|
HC W CARTIVA DEVICE 10MM
|
Facility
|
OP
|
$13,219.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,293.86 |
| Rate for Payer: Aetna Commercial |
$11,157.00
|
| Rate for Payer: Aetna Medicare |
$4,362.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,362.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,591.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,263.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,016.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,798.57
|
| Rate for Payer: Cash Price |
$8,195.90
|
| Rate for Payer: Cash Price |
$8,195.90
|
| Rate for Payer: Centivo All Commercial |
$6,741.79
|
| Rate for Payer: Cigna All Commercial |
$11,408.17
|
| Rate for Payer: CORVEL All Commercial |
$12,293.86
|
| Rate for Payer: Coventry All Commercial |
$11,632.90
|
| Rate for Payer: Encore All Commercial |
$12,168.27
|
| Rate for Payer: Frontpath All Commercial |
$12,161.66
|
| Rate for Payer: Humana ChoiceCare |
$11,417.42
|
| Rate for Payer: Humana Medicare |
$6,741.79
|
| Rate for Payer: Lucent All Commercial |
$6,741.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,897.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,914.40
|
| Rate for Payer: PHP All Commercial |
$10,025.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,155.49
|
| Rate for Payer: Sagamore Health Network All Products |
$10,205.22
|
| Rate for Payer: Signature Care EPO |
$10,971.94
|
| Rate for Payer: Signature Care PPO |
$11,632.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,236.32
|
| Rate for Payer: United Healthcare Commercial |
$10,416.73
|
| Rate for Payer: United Healthcare Medicare |
$4,362.34
|
|
|
HC W CARTIVA DEVICE 10MM
|
Facility
|
IP
|
$13,219.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,914.40 |
| Max. Negotiated Rate |
$12,293.86 |
| Rate for Payer: Aetna Commercial |
$11,421.39
|
| Rate for Payer: Cash Price |
$8,195.90
|
| Rate for Payer: Cigna All Commercial |
$11,408.17
|
| Rate for Payer: CORVEL All Commercial |
$12,293.86
|
| Rate for Payer: Coventry All Commercial |
$11,632.90
|
| Rate for Payer: Encore All Commercial |
$12,168.27
|
| Rate for Payer: Frontpath All Commercial |
$12,161.66
|
| Rate for Payer: Humana ChoiceCare |
$11,417.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,897.28
|
| Rate for Payer: PHCS All Commercial |
$9,914.40
|
| Rate for Payer: PHP All Commercial |
$10,025.44
|
| Rate for Payer: Sagamore Health Network All Products |
$10,205.22
|
| Rate for Payer: Signature Care EPO |
$10,971.94
|
| Rate for Payer: Signature Care PPO |
$11,632.90
|
| Rate for Payer: United Healthcare Commercial |
$10,416.73
|
|
|
HC W CNTRSNK 2.5 CANN
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
41604391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$675.20
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Centivo All Commercial |
$408.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Humana Medicare |
$408.00
|
| Rate for Payer: Lucent All Commercial |
$408.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.00
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
|
|
HC W CNTRSNK 2.5 CANN
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
41604391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
|
|
HC W CNTRSNK 2.8 CANN
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
41605107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
|
|
HC W CNTRSNK 2.8 CANN
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
41605107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$675.20
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Centivo All Commercial |
$408.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Humana Medicare |
$408.00
|
| Rate for Payer: Lucent All Commercial |
$408.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.00
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
|
|
HC W CNTRSNK 4.0 CANN
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
41605108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$675.20
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Centivo All Commercial |
$408.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Humana Medicare |
$408.00
|
| Rate for Payer: Lucent All Commercial |
$408.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.00
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
|
|
HC W CNTRSNK 4.0 CANN
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
41605108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
|
|
HC W CNTRSNK 5.0 CANN
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
41605109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
|
|
HC W CNTRSNK 5.0 CANN
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
41605109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$675.20
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Centivo All Commercial |
$408.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Humana Medicare |
