|
HC W DRILL BIT 4.0X60
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41605901
|
|
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 4.4 6514
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41605819
|
|
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 4.4 6514
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41605819
|
|
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 4.5 4513
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41605818
|
|
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 4.5 4513
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41605818
|
|
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 4.7
|
Facility
|
IP
|
$1,165.00
|
|
| Hospital Charge Code |
41606915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$873.75 |
| Max. Negotiated Rate |
$1,083.45 |
| Rate for Payer: Aetna Commercial |
$1,006.56
|
| Rate for Payer: Cash Price |
$722.30
|
| Rate for Payer: Cigna All Commercial |
$1,005.40
|
| Rate for Payer: CORVEL All Commercial |
$1,083.45
|
| Rate for Payer: Coventry All Commercial |
$1,025.20
|
| Rate for Payer: Encore All Commercial |
$1,072.38
|
| Rate for Payer: Frontpath All Commercial |
$1,071.80
|
| Rate for Payer: Humana ChoiceCare |
$1,006.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,048.50
|
| Rate for Payer: PHCS All Commercial |
$873.75
|
| Rate for Payer: PHP All Commercial |
$883.54
|
| Rate for Payer: Sagamore Health Network All Products |
$899.38
|
| Rate for Payer: Signature Care EPO |
$966.95
|
| Rate for Payer: Signature Care PPO |
$1,025.20
|
| Rate for Payer: United Healthcare Commercial |
$918.02
|
|
|
HC W DRILL BIT 4.7
|
Facility
|
OP
|
$1,165.00
|
|
| Hospital Charge Code |
41606915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,083.45 |
| Rate for Payer: Aetna Commercial |
$983.26
|
| Rate for Payer: Aetna Medicare |
$384.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$384.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$669.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$728.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$442.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$422.90
|
| Rate for Payer: Cash Price |
$722.30
|
| Rate for Payer: Cash Price |
$722.30
|
| Rate for Payer: Centivo All Commercial |
$594.15
|
| Rate for Payer: Cigna All Commercial |
$1,005.40
|
| Rate for Payer: CORVEL All Commercial |
$1,083.45
|
| Rate for Payer: Coventry All Commercial |
$1,025.20
|
| Rate for Payer: Encore All Commercial |
$1,072.38
|
| Rate for Payer: Frontpath All Commercial |
$1,071.80
|
| Rate for Payer: Humana ChoiceCare |
$1,006.21
|
| Rate for Payer: Humana Medicare |
$594.15
|
| Rate for Payer: Lucent All Commercial |
$594.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,048.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$873.75
|
| Rate for Payer: PHP All Commercial |
$883.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$454.35
|
| Rate for Payer: Sagamore Health Network All Products |
$899.38
|
| Rate for Payer: Signature Care EPO |
$966.95
|
| Rate for Payer: Signature Care PPO |
$1,025.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$990.25
|
| Rate for Payer: United Healthcare Commercial |
$918.02
|
| Rate for Payer: United Healthcare Medicare |
$384.45
|
|
|
HC W DRILL BIT 5.0 7514
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
41605820
|
|
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 5.0 7514
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
41605820
|
|
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 6.5 6522
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
41605827
|
|
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 6.5 6522
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
41605827
|
|
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 7.5 7522
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
41605828
|
|
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 7.5 7522
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
41605828
|
|
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 SELF 4.0X42 CANN
|
Facility
|
IP
|
$1,070.00
|
|
| Hospital Charge Code |
41606964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$802.50 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$924.48
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
|
|
HC W DRILL BIT SELF 4.0X42 CANN
|
Facility
|
OP
|
$1,070.00
|
|
| Hospital Charge Code |
41606964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$903.08
