|
HC W DRILL BIT 1.6 1160
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41605909
|
|
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 1.6 1630
|
Facility
|
IP
|
$955.00
|
|
| Hospital Charge Code |
41606318
|
|
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 1.6 1630
|
Facility
|
OP
|
$955.00
|
|
| Hospital Charge Code |
41606318
|
|
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 1.7 CANN 0017
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
41605914
|
|
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 1.7 CANN 0017
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
41605914
|
|
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 BIT 2.0
|
Facility
|
OP
|
$955.00
|
|
| Hospital Charge Code |
41606962
|
|
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 2.0
|
Facility
|
IP
|
$955.00
|
|
| Hospital Charge Code |
41606962
|
|
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 2.0/2.4/1.3
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41605910
|
|
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 2.0/2.4/1.3
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41605910
|
|
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 2.0/2.4/1.6
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41605911
|
|
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 2.0/2.4/1.6
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41605911
|
|
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 2.0 CANN
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
41604665
|
|
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 2.0 CANN
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
41604665
|
|
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 BIT 2.0 CANN 0001
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
41605812
|
|
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 BIT 2.0 CANN 0001
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
41605812
|
|
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 2.0 CANN 0020
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
41604362
|
|
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 2.0 CANN 0020
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
41604362
|
|
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 BIT 2.0X24
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41604920
|
|
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 2.0X24
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41604920
|
|
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 2.0X30
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41603577
|
|
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 2.0X30
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41603577
|
|
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 2.2 3125
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41604590
|
|
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 2.2 3125
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41604590
|
|
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 2.2 618
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41604601
|
|
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 2.2 618
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41604601
|
|
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
|
|