$408.00
|
| Rate for Payer: Lucent All Commercial |
$408.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.00
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
|
|
HC W CNTRSNK 6.0 CANN
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
41605110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$675.20
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Centivo All Commercial |
$408.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Humana Medicare |
$408.00
|
| Rate for Payer: Lucent All Commercial |
$408.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.00
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
|
|
HC W CNTRSNK 6.0 CANN
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
41605110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
|
|
HC W COUNTERSINK DARCO
|
Facility
|
OP
|
$1,960.00
|
|
| Hospital Charge Code |
41607742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,822.80 |
| Rate for Payer: Aetna Commercial |
$1,654.24
|
| Rate for Payer: Aetna Medicare |
$646.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$646.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,125.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,225.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$743.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$711.48
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Centivo All Commercial |
$999.60
|
| Rate for Payer: Cigna All Commercial |
$1,691.48
|
| Rate for Payer: CORVEL All Commercial |
$1,822.80
|
| Rate for Payer: Coventry All Commercial |
$1,724.80
|
| Rate for Payer: Encore All Commercial |
$1,804.18
|
| Rate for Payer: Frontpath All Commercial |
$1,803.20
|
| Rate for Payer: Humana ChoiceCare |
$1,692.85
|
| Rate for Payer: Humana Medicare |
$999.60
|
| Rate for Payer: Lucent All Commercial |
$999.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,764.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,470.00
|
| Rate for Payer: PHP All Commercial |
$1,486.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$764.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,513.12
|
| Rate for Payer: Signature Care EPO |
$1,626.80
|
| Rate for Payer: Signature Care PPO |
$1,724.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,666.00
|
| Rate for Payer: United Healthcare Commercial |
$1,544.48
|
| Rate for Payer: United Healthcare Medicare |
$646.80
|
|
|
HC W COUNTERSINK DARCO
|
Facility
|
IP
|
$1,960.00
|
|
| Hospital Charge Code |
41607742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$1,822.80 |
| Rate for Payer: Aetna Commercial |
$1,693.44
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cigna All Commercial |
$1,691.48
|
| Rate for Payer: CORVEL All Commercial |
$1,822.80
|
| Rate for Payer: Coventry All Commercial |
$1,724.80
|
| Rate for Payer: Encore All Commercial |
$1,804.18
|
| Rate for Payer: Frontpath All Commercial |
$1,803.20
|
| Rate for Payer: Humana ChoiceCare |
$1,692.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,764.00
|
| Rate for Payer: PHCS All Commercial |
$1,470.00
|
| Rate for Payer: PHP All Commercial |
$1,486.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,513.12
|
| Rate for Payer: Signature Care EPO |
$1,626.80
|
| Rate for Payer: Signature Care PPO |
$1,724.80
|
| Rate for Payer: United Healthcare Commercial |
$1,544.48
|
|
|
HC W DISP INST SET 10MM
|
Facility
|
IP
|
$1,375.00
|
|
| Hospital Charge Code |
41606346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.25 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$1,188.00
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna All Commercial |
$1,186.62
|
| Rate for Payer: CORVEL All Commercial |
$1,278.75
|
| Rate for Payer: Coventry All Commercial |
$1,210.00
|
| Rate for Payer: Encore All Commercial |
$1,265.69
|
| Rate for Payer: Frontpath All Commercial |
$1,265.00
|
| Rate for Payer: Humana ChoiceCare |
$1,187.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,237.50
|
| Rate for Payer: PHCS All Commercial |
$1,031.25
|
| Rate for Payer: PHP All Commercial |
$1,042.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,061.50
|
| Rate for Payer: Signature Care EPO |
$1,141.25
|
| Rate for Payer: Signature Care PPO |
$1,210.00
|
| Rate for Payer: United Healthcare Commercial |
$1,083.50
|
|
|
HC W DISP INST SET 10MM
|
Facility
|
OP
|
$1,375.00
|
|
| Hospital Charge Code |
41606346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$1,160.50
|
| Rate for Payer: Aetna Medicare |
$453.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$453.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$789.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$859.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$521.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$499.12
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Centivo All Commercial |
$701.25
|
| Rate for Payer: Cigna All Commercial |
