|
HC W K-WIRE 2.5X270 LG 2527
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605804
|
|
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
|
|
|
HC W K-WIRE 2.5X270 LG 2527
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605804
|
|
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 3X270 03027
|
Facility
OP
|
$658.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.14 |
| Max. Negotiated Rate |
$611.94 |
| Rate for Payer: Aetna Commercial |
$555.35
|
| Rate for Payer: Aetna Medicare |
$217.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$217.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.85
|
| Rate for Payer: Cash Price |
$407.96
|
| Rate for Payer: Cash Price |
$407.96
|
| Rate for Payer: Centivo All Commercial |
$335.58
|
| Rate for Payer: Cigna All Commercial |
$567.85
|
| Rate for Payer: CORVEL All Commercial |
$611.94
|
| Rate for Payer: Coventry All Commercial |
$579.04
|
| Rate for Payer: Encore All Commercial |
$605.69
|
| Rate for Payer: Frontpath All Commercial |
$605.36
|
| Rate for Payer: Humana ChoiceCare |
$568.31
|
| Rate for Payer: Humana Medicare |
$335.58
|
| Rate for Payer: Lucent All Commercial |
$335.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$592.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.50
|
| Rate for Payer: PHP All Commercial |
$499.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.62
|
| Rate for Payer: Sagamore Health Network All Products |
$507.98
|
| Rate for Payer: Signature Care EPO |
$546.14
|
| Rate for Payer: Signature Care PPO |
$579.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$559.30
|
| Rate for Payer: United Healthcare Commercial |
$518.50
|
| Rate for Payer: United Healthcare Medicare |
$217.14
|
|
|
HC W K-WIRE 3X270 03027
|
Facility
IP
|
$658.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.50 |
| Max. Negotiated Rate |
$611.94 |
| Rate for Payer: Aetna Commercial |
$568.51
|
| Rate for Payer: Cash Price |
$407.96
|
| Rate for Payer: Cigna All Commercial |
$567.85
|
| Rate for Payer: CORVEL All Commercial |
$611.94
|
| Rate for Payer: Coventry All Commercial |
$579.04
|
| Rate for Payer: Encore All Commercial |
$605.69
|
| Rate for Payer: Frontpath All Commercial |
$605.36
|
| Rate for Payer: Humana ChoiceCare |
$568.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$592.20
|
| Rate for Payer: PHCS All Commercial |
$493.50
|
| Rate for Payer: PHP All Commercial |
$499.03
|
| Rate for Payer: Sagamore Health Network All Products |
$507.98
|
| Rate for Payer: Signature Care EPO |
$546.14
|
| Rate for Payer: Signature Care PPO |
$579.04
|
| Rate for Payer: United Healthcare Commercial |
$518.50
|
|
|
HC W K-WIRE 3X270 3002
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605798
|
|
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
|
|
|
HC W K-WIRE 3X270 3002
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605798
|
|
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 3X270 3003
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605799
|
|
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 3X270 3003
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605799
|
|
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
|
|
|
HC W K-WIRE 3X270 3027
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605803
|
|
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 3X270 3027
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605803
|
|
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
|
|
|
HC W K-WIRE 3X270 LG 3027
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605805
|
|
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
|
|
|
HC W K-WIRE 3X270 LG 3027
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605805
|
|
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 .9X150 0002
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605794
|
|
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 .9X150 0002
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605794
|
|
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
|
|
|
HC WORK HARD/COND/ADD'L HOUR-OT
|
Facility
OP
|
$232.34
|
|
|
Service Code
|
CPT 97546 GO
|
| Hospital Charge Code |
01738093
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$76.67 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$196.09
