|
HC WAND SERFAS ENERGY 90-S
|
Facility
|
IP
|
$870.45
|
|
| Hospital Charge Code |
41602567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.84 |
| Max. Negotiated Rate |
$809.52 |
| Rate for Payer: Aetna Commercial |
$752.07
|
| Rate for Payer: Cash Price |
$539.68
|
| Rate for Payer: Cigna All Commercial |
$751.20
|
| Rate for Payer: CORVEL All Commercial |
$809.52
|
| Rate for Payer: Coventry All Commercial |
$766.00
|
| Rate for Payer: Encore All Commercial |
$801.25
|
| Rate for Payer: Frontpath All Commercial |
$800.81
|
| Rate for Payer: Humana ChoiceCare |
$751.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$783.40
|
| Rate for Payer: PHCS All Commercial |
$652.84
|
| Rate for Payer: PHP All Commercial |
$660.15
|
| Rate for Payer: Sagamore Health Network All Products |
$671.99
|
| Rate for Payer: Signature Care EPO |
$722.47
|
| Rate for Payer: Signature Care PPO |
$766.00
|
| Rate for Payer: United Healthcare Commercial |
$685.91
|
|
|
HC W AUGMENT 1.5 ML
|
Facility
|
IP
|
$7,236.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,427.00 |
| Max. Negotiated Rate |
$6,729.48 |
| Rate for Payer: Aetna Commercial |
$6,251.90
|
| Rate for Payer: Cash Price |
$4,486.32
|
| Rate for Payer: Cigna All Commercial |
$6,244.67
|
| Rate for Payer: CORVEL All Commercial |
$6,729.48
|
| Rate for Payer: Coventry All Commercial |
$6,367.68
|
| Rate for Payer: Encore All Commercial |
$6,660.74
|
| Rate for Payer: Frontpath All Commercial |
$6,657.12
|
| Rate for Payer: Humana ChoiceCare |
$6,249.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,512.40
|
| Rate for Payer: PHCS All Commercial |
$5,427.00
|
| Rate for Payer: PHP All Commercial |
$5,487.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5,586.19
|
| Rate for Payer: Signature Care EPO |
$6,005.88
|
| Rate for Payer: Signature Care PPO |
$6,367.68
|
| Rate for Payer: United Healthcare Commercial |
$5,701.97
|
|
|
HC W AUGMENT 1.5 ML
|
Facility
|
OP
|
$7,236.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,729.48 |
| Rate for Payer: Aetna Commercial |
$6,107.18
|
| Rate for Payer: Aetna Medicare |
$2,387.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,387.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,155.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,523.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,746.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,626.67
|
| Rate for Payer: Cash Price |
$4,486.32
|
| Rate for Payer: Cash Price |
$4,486.32
|
| Rate for Payer: Centivo All Commercial |
$3,690.36
|
| Rate for Payer: Cigna All Commercial |
$6,244.67
|
| Rate for Payer: CORVEL All Commercial |
$6,729.48
|
| Rate for Payer: Coventry All Commercial |
$6,367.68
|
| Rate for Payer: Encore All Commercial |
$6,660.74
|
| Rate for Payer: Frontpath All Commercial |
$6,657.12
|
| Rate for Payer: Humana ChoiceCare |
$6,249.73
|
| Rate for Payer: Humana Medicare |
$3,690.36
|
| Rate for Payer: Lucent All Commercial |
$3,690.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,512.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,427.00
|
| Rate for Payer: PHP All Commercial |
$5,487.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,822.04
|
| Rate for Payer: Sagamore Health Network All Products |
$5,586.19
|
| Rate for Payer: Signature Care EPO |
$6,005.88
|
| Rate for Payer: Signature Care PPO |
$6,367.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,150.60
|
| Rate for Payer: United Healthcare Commercial |
$5,701.97
|
| Rate for Payer: United Healthcare Medicare |
$2,387.88
|
|
|
HC W AUGMENT 1.5ML
|
Facility
|
OP
|
$7,448.40
|
|
|
Service Code
|
CPT C1734
|
| Hospital Charge Code |
41606135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,927.01 |
| Rate for Payer: Aetna Commercial |
$6,286.45
|
| Rate for Payer: Aetna Medicare |