|
| Rate for Payer: Aetna Medicare |
$353.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$614.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$668.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.41
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Centivo All Commercial |
$545.70
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Humana Medicare |
$545.70
|
| Rate for Payer: Lucent All Commercial |
$545.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.30
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$909.50
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
| Rate for Payer: United Healthcare Medicare |
$353.10
|
|
|
HC W DRIVER STAR 10
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
41605907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,046.25 |
| Rate for Payer: Aetna Commercial |
$949.50
|
| Rate for Payer: Aetna Medicare |
$371.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$371.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$646.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$703.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$426.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$408.38
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Centivo All Commercial |
$573.75
|
| Rate for Payer: Cigna All Commercial |
$970.88
|
| Rate for Payer: CORVEL All Commercial |
$1,046.25
|
| Rate for Payer: Coventry All Commercial |
$990.00
|
| Rate for Payer: Encore All Commercial |
$1,035.56
|
| Rate for Payer: Frontpath All Commercial |
$1,035.00
|
| Rate for Payer: Humana ChoiceCare |
$971.66
|
| Rate for Payer: Humana Medicare |
$573.75
|
| Rate for Payer: Lucent All Commercial |
$573.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,012.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$843.75
|
| Rate for Payer: PHP All Commercial |
$853.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$438.75
|
| Rate for Payer: Sagamore Health Network All Products |
$868.50
|
| Rate for Payer: Signature Care EPO |
$933.75
|
| Rate for Payer: Signature Care PPO |
$990.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$956.25
|
| Rate for Payer: United Healthcare Commercial |
$886.50
|
| Rate for Payer: United Healthcare Medicare |
$371.25
|
|
|
HC W DRIVER STAR 10
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
41605907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$843.75 |
| Max. Negotiated Rate |
$1,046.25 |
| Rate for Payer: Aetna Commercial |
$972.00
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna All Commercial |
$970.88
|
| Rate for Payer: CORVEL All Commercial |
$1,046.25
|
| Rate for Payer: Coventry All Commercial |
$990.00
|
| Rate for Payer: Encore All Commercial |
$1,035.56
|
| Rate for Payer: Frontpath All Commercial |
$1,035.00
|
| Rate for Payer: Humana ChoiceCare |
$971.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,012.50
|
| Rate for Payer: PHCS All Commercial |
$843.75
|
| Rate for Payer: PHP All Commercial |
$853.20
|
| Rate for Payer: Sagamore Health Network All Products |
$868.50
|
| Rate for Payer: Signature Care EPO |
$933.75
|
| Rate for Payer: Signature Care PPO |
$990.00
|
| Rate for Payer: United Healthcare Commercial |
$886.50
|
|
|
HC W DRIVER STAR 15
|
Facility
|
OP
|
$1,090.00
|
|
| Hospital Charge Code |
41605905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,013.70 |
| Rate for Payer: Aetna Commercial |
$919.96
|
| Rate for Payer: Aetna Medicare |
$359.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$359.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$625.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$681.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$413.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$395.67
|
| Rate for Payer: Cash Price |
$675.80
|
| Rate for Payer: Cash Price |
$675.80
|
| Rate for Payer: Centivo All Commercial |
$555.90
|
| Rate for Payer: Cigna All Commercial |
$940.67
|
| Rate for Payer: CORVEL All Commercial |
$1,013.70
|
| Rate for Payer: Coventry All Commercial |
$959.20
|
| Rate for Payer: Encore All Commercial |
$1,003.34
|
| Rate for Payer: Frontpath All Commercial |
$1,002.80
|
| Rate for Payer: Humana ChoiceCare |
$941.43
|
| Rate for Payer: Humana Medicare |
$555.90
|
| Rate for Payer: Lucent All Commercial |
$555.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$817.50
|
| Rate for Payer: PHP All Commercial |
$826.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$425.10
