|
HC W FUSIONFLEX 8X8X8
|
Facility
OP
|
$1,980.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,841.40 |
| Rate for Payer: Aetna Commercial |
$1,671.12
|
| Rate for Payer: Aetna Medicare |
$653.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$653.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,137.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,237.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$751.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$718.74
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Centivo All Commercial |
$1,009.80
|
| Rate for Payer: Cigna All Commercial |
$1,708.74
|
| Rate for Payer: CORVEL All Commercial |
$1,841.40
|
| Rate for Payer: Coventry All Commercial |
$1,742.40
|
| Rate for Payer: Encore All Commercial |
$1,822.59
|
| Rate for Payer: Frontpath All Commercial |
$1,821.60
|
| Rate for Payer: Humana ChoiceCare |
$1,710.13
|
| Rate for Payer: Humana Medicare |
$1,009.80
|
| Rate for Payer: Lucent All Commercial |
$1,009.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,782.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,485.00
|
| Rate for Payer: PHP All Commercial |
$1,501.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$772.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,528.56
|
| Rate for Payer: Signature Care EPO |
$1,643.40
|
| Rate for Payer: Signature Care PPO |
$1,742.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,683.00
|
| Rate for Payer: United Healthcare Commercial |
$1,560.24
|
| Rate for Payer: United Healthcare Medicare |
$653.40
|
|
|
HC W GRAFTJACKET THIN 2X4
|
Facility
OP
|
$3,880.80
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,609.14 |
| Rate for Payer: Aetna Commercial |
$3,275.40
|
| Rate for Payer: Aetna Medicare |
$1,280.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,280.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,228.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,425.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,472.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,408.73
|
| Rate for Payer: Cash Price |
$2,406.10
|
| Rate for Payer: Cash Price |
$2,406.10
|
| Rate for Payer: Centivo All Commercial |
$1,979.21
|
| Rate for Payer: Cigna All Commercial |
$3,349.13
|
| Rate for Payer: CORVEL All Commercial |
$3,609.14
|
| Rate for Payer: Coventry All Commercial |
$3,415.10
|
| Rate for Payer: Encore All Commercial |
$3,572.28
|
| Rate for Payer: Frontpath All Commercial |
$3,570.34
|
| Rate for Payer: Humana ChoiceCare |
$3,351.85
|
| Rate for Payer: Humana Medicare |
$1,979.21
|
| Rate for Payer: Lucent All Commercial |
$1,979.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,492.72
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,910.60
|
| Rate for Payer: PHP All Commercial |
$2,943.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,513.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,995.98
|
| Rate for Payer: Signature Care EPO |
$3,221.06
|
| Rate for Payer: Signature Care PPO |
$3,415.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,298.68
|
| Rate for Payer: United Healthcare Commercial |
$3,058.07
|
| Rate for Payer: United Healthcare Medicare |
$1,280.66
|
|
|
HC W GRAFTJACKET THIN 2X4
|
Facility
IP
|
$3,880.80
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,910.60 |
| Max. Negotiated Rate |
$3,609.14 |
| Rate for Payer: Aetna Commercial |
$3,353.01
|
| Rate for Payer: Cash Price |
$2,406.10
|
| Rate for Payer: Cigna All Commercial |
$3,349.13
|
| Rate for Payer: CORVEL All Commercial |
$3,609.14
|
| Rate for Payer: Coventry All Commercial |
$3,415.10
|
| Rate for Payer: Encore All Commercial |
$3,572.28
|
| Rate for Payer: Frontpath All Commercial |
$3,570.34
|
| Rate for Payer: Humana ChoiceCare |
$3,351.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,492.72
|
| Rate for Payer: PHCS All Commercial |
$2,910.60
|
| Rate for Payer: PHP All Commercial |
$2,943.20
|
| Rate for Payer: Sagamore Health Network All Products |
$2,995.98
|
| Rate for Payer: Signature Care EPO |
$3,221.06
|
| Rate for Payer: Signature Care PPO |
$3,415.10
|
| Rate for Payer: United Healthcare Commercial |
