|
HC WIRE GW WHISPER VIEW DS
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.12
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Centivo All Commercial |
$53.55
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Humana Medicare |
$53.55
|
| Rate for Payer: Lucent All Commercial |
$53.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.95
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
|
|
HC WIRE GW WHISPER VIEW DS CSJ
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.12
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Centivo All Commercial |
$53.55
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Humana Medicare |
$53.55
|
| Rate for Payer: Lucent All Commercial |
$53.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.95
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
|
|
HC WIRE GW WHISPER VIEW DS CSJ
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$90.72
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
|
|
HC WIRE GW WHISPER VIEW EDS
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.12
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Centivo All Commercial |
$53.55
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Humana Medicare |
$53.55
|
| Rate for Payer: Lucent All Commercial |
$53.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.95
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
|
|
HC WIRE GW WHISPER VIEW EDS
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$90.72
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
|
|
HC WIRE GW WHISPER VIEW EDS CSJ
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$90.72
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
|
|
HC WIRE GW WHISPER VIEW EDS CSJ
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.12
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Centivo All Commercial |
$53.55
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Humana Medicare |
$53.55
|
| Rate for Payer: Lucent All Commercial |
$53.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.95
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
|
|
HC WIRE GW WHISPER VIEW ES
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.12
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Centivo All Commercial |
$53.55
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Humana Medicare |
$53.55
|
| Rate for Payer: Lucent All Commercial |
$53.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.95
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
|
|
HC WIRE GW WHISPER VIEW ES
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$90.72
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
|
|
HC WIRE GW WHISPER VIEW ES CSJ
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.12
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Centivo All Commercial |
$53.55
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Humana Medicare |
$53.55
|
| Rate for Payer: Lucent All Commercial |
$53.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.95
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
|
|
HC WIRE GW WHISPER VIEW ES CSJ
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
41607273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$90.72
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
|
|
HC WIRE HIWIRE STIFF, GLUIDEWIRE .035
|
Facility
OP
|
$369.29
|
|
| Hospital Charge Code |
41601366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$343.44 |
| Rate for Payer: Aetna Commercial |
$311.68
|
| Rate for Payer: Aetna Medicare |
$121.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$121.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$230.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.05
|
| Rate for Payer: Cash Price |
$228.96
|
| Rate for Payer: Cash Price |
$228.96
|
| Rate for Payer: Centivo All Commercial |
$188.34
|
| Rate for Payer: Cigna All Commercial |
$318.70
|
| Rate for Payer: CORVEL All Commercial |
$343.44
|
| Rate for Payer: Coventry All Commercial |
$324.98
|
| Rate for Payer: Encore All Commercial |
$339.93
|
| Rate for Payer: Frontpath All Commercial |
$339.75
|
| Rate for Payer: Humana ChoiceCare |
$318.96
|
| Rate for Payer: Humana Medicare |
$188.34
|
| Rate for Payer: Lucent All Commercial |
$188.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.36
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$276.97
|
| Rate for Payer: PHP All Commercial |
$280.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.02
|
| Rate for Payer: Sagamore Health Network All Products |
$285.09
|
| Rate for Payer: Signature Care EPO |
$306.51
|
| Rate for Payer: Signature Care PPO |
$324.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$313.90
|
| Rate for Payer: United Healthcare Commercial |