$1,186.62
|
| Rate for Payer: CORVEL All Commercial |
$1,278.75
|
| Rate for Payer: Coventry All Commercial |
$1,210.00
|
| Rate for Payer: Encore All Commercial |
$1,265.69
|
| Rate for Payer: Frontpath All Commercial |
$1,265.00
|
| Rate for Payer: Humana ChoiceCare |
$1,187.59
|
| Rate for Payer: Humana Medicare |
$701.25
|
| Rate for Payer: Lucent All Commercial |
$701.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,237.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,031.25
|
| Rate for Payer: PHP All Commercial |
$1,042.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$536.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,061.50
|
| Rate for Payer: Signature Care EPO |
$1,141.25
|
| Rate for Payer: Signature Care PPO |
$1,210.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,168.75
|
| Rate for Payer: United Healthcare Commercial |
$1,083.50
|
| Rate for Payer: United Healthcare Medicare |
$453.75
|
|
|
HC W DRILL 3.2 CANN 3200
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
41606216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$603.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.15
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Centivo All Commercial |
$535.50
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$535.50
|
| Rate for Payer: Lucent All Commercial |
$535.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
|
|
HC W DRILL 3.2 CANN 3200
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
41606216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC W DRILL BIT 1.3 1130
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41605912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$897.45 |
| Rate for Payer: Aetna Commercial |
$814.46
|
| Rate for Payer: Aetna Medicare |
$318.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$554.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.30
|
| Rate for Payer: Cash Price |
$598.30
|
| Rate for Payer: Cash Price |
$598.30
|
| Rate for Payer: Centivo All Commercial |
$492.15
|
| Rate for Payer: Cigna All Commercial |
$832.80
|
| Rate for Payer: CORVEL All Commercial |
$897.45
|
| Rate for Payer: Coventry All Commercial |
$849.20
|
| Rate for Payer: Encore All Commercial |
$888.28
|
| Rate for Payer: Frontpath All Commercial |
$887.80
|
| Rate for Payer: Humana ChoiceCare |
$833.47
|
| Rate for Payer: Humana Medicare |
$492.15
|
| Rate for Payer: Lucent All Commercial |
$492.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$723.75
|
| Rate for Payer: PHP All Commercial |
$731.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.35
|
| Rate for Payer: Sagamore Health Network All Products |
$744.98
|
| Rate for Payer: Signature Care EPO |
$800.95
|
| Rate for Payer: Signature Care PPO |
$849.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.25
|
| Rate for Payer: United Healthcare Commercial |
$760.42
|
| Rate for Payer: United Healthcare Medicare |
$318.45
|
|
|
HC W DRILL BIT 1.3 1130
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41605912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.75 |
| Max. Negotiated Rate |
$897.45 |
| Rate for Payer: Aetna Commercial |
$833.76
|
| Rate for Payer: Cash Price |
$598.30
|
| Rate for Payer: Cigna All Commercial |
$832.80
|
| Rate for Payer: CORVEL All Commercial |
$897.45
|
| Rate for Payer: Coventry All Commercial |
$849.20
|
| Rate for Payer: Encore All Commercial |
$888.28
|
| Rate for Payer: Frontpath All Commercial |
$887.80
|
| Rate for Payer: Humana ChoiceCare |
$833.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.50
|
| Rate for Payer: PHCS All Commercial |
$723.75
|
| Rate for Payer: PHP All Commercial |
$731.86
|
| Rate for Payer: Sagamore Health Network All Products |
$744.98
|
| Rate for Payer: Signature Care EPO |
$800.95
|
| Rate for Payer: Signature Care PPO |
$849.20
|
| Rate for Payer: United Healthcare Commercial |
$760.42
|
|
|
HC W DRILL BIT 1.3 1330
|
Facility
|
IP
|
$955.00
|
|
| Hospital Charge Code |
41606317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$716.25 |
| Max. Negotiated Rate |
$888.15 |
| Rate for Payer: Aetna Commercial |
$825.12
|
| Rate for Payer: Cash Price |
$592.10
|
| Rate for Payer: Cigna All Commercial |
$824.16
|
| Rate for Payer: CORVEL All Commercial |
$888.15
|
| Rate for Payer: Coventry All Commercial |
$840.40
|
| Rate for Payer: Encore All Commercial |
$879.08
|
| Rate for Payer: Frontpath All Commercial |
$878.60
|
| Rate for Payer: Humana ChoiceCare |
$824.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$859.50
|
| Rate for Payer: PHCS All Commercial |
$716.25
|
| Rate for Payer: PHP All Commercial |
$724.27
|
| Rate for Payer: Sagamore Health Network All Products |
$737.26
|
| Rate for Payer: Signature Care EPO |
$792.65
|
| Rate for Payer: Signature Care PPO |
$840.40
|
| Rate for Payer: United Healthcare Commercial |
$752.54
|
|
|
HC W DRILL BIT 1.3 1330
|
Facility
|