|
| Rate for Payer: Sagamore Health Network All Products |
$841.48
|
| Rate for Payer: Signature Care EPO |
$904.70
|
| Rate for Payer: Signature Care PPO |
$959.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$926.50
|
| Rate for Payer: United Healthcare Commercial |
$858.92
|
| Rate for Payer: United Healthcare Medicare |
$359.70
|
|
|
HC W DRIVER STAR 15
|
Facility
|
IP
|
$1,090.00
|
|
| Hospital Charge Code |
41605905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$817.50 |
| Max. Negotiated Rate |
$1,013.70 |
| Rate for Payer: Aetna Commercial |
$941.76
|
| Rate for Payer: Cash Price |
$675.80
|
| Rate for Payer: Cigna All Commercial |
$940.67
|
| Rate for Payer: CORVEL All Commercial |
$1,013.70
|
| Rate for Payer: Coventry All Commercial |
$959.20
|
| Rate for Payer: Encore All Commercial |
$1,003.34
|
| Rate for Payer: Frontpath All Commercial |
$1,002.80
|
| Rate for Payer: Humana ChoiceCare |
$941.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.00
|
| Rate for Payer: PHCS All Commercial |
$817.50
|
| Rate for Payer: PHP All Commercial |
$826.66
|
| Rate for Payer: Sagamore Health Network All Products |
$841.48
|
| Rate for Payer: Signature Care EPO |
$904.70
|
| Rate for Payer: Signature Care PPO |
$959.20
|
| Rate for Payer: United Healthcare Commercial |
$858.92
|
|
|
HC W DRIVER STAR 20
|
Facility
|
IP
|
$1,170.00
|
|
| Hospital Charge Code |
41605904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$877.50 |
| Max. Negotiated Rate |
$1,088.10 |
| Rate for Payer: Aetna Commercial |
$1,010.88
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna All Commercial |
$1,009.71
|
| Rate for Payer: CORVEL All Commercial |
$1,088.10
|
| Rate for Payer: Coventry All Commercial |
$1,029.60
|
| Rate for Payer: Encore All Commercial |
$1,076.98
|
| Rate for Payer: Frontpath All Commercial |
$1,076.40
|
| Rate for Payer: Humana ChoiceCare |
$1,010.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,053.00
|
| Rate for Payer: PHCS All Commercial |
$877.50
|
| Rate for Payer: PHP All Commercial |
$887.33
|
| Rate for Payer: Sagamore Health Network All Products |
$903.24
|
| Rate for Payer: Signature Care EPO |
$971.10
|
| Rate for Payer: Signature Care PPO |
$1,029.60
|
| Rate for Payer: United Healthcare Commercial |
$921.96
|
|
|
HC W DRIVER STAR 20
|
Facility
|
OP
|
$1,170.00
|
|
| Hospital Charge Code |
41605904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,088.10 |
| Rate for Payer: Aetna Commercial |
$987.48
|
| Rate for Payer: Aetna Medicare |
$386.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$386.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$671.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$731.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$444.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$424.71
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Centivo All Commercial |
$596.70
|
| Rate for Payer: Cigna All Commercial |
$1,009.71
|
| Rate for Payer: CORVEL All Commercial |
$1,088.10
|
| Rate for Payer: Coventry All Commercial |
$1,029.60
|
| Rate for Payer: Encore All Commercial |
$1,076.98
|
| Rate for Payer: Frontpath All Commercial |
$1,076.40
|
| Rate for Payer: Humana ChoiceCare |
$1,010.53
|
| Rate for Payer: Humana Medicare |
$596.70
|
| Rate for Payer: Lucent All Commercial |
$596.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,053.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$877.50
|
| Rate for Payer: PHP All Commercial |
$887.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$456.30
|
| Rate for Payer: Sagamore Health Network All Products |
$903.24
|
| Rate for Payer: Signature Care EPO |
$971.10
|
| Rate for Payer: Signature Care PPO |
$1,029.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$994.50
|
| Rate for Payer: United Healthcare Commercial |
$921.96
|
| Rate for Payer: United Healthcare Medicare |
$386.10
|
|
|
HC W DRIVER STAR 7
|
Facility
|
OP
|
$1,001.00
|
|
| Hospital Charge Code |
41605908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$930.93 |
| Rate for Payer: Aetna Commercial |
$844.84
|
| Rate for Payer: Aetna Medicare |
$330.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$330.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$574.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$625.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$379.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$363.36