$2,457.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,457.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,277.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,655.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,826.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,703.77
|
| Rate for Payer: Cash Price |
$4,618.01
|
| Rate for Payer: Cash Price |
$4,618.01
|
| Rate for Payer: Centivo All Commercial |
$3,798.68
|
| Rate for Payer: Cigna All Commercial |
$6,427.97
|
| Rate for Payer: CORVEL All Commercial |
$6,927.01
|
| Rate for Payer: Coventry All Commercial |
$6,554.59
|
| Rate for Payer: Encore All Commercial |
$6,856.25
|
| Rate for Payer: Frontpath All Commercial |
$6,852.53
|
| Rate for Payer: Humana ChoiceCare |
$6,433.18
|
| Rate for Payer: Humana Medicare |
$3,798.68
|
| Rate for Payer: Lucent All Commercial |
$3,798.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,703.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,586.30
|
| Rate for Payer: PHP All Commercial |
$5,648.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,904.88
|
| Rate for Payer: Sagamore Health Network All Products |
$5,750.16
|
| Rate for Payer: Signature Care EPO |
$6,182.17
|
| Rate for Payer: Signature Care PPO |
$6,554.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,331.14
|
| Rate for Payer: United Healthcare Commercial |
$5,869.34
|
| Rate for Payer: United Healthcare Medicare |
$2,457.97
|
|
|
HC W AUGMENT 1.5ML
|
Facility
|
IP
|
$7,448.40
|
|
|
Service Code
|
CPT C1734
|
| Hospital Charge Code |
41606135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,586.30 |
| Max. Negotiated Rate |
$6,927.01 |
| Rate for Payer: Aetna Commercial |
$6,435.42
|
| Rate for Payer: Cash Price |
$4,618.01
|
| Rate for Payer: Cigna All Commercial |
$6,427.97
|
| Rate for Payer: CORVEL All Commercial |
$6,927.01
|
| Rate for Payer: Coventry All Commercial |
$6,554.59
|
| Rate for Payer: Encore All Commercial |
$6,856.25
|
| Rate for Payer: Frontpath All Commercial |
$6,852.53
|
| Rate for Payer: Humana ChoiceCare |
$6,433.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,703.56
|
| Rate for Payer: PHCS All Commercial |
$5,586.30
|
| Rate for Payer: PHP All Commercial |
$5,648.87
|
| Rate for Payer: Sagamore Health Network All Products |
$5,750.16
|
| Rate for Payer: Signature Care EPO |
$6,182.17
|
| Rate for Payer: Signature Care PPO |
$6,554.59
|
| Rate for Payer: United Healthcare Commercial |
$5,869.34
|
|
|
HC W AUGMENT 3 ML
|
Facility
|
OP
|
$13,366.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,431.12 |
| Rate for Payer: Aetna Commercial |
$11,281.58
|
| Rate for Payer: Aetna Medicare |
$4,411.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,411.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,676.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,355.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,072.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,852.15
|
| Rate for Payer: Cash Price |
$8,287.42
|
| Rate for Payer: Cash Price |
$8,287.42
|
| Rate for Payer: Centivo All Commercial |
$6,817.07
|
| Rate for Payer: Cigna All Commercial |
$11,535.55
|
| Rate for Payer: CORVEL All Commercial |
$12,431.12
|
| Rate for Payer: Coventry All Commercial |
$11,762.78
|
| Rate for Payer: Encore All Commercial |
$12,304.14
|
| Rate for Payer: Frontpath All Commercial |
$12,297.46
|
| Rate for Payer: Humana ChoiceCare |
$11,544.91
|
| Rate for Payer: Humana Medicare |
$6,817.07
|
| Rate for Payer: Lucent All Commercial |
$6,817.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,030.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$10,025.10
|
| Rate for Payer: PHP All Commercial |
$10,137.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,213.05
|
| Rate for Payer: Sagamore Health Network All Products |
$10,319.17
|
| Rate for Payer: Signature Care EPO |
$11,094.44
|
| Rate for Payer: Signature Care PPO |