OP
|
$955.00
|
|
| Hospital Charge Code |
41606317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$888.15 |
| Rate for Payer: Aetna Commercial |
$806.02
|
| Rate for Payer: Aetna Medicare |
$315.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$315.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$548.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$596.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$362.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$346.66
|
| Rate for Payer: Cash Price |
$592.10
|
| Rate for Payer: Cash Price |
$592.10
|
| Rate for Payer: Centivo All Commercial |
$487.05
|
| Rate for Payer: Cigna All Commercial |
$824.16
|
| Rate for Payer: CORVEL All Commercial |
$888.15
|
| Rate for Payer: Coventry All Commercial |
$840.40
|
| Rate for Payer: Encore All Commercial |
$879.08
|
| Rate for Payer: Frontpath All Commercial |
$878.60
|
| Rate for Payer: Humana ChoiceCare |
$824.83
|
| Rate for Payer: Humana Medicare |
$487.05
|
| Rate for Payer: Lucent All Commercial |
$487.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$859.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$716.25
|
| Rate for Payer: PHP All Commercial |
$724.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$372.45
|
| Rate for Payer: Sagamore Health Network All Products |
$737.26
|
| Rate for Payer: Signature Care EPO |
$792.65
|
| Rate for Payer: Signature Care PPO |
$840.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$811.75
|
| Rate for Payer: United Healthcare Commercial |
$752.54
|
| Rate for Payer: United Healthcare Medicare |
$315.15
|
|
|
HC W DRILL BIT 15
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41605823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$897.45 |
| Rate for Payer: Aetna Commercial |
$814.46
|
| Rate for Payer: Aetna Medicare |
$318.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$554.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.30
|
| Rate for Payer: Cash Price |
$598.30
|
| Rate for Payer: Cash Price |
$598.30
|
| Rate for Payer: Centivo All Commercial |
$492.15
|
| Rate for Payer: Cigna All Commercial |
$832.80
|
| Rate for Payer: CORVEL All Commercial |
$897.45
|
| Rate for Payer: Coventry All Commercial |
$849.20
|
| Rate for Payer: Encore All Commercial |
$888.28
|
| Rate for Payer: Frontpath All Commercial |
$887.80
|
| Rate for Payer: Humana ChoiceCare |
$833.47
|
| Rate for Payer: Humana Medicare |
$492.15
|
| Rate for Payer: Lucent All Commercial |
$492.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$723.75
|
| Rate for Payer: PHP All Commercial |
$731.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.35
|
| Rate for Payer: Sagamore Health Network All Products |
$744.98
|
| Rate for Payer: Signature Care EPO |
$800.95
|
| Rate for Payer: Signature Care PPO |
$849.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.25
|
| Rate for Payer: United Healthcare Commercial |
$760.42
|
| Rate for Payer: United Healthcare Medicare |
$318.45
|
|
|
HC W DRILL BIT 15
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41605823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.75 |
| Max. Negotiated Rate |
$897.45 |
| Rate for Payer: Aetna Commercial |
$833.76
|
| Rate for Payer: Cash Price |
$598.30
|
| Rate for Payer: Cigna All Commercial |
$832.80
|
| Rate for Payer: CORVEL All Commercial |
$897.45
|
| Rate for Payer: Coventry All Commercial |
$849.20
|
| Rate for Payer: Encore All Commercial |
$888.28
|
| Rate for Payer: Frontpath All Commercial |
$887.80
|
| Rate for Payer: Humana ChoiceCare |
$833.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.50
|
| Rate for Payer: PHCS All Commercial |
$723.75
|
| Rate for Payer: PHP All Commercial |
$731.86
|
| Rate for Payer: Sagamore Health Network All Products |
$744.98
|
| Rate for Payer: Signature Care EPO |
$800.95
|
| Rate for Payer: Signature Care PPO |
$849.20
|
| Rate for Payer: United Healthcare Commercial |
$760.42
|
|
|
HC W DRILL BIT 1.6 1160
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41605909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.75 |
| Max. Negotiated Rate |
$897.45 |
| Rate for Payer: Aetna Commercial |
$833.76
|
| Rate for Payer: Cash Price |
$598.30
|
| Rate for Payer: Cigna All Commercial |
$832.80
|
| Rate for Payer: CORVEL All Commercial |
$897.45
|
| Rate for Payer: Coventry All Commercial |
$849.20
|
| Rate for Payer: Encore All Commercial |
$888.28
|
| Rate for Payer: Frontpath All Commercial |
$887.80
|
| Rate for Payer: Humana ChoiceCare |
$833.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.50
|
| Rate for Payer: PHCS All Commercial |
$723.75
|
| Rate for Payer: PHP All Commercial |
$731.86
|
| Rate for Payer: Sagamore Health Network All Products |
$744.98
|
| Rate for Payer: Signature Care EPO |
$800.95
|
| Rate for Payer: Signature Care PPO |
$849.20
|
| Rate for Payer: United Healthcare Commercial |
$760.42
|
|