$3,058.07
|
|
|
HC W GRAFTJACKET THIN 4X4
|
Facility
IP
|
$7,952.40
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,964.30 |
| Max. Negotiated Rate |
$7,395.73 |
| Rate for Payer: Aetna Commercial |
$6,870.87
|
| Rate for Payer: Cash Price |
$4,930.49
|
| Rate for Payer: Cigna All Commercial |
$6,862.92
|
| Rate for Payer: CORVEL All Commercial |
$7,395.73
|
| Rate for Payer: Coventry All Commercial |
$6,998.11
|
| Rate for Payer: Encore All Commercial |
$7,320.18
|
| Rate for Payer: Frontpath All Commercial |
$7,316.21
|
| Rate for Payer: Humana ChoiceCare |
$6,868.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,157.16
|
| Rate for Payer: PHCS All Commercial |
$5,964.30
|
| Rate for Payer: PHP All Commercial |
$6,031.10
|
| Rate for Payer: Sagamore Health Network All Products |
$6,139.25
|
| Rate for Payer: Signature Care EPO |
$6,600.49
|
| Rate for Payer: Signature Care PPO |
$6,998.11
|
| Rate for Payer: United Healthcare Commercial |
$6,266.49
|
|
|
HC W GRAFTJACKET THIN 4X4
|
Facility
OP
|
$7,952.40
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,395.73 |
| Rate for Payer: Aetna Commercial |
$6,711.83
|
| Rate for Payer: Aetna Medicare |
$2,624.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,624.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,567.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,971.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,017.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,886.72
|
| Rate for Payer: Cash Price |
$4,930.49
|
| Rate for Payer: Cash Price |
$4,930.49
|
| Rate for Payer: Centivo All Commercial |
$4,055.72
|
| Rate for Payer: Cigna All Commercial |
$6,862.92
|
| Rate for Payer: CORVEL All Commercial |
$7,395.73
|
| Rate for Payer: Coventry All Commercial |
$6,998.11
|
| Rate for Payer: Encore All Commercial |
$7,320.18
|
| Rate for Payer: Frontpath All Commercial |
$7,316.21
|
| Rate for Payer: Humana ChoiceCare |
$6,868.49
|
| Rate for Payer: Humana Medicare |
$4,055.72
|
| Rate for Payer: Lucent All Commercial |
$4,055.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,157.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,964.30
|
| Rate for Payer: PHP All Commercial |
$6,031.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,101.44
|
| Rate for Payer: Sagamore Health Network All Products |
$6,139.25
|
| Rate for Payer: Signature Care EPO |
$6,600.49
|
| Rate for Payer: Signature Care PPO |
$6,998.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,759.54
|
| Rate for Payer: United Healthcare Commercial |
$6,266.49
|
| Rate for Payer: United Healthcare Medicare |
$2,624.29
|
|
|
HC W GRAFTJACKET THIN 4X8
|
Facility
IP
|
$8,406.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,304.50 |
| Max. Negotiated Rate |
$7,817.58 |
| Rate for Payer: Aetna Commercial |
$7,262.78
|
| Rate for Payer: Cash Price |
$5,211.72
|
| Rate for Payer: Cigna All Commercial |
$7,254.38
|
| Rate for Payer: CORVEL All Commercial |
$7,817.58
|
| Rate for Payer: Coventry All Commercial |
$7,397.28
|
| Rate for Payer: Encore All Commercial |
$7,737.72
|
| Rate for Payer: Frontpath All Commercial |
$7,733.52
|
| Rate for Payer: Humana ChoiceCare |
$7,260.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,565.40
|
| Rate for Payer: PHCS All Commercial |
$6,304.50
|
| Rate for Payer: PHP All Commercial |
$6,375.11
|
| Rate for Payer: Sagamore Health Network All Products |
$6,489.43
|
| Rate for Payer: Signature Care EPO |
$6,976.98
|
| Rate for Payer: Signature Care PPO |
$7,397.28
|
| Rate for Payer: United Healthcare Commercial |
$6,623.93
|
|
|
HC W GRAFTJACKET THIN 4X8
|
Facility
OP
|
$8,406.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,817.58 |
| Rate for Payer: Aetna Commercial |
$7,094.66
|
| Rate for Payer: Aetna Medicare |
$2,773.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,773.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,827.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,254.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,190.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,051.38
|
| Rate for Payer: Cash Price |
$5,211.72
|
| Rate for Payer: Cash Price |