$11,762.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,361.78
|
| Rate for Payer: United Healthcare Commercial |
$10,533.04
|
| Rate for Payer: United Healthcare Medicare |
$4,411.04
|
|
|
HC W AUGMENT 3 ML
|
Facility
|
IP
|
$13,366.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,025.10 |
| Max. Negotiated Rate |
$12,431.12 |
| Rate for Payer: Aetna Commercial |
$11,548.92
|
| Rate for Payer: Cash Price |
$8,287.42
|
| Rate for Payer: Cigna All Commercial |
$11,535.55
|
| Rate for Payer: CORVEL All Commercial |
$12,431.12
|
| Rate for Payer: Coventry All Commercial |
$11,762.78
|
| Rate for Payer: Encore All Commercial |
$12,304.14
|
| Rate for Payer: Frontpath All Commercial |
$12,297.46
|
| Rate for Payer: Humana ChoiceCare |
$11,544.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,030.12
|
| Rate for Payer: PHCS All Commercial |
$10,025.10
|
| Rate for Payer: PHP All Commercial |
$10,137.38
|
| Rate for Payer: Sagamore Health Network All Products |
$10,319.17
|
| Rate for Payer: Signature Care EPO |
$11,094.44
|
| Rate for Payer: Signature Care PPO |
$11,762.78
|
| Rate for Payer: United Healthcare Commercial |
$10,533.04
|
|
|
HC WBC-AUTOMATED
|
Facility
|
IP
|
$71.81
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
63001231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$62.04
|
| Rate for Payer: Cash Price |
$44.52
|
| Rate for Payer: Cigna All Commercial |
$61.97
|
| Rate for Payer: CORVEL All Commercial |
$66.78
|
| Rate for Payer: Coventry All Commercial |
$63.19
|
| Rate for Payer: Encore All Commercial |
$66.10
|
| Rate for Payer: Frontpath All Commercial |
$66.06
|
| Rate for Payer: Humana ChoiceCare |
$62.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.63
|
| Rate for Payer: PHCS All Commercial |
$53.86
|
| Rate for Payer: PHP All Commercial |
$54.46
|
| Rate for Payer: Sagamore Health Network All Products |
$55.44
|
| Rate for Payer: Signature Care EPO |
$59.60
|
| Rate for Payer: Signature Care PPO |
$63.19
|
| Rate for Payer: United Healthcare Commercial |
$56.58
|
|
|
HC WBC-AUTOMATED
|
Facility
|
OP
|
$71.81
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
63001231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$60.61
|
| Rate for Payer: Aetna Medicare |
$23.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$44.52
|
| Rate for Payer: Cash Price |
$44.52
|
| Rate for Payer: Centivo All Commercial |
$36.62
|
| Rate for Payer: Cigna All Commercial |
$61.97
|
| Rate for Payer: CORVEL All Commercial |
$66.78
|
| Rate for Payer: Coventry All Commercial |
$63.19
|
| Rate for Payer: Encore All Commercial |
$66.10
|
| Rate for Payer: Frontpath All Commercial |
$66.06
|
| Rate for Payer: Humana ChoiceCare |
$62.02
|
| Rate for Payer: Humana Medicare |
$36.62
|
| Rate for Payer: Lucent All Commercial |
$36.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.63
|
| Rate for Payer: Managed Health Services Medicaid |
$2.54
|
| Rate for Payer: MDWise Medicaid |
$2.54
|
| Rate for Payer: PHCS All Commercial |
$53.86
|
| Rate for Payer: PHP All Commercial |
$54.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.01
|
| Rate for Payer: Sagamore Health Network All Products |
$55.44
|
| Rate for Payer: Signature Care EPO |
$59.60
|
| Rate for Payer: Signature Care PPO |
$63.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.04
|
| Rate for Payer: United Healthcare Commercial |
$56.58
|
| Rate for Payer: United Healthcare Medicare |
$23.70
|
|
|
HC WBC-AUTOMATED*
|
Facility
|
OP
|
$56.95
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
63001232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$48.06
|
| Rate for Payer: Aetna Medicare |
$18.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.67
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Centivo All Commercial |
$29.04
|
| Rate for Payer: Cigna All Commercial |
$49.14
|
| Rate for Payer: CORVEL All Commercial |
$52.96
|
