|
HC SUT PDS+ 0 CT-2 27" PDP334H
|
Facility
|
OP
|
$21.59
|
|
| Hospital Charge Code |
41607972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Medicare |
$7.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.84
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Centivo All Commercial |
$11.01
|
| Rate for Payer: Cigna All Commercial |
$18.63
|
| Rate for Payer: CORVEL All Commercial |
$20.08
|
| Rate for Payer: Coventry All Commercial |
$19.00
|
| Rate for Payer: Encore All Commercial |
$19.87
|
| Rate for Payer: Frontpath All Commercial |
$19.86
|
| Rate for Payer: Humana ChoiceCare |
$18.65
|
| Rate for Payer: Humana Medicare |
$11.01
|
| Rate for Payer: Lucent All Commercial |
$11.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.43
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$16.19
|
| Rate for Payer: PHP All Commercial |
$16.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.42
|
| Rate for Payer: Sagamore Health Network All Products |
$16.67
|
| Rate for Payer: Signature Care EPO |
$17.92
|
| Rate for Payer: Signature Care PPO |
$19.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.35
|
| Rate for Payer: United Healthcare Commercial |
$17.01
|
| Rate for Payer: United Healthcare Medicare |
$7.12
|
|
|
HC SUT PDS+ 0 CT-2 27" PDP334H
|
Facility
|
IP
|
$21.59
|
|
| Hospital Charge Code |
41607972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$20.08 |
| Rate for Payer: Aetna Commercial |
$18.65
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cigna All Commercial |
$18.63
|
| Rate for Payer: CORVEL All Commercial |
$20.08
|
| Rate for Payer: Coventry All Commercial |
$19.00
|
| Rate for Payer: Encore All Commercial |
$19.87
|
| Rate for Payer: Frontpath All Commercial |
$19.86
|
| Rate for Payer: Humana ChoiceCare |
$18.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.43
|
| Rate for Payer: PHCS All Commercial |
$16.19
|
| Rate for Payer: PHP All Commercial |
$16.37
|
| Rate for Payer: Sagamore Health Network All Products |
$16.67
|
| Rate for Payer: Signature Care EPO |
$17.92
|
| Rate for Payer: Signature Care PPO |
$19.00
|
| Rate for Payer: United Healthcare Commercial |
$17.01
|
|
|
HC SUT PDS+ 0 CTX 30" PDP990G
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
41607973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$37.98
|
| Rate for Payer: Aetna Medicare |
$14.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.34
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Centivo All Commercial |
$22.95
|
| Rate for Payer: Cigna All Commercial |
$38.84
|
| Rate for Payer: CORVEL All Commercial |
$41.85
|
| Rate for Payer: Coventry All Commercial |
$39.60
|
| Rate for Payer: Encore All Commercial |
$41.42
|
| Rate for Payer: Frontpath All Commercial |
$41.40
|
| Rate for Payer: Humana ChoiceCare |
$38.87
|
| Rate for Payer: Humana Medicare |
$22.95
|
| Rate for Payer: Lucent All Commercial |
$22.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$33.75
|
| Rate for Payer: PHP All Commercial |
$34.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.55
|
| Rate for Payer: Sagamore Health Network All Products |
$34.74
|
| Rate for Payer: Signature Care EPO |
$37.35
|
| Rate for Payer: Signature Care PPO |
$39.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.25
|
| Rate for Payer: United Healthcare Commercial |
$35.46
|
| Rate for Payer: United Healthcare Medicare |
$14.85
|
|
|
HC SUT PDS+ 0 CTX 30" PDP990G
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
41607973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$41.85 |
| Rate for Payer: Aetna Commercial |
$38.88
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna All Commercial |
$38.84
|
| Rate for Payer: CORVEL All Commercial |
$41.85
|
| Rate for Payer: Coventry All Commercial |
$39.60
|
| Rate for Payer: Encore All Commercial |
$41.42
|
| Rate for Payer: Frontpath All Commercial |
$41.40
|
| Rate for Payer: Humana ChoiceCare |
$38.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.50
|
| Rate for Payer: PHCS All Commercial |
$33.75
|
| Rate for Payer: PHP All Commercial |
$34.13
|
| Rate for Payer: Sagamore Health Network All Products |
$34.74
|
| Rate for Payer: Signature Care EPO |
$37.35
|
| Rate for Payer: Signature Care PPO |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$35.46
|
|