$5,211.72
|
| Rate for Payer: Centivo All Commercial |
$4,287.06
|
| Rate for Payer: Cigna All Commercial |
$7,254.38
|
| Rate for Payer: CORVEL All Commercial |
$7,817.58
|
| Rate for Payer: Coventry All Commercial |
$7,397.28
|
| Rate for Payer: Encore All Commercial |
$7,737.72
|
| Rate for Payer: Frontpath All Commercial |
$7,733.52
|
| Rate for Payer: Humana ChoiceCare |
$7,260.26
|
| Rate for Payer: Humana Medicare |
$4,287.06
|
| Rate for Payer: Lucent All Commercial |
$4,287.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,565.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,304.50
|
| Rate for Payer: PHP All Commercial |
$6,375.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,278.34
|
| Rate for Payer: Sagamore Health Network All Products |
$6,489.43
|
| Rate for Payer: Signature Care EPO |
$6,976.98
|
| Rate for Payer: Signature Care PPO |
$7,397.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,145.10
|
| Rate for Payer: United Healthcare Commercial |
$6,623.93
|
| Rate for Payer: United Healthcare Medicare |
$2,773.98
|
|
|
HC W GUIDWIRE SUT LOOP
|
Facility
IP
|
$830.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.50 |
| Max. Negotiated Rate |
$771.90 |
| Rate for Payer: Aetna Commercial |
$717.12
|
| Rate for Payer: Cash Price |
$514.60
|
| Rate for Payer: Cigna All Commercial |
$716.29
|
| Rate for Payer: CORVEL All Commercial |
$771.90
|
| Rate for Payer: Coventry All Commercial |
$730.40
|
| Rate for Payer: Encore All Commercial |
$764.02
|
| Rate for Payer: Frontpath All Commercial |
$763.60
|
| Rate for Payer: Humana ChoiceCare |
$716.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$747.00
|
| Rate for Payer: PHCS All Commercial |
$622.50
|
| Rate for Payer: PHP All Commercial |
$629.47
|
| Rate for Payer: Sagamore Health Network All Products |
$640.76
|
| Rate for Payer: Signature Care EPO |
$688.90
|
| Rate for Payer: Signature Care PPO |
$730.40
|
| Rate for Payer: United Healthcare Commercial |
$654.04
|
|
|
HC W GUIDWIRE SUT LOOP
|
Facility
OP
|
$830.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.90 |
| Max. Negotiated Rate |
$771.90 |
| Rate for Payer: Aetna Commercial |
$700.52
|
| Rate for Payer: Aetna Medicare |
$273.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$273.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$476.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$518.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$314.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.29
|
| Rate for Payer: Cash Price |
$514.60
|
| Rate for Payer: Cash Price |
$514.60
|
| Rate for Payer: Centivo All Commercial |
$423.30
|
| Rate for Payer: Cigna All Commercial |
$716.29
|
| Rate for Payer: CORVEL All Commercial |
$771.90
|
| Rate for Payer: Coventry All Commercial |
$730.40
|
| Rate for Payer: Encore All Commercial |
$764.02
|
| Rate for Payer: Frontpath All Commercial |
$763.60
|
| Rate for Payer: Humana ChoiceCare |
$716.87
|
| Rate for Payer: Humana Medicare |
$423.30
|
| Rate for Payer: Lucent All Commercial |
$423.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$747.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$622.50
|
| Rate for Payer: PHP All Commercial |
$629.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$323.70
|
| Rate for Payer: Sagamore Health Network All Products |
$640.76
|
| Rate for Payer: Signature Care EPO |
$688.90
|
| Rate for Payer: Signature Care PPO |
$730.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$705.50
|
| Rate for Payer: United Healthcare Commercial |
$654.04
|
| Rate for Payer: United Healthcare Medicare |
$273.90
|
|
|
HC W HAMMERTOE SMALL CANN
|
Facility
OP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,291.08 |
| Rate for Payer: Aetna Commercial |
$2,986.75
|
| Rate for Payer: Aetna Medicare |
$1,167.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,167.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,032.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,212.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,342.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,284.58
|
| Rate for Payer: Cash Price |
$2,194.06
|
