|
HC W PLATE TRANS-MET LAP R
|
Facility
IP
|
$7,120.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,340.60 |
| Max. Negotiated Rate |
$6,622.34 |
| Rate for Payer: Aetna Commercial |
$6,152.37
|
| Rate for Payer: Cash Price |
$4,414.90
|
| Rate for Payer: Cigna All Commercial |
$6,145.25
|
| Rate for Payer: CORVEL All Commercial |
$6,622.34
|
| Rate for Payer: Coventry All Commercial |
$6,266.30
|
| Rate for Payer: Encore All Commercial |
$6,554.70
|
| Rate for Payer: Frontpath All Commercial |
$6,551.14
|
| Rate for Payer: Humana ChoiceCare |
$6,150.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,408.72
|
| Rate for Payer: PHCS All Commercial |
$5,340.60
|
| Rate for Payer: PHP All Commercial |
$5,400.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,497.26
|
| Rate for Payer: Signature Care EPO |
$5,910.26
|
| Rate for Payer: Signature Care PPO |
$6,266.30
|
| Rate for Payer: United Healthcare Commercial |
$5,611.19
|
|
|
HC W PLATE TRANS-MET LAP R
|
Facility
OP
|
$7,120.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,622.34 |
| Rate for Payer: Aetna Commercial |
$6,009.96
|
| Rate for Payer: Aetna Medicare |
$2,349.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,349.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,089.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,451.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,702.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,584.85
|
| Rate for Payer: Cash Price |
$4,414.90
|
| Rate for Payer: Cash Price |
$4,414.90
|
| Rate for Payer: Centivo All Commercial |
$3,631.61
|
| Rate for Payer: Cigna All Commercial |
$6,145.25
|
| Rate for Payer: CORVEL All Commercial |
$6,622.34
|
| Rate for Payer: Coventry All Commercial |
$6,266.30
|
| Rate for Payer: Encore All Commercial |
$6,554.70
|
| Rate for Payer: Frontpath All Commercial |
$6,551.14
|
| Rate for Payer: Humana ChoiceCare |
$6,150.23
|
| Rate for Payer: Humana Medicare |
$3,631.61
|
| Rate for Payer: Lucent All Commercial |
$3,631.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,408.72
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,340.60
|
| Rate for Payer: PHP All Commercial |
$5,400.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,777.11
|
| Rate for Payer: Sagamore Health Network All Products |
$5,497.26
|
| Rate for Payer: Signature Care EPO |
$5,910.26
|
| Rate for Payer: Signature Care PPO |
$6,266.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,052.68
|
| Rate for Payer: United Healthcare Commercial |
$5,611.19
|
| Rate for Payer: United Healthcare Medicare |
$2,349.86
|
|
|
HC W PLATE Y
|
Facility
OP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,833.27 |
| Rate for Payer: Aetna Commercial |
$6,201.37
|
| Rate for Payer: Aetna Medicare |
$2,424.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,424.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,219.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,592.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,788.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,667.18
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Centivo All Commercial |
$3,747.28
|
| Rate for Payer: Cigna All Commercial |
$6,340.98
|
| Rate for Payer: CORVEL All Commercial |
$6,833.27
|
| Rate for Payer: Coventry All Commercial |
$6,465.89
|
| Rate for Payer: Encore All Commercial |
$6,763.47
|
| Rate for Payer: Frontpath All Commercial |
$6,759.79
|
| Rate for Payer: Humana ChoiceCare |
$6,346.12
|
| Rate for Payer: Humana Medicare |
$3,747.28
|
| Rate for Payer: Lucent All Commercial |
$3,747.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,612.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,510.70
|
| Rate for Payer: PHP All Commercial |
$5,572.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,865.56
|
| Rate for Payer: Sagamore Health Network All Products |