|
| Rate for Payer: Aetna Medicare |
$76.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$133.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$145.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.34
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Centivo All Commercial |
$118.49
|
| Rate for Payer: Cigna All Commercial |
$200.51
|
| Rate for Payer: CORVEL All Commercial |
$216.07
|
| Rate for Payer: Coventry All Commercial |
$204.46
|
| Rate for Payer: Encore All Commercial |
$213.86
|
| Rate for Payer: Frontpath All Commercial |
$213.75
|
| Rate for Payer: Humana ChoiceCare |
$200.67
|
| Rate for Payer: Humana Medicare |
$118.49
|
| Rate for Payer: Lucent All Commercial |
$118.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$209.10
|
| Rate for Payer: PHCS All Commercial |
$174.25
|
| Rate for Payer: PHP All Commercial |
$176.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.61
|
| Rate for Payer: Sagamore Health Network All Products |
$179.36
|
| Rate for Payer: Signature Care EPO |
$192.84
|
| Rate for Payer: Signature Care PPO |
$204.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$197.49
|
| Rate for Payer: United Healthcare Commercial |
$183.08
|
| Rate for Payer: United Healthcare Medicare |
$76.67
|
|
|
HC WORK HARD/COND/ADD'L HOUR-OT
|
Facility
IP
|
$232.34
|
|
|
Service Code
|
CPT 97546 GO
|
| Hospital Charge Code |
01738093
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cigna All Commercial |
$200.51
|
| Rate for Payer: CORVEL All Commercial |
$216.07
|
| Rate for Payer: Coventry All Commercial |
$204.46
|
| Rate for Payer: Encore All Commercial |
$213.86
|
| Rate for Payer: Frontpath All Commercial |
$213.75
|
| Rate for Payer: Humana ChoiceCare |
$200.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$209.10
|
| Rate for Payer: PHCS All Commercial |
$174.25
|
| Rate for Payer: PHP All Commercial |
$176.20
|
| Rate for Payer: Sagamore Health Network All Products |
$179.36
|
| Rate for Payer: Signature Care EPO |
$192.84
|
| Rate for Payer: Signature Care PPO |
$204.46
|
| Rate for Payer: United Healthcare Commercial |
$183.08
|
|
|
HC WORK HARD/COND/ADD'L HOUR-PT
|
Facility
OP
|
$223.40
|
|
|
Service Code
|
CPT 97546 GP
|
| Hospital Charge Code |
01728092
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.72 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$188.55
|
| Rate for Payer: Aetna Medicare |
$73.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$128.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.09
|
| Rate for Payer: Cash Price |
$138.51
|
| Rate for Payer: Centivo All Commercial |
$113.93
|
| Rate for Payer: Cigna All Commercial |
$192.79
|
| Rate for Payer: CORVEL All Commercial |
$207.76
|
| Rate for Payer: Coventry All Commercial |
$196.59
|
| Rate for Payer: Encore All Commercial |
$205.64
|
| Rate for Payer: Frontpath All Commercial |
$205.53
|
| Rate for Payer: Humana ChoiceCare |
$192.95
|
| Rate for Payer: Humana Medicare |
$113.93
|
| Rate for Payer: Lucent All Commercial |
$113.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$201.06
|
| Rate for Payer: PHCS All Commercial |
$167.55
|
| Rate for Payer: PHP All Commercial |
$169.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.13
|
| Rate for Payer: Sagamore Health Network All Products |
$172.47
|
| Rate for Payer: Signature Care EPO |
$185.42
|
| Rate for Payer: Signature Care PPO |
$196.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$189.89
|
| Rate for Payer: United Healthcare Commercial |
$176.04
|
| Rate for Payer: United Healthcare Medicare |
$73.72
|
|
|
HC WORK HARD/COND/ADD'L HOUR-PT
|
Facility
IP
|
$223.40
|
|
|
Service Code
|
CPT 97546 GP
|
| Hospital Charge Code |
01728092
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$167.55 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$193.02
|
| Rate for Payer: Cash Price |
$138.51
|
| Rate for Payer: Cigna All Commercial |
$192.79
|
| Rate for Payer: CORVEL All Commercial |
$207.76
|
| Rate for Payer: Coventry All Commercial |
$196.59
|
| Rate for Payer: Encore All Commercial |
$205.64
|
| Rate for Payer: Frontpath All Commercial |
$205.53
|
| Rate for Payer: Humana ChoiceCare |
$192.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$201.06
|