| Rate for Payer: Coventry All Commercial |
$50.11
|
| Rate for Payer: Encore All Commercial |
$52.42
|
| Rate for Payer: Frontpath All Commercial |
$52.39
|
| Rate for Payer: Humana ChoiceCare |
$49.18
|
| Rate for Payer: Humana Medicare |
$29.04
|
| Rate for Payer: Lucent All Commercial |
$29.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.25
|
| Rate for Payer: Managed Health Services Medicaid |
$2.54
|
| Rate for Payer: MDWise Medicaid |
$2.54
|
| Rate for Payer: PHCS All Commercial |
$42.71
|
| Rate for Payer: PHP All Commercial |
$43.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.21
|
| Rate for Payer: Sagamore Health Network All Products |
$43.96
|
| Rate for Payer: Signature Care EPO |
$47.27
|
| Rate for Payer: Signature Care PPO |
$50.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.40
|
| Rate for Payer: United Healthcare Commercial |
$44.87
|
| Rate for Payer: United Healthcare Medicare |
$18.79
|
|
|
HC WBC-AUTOMATED*
|
Facility
|
IP
|
$56.95
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
63001232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Cigna All Commercial |
$49.14
|
| Rate for Payer: CORVEL All Commercial |
$52.96
|
| Rate for Payer: Coventry All Commercial |
$50.11
|
| Rate for Payer: Encore All Commercial |
$52.42
|
| Rate for Payer: Frontpath All Commercial |
$52.39
|
| Rate for Payer: Humana ChoiceCare |
$49.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.25
|
| Rate for Payer: PHCS All Commercial |
$42.71
|
| Rate for Payer: PHP All Commercial |
$43.19
|
| Rate for Payer: Sagamore Health Network All Products |
$43.96
|
| Rate for Payer: Signature Care EPO |
$47.27
|
| Rate for Payer: Signature Care PPO |
$50.11
|
| Rate for Payer: United Healthcare Commercial |
$44.87
|
|
|
HC WBC STOOL
|
Facility
|
OP
|
$101.46
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
63001295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$94.36 |
| Rate for Payer: Aetna Commercial |
$85.63
|
| Rate for Payer: Aetna Medicare |
$33.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.83
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Centivo All Commercial |
$51.74
|
| Rate for Payer: Cigna All Commercial |
$87.56
|
| Rate for Payer: CORVEL All Commercial |
$94.36
|
| Rate for Payer: Coventry All Commercial |
$89.28
|
| Rate for Payer: Encore All Commercial |
$93.39
|
| Rate for Payer: Frontpath All Commercial |
$93.34
|
| Rate for Payer: Humana ChoiceCare |
$87.63
|
| Rate for Payer: Humana Medicare |
$51.74
|
| Rate for Payer: Lucent All Commercial |
$51.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.31
|
| Rate for Payer: Managed Health Services Medicaid |
$4.27
|
| Rate for Payer: MDWise Medicaid |
$4.27
|
| Rate for Payer: PHCS All Commercial |
$76.09
|
| Rate for Payer: PHP All Commercial |
$76.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.57
|
| Rate for Payer: Sagamore Health Network All Products |
$78.33
|
| Rate for Payer: Signature Care EPO |
$84.21
|
| Rate for Payer: Signature Care PPO |
$89.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86.24
|
| Rate for Payer: United Healthcare Commercial |
$79.95
|
| Rate for Payer: United Healthcare Medicare |
$33.48
|
|
|
HC WBC STOOL
|
Facility
|
IP
|
$101.46
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
63001295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.09 |
| Max. Negotiated Rate |
$94.36 |
| Rate for Payer: Aetna Commercial |
$87.66
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Cigna All Commercial |
$87.56
|
| Rate for Payer: CORVEL All Commercial |
$94.36
|
| Rate for Payer: Coventry All Commercial |
$89.28
|
| Rate for Payer: Encore All Commercial |
$93.39
|
| Rate for Payer: Frontpath All Commercial |
$93.34
|
| Rate for Payer: Humana ChoiceCare |
$87.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.31
|
| Rate for Payer: PHCS All Commercial |
$76.09
|