$5,672.35
|
| Rate for Payer: Signature Care EPO |
$6,098.51
|
| Rate for Payer: Signature Care PPO |
$6,465.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,245.46
|
| Rate for Payer: United Healthcare Commercial |
$5,789.91
|
| Rate for Payer: United Healthcare Medicare |
$2,424.71
|
|
|
HC W PLATE Y
|
Facility
IP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.70 |
| Max. Negotiated Rate |
$6,833.27 |
| Rate for Payer: Aetna Commercial |
$6,348.33
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Cigna All Commercial |
$6,340.98
|
| Rate for Payer: CORVEL All Commercial |
$6,833.27
|
| Rate for Payer: Coventry All Commercial |
$6,465.89
|
| Rate for Payer: Encore All Commercial |
$6,763.47
|
| Rate for Payer: Frontpath All Commercial |
$6,759.79
|
| Rate for Payer: Humana ChoiceCare |
$6,346.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,612.84
|
| Rate for Payer: PHCS All Commercial |
$5,510.70
|
| Rate for Payer: PHP All Commercial |
$5,572.42
|
| Rate for Payer: Sagamore Health Network All Products |
$5,672.35
|
| Rate for Payer: Signature Care EPO |
$6,098.51
|
| Rate for Payer: Signature Care PPO |
$6,465.89
|
| Rate for Payer: United Healthcare Commercial |
$5,789.91
|
|
|
HC WRENCH TORQUE-BI GREEN
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC WRENCH TORQUE-BI GREEN
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC WRENCH TORQUE-BI ORANGE
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC WRENCH TORQUE-BI ORANGE
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC WRIGHT TOE METAL LARGE
|
Facility
IP
|
$6,120.00
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,590.00 |
| Max. Negotiated Rate |
$5,691.60 |
| Rate for Payer: Aetna Commercial |
$5,287.68
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Cigna All Commercial |
$5,281.56
|
| Rate for Payer: CORVEL All Commercial |
$5,691.60
|
| Rate for Payer: Coventry All Commercial |
$5,385.60
|
| Rate for Payer: Encore All Commercial |
$5,633.46
|
| Rate for Payer: Frontpath All Commercial |
$5,630.40
|
| Rate for Payer: Humana ChoiceCare |
$5,285.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,508.00
|
| Rate for Payer: PHCS All Commercial |
$4,590.00
|
| Rate for Payer: PHP All Commercial |
$4,641.41
|
| Rate for Payer: Sagamore Health Network All Products |
$4,724.64
|
| Rate for Payer: Signature Care EPO |
$5,079.60
|
| Rate for Payer: Signature Care PPO |
$5,385.60
|
| Rate for Payer: United Healthcare Commercial |
$4,822.56
|
|
|
HC WRIGHT TOE METAL LARGE
|
Facility
OP
|
$6,120.00
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,691.60 |
| Rate for Payer: Aetna Commercial |
$5,165.28
|
| Rate for Payer: Aetna Medicare |
$2,019.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,019.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,514.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,825.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,322.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,221.56
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Centivo All Commercial |
$3,121.20
|
| Rate for Payer: Cigna All Commercial |
$5,281.56
|
| Rate for Payer: CORVEL All Commercial |
$5,691.60
|
| Rate for Payer: Coventry All Commercial |
$5,385.60
|
| Rate for Payer: Encore All Commercial |
$5,633.46
|
| Rate for Payer: Frontpath All Commercial |
$5,630.40
|
| Rate for Payer: Humana ChoiceCare |
$5,285.84
|
| Rate for Payer: Humana Medicare |
$3,121.20
|
| Rate for Payer: Lucent All Commercial |
$3,121.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,508.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,590.00
|
| Rate for Payer: PHP All Commercial |
$4,641.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,386.80
|
| Rate for Payer: Sagamore Health Network All Products |
$4,724.64
|
| Rate for Payer: Signature Care EPO |
$5,079.60
|
| Rate for Payer: Signature Care PPO |