| Rate for Payer: PHCS All Commercial |
$167.55
|
| Rate for Payer: PHP All Commercial |
$169.43
|
| Rate for Payer: Sagamore Health Network All Products |
$172.47
|
| Rate for Payer: Signature Care EPO |
$185.42
|
| Rate for Payer: Signature Care PPO |
$196.59
|
| Rate for Payer: United Healthcare Commercial |
$176.04
|
|
|
HC WORK HARD/COND/INIT 2 HRS-OT
|
Facility
OP
|
$464.24
|
|
|
Service Code
|
CPT 97545 GO
|
| Hospital Charge Code |
01738094
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$431.75 |
| Rate for Payer: Aetna Commercial |
$391.82
|
| Rate for Payer: Aetna Medicare |
$153.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$153.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$266.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$290.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$176.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$168.52
|
| Rate for Payer: Cash Price |
$287.83
|
| Rate for Payer: Centivo All Commercial |
$236.76
|
| Rate for Payer: Cigna All Commercial |
$400.64
|
| Rate for Payer: CORVEL All Commercial |
$431.75
|
| Rate for Payer: Coventry All Commercial |
$408.53
|
| Rate for Payer: Encore All Commercial |
$427.34
|
| Rate for Payer: Frontpath All Commercial |
$427.10
|
| Rate for Payer: Humana ChoiceCare |
$400.97
|
| Rate for Payer: Humana Medicare |
$236.76
|
| Rate for Payer: Lucent All Commercial |
$236.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$417.82
|
| Rate for Payer: PHCS All Commercial |
$348.18
|
| Rate for Payer: PHP All Commercial |
$352.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.05
|
| Rate for Payer: Sagamore Health Network All Products |
$358.40
|
| Rate for Payer: Signature Care EPO |
$385.32
|
| Rate for Payer: Signature Care PPO |
$408.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$394.61
|
| Rate for Payer: United Healthcare Commercial |
$365.82
|
| Rate for Payer: United Healthcare Medicare |
$153.20
|
|
|
HC WORK HARD/COND/INIT 2 HRS-OT
|
Facility
IP
|
$464.24
|
|
|
Service Code
|
CPT 97545 GO
|
| Hospital Charge Code |
01738094
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$348.18 |
| Max. Negotiated Rate |
$431.75 |
| Rate for Payer: Aetna Commercial |
$401.11
|
| Rate for Payer: Cash Price |
$287.83
|
| Rate for Payer: Cigna All Commercial |
$400.64
|
| Rate for Payer: CORVEL All Commercial |
$431.75
|
| Rate for Payer: Coventry All Commercial |
$408.53
|
| Rate for Payer: Encore All Commercial |
$427.34
|
| Rate for Payer: Frontpath All Commercial |
$427.10
|
| Rate for Payer: Humana ChoiceCare |
$400.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$417.82
|
| Rate for Payer: PHCS All Commercial |
$348.18
|
| Rate for Payer: PHP All Commercial |
$352.08
|
| Rate for Payer: Sagamore Health Network All Products |
$358.40
|
| Rate for Payer: Signature Care EPO |
$385.32
|
| Rate for Payer: Signature Care PPO |
$408.53
|
| Rate for Payer: United Healthcare Commercial |
$365.82
|
|
|
HC WORK HARD/COND/INITIAL 2HRS-PT
|
Facility
IP
|
$446.38
|
|
|
Service Code
|
CPT 97545 GP
|
| Hospital Charge Code |
01728093
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$334.79 |
| Max. Negotiated Rate |
$415.14 |
| Rate for Payer: Aetna Commercial |
$385.67
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cigna All Commercial |
$385.23
|
| Rate for Payer: CORVEL All Commercial |
$415.14
|
| Rate for Payer: Coventry All Commercial |
$392.82
|
| Rate for Payer: Encore All Commercial |
$410.90
|
| Rate for Payer: Frontpath All Commercial |
$410.67
|
| Rate for Payer: Humana ChoiceCare |
$385.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$401.74
|
| Rate for Payer: PHCS All Commercial |
$334.79
|
| Rate for Payer: PHP All Commercial |
$338.54
|
| Rate for Payer: Sagamore Health Network All Products |
$344.61
|
| Rate for Payer: Signature Care EPO |
$370.50
|
| Rate for Payer: Signature Care PPO |
$392.82
|
| Rate for Payer: United Healthcare Commercial |
$351.75
|
|
|
HC WORK HARD/COND/INITIAL 2HRS-PT
|
Facility
OP
|
$446.38
|
|
|
Service Code
|
CPT 97545 GP
|
| Hospital Charge Code |
01728093
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$147.31 |
| Max. Negotiated Rate |
$415.14 |
| Rate for Payer: Aetna Commercial |
$376.75
|
| Rate for Payer: Aetna Medicare |