| Rate for Payer: PHP All Commercial |
$76.95
|
| Rate for Payer: Sagamore Health Network All Products |
$78.33
|
| Rate for Payer: Signature Care EPO |
$84.21
|
| Rate for Payer: Signature Care PPO |
$89.28
|
| Rate for Payer: United Healthcare Commercial |
$79.95
|
|
|
HC W BIOSKIN 2X2
|
Facility
|
IP
|
$3,240.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,430.00 |
| Max. Negotiated Rate |
$3,013.20 |
| Rate for Payer: Aetna Commercial |
$2,799.36
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cigna All Commercial |
$2,796.12
|
| Rate for Payer: CORVEL All Commercial |
$3,013.20
|
| Rate for Payer: Coventry All Commercial |
$2,851.20
|
| Rate for Payer: Encore All Commercial |
$2,982.42
|
| Rate for Payer: Frontpath All Commercial |
$2,980.80
|
| Rate for Payer: Humana ChoiceCare |
$2,798.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,916.00
|
| Rate for Payer: PHCS All Commercial |
$2,430.00
|
| Rate for Payer: PHP All Commercial |
$2,457.22
|
| Rate for Payer: Sagamore Health Network All Products |
$2,501.28
|
| Rate for Payer: Signature Care EPO |
$2,689.20
|
| Rate for Payer: Signature Care PPO |
$2,851.20
|
| Rate for Payer: United Healthcare Commercial |
$2,553.12
|
|
|
HC W BIOSKIN 2X2
|
Facility
|
OP
|
$3,240.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,013.20 |
| Rate for Payer: Aetna Commercial |
$2,734.56
|
| Rate for Payer: Aetna Medicare |
$1,069.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,069.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,860.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,025.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,229.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,176.12
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Centivo All Commercial |
$1,652.40
|
| Rate for Payer: Cigna All Commercial |
$2,796.12
|
| Rate for Payer: CORVEL All Commercial |
$3,013.20
|
| Rate for Payer: Coventry All Commercial |
$2,851.20
|
| Rate for Payer: Encore All Commercial |
$2,982.42
|
| Rate for Payer: Frontpath All Commercial |
$2,980.80
|
| Rate for Payer: Humana ChoiceCare |
$2,798.39
|
| Rate for Payer: Humana Medicare |
$1,652.40
|
| Rate for Payer: Lucent All Commercial |
$1,652.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,916.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,430.00
|
| Rate for Payer: PHP All Commercial |
$2,457.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,263.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,501.28
|
| Rate for Payer: Signature Care EPO |
$2,689.20
|
| Rate for Payer: Signature Care PPO |
$2,851.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,754.00
|
| Rate for Payer: United Healthcare Commercial |
$2,553.12
|
| Rate for Payer: United Healthcare Medicare |
$1,069.20
|
|
|
HC W BIOSKIN 2X3
|
Facility
|
IP
|
$4,536.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,402.00 |
| Max. Negotiated Rate |
$4,218.48 |
| Rate for Payer: Aetna Commercial |
$3,919.10
|
| Rate for Payer: Cash Price |
$2,812.32
|
| Rate for Payer: Cigna All Commercial |
$3,914.57
|
| Rate for Payer: CORVEL All Commercial |
$4,218.48
|
| Rate for Payer: Coventry All Commercial |
$3,991.68
|
| Rate for Payer: Encore All Commercial |
$4,175.39
|
| Rate for Payer: Frontpath All Commercial |
$4,173.12
|
| Rate for Payer: Humana ChoiceCare |
$3,917.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,082.40
|
| Rate for Payer: PHCS All Commercial |
$3,402.00
|
| Rate for Payer: PHP All Commercial |
$3,440.10
|
| Rate for Payer: Sagamore Health Network All Products |
$3,501.79
|
| Rate for Payer: Signature Care EPO |
$3,764.88
|
| Rate for Payer: Signature Care PPO |
$3,991.68
|
| Rate for Payer: United Healthcare Commercial |
$3,574.37
|
|
|
HC W BIOSKIN 2X3
|
Facility
|
OP
|
$4,536.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,218.48 |
| Rate for Payer: Aetna Commercial |
$3,828.38
|