| Rate for Payer: Cash Price |
$2,194.06
|
| Rate for Payer: Centivo All Commercial |
$1,804.79
|
| Rate for Payer: Cigna All Commercial |
$3,053.98
|
| Rate for Payer: CORVEL All Commercial |
$3,291.08
|
| Rate for Payer: Coventry All Commercial |
$3,114.14
|
| Rate for Payer: Encore All Commercial |
$3,257.47
|
| Rate for Payer: Frontpath All Commercial |
$3,255.70
|
| Rate for Payer: Humana ChoiceCare |
$3,056.46
|
| Rate for Payer: Humana Medicare |
$1,804.79
|
| Rate for Payer: Lucent All Commercial |
$1,804.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,184.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,654.10
|
| Rate for Payer: PHP All Commercial |
$2,683.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,380.13
|
| Rate for Payer: Sagamore Health Network All Products |
$2,731.95
|
| Rate for Payer: Signature Care EPO |
$2,937.20
|
| Rate for Payer: Signature Care PPO |
$3,114.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,007.98
|
| Rate for Payer: United Healthcare Commercial |
$2,788.57
|
| Rate for Payer: United Healthcare Medicare |
$1,167.80
|
|
|
HC W HAMMERTOE SMALL CANN
|
Facility
IP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,654.10 |
| Max. Negotiated Rate |
$3,291.08 |
| Rate for Payer: Aetna Commercial |
$3,057.52
|
| Rate for Payer: Cash Price |
$2,194.06
|
| Rate for Payer: Cigna All Commercial |
$3,053.98
|
| Rate for Payer: CORVEL All Commercial |
$3,291.08
|
| Rate for Payer: Coventry All Commercial |
$3,114.14
|
| Rate for Payer: Encore All Commercial |
$3,257.47
|
| Rate for Payer: Frontpath All Commercial |
$3,255.70
|
| Rate for Payer: Humana ChoiceCare |
$3,056.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,184.92
|
| Rate for Payer: PHCS All Commercial |
$2,654.10
|
| Rate for Payer: PHP All Commercial |
$2,683.83
|
| Rate for Payer: Sagamore Health Network All Products |
$2,731.95
|
| Rate for Payer: Signature Care EPO |
$2,937.20
|
| Rate for Payer: Signature Care PPO |
$3,114.14
|
| Rate for Payer: United Healthcare Commercial |
$2,788.57
|
|
|
HC WHEELCHAIR MGMT/TRN/15 MIN-PT
|
Facility
OP
|
$209.75
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
01728089
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$69.22 |
| Max. Negotiated Rate |
$195.07 |
| Rate for Payer: Aetna Commercial |
$177.03
|
| Rate for Payer: Aetna Medicare |
$69.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.14
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Centivo All Commercial |
$106.97
|
| Rate for Payer: Cigna All Commercial |
$181.02
|
| Rate for Payer: CORVEL All Commercial |
$195.07
|
| Rate for Payer: Coventry All Commercial |
$184.58
|
| Rate for Payer: Encore All Commercial |
$193.08
|
| Rate for Payer: Frontpath All Commercial |
$192.97
|
| Rate for Payer: Humana ChoiceCare |
$181.16
|
| Rate for Payer: Humana Medicare |
$106.97
|
| Rate for Payer: Lucent All Commercial |
$106.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.78
|
| Rate for Payer: PHCS All Commercial |
$157.31
|
| Rate for Payer: PHP All Commercial |
$159.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.80
|
| Rate for Payer: Sagamore Health Network All Products |
$161.93
|
| Rate for Payer: Signature Care EPO |
$174.09
|
| Rate for Payer: Signature Care PPO |
$184.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.29
|
| Rate for Payer: United Healthcare Commercial |
$165.29
|
| Rate for Payer: United Healthcare Medicare |
$69.22
|
|
|
HC WHEELCHAIR MGMT/TRN/15 MIN-PT
|
Facility
IP
|
$209.75
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
01728089
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$157.31 |
| Max. Negotiated Rate |
$195.07 |
| Rate for Payer: Aetna Commercial |
$181.23
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cigna All Commercial |
$181.02
|
| Rate for Payer: CORVEL All Commercial |
$195.07
|
| Rate for Payer: Coventry All Commercial |
$184.58
|
| Rate for Payer: Encore All Commercial |
$193.08
|
| Rate for Payer: Frontpath All Commercial |
$192.97
|
| Rate for Payer: Humana ChoiceCare |
$181.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.78
|
| Rate for Payer: PHCS All Commercial |