|
HC SUT PDS+ 0 TP-1 30" PDP991G
|
Facility
|
IP
|
$45.63
|
|
| Hospital Charge Code |
41607974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$42.44 |
| Rate for Payer: Aetna Commercial |
$39.42
|
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Cigna All Commercial |
$39.38
|
| Rate for Payer: CORVEL All Commercial |
$42.44
|
| Rate for Payer: Coventry All Commercial |
$40.15
|
| Rate for Payer: Encore All Commercial |
$42.00
|
| Rate for Payer: Frontpath All Commercial |
$41.98
|
| Rate for Payer: Humana ChoiceCare |
$39.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.07
|
| Rate for Payer: PHCS All Commercial |
$34.22
|
| Rate for Payer: PHP All Commercial |
$34.61
|
| Rate for Payer: Sagamore Health Network All Products |
$35.23
|
| Rate for Payer: Signature Care EPO |
$37.87
|
| Rate for Payer: Signature Care PPO |
$40.15
|
| Rate for Payer: United Healthcare Commercial |
$35.96
|
|
|
HC SUT PDS+ 0 TP-1 30" PDP991G
|
Facility
|
OP
|
$45.63
|
|
| Hospital Charge Code |
41607974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$38.51
|
| Rate for Payer: Aetna Medicare |
$15.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.56
|
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Centivo All Commercial |
$23.27
|
| Rate for Payer: Cigna All Commercial |
$39.38
|
| Rate for Payer: CORVEL All Commercial |
$42.44
|
| Rate for Payer: Coventry All Commercial |
$40.15
|
| Rate for Payer: Encore All Commercial |
$42.00
|
| Rate for Payer: Frontpath All Commercial |
$41.98
|
| Rate for Payer: Humana ChoiceCare |
$39.41
|
| Rate for Payer: Humana Medicare |
$23.27
|
| Rate for Payer: Lucent All Commercial |
$23.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.07
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$34.22
|
| Rate for Payer: PHP All Commercial |
$34.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.80
|
| Rate for Payer: Sagamore Health Network All Products |
$35.23
|
| Rate for Payer: Signature Care EPO |
$37.87
|
| Rate for Payer: Signature Care PPO |
$40.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.79
|
| Rate for Payer: United Healthcare Commercial |
$35.96
|
| Rate for Payer: United Healthcare Medicare |
$15.06
|
|
|
HC SUT PDS+ 1 CT-1 27" PDP341H
|
Facility
|
IP
|
$20.64
|
|
| Hospital Charge Code |
41607975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cigna All Commercial |
$17.81
|
| Rate for Payer: CORVEL All Commercial |
$19.20
|
| Rate for Payer: Coventry All Commercial |
$18.16
|
| Rate for Payer: Encore All Commercial |
$19.00
|
| Rate for Payer: Frontpath All Commercial |
$18.99
|
| Rate for Payer: Humana ChoiceCare |
$17.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.58
|
| Rate for Payer: PHCS All Commercial |
$15.48
|
| Rate for Payer: PHP All Commercial |
$15.65
|
| Rate for Payer: Sagamore Health Network All Products |
$15.93
|
| Rate for Payer: Signature Care EPO |
$17.13
|
| Rate for Payer: Signature Care PPO |
$18.16
|
| Rate for Payer: United Healthcare Commercial |
$16.26
|
|
|
HC SUT PDS+ 1 CT-1 27" PDP341H
|
Facility
|
OP
|
$20.64
|
|
| Hospital Charge Code |
41607975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna Medicare |
$6.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.49
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Centivo All Commercial |
$10.53
|
| Rate for Payer: Cigna All Commercial |
$17.81
|
| Rate for Payer: CORVEL All Commercial |
$19.20
|
| Rate for Payer: Coventry All Commercial |
$18.16
|
| Rate for Payer: Encore All Commercial |
$19.00
|
| Rate for Payer: Frontpath All Commercial |
$18.99
|
| Rate for Payer: Humana ChoiceCare |
$17.83
|
| Rate for Payer: Humana Medicare |
$10.53
|
| Rate for Payer: Lucent All Commercial |
$10.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$15.48
|
| Rate for Payer: PHP All Commercial |
$15.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.05
|
| Rate for Payer: Sagamore Health Network All Products |
$15.93
|
| Rate for Payer: Signature Care EPO |
$17.13
|
| Rate for Payer: Signature Care PPO |
$18.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.54
|
| Rate for Payer: United Healthcare Commercial |
$16.26
|
| Rate for Payer: United Healthcare Medicare |
$6.81
|
|
|
HC SUT PDS+ 1 CTX 36" PDP371T
|
Facility
|
IP
|
$21.96
|
|
| Hospital Charge Code |