| Rate for Payer: Aetna Medicare |
$1,496.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,496.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,605.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,835.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,721.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,646.57
|
| Rate for Payer: Cash Price |
$2,812.32
|
| Rate for Payer: Cash Price |
$2,812.32
|
| Rate for Payer: Centivo All Commercial |
$2,313.36
|
| Rate for Payer: Cigna All Commercial |
$3,914.57
|
| Rate for Payer: CORVEL All Commercial |
$4,218.48
|
| Rate for Payer: Coventry All Commercial |
$3,991.68
|
| Rate for Payer: Encore All Commercial |
$4,175.39
|
| Rate for Payer: Frontpath All Commercial |
$4,173.12
|
| Rate for Payer: Humana ChoiceCare |
$3,917.74
|
| Rate for Payer: Humana Medicare |
$2,313.36
|
| Rate for Payer: Lucent All Commercial |
$2,313.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,082.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,402.00
|
| Rate for Payer: PHP All Commercial |
$3,440.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,769.04
|
| Rate for Payer: Sagamore Health Network All Products |
$3,501.79
|
| Rate for Payer: Signature Care EPO |
$3,764.88
|
| Rate for Payer: Signature Care PPO |
$3,991.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,855.60
|
| Rate for Payer: United Healthcare Commercial |
$3,574.37
|
| Rate for Payer: United Healthcare Medicare |
$1,496.88
|
|
|
HC W BIOSKIN 2X4
|
Facility
|
OP
|
$5,713.20
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,313.28 |
| Rate for Payer: Aetna Commercial |
$4,821.94
|
| Rate for Payer: Aetna Medicare |
$1,885.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,885.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,281.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,571.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,168.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,073.89
|
| Rate for Payer: Cash Price |
$3,542.18
|
| Rate for Payer: Cash Price |
$3,542.18
|
| Rate for Payer: Centivo All Commercial |
$2,913.73
|
| Rate for Payer: Cigna All Commercial |
$4,930.49
|
| Rate for Payer: CORVEL All Commercial |
$5,313.28
|
| Rate for Payer: Coventry All Commercial |
$5,027.62
|
| Rate for Payer: Encore All Commercial |
$5,259.00
|
| Rate for Payer: Frontpath All Commercial |
$5,256.14
|
| Rate for Payer: Humana ChoiceCare |
$4,934.49
|
| Rate for Payer: Humana Medicare |
$2,913.73
|
| Rate for Payer: Lucent All Commercial |
$2,913.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,141.88
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,284.90
|
| Rate for Payer: PHP All Commercial |
$4,332.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,228.15
|
| Rate for Payer: Sagamore Health Network All Products |
$4,410.59
|
| Rate for Payer: Signature Care EPO |
$4,741.96
|
| Rate for Payer: Signature Care PPO |
$5,027.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,856.22
|
| Rate for Payer: United Healthcare Commercial |
$4,502.00
|
| Rate for Payer: United Healthcare Medicare |
$1,885.36
|
|
|
HC W BIOSKIN 2X4
|
Facility
|
IP
|
$5,713.20
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,284.90 |
| Max. Negotiated Rate |
$5,313.28 |
| Rate for Payer: Aetna Commercial |
$4,936.20
|
| Rate for Payer: Cash Price |
$3,542.18
|
| Rate for Payer: Cigna All Commercial |
$4,930.49
|
| Rate for Payer: CORVEL All Commercial |
$5,313.28
|
| Rate for Payer: Coventry All Commercial |
$5,027.62
|
| Rate for Payer: Encore All Commercial |
$5,259.00
|
| Rate for Payer: Frontpath All Commercial |
$5,256.14
|
| Rate for Payer: Humana ChoiceCare |
$4,934.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,141.88
|
| Rate for Payer: PHCS All Commercial |
$4,284.90
|
| Rate for Payer: PHP All Commercial |
$4,332.89
|
| Rate for Payer: Sagamore Health Network All Products |