$291.00
|
| Rate for Payer: United Healthcare Medicare |
$121.87
|
|
|
HC WIRE HIWIRE STIFF, GLUIDEWIRE .035
|
Facility
IP
|
$369.29
|
|
| Hospital Charge Code |
41601366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.97 |
| Max. Negotiated Rate |
$343.44 |
| Rate for Payer: Aetna Commercial |
$319.07
|
| Rate for Payer: Cash Price |
$228.96
|
| Rate for Payer: Cigna All Commercial |
$318.70
|
| Rate for Payer: CORVEL All Commercial |
$343.44
|
| Rate for Payer: Coventry All Commercial |
$324.98
|
| Rate for Payer: Encore All Commercial |
$339.93
|
| Rate for Payer: Frontpath All Commercial |
$339.75
|
| Rate for Payer: Humana ChoiceCare |
$318.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.36
|
| Rate for Payer: PHCS All Commercial |
$276.97
|
| Rate for Payer: PHP All Commercial |
$280.07
|
| Rate for Payer: Sagamore Health Network All Products |
$285.09
|
| Rate for Payer: Signature Care EPO |
$306.51
|
| Rate for Payer: Signature Care PPO |
$324.98
|
| Rate for Payer: United Healthcare Commercial |
$291.00
|
|
|
HC WIRE HIWIRE STIFF, GLUIDEWIRE .038
|
Facility
IP
|
$429.09
|
|
| Hospital Charge Code |
41601367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.82 |
| Max. Negotiated Rate |
$399.05 |
| Rate for Payer: Aetna Commercial |
$370.73
|
| Rate for Payer: Cash Price |
$266.04
|
| Rate for Payer: Cigna All Commercial |
$370.30
|
| Rate for Payer: CORVEL All Commercial |
$399.05
|
| Rate for Payer: Coventry All Commercial |
$377.60
|
| Rate for Payer: Encore All Commercial |
$394.98
|
| Rate for Payer: Frontpath All Commercial |
$394.76
|
| Rate for Payer: Humana ChoiceCare |
$370.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$386.18
|
| Rate for Payer: PHCS All Commercial |
$321.82
|
| Rate for Payer: PHP All Commercial |
$325.42
|
| Rate for Payer: Sagamore Health Network All Products |
$331.26
|
| Rate for Payer: Signature Care EPO |
$356.14
|
| Rate for Payer: Signature Care PPO |
$377.60
|
| Rate for Payer: United Healthcare Commercial |
$338.12
|
|
|
HC WIRE HIWIRE STIFF, GLUIDEWIRE .038
|
Facility
OP
|
$429.09
|
|
| Hospital Charge Code |
41601367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$399.05 |
| Rate for Payer: Aetna Commercial |
$362.15
|
| Rate for Payer: Aetna Medicare |
$141.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$246.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$268.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.76
|
| Rate for Payer: Cash Price |
$266.04
|
| Rate for Payer: Cash Price |
$266.04
|
| Rate for Payer: Centivo All Commercial |
$218.84
|
| Rate for Payer: Cigna All Commercial |
$370.30
|
| Rate for Payer: CORVEL All Commercial |
$399.05
|
| Rate for Payer: Coventry All Commercial |
$377.60
|
| Rate for Payer: Encore All Commercial |
$394.98
|
| Rate for Payer: Frontpath All Commercial |
$394.76
|
| Rate for Payer: Humana ChoiceCare |
$370.61
|
| Rate for Payer: Humana Medicare |
$218.84
|
| Rate for Payer: Lucent All Commercial |
$218.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$386.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$321.82
|
| Rate for Payer: PHP All Commercial |
$325.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$167.35
|
| Rate for Payer: Sagamore Health Network All Products |
$331.26
|
| Rate for Payer: Signature Care EPO |
$356.14
|
| Rate for Payer: Signature Care PPO |
$377.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$364.73
|
| Rate for Payer: United Healthcare Commercial |
$338.12
|
| Rate for Payer: United Healthcare Medicare |
$141.60
|
|
|
HC WIRE MONOFILAMENT SZ 7 18G
|
Facility
IP
|
$31.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$29.23 |
| Rate for Payer: Aetna Commercial |
$27.16
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cigna All Commercial |
$27.12
|
| Rate for Payer: CORVEL All Commercial |
$29.23
|
| Rate for Payer: Coventry All Commercial |
$27.66
|
| Rate for Payer: Encore All Commercial |
$28.93
|
| Rate for Payer: Frontpath All Commercial |
$28.92
|
| Rate for Payer: Humana ChoiceCare |
$27.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.29
|
| Rate for Payer: PHCS All Commercial |
$23.57
|
| Rate for Payer: PHP All Commercial |
$23.84
|
| Rate for Payer: Sagamore Health Network All Products |
$24.26
|
| Rate for Payer: Signature Care EPO |
$26.09
|
| Rate for Payer: Signature Care PPO |
$27.66
|
| Rate for Payer: United Healthcare Commercial |
$24.77
|
|
|
HC WIRE MONOFILAMENT SZ 7 18G
|
Facility
OP
|
$31.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$10.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.41
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Centivo All Commercial |
$16.03
|
| Rate for Payer: Cigna All Commercial |
$27.12