41607976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$20.42 |
| Rate for Payer: Aetna Commercial |
$18.97
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cigna All Commercial |
$18.95
|
| Rate for Payer: CORVEL All Commercial |
$20.42
|
| Rate for Payer: Coventry All Commercial |
$19.32
|
| Rate for Payer: Encore All Commercial |
$20.21
|
| Rate for Payer: Frontpath All Commercial |
$20.20
|
| Rate for Payer: Humana ChoiceCare |
$18.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.76
|
| Rate for Payer: PHCS All Commercial |
$16.47
|
| Rate for Payer: PHP All Commercial |
$16.65
|
| Rate for Payer: Sagamore Health Network All Products |
$16.95
|
| Rate for Payer: Signature Care EPO |
$18.23
|
| Rate for Payer: Signature Care PPO |
$19.32
|
| Rate for Payer: United Healthcare Commercial |
$17.30
|
|
|
HC SUT PDS+ 1 CTX 36" PDP371T
|
Facility
|
OP
|
$21.96
|
|
| Hospital Charge Code |
41607976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$18.53
|
| Rate for Payer: Aetna Medicare |
$7.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.97
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Centivo All Commercial |
$11.20
|
| Rate for Payer: Cigna All Commercial |
$18.95
|
| Rate for Payer: CORVEL All Commercial |
$20.42
|
| Rate for Payer: Coventry All Commercial |
$19.32
|
| Rate for Payer: Encore All Commercial |
$20.21
|
| Rate for Payer: Frontpath All Commercial |
$20.20
|
| Rate for Payer: Humana ChoiceCare |
$18.97
|
| Rate for Payer: Humana Medicare |
$11.20
|
| Rate for Payer: Lucent All Commercial |
$11.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$16.47
|
| Rate for Payer: PHP All Commercial |
$16.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.56
|
| Rate for Payer: Sagamore Health Network All Products |
$16.95
|
| Rate for Payer: Signature Care EPO |
$18.23
|
| Rate for Payer: Signature Care PPO |
$19.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.67
|
| Rate for Payer: United Healthcare Commercial |
$17.30
|
| Rate for Payer: United Healthcare Medicare |
$7.25
|
|
|
HC SUT PDS+ 1 TP-1 96" PDP880G
|
Facility
|
OP
|
$40.05
|
|
| Hospital Charge Code |
41607977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: Aetna Medicare |
$13.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.54
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Centivo All Commercial |
$20.43
|
| Rate for Payer: Cigna All Commercial |
$34.56
|
| Rate for Payer: CORVEL All Commercial |
$37.25
|
| Rate for Payer: Coventry All Commercial |
$35.24
|
| Rate for Payer: Encore All Commercial |
$36.87
|
| Rate for Payer: Frontpath All Commercial |
$36.85
|
| Rate for Payer: Humana ChoiceCare |
$34.59
|
| Rate for Payer: Humana Medicare |
$20.43
|
| Rate for Payer: Lucent All Commercial |
$20.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.04
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$30.04
|
| Rate for Payer: PHP All Commercial |
$30.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.62
|
| Rate for Payer: Sagamore Health Network All Products |
$30.92
|
| Rate for Payer: Signature Care EPO |
$33.24
|
| Rate for Payer: Signature Care PPO |
$35.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.04
|
| Rate for Payer: United Healthcare Commercial |
$31.56
|
| Rate for Payer: United Healthcare Medicare |
$13.22
|
|
|
HC SUT PDS+ 1 TP-1 96" PDP880G
|
Facility
|
IP
|
$40.05
|
|
| Hospital Charge Code |
41607977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.04 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cigna All Commercial |
$34.56
|
| Rate for Payer: CORVEL All Commercial |
$37.25
|
| Rate for Payer: Coventry All Commercial |
$35.24
|
| Rate for Payer: Encore All Commercial |
$36.87
|
| Rate for Payer: Frontpath All Commercial |
$36.85
|
| Rate for Payer: Humana ChoiceCare |
$34.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.04
|
| Rate for Payer: PHCS All Commercial |
$30.04
|
| Rate for Payer: PHP All Commercial |
$30.37
|
| Rate for Payer: Sagamore Health Network All Products |
$30.92
|
| Rate for Payer: Signature Care EPO |
$33.24
|
| Rate for Payer: Signature Care PPO |
$35.24
|
| Rate for Payer: United Healthcare Commercial |
$31.56
|
|
|
HC SUT PDS+ 2-0 SH 27" PDP317H
|
Facility
|
IP
|
$19.28
|
|
| Hospital Charge Code |