$5,385.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,202.00
|
| Rate for Payer: United Healthcare Commercial |
$4,822.56
|
| Rate for Payer: United Healthcare Medicare |
$2,019.60
|
|
|
HC WRIGHT TOE METAL MEDIUM
|
Facility
IP
|
$6,120.00
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,590.00 |
| Max. Negotiated Rate |
$5,691.60 |
| Rate for Payer: Aetna Commercial |
$5,287.68
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Cigna All Commercial |
$5,281.56
|
| Rate for Payer: CORVEL All Commercial |
$5,691.60
|
| Rate for Payer: Coventry All Commercial |
$5,385.60
|
| Rate for Payer: Encore All Commercial |
$5,633.46
|
| Rate for Payer: Frontpath All Commercial |
$5,630.40
|
| Rate for Payer: Humana ChoiceCare |
$5,285.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,508.00
|
| Rate for Payer: PHCS All Commercial |
$4,590.00
|
| Rate for Payer: PHP All Commercial |
$4,641.41
|
| Rate for Payer: Sagamore Health Network All Products |
$4,724.64
|
| Rate for Payer: Signature Care EPO |
$5,079.60
|
| Rate for Payer: Signature Care PPO |
$5,385.60
|
| Rate for Payer: United Healthcare Commercial |
$4,822.56
|
|
|
HC WRIGHT TOE METAL MEDIUM
|
Facility
OP
|
$6,120.00
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,691.60 |
| Rate for Payer: Aetna Commercial |
$5,165.28
|
| Rate for Payer: Aetna Medicare |
$2,019.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,019.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,514.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,825.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,322.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,221.56
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Centivo All Commercial |
$3,121.20
|
| Rate for Payer: Cigna All Commercial |
$5,281.56
|
| Rate for Payer: CORVEL All Commercial |
$5,691.60
|
| Rate for Payer: Coventry All Commercial |
$5,385.60
|
| Rate for Payer: Encore All Commercial |
$5,633.46
|
| Rate for Payer: Frontpath All Commercial |
$5,630.40
|
| Rate for Payer: Humana ChoiceCare |
$5,285.84
|
| Rate for Payer: Humana Medicare |
$3,121.20
|
| Rate for Payer: Lucent All Commercial |
$3,121.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,508.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,590.00
|
| Rate for Payer: PHP All Commercial |
$4,641.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,386.80
|
| Rate for Payer: Sagamore Health Network All Products |
$4,724.64
|
| Rate for Payer: Signature Care EPO |
$5,079.60
|
| Rate for Payer: Signature Care PPO |
$5,385.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,202.00
|
| Rate for Payer: United Healthcare Commercial |
$4,822.56
|
| Rate for Payer: United Healthcare Medicare |
$2,019.60
|
|
|
HC WRIGHT TOE METAL SMALL
|
Facility
OP
|
$6,120.00
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,691.60 |
| Rate for Payer: Aetna Commercial |
$5,165.28
|
| Rate for Payer: Aetna Medicare |
$2,019.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,019.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,514.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,825.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,322.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,221.56
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Centivo All Commercial |
$3,121.20
|
| Rate for Payer: Cigna All Commercial |
$5,281.56
|
| Rate for Payer: CORVEL All Commercial |
$5,691.60
|
| Rate for Payer: Coventry All Commercial |
$5,385.60
|
| Rate for Payer: Encore All Commercial |
$5,633.46
|
| Rate for Payer: Frontpath All Commercial |
$5,630.40
|
| Rate for Payer: Humana ChoiceCare |
$5,285.84
|
| Rate for Payer: Humana Medicare |
$3,121.20
|
| Rate for Payer: Lucent All Commercial |
$3,121.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,508.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,590.00
