Commercial |
$22.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.35
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$32.79
|
| Rate for Payer: PHP All Commercial |
$33.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.05
|
| Rate for Payer: Sagamore Health Network All Products |
$33.75
|
| Rate for Payer: Signature Care EPO |
$36.29
|
| Rate for Payer: Signature Care PPO |
$38.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.16
|
| Rate for Payer: United Healthcare Commercial |
$34.45
|
| Rate for Payer: United Healthcare Medicare |
$14.43
|
|
|
HC STOCKING KNEE XXX LARGE/LONG
|
Facility
OP
|
$39.51
|
|
| Hospital Charge Code |
41601111
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$33.35
|
| Rate for Payer: Aetna Medicare |
$13.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.34
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Centivo All Commercial |
$20.15
|
| Rate for Payer: Cigna All Commercial |
$34.10
|
| Rate for Payer: CORVEL All Commercial |
$36.74
|
| Rate for Payer: Coventry All Commercial |
$34.77
|
| Rate for Payer: Encore All Commercial |
$36.37
|
| Rate for Payer: Frontpath All Commercial |
$36.35
|
| Rate for Payer: Humana ChoiceCare |
$34.12
|
| Rate for Payer: Humana Medicare |
$20.15
|
| Rate for Payer: Lucent All Commercial |
$20.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.56
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$29.63
|
| Rate for Payer: PHP All Commercial |
$29.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.41
|
| Rate for Payer: Sagamore Health Network All Products |
$30.50
|
| Rate for Payer: Signature Care EPO |
$32.79
|
| Rate for Payer: Signature Care PPO |
$34.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.58
|
| Rate for Payer: United Healthcare Commercial |
$31.13
|
| Rate for Payer: United Healthcare Medicare |
$13.04
|
|
|
HC STOCKING KNEE XXX LARGE/LONG
|
Facility
IP
|
$39.51
|
|
| Hospital Charge Code |
41601111
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.63 |
| Max. Negotiated Rate |
$36.74 |
| Rate for Payer: Aetna Commercial |
$34.14
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna All Commercial |
$34.10
|
| Rate for Payer: CORVEL All Commercial |
$36.74
|
| Rate for Payer: Coventry All Commercial |
$34.77
|
| Rate for Payer: Encore All Commercial |
$36.37
|
| Rate for Payer: Frontpath All Commercial |
$36.35
|
| Rate for Payer: Humana ChoiceCare |
$34.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.56
|
| Rate for Payer: PHCS All Commercial |
$29.63
|
| Rate for Payer: PHP All Commercial |
$29.96
|
| Rate for Payer: Sagamore Health Network All Products |
$30.50
|
| Rate for Payer: Signature Care EPO |
$32.79
|
| Rate for Payer: Signature Care PPO |
$34.77
|
| Rate for Payer: United Healthcare Commercial |
$31.13
|
|
|
HC STOCKING KNEE XXX LARGE/REGULAR
|
Facility
OP
|
$43.72
|
|
| Hospital Charge Code |
41601112
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$36.90
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.87
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Centivo All Commercial |
$22.30
|
| Rate for Payer: Cigna All Commercial |
$37.73
|
| Rate for Payer: CORVEL All Commercial |
$40.66
|
| Rate for Payer: Coventry All Commercial |
$38.47
|
| Rate for Payer: Encore All Commercial |
$40.24
|
| Rate for Payer: Frontpath All Commercial |
$40.22
|
| Rate for Payer: Humana ChoiceCare |
$37.76
|
| Rate for Payer: Humana Medicare |
$22.30
|
| Rate for Payer: Lucent All Commercial |
$22.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.35
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$32.79
|
| Rate for Payer: PHP All Commercial |
$33.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.05
|
| Rate for Payer: Sagamore Health Network All Products |
$33.75
|
| Rate for Payer: Signature Care EPO |
$36.29
|
| Rate for Payer: Signature Care PPO |
$38.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.16
|
| Rate for Payer: United Healthcare Commercial |
$34.45
|
| Rate for Payer: United Healthcare Medicare |
$14.43
|
|
|
HC STOCKING KNEE XXX LARGE/REGULAR
|
Facility
IP
|
$43.72
|
|
| Hospital Charge Code |
41601112
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.79 |
| Max. Negotiated Rate |
$40.66 |
| Rate for Payer: Aetna Commercial |
$37.77
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cigna All Commercial |
$37.73
|
| Rate for Payer: CORVEL All Commercial |
$40.66
|
| Rate for Payer: Coventry All Commercial |
$38.47
|
| Rate for Payer: Encore All Commercial |
$40.24
|
| Rate for Payer: Frontpath All Commercial |
$40.22
|
| Rate for Payer: Humana ChoiceCare |
$37.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.35
|
| Rate for Payer: PHCS All Commercial |
$32.79
|
| Rate for Payer: PHP All Commercial |
$33.16
|
| Rate for Payer: Sagamore Health Network All Products |
$33.75
|
| Rate for Payer: Signature Care EPO |
$36.29
|
| Rate for Payer: Signature Care PPO |
$38.47
|
| Rate for Payer: United Healthcare Commercial |
$34.45
|
|
|
HC STOCKING THIGH LARGE/LONG
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601113
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH LARGE/LONG
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601113
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH LARGE/REGULAR
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601114
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH LARGE/REGULAR
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601114
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH LARGE/SHORT
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601115
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH LARGE/SHORT
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601115
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
|
HC STOCKING THIGH MEDIUM/LONG
|
Facility
OP
|
$41.80
|
|
| Hospital Charge Code |
41601116
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$21.32
|
| Rate for Payer: Lucent All Commercial |
$21.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.30
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare |
$13.79
|
|
|
HC STOCKING THIGH MEDIUM/LONG
|
Facility
IP
|
$41.80
|
|
| Hospital Charge Code |
41601116
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cigna All Commercial |
$36.07
|
| Rate for Payer: CORVEL All Commercial |
$38.87
|
| Rate for Payer: Coventry All Commercial |
$36.78
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.62
|
| Rate for Payer: PHCS All Commercial |
$31.35
|
| Rate for Payer: PHP All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$32.27
|
| Rate for Payer: Signature Care EPO |
$34.69
|
| Rate for Payer: Signature Care PPO |
$36.78
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
|