41607978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$17.93 |
| Rate for Payer: Aetna Commercial |
$16.66
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna All Commercial |
$16.64
|
| Rate for Payer: CORVEL All Commercial |
$17.93
|
| Rate for Payer: Coventry All Commercial |
$16.97
|
| Rate for Payer: Encore All Commercial |
$17.75
|
| Rate for Payer: Frontpath All Commercial |
$17.74
|
| Rate for Payer: Humana ChoiceCare |
$16.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.35
|
| Rate for Payer: PHCS All Commercial |
$14.46
|
| Rate for Payer: PHP All Commercial |
$14.62
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$16.00
|
| Rate for Payer: Signature Care PPO |
$16.97
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
|
|
HC SUT PDS+ 2-0 SH 27" PDP317H
|
Facility
|
OP
|
$19.28
|
|
| Hospital Charge Code |
41607978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Centivo All Commercial |
$9.83
|
| Rate for Payer: Cigna All Commercial |
$16.64
|
| Rate for Payer: CORVEL All Commercial |
$17.93
|
| Rate for Payer: Coventry All Commercial |
$16.97
|
| Rate for Payer: Encore All Commercial |
$17.75
|
| Rate for Payer: Frontpath All Commercial |
$17.74
|
| Rate for Payer: Humana ChoiceCare |
$16.65
|
| Rate for Payer: Humana Medicare |
$9.83
|
| Rate for Payer: Lucent All Commercial |
$9.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.35
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.46
|
| Rate for Payer: PHP All Commercial |
$14.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$16.00
|
| Rate for Payer: Signature Care PPO |
$16.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.39
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
|
|
HC SUT PDS+ 3-0 SH 27" PDP316H
|
Facility
|
IP
|
$19.71
|
|
| Hospital Charge Code |
41607979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$18.33 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Cash Price |
$12.22
|
| Rate for Payer: Cigna All Commercial |
$17.01
|
| Rate for Payer: CORVEL All Commercial |
$18.33
|
| Rate for Payer: Coventry All Commercial |
$17.34
|
| Rate for Payer: Encore All Commercial |
$18.14
|
| Rate for Payer: Frontpath All Commercial |
$18.13
|
| Rate for Payer: Humana ChoiceCare |
$17.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.74
|
| Rate for Payer: PHCS All Commercial |
$14.78
|
| Rate for Payer: PHP All Commercial |
$14.95
|
| Rate for Payer: Sagamore Health Network All Products |
$15.22
|
| Rate for Payer: Signature Care EPO |
$16.36
|
| Rate for Payer: Signature Care PPO |
$17.34
|
| Rate for Payer: United Healthcare Commercial |
$15.53
|
|
|
HC SUT PDS+ 3-0 SH 27" PDP316H
|
Facility
|
OP
|
$19.71
|
|
| Hospital Charge Code |
41607979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.15
|
| Rate for Payer: Cash Price |
$12.22
|
| Rate for Payer: Cash Price |
$12.22
|
| Rate for Payer: Centivo All Commercial |
$10.05
|
| Rate for Payer: Cigna All Commercial |
$17.01
|
| Rate for Payer: CORVEL All Commercial |
$18.33
|
| Rate for Payer: Coventry All Commercial |
$17.34
|
| Rate for Payer: Encore All Commercial |
$18.14
|
| Rate for Payer: Frontpath All Commercial |
$18.13
|
| Rate for Payer: Humana ChoiceCare |
$17.02
|
| Rate for Payer: Humana Medicare |
$10.05
|
| Rate for Payer: Lucent All Commercial |
$10.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.74
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.78
|
| Rate for Payer: PHP All Commercial |
$14.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.69
|
| Rate for Payer: Sagamore Health Network All Products |
$15.22
|
| Rate for Payer: Signature Care EPO |
$16.36
|
| Rate for Payer: Signature Care PPO |
$17.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.75
|
| Rate for Payer: United Healthcare Commercial |
$15.53
|
| Rate for Payer: United Healthcare Medicare |
$6.50
|
|
|
HC SUTURE 0 FIBERWIRE
|
Facility
|
IP
|
$169.40
|
|
| Hospital Charge Code |
41601615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$146.36
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
|
|
HC SUTURE 0 FIBERWIRE
|
Facility
|
OP
|
$169.40
|
|
| Hospital Charge Code |
41601615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.49
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Centivo All Commercial |
$86.39
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$86.39