$157.31
|
| Rate for Payer: PHP All Commercial |
$159.08
|
| Rate for Payer: Sagamore Health Network All Products |
$161.93
|
| Rate for Payer: Signature Care EPO |
$174.09
|
| Rate for Payer: Signature Care PPO |
$184.58
|
| Rate for Payer: United Healthcare Commercial |
$165.29
|
|
|
HC WHIRLPOOL-PT
|
Facility
OP
|
$145.31
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
01728090
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.95 |
| Max. Negotiated Rate |
$135.14 |
| Rate for Payer: Aetna Commercial |
$122.64
|
| Rate for Payer: Aetna Medicare |
$47.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.75
|
| Rate for Payer: Cash Price |
$90.09
|
| Rate for Payer: Centivo All Commercial |
$74.11
|
| Rate for Payer: Cigna All Commercial |
$125.40
|
| Rate for Payer: CORVEL All Commercial |
$135.14
|
| Rate for Payer: Coventry All Commercial |
$127.87
|
| Rate for Payer: Encore All Commercial |
$133.76
|
| Rate for Payer: Frontpath All Commercial |
$133.68
|
| Rate for Payer: Humana ChoiceCare |
$125.50
|
| Rate for Payer: Humana Medicare |
$74.11
|
| Rate for Payer: Lucent All Commercial |
$74.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.78
|
| Rate for Payer: PHCS All Commercial |
$108.98
|
| Rate for Payer: PHP All Commercial |
$110.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.67
|
| Rate for Payer: Sagamore Health Network All Products |
$112.18
|
| Rate for Payer: Signature Care EPO |
$120.61
|
| Rate for Payer: Signature Care PPO |
$127.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.51
|
| Rate for Payer: United Healthcare Commercial |
$114.50
|
| Rate for Payer: United Healthcare Medicare |
$47.95
|
|
|
HC WHIRLPOOL-PT
|
Facility
IP
|
$145.31
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
01728090
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$108.98 |
| Max. Negotiated Rate |
$135.14 |
| Rate for Payer: Aetna Commercial |
$125.55
|
| Rate for Payer: Cash Price |
$90.09
|
| Rate for Payer: Cigna All Commercial |
$125.40
|
| Rate for Payer: CORVEL All Commercial |
$135.14
|
| Rate for Payer: Coventry All Commercial |
$127.87
|
| Rate for Payer: Encore All Commercial |
$133.76
|
| Rate for Payer: Frontpath All Commercial |
$133.68
|
| Rate for Payer: Humana ChoiceCare |
$125.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.78
|
| Rate for Payer: PHCS All Commercial |
$108.98
|
| Rate for Payer: PHP All Commercial |
$110.20
|
| Rate for Payer: Sagamore Health Network All Products |
$112.18
|
| Rate for Payer: Signature Care EPO |
$120.61
|
| Rate for Payer: Signature Care PPO |
$127.87
|
| Rate for Payer: United Healthcare Commercial |
$114.50
|
|
|
HC WHITE FOAM LG
|
Facility
OP
|
$94.76
|
|
| Hospital Charge Code |
41606588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.27 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$79.98
|
| Rate for Payer: Aetna Medicare |
$31.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.40
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Centivo All Commercial |
$48.33
|
| Rate for Payer: Cigna All Commercial |
$81.78
|
| Rate for Payer: CORVEL All Commercial |
$88.13
|
| Rate for Payer: Coventry All Commercial |
$83.39
|
| Rate for Payer: Encore All Commercial |
$87.23
|
| Rate for Payer: Frontpath All Commercial |
$87.18
|
| Rate for Payer: Humana ChoiceCare |
$81.84
|
| Rate for Payer: Humana Medicare |
$48.33
|
| Rate for Payer: Lucent All Commercial |
$48.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$71.07
|
| Rate for Payer: PHP All Commercial |
$71.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.96
|
| Rate for Payer: Sagamore Health Network All Products |
$73.15
|
| Rate for Payer: Signature Care EPO |
$78.65
|
| Rate for Payer: Signature Care PPO |
$83.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.55
|
| Rate for Payer: United Healthcare Commercial |
$74.67
|
| Rate for Payer: United Healthcare Medicare |
$31.27
|
|
|
HC WHITE FOAM LG
|
Facility
IP
|
$94.76
|
|
| Hospital Charge Code |
41606588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.07 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Aetna Commercial |
$81.87