|
| Rate for Payer: PHP All Commercial |
$4,641.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,386.80
|
| Rate for Payer: Sagamore Health Network All Products |
$4,724.64
|
| Rate for Payer: Signature Care EPO |
$5,079.60
|
| Rate for Payer: Signature Care PPO |
$5,385.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,202.00
|
| Rate for Payer: United Healthcare Commercial |
$4,822.56
|
| Rate for Payer: United Healthcare Medicare |
$2,019.60
|
|
|
HC WRIGHT TOE METAL SMALL
|
Facility
IP
|
$6,120.00
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,590.00 |
| Max. Negotiated Rate |
$5,691.60 |
| Rate for Payer: Aetna Commercial |
$5,287.68
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Cigna All Commercial |
$5,281.56
|
| Rate for Payer: CORVEL All Commercial |
$5,691.60
|
| Rate for Payer: Coventry All Commercial |
$5,385.60
|
| Rate for Payer: Encore All Commercial |
$5,633.46
|
| Rate for Payer: Frontpath All Commercial |
$5,630.40
|
| Rate for Payer: Humana ChoiceCare |
$5,285.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,508.00
|
| Rate for Payer: PHCS All Commercial |
$4,590.00
|
| Rate for Payer: PHP All Commercial |
$4,641.41
|
| Rate for Payer: Sagamore Health Network All Products |
$4,724.64
|
| Rate for Payer: Signature Care EPO |
$5,079.60
|
| Rate for Payer: Signature Care PPO |
$5,385.60
|
| Rate for Payer: United Healthcare Commercial |
$4,822.56
|
|
|
HC WRIGHT TOE METAL X-LARGE
|
Facility
IP
|
$6,120.00
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,590.00 |
| Max. Negotiated Rate |
$5,691.60 |
| Rate for Payer: Aetna Commercial |
$5,287.68
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Cigna All Commercial |
$5,281.56
|
| Rate for Payer: CORVEL All Commercial |
$5,691.60
|
| Rate for Payer: Coventry All Commercial |
$5,385.60
|
| Rate for Payer: Encore All Commercial |
$5,633.46
|
| Rate for Payer: Frontpath All Commercial |
$5,630.40
|
| Rate for Payer: Humana ChoiceCare |
$5,285.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,508.00
|
| Rate for Payer: PHCS All Commercial |
$4,590.00
|
| Rate for Payer: PHP All Commercial |
$4,641.41
|
| Rate for Payer: Sagamore Health Network All Products |
$4,724.64
|
| Rate for Payer: Signature Care EPO |
$5,079.60
|
| Rate for Payer: Signature Care PPO |
$5,385.60
|
| Rate for Payer: United Healthcare Commercial |
$4,822.56
|
|
|
HC WRIGHT TOE METAL X-LARGE
|
Facility
OP
|
$6,120.00
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,691.60 |
| Rate for Payer: Aetna Commercial |
$5,165.28
|
| Rate for Payer: Aetna Medicare |
$2,019.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,019.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,514.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,825.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,322.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,221.56
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Cash Price |
$3,794.40
|
| Rate for Payer: Centivo All Commercial |
$3,121.20
|
| Rate for Payer: Cigna All Commercial |
$5,281.56
|
| Rate for Payer: CORVEL All Commercial |
$5,691.60
|
| Rate for Payer: Coventry All Commercial |
$5,385.60
|
| Rate for Payer: Encore All Commercial |
$5,633.46
|
| Rate for Payer: Frontpath All Commercial |
$5,630.40
|
| Rate for Payer: Humana ChoiceCare |
$5,285.84
|
| Rate for Payer: Humana Medicare |
$3,121.20
|
| Rate for Payer: Lucent All Commercial |
$3,121.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,508.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,590.00
|
| Rate for Payer: PHP All Commercial |
$4,641.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,386.80
|
| Rate for Payer: Sagamore Health Network All Products |
$4,724.64
|
| Rate for Payer: Signature Care EPO |
$5,079.60
|
| Rate for Payer: Signature Care PPO |
$5,385.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,202.00