|
| Rate for Payer: CORVEL All Commercial |
$29.23
|
| Rate for Payer: Coventry All Commercial |
$27.66
|
| Rate for Payer: Encore All Commercial |
$28.93
|
| Rate for Payer: Frontpath All Commercial |
$28.92
|
| Rate for Payer: Humana ChoiceCare |
$27.15
|
| Rate for Payer: Humana Medicare |
$16.03
|
| Rate for Payer: Lucent All Commercial |
$16.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.29
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$23.57
|
| Rate for Payer: PHP All Commercial |
$23.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.26
|
| Rate for Payer: Sagamore Health Network All Products |
$24.26
|
| Rate for Payer: Signature Care EPO |
$26.09
|
| Rate for Payer: Signature Care PPO |
$27.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.72
|
| Rate for Payer: United Healthcare Commercial |
$24.77
|
| Rate for Payer: United Healthcare Medicare |
$10.37
|
|
|
HC WIRE PT GUIDE 1.7MM
|
Facility
OP
|
$466.06
|
|
| Hospital Charge Code |
41602330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$433.44 |
| Rate for Payer: Aetna Commercial |
$393.35
|
| Rate for Payer: Aetna Medicare |
$153.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$153.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$267.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$291.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$176.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$169.18
|
| Rate for Payer: Cash Price |
$288.96
|
| Rate for Payer: Cash Price |
$288.96
|
| Rate for Payer: Centivo All Commercial |
$237.69
|
| Rate for Payer: Cigna All Commercial |
$402.21
|
| Rate for Payer: CORVEL All Commercial |
$433.44
|
| Rate for Payer: Coventry All Commercial |
$410.13
|
| Rate for Payer: Encore All Commercial |
$429.01
|
| Rate for Payer: Frontpath All Commercial |
$428.78
|
| Rate for Payer: Humana ChoiceCare |
$402.54
|
| Rate for Payer: Humana Medicare |
$237.69
|
| Rate for Payer: Lucent All Commercial |
$237.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$349.54
|
| Rate for Payer: PHP All Commercial |
$353.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.76
|
| Rate for Payer: Sagamore Health Network All Products |
$359.80
|
| Rate for Payer: Signature Care EPO |
$386.83
|
| Rate for Payer: Signature Care PPO |
$410.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$396.15
|
| Rate for Payer: United Healthcare Commercial |
$367.26
|
| Rate for Payer: United Healthcare Medicare |
$153.80
|
|
|
HC WIRE PT GUIDE 1.7MM
|
Facility
IP
|
$466.06
|
|
| Hospital Charge Code |
41602330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.54 |
| Max. Negotiated Rate |
$433.44 |
| Rate for Payer: Aetna Commercial |
$402.68
|
| Rate for Payer: Cash Price |
$288.96
|
| Rate for Payer: Cigna All Commercial |
$402.21
|
| Rate for Payer: CORVEL All Commercial |
$433.44
|
| Rate for Payer: Coventry All Commercial |
$410.13
|
| Rate for Payer: Encore All Commercial |
$429.01
|
| Rate for Payer: Frontpath All Commercial |
$428.78
|
| Rate for Payer: Humana ChoiceCare |
$402.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.45
|
| Rate for Payer: PHCS All Commercial |
$349.54
|
| Rate for Payer: PHP All Commercial |
$353.46
|
| Rate for Payer: Sagamore Health Network All Products |
$359.80
|
| Rate for Payer: Signature Care EPO |
$386.83
|
| Rate for Payer: Signature Care PPO |
$410.13
|
| Rate for Payer: United Healthcare Commercial |
$367.26
|
|
|
HC WIRE PT GUIDE 2.5MM
|
Facility
OP
|
$466.06
|
|
| Hospital Charge Code |
41602331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$433.44 |
| Rate for Payer: Aetna Commercial |
$393.35
|
| Rate for Payer: Aetna Medicare |
$153.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$153.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$267.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$291.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$176.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$169.18
|
| Rate for Payer: Cash Price |
$288.96
|
| Rate for Payer: Cash Price |
$288.96
|
| Rate for Payer: Centivo All Commercial |
$237.69
|
| Rate for Payer: Cigna All Commercial |
$402.21
|
| Rate for Payer: CORVEL All Commercial |
$433.44
|
| Rate for Payer: Coventry All Commercial |
$410.13
|
| Rate for Payer: Encore All Commercial |
$429.01
|
| Rate for Payer: Frontpath All Commercial |
$428.78
|
| Rate for Payer: Humana ChoiceCare |
$402.54
|
| Rate for Payer: Humana Medicare |
$237.69
|
| Rate for Payer: Lucent All Commercial |
$237.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$349.54
|
| Rate for Payer: PHP All Commercial |
$353.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.76
|
| Rate for Payer: Sagamore Health Network All Products |