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cigna All Commercial |
$81.78
|
| Rate for Payer: CORVEL All Commercial |
$88.13
|
| Rate for Payer: Coventry All Commercial |
$83.39
|
| Rate for Payer: Encore All Commercial |
$87.23
|
| Rate for Payer: Frontpath All Commercial |
$87.18
|
| Rate for Payer: Humana ChoiceCare |
$81.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.28
|
| Rate for Payer: PHCS All Commercial |
$71.07
|
| Rate for Payer: PHP All Commercial |
$71.87
|
| Rate for Payer: Sagamore Health Network All Products |
$73.15
|
| Rate for Payer: Signature Care EPO |
$78.65
|
| Rate for Payer: Signature Care PPO |
$83.39
|
| Rate for Payer: United Healthcare Commercial |
$74.67
|
|
|
HC WHITE PINE IGE
|
Facility
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC WHITE PINE IGE
|
Facility
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.19
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Cash Price |
$63.53
|
| Rate for Payer: Centivo All Commercial |
$52.25
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$52.25
|
| Rate for Payer: Lucent All Commercial |
$52.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC WHOLE BLOOD PROCESSING
|
Facility
IP
|
$494.58
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
01370121
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$370.93 |
| Max. Negotiated Rate |
$459.96 |
| Rate for Payer: Aetna Commercial |
$427.32
|
| Rate for Payer: Cash Price |
$306.64
|
| Rate for Payer: Cigna All Commercial |
$426.82
|
| Rate for Payer: CORVEL All Commercial |
$459.96
|
| Rate for Payer: Coventry All Commercial |
$435.23
|
| Rate for Payer: Encore All Commercial |
$455.26
|
| Rate for Payer: Frontpath All Commercial |
$455.01
|
| Rate for Payer: Humana ChoiceCare |
$427.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$445.12
|
| Rate for Payer: PHCS All Commercial |
$370.93
|
| Rate for Payer: PHP All Commercial |
$375.09
|
| Rate for Payer: Sagamore Health Network All Products |
$381.81
|
| Rate for Payer: Signature Care EPO |
$410.50
|
| Rate for Payer: Signature Care PPO |
$435.23
|
| Rate for Payer: United Healthcare Commercial |
$389.73
|
|
|
HC WHOLE BLOOD PROCESSING
|
Facility
OP
|
$494.58
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
01370121
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$163.21 |
| Max. Negotiated Rate |
$459.96 |
| Rate for Payer: Aetna Commercial |
$417.42
|
| Rate for Payer: Aetna Medicare |
$163.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$163.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$284.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$309.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$187.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$179.53
|
| Rate for Payer: Cash Price |
$306.64
|
| Rate for Payer: Cash Price |
$306.64
|
| Rate for Payer: Centivo All Commercial |
$252.23
|
| Rate for Payer: Cigna All Commercial |
$426.82
|
| Rate for Payer: CORVEL All Commercial |
$459.96
|
| Rate for Payer: Coventry All Commercial |
$435.23
|
| Rate for Payer: Encore All Commercial |
$455.26
|
| Rate for Payer: Frontpath All Commercial |
$455.01
|
| Rate for Payer: Humana ChoiceCare |
$427.17
|
| Rate for Payer: Humana Medicare |
$252.23
|
| Rate for Payer: Lucent All Commercial |
$252.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$445.12
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$370.93
|
| Rate for Payer: PHP All Commercial |
$375.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$192.89
|
| Rate for Payer: Sagamore Health Network All Products |
$381.81
|
| Rate for Payer: Signature Care EPO |
$410.50
|
| Rate for Payer: Signature Care PPO |
$435.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$420.39
|
| Rate for Payer: United Healthcare Commercial |
$389.73
|
| Rate for Payer: United Healthcare Medicare |
$163.21
|
|
|
HC WHOLE BODY TUMOR LOC
|
Facility
OP
|
$4,333.98
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
01638430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,418.55 |
| Max. Negotiated Rate |
$4,030.60 |
| Rate for Payer: Aetna Commercial |
$3,657.88
|
| Rate for Payer: Aetna Medicare |