$4,410.59
|
| Rate for Payer: Signature Care EPO |
$4,741.96
|
| Rate for Payer: Signature Care PPO |
$5,027.62
|
| Rate for Payer: United Healthcare Commercial |
$4,502.00
|
|
|
HC W BIOSKIN 4X4
|
Facility
|
IP
|
$6,998.40
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,248.80 |
| Max. Negotiated Rate |
$6,508.51 |
| Rate for Payer: Aetna Commercial |
$6,046.62
|
| Rate for Payer: Cash Price |
$4,339.01
|
| Rate for Payer: Cigna All Commercial |
$6,039.62
|
| Rate for Payer: CORVEL All Commercial |
$6,508.51
|
| Rate for Payer: Coventry All Commercial |
$6,158.59
|
| Rate for Payer: Encore All Commercial |
$6,442.03
|
| Rate for Payer: Frontpath All Commercial |
$6,438.53
|
| Rate for Payer: Humana ChoiceCare |
$6,044.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,298.56
|
| Rate for Payer: PHCS All Commercial |
$5,248.80
|
| Rate for Payer: PHP All Commercial |
$5,307.59
|
| Rate for Payer: Sagamore Health Network All Products |
$5,402.76
|
| Rate for Payer: Signature Care EPO |
$5,808.67
|
| Rate for Payer: Signature Care PPO |
$6,158.59
|
| Rate for Payer: United Healthcare Commercial |
$5,514.74
|
|
|
HC W BIOSKIN 4X4
|
Facility
|
OP
|
$6,998.40
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,508.51 |
| Rate for Payer: Aetna Commercial |
$5,906.65
|
| Rate for Payer: Aetna Medicare |
$2,309.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,309.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,019.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,374.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,655.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,540.42
|
| Rate for Payer: Cash Price |
$4,339.01
|
| Rate for Payer: Cash Price |
$4,339.01
|
| Rate for Payer: Centivo All Commercial |
$3,569.18
|
| Rate for Payer: Cigna All Commercial |
$6,039.62
|
| Rate for Payer: CORVEL All Commercial |
$6,508.51
|
| Rate for Payer: Coventry All Commercial |
$6,158.59
|
| Rate for Payer: Encore All Commercial |
$6,442.03
|
| Rate for Payer: Frontpath All Commercial |
$6,438.53
|
| Rate for Payer: Humana ChoiceCare |
$6,044.52
|
| Rate for Payer: Humana Medicare |
$3,569.18
|
| Rate for Payer: Lucent All Commercial |
$3,569.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,298.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,248.80
|
| Rate for Payer: PHP All Commercial |
$5,307.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,729.38
|
| Rate for Payer: Sagamore Health Network All Products |
$5,402.76
|
| Rate for Payer: Signature Care EPO |
$5,808.67
|
| Rate for Payer: Signature Care PPO |
$6,158.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,948.64
|
| Rate for Payer: United Healthcare Commercial |
$5,514.74
|
| Rate for Payer: United Healthcare Medicare |
$2,309.47
|
|
|
HC W BIOSKIN DISC 15MM
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$2,025.60
|
| Rate for Payer: Aetna Medicare |
$792.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$792.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,378.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,500.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$910.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$871.20
|
| Rate for Payer: Cash Price |
$1,488.00
|
| Rate for Payer: Cash Price |
$1,488.00
|
| Rate for Payer: Centivo All Commercial |
$1,224.00
|
| Rate for Payer: Cigna All Commercial |
$2,071.20
|
| Rate for Payer: CORVEL All Commercial |
$2,232.00
|
| Rate for Payer: Coventry All Commercial |
$2,112.00
|
| Rate for Payer: Encore All Commercial |
$2,209.20
|
| Rate for Payer: Frontpath All Commercial |
$2,208.00
|
| Rate for Payer: Humana ChoiceCare |
$2,072.88
|
| Rate for Payer: Humana Medicare |
$1,224.00
|
| Rate for Payer: Lucent All Commercial |
$1,224.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,160.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,800.00
|