$359.80
|
| Rate for Payer: Signature Care EPO |
$386.83
|
| Rate for Payer: Signature Care PPO |
$410.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$396.15
|
| Rate for Payer: United Healthcare Commercial |
$367.26
|
| Rate for Payer: United Healthcare Medicare |
$153.80
|
|
|
HC WIRE PT GUIDE 2.5MM
|
Facility
IP
|
$466.06
|
|
| Hospital Charge Code |
41602331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.54 |
| Max. Negotiated Rate |
$433.44 |
| Rate for Payer: Aetna Commercial |
$402.68
|
| Rate for Payer: Cash Price |
$288.96
|
| Rate for Payer: Cigna All Commercial |
$402.21
|
| Rate for Payer: CORVEL All Commercial |
$433.44
|
| Rate for Payer: Coventry All Commercial |
$410.13
|
| Rate for Payer: Encore All Commercial |
$429.01
|
| Rate for Payer: Frontpath All Commercial |
$428.78
|
| Rate for Payer: Humana ChoiceCare |
$402.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.45
|
| Rate for Payer: PHCS All Commercial |
$349.54
|
| Rate for Payer: PHP All Commercial |
$353.46
|
| Rate for Payer: Sagamore Health Network All Products |
$359.80
|
| Rate for Payer: Signature Care EPO |
$386.83
|
| Rate for Payer: Signature Care PPO |
$410.13
|
| Rate for Payer: United Healthcare Commercial |
$367.26
|
|
|
HC W KIT HIP PRO-DENSE CORE 15 ML
|
Facility
IP
|
$19,645.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,733.90 |
| Max. Negotiated Rate |
$18,270.04 |
| Rate for Payer: Aetna Commercial |
$16,973.45
|
| Rate for Payer: Cash Price |
$12,180.02
|
| Rate for Payer: Cigna All Commercial |
$16,953.81
|
| Rate for Payer: CORVEL All Commercial |
$18,270.04
|
| Rate for Payer: Coventry All Commercial |
$17,287.78
|
| Rate for Payer: Encore All Commercial |
$18,083.41
|
| Rate for Payer: Frontpath All Commercial |
$18,073.58
|
| Rate for Payer: Humana ChoiceCare |
$16,967.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,680.68
|
| Rate for Payer: PHCS All Commercial |
$14,733.90
|
| Rate for Payer: PHP All Commercial |
$14,898.92
|
| Rate for Payer: Sagamore Health Network All Products |
$15,166.09
|
| Rate for Payer: Signature Care EPO |
$16,305.52
|
| Rate for Payer: Signature Care PPO |
$17,287.78
|
| Rate for Payer: United Healthcare Commercial |
$15,480.42
|
|
|
HC W KIT HIP PRO-DENSE CORE 15 ML
|
Facility
OP
|
$19,645.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$18,270.04 |
| Rate for Payer: Aetna Commercial |
$16,580.55
|
| Rate for Payer: Aetna Medicare |
$6,482.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6,482.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11,282.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12,280.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7,455.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7,131.21
|
| Rate for Payer: Cash Price |
$12,180.02
|
| Rate for Payer: Cash Price |
$12,180.02
|
| Rate for Payer: Centivo All Commercial |
$10,019.05
|
| Rate for Payer: Cigna All Commercial |
$16,953.81
|
| Rate for Payer: CORVEL All Commercial |
$18,270.04
|
| Rate for Payer: Coventry All Commercial |
$17,287.78
|
| Rate for Payer: Encore All Commercial |
$18,083.41
|
| Rate for Payer: Frontpath All Commercial |
$18,073.58
|
| Rate for Payer: Humana ChoiceCare |
$16,967.56
|
| Rate for Payer: Humana Medicare |
$10,019.05
|
| Rate for Payer: Lucent All Commercial |
$10,019.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,680.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$14,733.90
|
| Rate for Payer: PHP All Commercial |
$14,898.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,661.63
|
| Rate for Payer: Sagamore Health Network All Products |
$15,166.09
|
| Rate for Payer: Signature Care EPO |
$16,305.52
|
| Rate for Payer: Signature Care PPO |
$17,287.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,698.42
|
| Rate for Payer: United Healthcare Commercial |
$15,480.42
|
| Rate for Payer: United Healthcare Medicare |
$6,482.92
|
|
|
HC W K-WIRE 0.9 102
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$181.44
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.30
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
|
|
HC W K-WIRE 0.9 102
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$177.24
|
| Rate for Payer: Aetna Medicare |
$69.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.23
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Centivo All Commercial |
$107.10
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.30
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Humana Medicare |
$107.10
|
| Rate for Payer: Lucent All Commercial |
$107.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.90
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.50
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
|