$1,430.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,430.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,489.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,709.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,418.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,644.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,573.23
|
| Rate for Payer: Cash Price |
$2,687.07
|
| Rate for Payer: Cash Price |
$2,687.07
|
| Rate for Payer: Centivo All Commercial |
$2,210.33
|
| Rate for Payer: Cigna All Commercial |
$3,740.22
|
| Rate for Payer: CORVEL All Commercial |
$4,030.60
|
| Rate for Payer: Coventry All Commercial |
$3,813.90
|
| Rate for Payer: Encore All Commercial |
$3,989.43
|
| Rate for Payer: Frontpath All Commercial |
$3,987.26
|
| Rate for Payer: Humana ChoiceCare |
$3,743.26
|
| Rate for Payer: Humana Medicare |
$2,210.33
|
| Rate for Payer: Lucent All Commercial |
$2,210.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,900.58
|
| Rate for Payer: Managed Health Services Medicaid |
$1,418.55
|
| Rate for Payer: MDWise Medicaid |
$1,418.55
|
| Rate for Payer: PHCS All Commercial |
$3,250.48
|
| Rate for Payer: PHP All Commercial |
$3,286.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,690.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,345.83
|
| Rate for Payer: Signature Care EPO |
$3,597.20
|
| Rate for Payer: Signature Care PPO |
$3,813.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,683.88
|
| Rate for Payer: United Healthcare Commercial |
$3,415.18
|
| Rate for Payer: United Healthcare Medicare |
$1,430.21
|
|
|
HC WHOLE BODY TUMOR LOC
|
Facility
IP
|
$4,333.98
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
01638430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,250.48 |
| Max. Negotiated Rate |
$4,030.60 |
| Rate for Payer: Aetna Commercial |
$3,744.56
|
| Rate for Payer: Cash Price |
$2,687.07
|
| Rate for Payer: Cigna All Commercial |
$3,740.22
|
| Rate for Payer: CORVEL All Commercial |
$4,030.60
|
| Rate for Payer: Coventry All Commercial |
$3,813.90
|
| Rate for Payer: Encore All Commercial |
$3,989.43
|
| Rate for Payer: Frontpath All Commercial |
$3,987.26
|
| Rate for Payer: Humana ChoiceCare |
$3,743.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,900.58
|
| Rate for Payer: PHCS All Commercial |
$3,250.48
|
| Rate for Payer: PHP All Commercial |
$3,286.89
|
| Rate for Payer: Sagamore Health Network All Products |
$3,345.83
|
| Rate for Payer: Signature Care EPO |
$3,597.20
|
| Rate for Payer: Signature Care PPO |
$3,813.90
|
| Rate for Payer: United Healthcare Commercial |
$3,415.18
|
|
|
HC WIRE ACUITY WHISPER VIEW DS
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$443.10
|
| Rate for Payer: Aetna Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$173.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$301.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$328.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.58
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Centivo All Commercial |
$267.75
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Humana Medicare |
$267.75
|
| Rate for Payer: Lucent All Commercial |
$267.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$204.75
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$446.25
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
| Rate for Payer: United Healthcare Medicare |
$173.25
|
|
|
HC WIRE ACUITY WHISPER VIEW DS
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna All Commercial |
$453.08
|
| Rate for Payer: CORVEL All Commercial |
$488.25
|
| Rate for Payer: Coventry All Commercial |
$462.00
|
| Rate for Payer: Encore All Commercial |
$483.26
|
| Rate for Payer: Frontpath All Commercial |
$483.00
|
| Rate for Payer: Humana ChoiceCare |
$453.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.50
|
| Rate for Payer: PHCS All Commercial |
$393.75
|
| Rate for Payer: PHP All Commercial |
$398.16
|
| Rate for Payer: Sagamore Health Network All Products |
$405.30
|
| Rate for Payer: Signature Care EPO |
$435.75
|
| Rate for Payer: Signature Care PPO |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$413.70
|
|