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Centivo All Commercial |
$510.51
|
| Rate for Payer: Cigna All Commercial |
$863.86
|
| Rate for Payer: CORVEL All Commercial |
$930.93
|
| Rate for Payer: Coventry All Commercial |
$880.88
|
| Rate for Payer: Encore All Commercial |
$921.42
|
| Rate for Payer: Frontpath All Commercial |
$920.92
|
| Rate for Payer: Humana ChoiceCare |
$864.56
|
| Rate for Payer: Humana Medicare |
$510.51
|
| Rate for Payer: Lucent All Commercial |
$510.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$900.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$750.75
|
| Rate for Payer: PHP All Commercial |
$759.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.39
|
| Rate for Payer: Sagamore Health Network All Products |
$772.77
|
| Rate for Payer: Signature Care EPO |
$830.83
|
| Rate for Payer: Signature Care PPO |
$880.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$850.85
|
| Rate for Payer: United Healthcare Commercial |
$788.79
|
| Rate for Payer: United Healthcare Medicare |
$330.33
|
|
|
HC W DRIVER STAR 7
|
Facility
|
IP
|
$1,001.00
|
|
| Hospital Charge Code |
41605908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$750.75 |
| Max. Negotiated Rate |
$930.93 |
| Rate for Payer: Aetna Commercial |
$864.86
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Cigna All Commercial |
$863.86
|
| Rate for Payer: CORVEL All Commercial |
$930.93
|
| Rate for Payer: Coventry All Commercial |
$880.88
|
| Rate for Payer: Encore All Commercial |
$921.42
|
| Rate for Payer: Frontpath All Commercial |
$920.92
|
| Rate for Payer: Humana ChoiceCare |
$864.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$900.90
|
| Rate for Payer: PHCS All Commercial |
$750.75
|
| Rate for Payer: PHP All Commercial |
$759.16
|
| Rate for Payer: Sagamore Health Network All Products |
$772.77
|
| Rate for Payer: Signature Care EPO |
$830.83
|
| Rate for Payer: Signature Care PPO |
$880.88
|
| Rate for Payer: United Healthcare Commercial |
$788.79
|
|
|
HC WESTERN BLOT
|
Facility
|
IP
|
$169.77
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
63001942
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.33 |
| Max. Negotiated Rate |
$157.88 |
| Rate for Payer: Aetna Commercial |
$146.68
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cigna All Commercial |
$146.51
|
| Rate for Payer: CORVEL All Commercial |
$157.88
|
| Rate for Payer: Coventry All Commercial |
$149.40
|
| Rate for Payer: Encore All Commercial |
$156.27
|
| Rate for Payer: Frontpath All Commercial |
$156.19
|
| Rate for Payer: Humana ChoiceCare |
$146.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.79
|
| Rate for Payer: PHCS All Commercial |
$127.33
|
| Rate for Payer: PHP All Commercial |
$128.75
|
| Rate for Payer: Sagamore Health Network All Products |
$131.06
|
| Rate for Payer: Signature Care EPO |
$140.91
|
| Rate for Payer: Signature Care PPO |
$149.40
|
| Rate for Payer: United Healthcare Commercial |
$133.78
|
|
|
HC WESTERN BLOT
|
Facility
|
OP
|
$169.77
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
63001942
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$157.88 |
| Rate for Payer: Aetna Commercial |
$143.28
|
| Rate for Payer: Aetna Medicare |
$56.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$19.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.63
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Centivo All Commercial |
$86.58
|
| Rate for Payer: Cigna All Commercial |
$146.51
|
| Rate for Payer: CORVEL All Commercial |
$157.88
|
| Rate for Payer: Coventry All Commercial |
$149.40
|
| Rate for Payer: Encore All Commercial |
$156.27
|
| Rate for Payer: Frontpath All Commercial |
$156.19
|
| Rate for Payer: Humana ChoiceCare |
$146.63
|
| Rate for Payer: Humana Medicare |
$86.58
|
| Rate for Payer: Lucent All Commercial |
$86.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.79
|
| Rate for Payer: Managed Health Services Medicaid |
$19.35
|
| Rate for Payer: MDWise Medicaid |
$19.35
|
| Rate for Payer: PHCS All Commercial |
$127.33
|
| Rate for Payer: PHP All Commercial |
$128.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.21
|
| Rate for Payer: Sagamore Health Network All Products |
$131.06
|
| Rate for Payer: Signature Care EPO |
$140.91
|
| Rate for Payer: Signature Care PPO |
$149.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144.30
|
| Rate for Payer: United Healthcare Commercial |
$133.78
|
| Rate for Payer: United Healthcare Medicare |
$56.02
|
|