|
| Rate for Payer: Lucent All Commercial |
$86.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.07
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.99
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
| Rate for Payer: United Healthcare Medicare |
$55.90
|
|
|
HC SUTURE 2-0 FIBERWIRE
|
Facility
|
IP
|
$169.40
|
|
| Hospital Charge Code |
41601617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$146.36
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
|
|
HC SUTURE 2-0 FIBERWIRE
|
Facility
|
OP
|
$169.40
|
|
| Hospital Charge Code |
41601617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.49
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Centivo All Commercial |
$86.39
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$86.39
|
| Rate for Payer: Lucent All Commercial |
$86.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.07
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.99
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
| Rate for Payer: United Healthcare Medicare |
$55.90
|
|
|
HC SUTURE #2 FIBERWIRE
|
Facility
|
IP
|
$169.40
|
|
| Hospital Charge Code |
41601616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$146.36
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
|
|
HC SUTURE #2 FIBERWIRE
|
Facility
|
OP
|
$169.40
|
|
| Hospital Charge Code |
41601616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.49
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Cash Price |
$105.03
|
| Rate for Payer: Centivo All Commercial |
$86.39
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$86.39
|
| Rate for Payer: Lucent All Commercial |
$86.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.07
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.99
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
| Rate for Payer: United Healthcare Medicare |
$55.90
|
|
|
HC SUTURE ANCHOR BC SL 3.5 X 15.8
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,046.00 |
| Rate for Payer: Aetna Commercial |
$1,856.80
|
| Rate for Payer: Aetna Medicare |
$726.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$726.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,263.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,375.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$834.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$798.60
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Centivo All Commercial |
$1,122.00
|
| Rate for Payer: Cigna All Commercial |
$1,898.60
|
| Rate for Payer: CORVEL All Commercial |
$2,046.00
|
| Rate for Payer: Coventry All Commercial |
$1,936.00
|
| Rate for Payer: Encore All Commercial |
$2,025.10
|
| Rate for Payer: Frontpath All Commercial |
$2,024.00
|
| Rate for Payer: Humana ChoiceCare |
$1,900.14
|
| Rate for Payer: Humana Medicare |
$1,122.00
|
| Rate for Payer: Lucent All Commercial |
$1,122.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,980.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,650.00
|
| Rate for Payer: PHP All Commercial |
$1,668.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$858.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,698.40
|
| Rate for Payer: Signature Care EPO |
$1,826.00
|
| Rate for Payer: Signature Care PPO |
$1,936.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,733.60
|
| Rate for Payer: United Healthcare Medicare |
$726.00
|
|
|
HC SUTURE ANCHOR BC SL 3.5 X 15.8
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$2,046.00 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cigna All Commercial |
$1,898.60
|
| Rate for Payer: CORVEL All Commercial |
$2,046.00
|
| Rate for Payer: Coventry All Commercial |
$1,936.00
|
| Rate for Payer: Encore All Commercial |
$2,025.10
|
| Rate for Payer: Frontpath All Commercial |
$2,024.00
|
| Rate for Payer: Humana ChoiceCare |
$1,900.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,980.00
|
| Rate for Payer: PHCS All Commercial |
$1,650.00
|
| Rate for Payer: PHP All Commercial |
$1,668.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,698.40
|
| Rate for Payer: Signature Care EPO |
$1,826.00
|
| Rate for Payer: Signature Care PPO |
$1,936.00
|
| Rate for Payer: United Healthcare Commercial |
$1,733.60
|
|
|
HC SUTURE ANCHOR MINI BC S-TAK 2.4 X 8.5
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
|