|
| Rate for Payer: United Healthcare Commercial |
$4,822.56
|
| Rate for Payer: United Healthcare Medicare |
$2,019.60
|
|
|
HC WRIST ARTHROGRAM BI
|
Facility
OP
|
$1,003.04
|
|
|
Service Code
|
CPT 73115 50
|
| Hospital Charge Code |
21613116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$331.00 |
| Max. Negotiated Rate |
$932.82 |
| Rate for Payer: Aetna Commercial |
$846.56
|
| Rate for Payer: Aetna Medicare |
$331.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$331.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$576.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$627.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$380.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$364.10
|
| Rate for Payer: Cash Price |
$621.88
|
| Rate for Payer: Centivo All Commercial |
$511.55
|
| Rate for Payer: Cigna All Commercial |
$865.62
|
| Rate for Payer: CORVEL All Commercial |
$932.82
|
| Rate for Payer: Coventry All Commercial |
$882.67
|
| Rate for Payer: Encore All Commercial |
$923.30
|
| Rate for Payer: Frontpath All Commercial |
$922.79
|
| Rate for Payer: Humana ChoiceCare |
$866.32
|
| Rate for Payer: Humana Medicare |
$511.55
|
| Rate for Payer: Lucent All Commercial |
$511.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$902.73
|
| Rate for Payer: PHCS All Commercial |
$752.28
|
| Rate for Payer: PHP All Commercial |
$760.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$391.18
|
| Rate for Payer: Sagamore Health Network All Products |
$774.34
|
| Rate for Payer: Signature Care EPO |
$832.52
|
| Rate for Payer: Signature Care PPO |
$882.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$852.58
|
| Rate for Payer: United Healthcare Commercial |
$790.39
|
| Rate for Payer: United Healthcare Medicare |
$331.00
|
|
|
HC WRIST ARTHROGRAM BI
|
Facility
IP
|
$1,003.04
|
|
|
Service Code
|
CPT 73115 50
|
| Hospital Charge Code |
21613116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$752.28 |
| Max. Negotiated Rate |
$932.82 |
| Rate for Payer: Aetna Commercial |
$866.62
|
| Rate for Payer: Cash Price |
$621.88
|
| Rate for Payer: Cigna All Commercial |
$865.62
|
| Rate for Payer: CORVEL All Commercial |
$932.82
|
| Rate for Payer: Coventry All Commercial |
$882.67
|
| Rate for Payer: Encore All Commercial |
$923.30
|
| Rate for Payer: Frontpath All Commercial |
$922.79
|
| Rate for Payer: Humana ChoiceCare |
$866.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$902.73
|
| Rate for Payer: PHCS All Commercial |
$752.28
|
| Rate for Payer: PHP All Commercial |
$760.70
|
| Rate for Payer: Sagamore Health Network All Products |
$774.34
|
| Rate for Payer: Signature Care EPO |
$832.52
|
| Rate for Payer: Signature Care PPO |
$882.67
|
| Rate for Payer: United Healthcare Commercial |
$790.39
|
|
|
HC WRIST ARTHROGRAM LT
|
Facility
IP
|
$668.68
|
|
|
Service Code
|
CPT 73115 LT
|
| Hospital Charge Code |
01613116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$501.51 |
| Max. Negotiated Rate |
$621.87 |
| Rate for Payer: Aetna Commercial |
$577.74
|
| Rate for Payer: Cash Price |
$414.58
|
| Rate for Payer: Cigna All Commercial |
$577.07
|
| Rate for Payer: CORVEL All Commercial |
$621.87
|
| Rate for Payer: Coventry All Commercial |
$588.44
|
| Rate for Payer: Encore All Commercial |
$615.52
|
| Rate for Payer: Frontpath All Commercial |
$615.19
|
| Rate for Payer: Humana ChoiceCare |
$577.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$601.81
|
| Rate for Payer: PHCS All Commercial |
$501.51
|
| Rate for Payer: PHP All Commercial |
$507.13
|
| Rate for Payer: Sagamore Health Network All Products |
$516.22
|
| Rate for Payer: Signature Care EPO |
$555.01
|
| Rate for Payer: Signature Care PPO |
$588.44
|
| Rate for Payer: United Healthcare Commercial |
$526.92
|
|
|
HC WRIST ARTHROGRAM LT
|
Facility
OP
|
$668.68
|
|
|