| Rate for Payer: PHP All Commercial |
$1,820.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$936.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,852.80
|
| Rate for Payer: Signature Care EPO |
$1,992.00
|
| Rate for Payer: Signature Care PPO |
$2,112.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare Commercial |
$1,891.20
|
| Rate for Payer: United Healthcare Medicare |
$792.00
|
|
|
HC W BIOSKIN DISC 15MM
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$2,073.60
|
| Rate for Payer: Cash Price |
$1,488.00
|
| Rate for Payer: Cigna All Commercial |
$2,071.20
|
| Rate for Payer: CORVEL All Commercial |
$2,232.00
|
| Rate for Payer: Coventry All Commercial |
$2,112.00
|
| Rate for Payer: Encore All Commercial |
$2,209.20
|
| Rate for Payer: Frontpath All Commercial |
$2,208.00
|
| Rate for Payer: Humana ChoiceCare |
$2,072.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,160.00
|
| Rate for Payer: PHCS All Commercial |
$1,800.00
|
| Rate for Payer: PHP All Commercial |
$1,820.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,852.80
|
| Rate for Payer: Signature Care EPO |
$1,992.00
|
| Rate for Payer: Signature Care PPO |
$2,112.00
|
| Rate for Payer: United Healthcare Commercial |
$1,891.20
|
|
|
HC W BLADE REAMER X-REAM
|
Facility
|
IP
|
$1,929.60
|
|
| Hospital Charge Code |
41603900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,447.20 |
| Max. Negotiated Rate |
$1,794.53 |
| Rate for Payer: Aetna Commercial |
$1,667.17
|
| Rate for Payer: Cash Price |
$1,196.35
|
| Rate for Payer: Cigna All Commercial |
$1,665.24
|
| Rate for Payer: CORVEL All Commercial |
$1,794.53
|
| Rate for Payer: Coventry All Commercial |
$1,698.05
|
| Rate for Payer: Encore All Commercial |
$1,776.20
|
| Rate for Payer: Frontpath All Commercial |
$1,775.23
|
| Rate for Payer: Humana ChoiceCare |
$1,666.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,736.64
|
| Rate for Payer: PHCS All Commercial |
$1,447.20
|
| Rate for Payer: PHP All Commercial |
$1,463.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,489.65
|
| Rate for Payer: Signature Care EPO |
$1,601.57
|
| Rate for Payer: Signature Care PPO |
$1,698.05
|
| Rate for Payer: United Healthcare Commercial |
$1,520.52
|
|
|
HC W BLADE REAMER X-REAM
|
Facility
|
OP
|
$1,929.60
|
|
| Hospital Charge Code |
41603900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,794.53 |
| Rate for Payer: Aetna Commercial |
$1,628.58
|
| Rate for Payer: Aetna Medicare |
$636.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$636.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,108.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,206.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$732.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$700.44
|
| Rate for Payer: Cash Price |
$1,196.35
|
| Rate for Payer: Cash Price |
$1,196.35
|
| Rate for Payer: Centivo All Commercial |
$984.10
|
| Rate for Payer: Cigna All Commercial |
$1,665.24
|
| Rate for Payer: CORVEL All Commercial |
$1,794.53
|
| Rate for Payer: Coventry All Commercial |
$1,698.05
|
| Rate for Payer: Encore All Commercial |
$1,776.20
|
| Rate for Payer: Frontpath All Commercial |
$1,775.23
|
| Rate for Payer: Humana ChoiceCare |
$1,666.60
|
| Rate for Payer: Humana Medicare |
$984.10
|
| Rate for Payer: Lucent All Commercial |
$984.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,736.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,447.20
|
| Rate for Payer: PHP All Commercial |
$1,463.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$752.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,489.65
|
| Rate for Payer: Signature Care EPO |
$1,601.57
|
| Rate for Payer: Signature Care PPO |
$1,698.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,640.16
|
| Rate for Payer: United Healthcare Commercial |
$1,520.52
|
| Rate for Payer: United Healthcare Medicare |
$636.77
|
|