$147.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$256.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$279.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$169.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.04
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Centivo All Commercial |
$227.66
|
| Rate for Payer: Cigna All Commercial |
$385.23
|
| Rate for Payer: CORVEL All Commercial |
$415.14
|
| Rate for Payer: Coventry All Commercial |
$392.82
|
| Rate for Payer: Encore All Commercial |
$410.90
|
| Rate for Payer: Frontpath All Commercial |
$410.67
|
| Rate for Payer: Humana ChoiceCare |
$385.54
|
| Rate for Payer: Humana Medicare |
$227.66
|
| Rate for Payer: Lucent All Commercial |
$227.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$401.74
|
| Rate for Payer: PHCS All Commercial |
$334.79
|
| Rate for Payer: PHP All Commercial |
$338.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.09
|
| Rate for Payer: Sagamore Health Network All Products |
$344.61
|
| Rate for Payer: Signature Care EPO |
$370.50
|
| Rate for Payer: Signature Care PPO |
$392.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$379.43
|
| Rate for Payer: United Healthcare Commercial |
$351.75
|
| Rate for Payer: United Healthcare Medicare |
$147.31
|
|
|
HC WOUND CARE NON SELECTIVE DBRDMT
|
Facility
IP
|
$205.80
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
01687602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$191.39 |
| Rate for Payer: Aetna Commercial |
$177.81
|
| Rate for Payer: Cash Price |
$127.59
|
| Rate for Payer: Cigna All Commercial |
$177.60
|
| Rate for Payer: CORVEL All Commercial |
$191.39
|
| Rate for Payer: Coventry All Commercial |
$181.10
|
| Rate for Payer: Encore All Commercial |
$189.43
|
| Rate for Payer: Frontpath All Commercial |
$189.33
|
| Rate for Payer: Humana ChoiceCare |
$177.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.22
|
| Rate for Payer: PHCS All Commercial |
$154.35
|
| Rate for Payer: PHP All Commercial |
$156.08
|
| Rate for Payer: Sagamore Health Network All Products |
$158.87
|
| Rate for Payer: Signature Care EPO |
$170.81
|
| Rate for Payer: Signature Care PPO |
$181.10
|
| Rate for Payer: United Healthcare Commercial |
$162.17
|
|
|
HC WOUND CARE NON SELECTIVE DBRDMT
|
Facility
OP
|
$205.80
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
01687602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.91 |
| Max. Negotiated Rate |
$381.15 |
| Rate for Payer: Aetna Commercial |
$173.69
|
| Rate for Payer: Aetna Medicare |
$67.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$128.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$381.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.70
|
| Rate for Payer: Cash Price |
$127.59
|
| Rate for Payer: Cash Price |
$127.59
|
| Rate for Payer: Centivo All Commercial |
$104.96
|
| Rate for Payer: Cigna All Commercial |
$177.60
|
| Rate for Payer: CORVEL All Commercial |
$191.39
|
| Rate for Payer: Coventry All Commercial |
$181.10
|
| Rate for Payer: Encore All Commercial |
$189.43
|
| Rate for Payer: Frontpath All Commercial |
$189.33
|
| Rate for Payer: Humana ChoiceCare |
$177.75
|
| Rate for Payer: Humana Medicare |
$104.96
|
| Rate for Payer: Lucent All Commercial |
$104.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.22
|
| Rate for Payer: Managed Health Services Medicaid |
$381.15
|
| Rate for Payer: MDWise Medicaid |
$381.15
|
| Rate for Payer: PHCS All Commercial |
$154.35
|
| Rate for Payer: PHP All Commercial |
$156.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.26
|
| Rate for Payer: Sagamore Health Network All Products |
$158.87
|
| Rate for Payer: Signature Care EPO |
$170.81
|
| Rate for Payer: Signature Care PPO |
$181.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$174.93
|
| Rate for Payer: United Healthcare Commercial |
$162.17
|
| Rate for Payer: United Healthcare Medicare |
$67.91
|
|
|
HC WOUND CULTURE
|
Facility
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.22
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Centivo All Commercial |
$111.30
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$111.30
|
| Rate for Payer: Lucent All Commercial |
$111.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$72.02
|
|