Service Code
|
CPT 73115 LT
|
| Hospital Charge Code |
01613116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.66 |
| Max. Negotiated Rate |
$621.87 |
| Rate for Payer: Aetna Commercial |
$564.37
|
| Rate for Payer: Aetna Medicare |
$220.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$220.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$384.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$417.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$253.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$242.73
|
| Rate for Payer: Cash Price |
$414.58
|
| Rate for Payer: Centivo All Commercial |
$341.03
|
| Rate for Payer: Cigna All Commercial |
$577.07
|
| Rate for Payer: CORVEL All Commercial |
$621.87
|
| Rate for Payer: Coventry All Commercial |
$588.44
|
| Rate for Payer: Encore All Commercial |
$615.52
|
| Rate for Payer: Frontpath All Commercial |
$615.19
|
| Rate for Payer: Humana ChoiceCare |
$577.54
|
| Rate for Payer: Humana Medicare |
$341.03
|
| Rate for Payer: Lucent All Commercial |
$341.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$601.81
|
| Rate for Payer: PHCS All Commercial |
$501.51
|
| Rate for Payer: PHP All Commercial |
$507.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$260.79
|
| Rate for Payer: Sagamore Health Network All Products |
$516.22
|
| Rate for Payer: Signature Care EPO |
$555.01
|
| Rate for Payer: Signature Care PPO |
$588.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$568.38
|
| Rate for Payer: United Healthcare Commercial |
$526.92
|
| Rate for Payer: United Healthcare Medicare |
$220.66
|
|
|
HC WRIST ARTHROGRAM RT
|
Facility
IP
|
$668.68
|
|
|
Service Code
|
CPT 73115 RT
|
| Hospital Charge Code |
11613116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$501.51 |
| Max. Negotiated Rate |
$621.87 |
| Rate for Payer: Aetna Commercial |
$577.74
|
| Rate for Payer: Cash Price |
$414.58
|
| Rate for Payer: Cigna All Commercial |
$577.07
|
| Rate for Payer: CORVEL All Commercial |
$621.87
|
| Rate for Payer: Coventry All Commercial |
$588.44
|
| Rate for Payer: Encore All Commercial |
$615.52
|
| Rate for Payer: Frontpath All Commercial |
$615.19
|
| Rate for Payer: Humana ChoiceCare |
$577.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$601.81
|
| Rate for Payer: PHCS All Commercial |
$501.51
|
| Rate for Payer: PHP All Commercial |
$507.13
|
| Rate for Payer: Sagamore Health Network All Products |
$516.22
|
| Rate for Payer: Signature Care EPO |
$555.01
|
| Rate for Payer: Signature Care PPO |
$588.44
|
| Rate for Payer: United Healthcare Commercial |
$526.92
|
|
|
HC WRIST ARTHROGRAM RT
|
Facility
OP
|
$668.68
|
|
|
Service Code
|
CPT 73115 RT
|
| Hospital Charge Code |
11613116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.66 |
| Max. Negotiated Rate |
$621.87 |
| Rate for Payer: Aetna Commercial |
$564.37
|
| Rate for Payer: Aetna Medicare |
$220.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$220.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$384.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$417.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$253.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$242.73
|
| Rate for Payer: Cash Price |
$414.58
|
| Rate for Payer: Centivo All Commercial |
$341.03
|
| Rate for Payer: Cigna All Commercial |
$577.07
|
| Rate for Payer: CORVEL All Commercial |
$621.87
|
| Rate for Payer: Coventry All Commercial |
$588.44
|
| Rate for Payer: Encore All Commercial |
$615.52
|
| Rate for Payer: Frontpath All Commercial |
$615.19
|
| Rate for Payer: Humana ChoiceCare |
$577.54
|
| Rate for Payer: Humana Medicare |
$341.03
|
| Rate for Payer: Lucent All Commercial |
$341.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$601.81
|
| Rate for Payer: PHCS All Commercial |
$501.51
|
| Rate for Payer: PHP All Commercial |
$507.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$260.79
|
| Rate for Payer: Sagamore Health Network All Products |
$516.22
|
| Rate for Payer: Signature Care EPO |
$555.01
|
| Rate for Payer: Signature Care PPO |
$588.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$568.38
|
| Rate for Payer: United Healthcare Commercial |
$526.92
|
| Rate for Payer: United Healthcare Medicare |
$220.66
|
|
|
HC W SCREW 2.0X10 LOCK TM
|
Facility
IP
|
$1,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$1,204.35 |
| Rate for Payer: Aetna Commercial |
$1,118.88
|
| Rate for Payer: Cash Price |
$802.90
|
| Rate for Payer: Cigna All Commercial |
$1,117.58
|
| Rate for Payer: CORVEL All Commercial |
$1,204.35
|
| Rate for Payer: Coventry All Commercial |
$1,139.60
|
| Rate for Payer: Encore All Commercial |
$1,192.05
|
| Rate for Payer: Frontpath All Commercial |
$1,191.40
|
| Rate for Payer: Humana ChoiceCare |
$1,118.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,165.50
|
| Rate for Payer: PHCS All Commercial |
$971.25
|
| Rate for Payer: PHP All Commercial |
$982.13
|
| Rate for Payer: Sagamore Health Network All Products |
$999.74
|
| Rate for Payer: Signature Care EPO |
$1,074.85
|
| Rate for Payer: Signature Care PPO |
$1,139.60
|
| Rate for Payer: United Healthcare Commercial |
$1,020.46
|
|
|
HC W SCREW 2.0X10 LOCK TM
|
Facility
OP
|
$1,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$427.35 |
| Max. Negotiated Rate |
$1,204.35 |
| Rate for Payer: Aetna Commercial |
$1,092.98
|
| Rate for Payer: Aetna Medicare |
$427.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$427.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$743.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$809.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$491.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$470.08
|
| Rate for Payer: Cash Price |
$802.90
|
| Rate for Payer: Cash Price |
$802.90
|
| Rate for Payer: Centivo All Commercial |
$660.45
|
| Rate for Payer: Cigna All Commercial |
$1,117.58
|
| Rate for Payer: CORVEL All Commercial |
$1,204.35
|
| Rate for Payer: Coventry All Commercial |
$1,139.60
|
| Rate for Payer: Encore All Commercial |
$1,192.05
|
| Rate for Payer: Frontpath All Commercial |
$1,191.40
|
| Rate for Payer: Humana ChoiceCare |
$1,118.49
|
| Rate for Payer: Humana Medicare |
$660.45
|
| Rate for Payer: Lucent All Commercial |
$660.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,165.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$971.25
|
| Rate for Payer: PHP All Commercial |
$982.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$505.05
|
| Rate for Payer: Sagamore Health Network All Products |
$999.74
|
| Rate for Payer: Signature Care EPO |
$1,074.85
|
| Rate for Payer: Signature Care PPO |
$1,139.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,100.75
|
| Rate for Payer: United Healthcare Commercial |
$1,020.46
|
| Rate for Payer: United Healthcare Medicare |
$427.35
|
|
|
HC W SCREW 2.0X10 NON LOCK TM
|
Facility
IP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.25 |
| Max. Negotiated Rate |
$709.59 |
| Rate for Payer: Aetna Commercial |
$659.23
|
| Rate for Payer: Cash Price |
$473.06
|
| Rate for Payer: Cigna All Commercial |
$658.47
|
| Rate for Payer: CORVEL All Commercial |
$709.59
|
| Rate for Payer: Coventry All Commercial |
$671.44
|
| Rate for Payer: Encore All Commercial |
$702.34
|
| Rate for Payer: Frontpath All Commercial |
$701.96
|
| Rate for Payer: Humana ChoiceCare |
$659.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$686.70
|
| Rate for Payer: PHCS All Commercial |
$572.25
|
| Rate for Payer: PHP All Commercial |
$578.66
|
| Rate for Payer: Sagamore Health Network All Products |
$589.04
|
| Rate for Payer: Signature Care EPO |
$633.29
|
| Rate for Payer: Signature Care PPO |
$671.44
|
| Rate for Payer: United Healthcare Commercial |
$601.24
|
|
