|
HC W STAPLE SIZER
|
Facility
|
IP
|
$812.00
|
|
| Hospital Charge Code |
41606928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$609.00 |
| Max. Negotiated Rate |
$755.16 |
| Rate for Payer: Aetna Commercial |
$701.57
|
| Rate for Payer: Cash Price |
$503.44
|
| Rate for Payer: Cigna All Commercial |
$700.76
|
| Rate for Payer: CORVEL All Commercial |
$755.16
|
| Rate for Payer: Coventry All Commercial |
$714.56
|
| Rate for Payer: Encore All Commercial |
$747.45
|
| Rate for Payer: Frontpath All Commercial |
$747.04
|
| Rate for Payer: Humana ChoiceCare |
$701.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$730.80
|
| Rate for Payer: PHCS All Commercial |
$609.00
|
| Rate for Payer: PHP All Commercial |
$615.82
|
| Rate for Payer: Sagamore Health Network All Products |
$626.86
|
| Rate for Payer: Signature Care EPO |
$673.96
|
| Rate for Payer: Signature Care PPO |
$714.56
|
| Rate for Payer: United Healthcare Commercial |
$639.86
|
|
|
HC W SUT ANCHOR 2.7
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,646.10 |
| Rate for Payer: Aetna Commercial |
$1,493.88
|
| Rate for Payer: Aetna Medicare |
$584.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$584.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,016.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,106.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$671.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$642.51
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Centivo All Commercial |
$902.70
|
| Rate for Payer: Cigna All Commercial |
$1,527.51
|
| Rate for Payer: CORVEL All Commercial |
$1,646.10
|
| Rate for Payer: Coventry All Commercial |
$1,557.60
|
| Rate for Payer: Encore All Commercial |
$1,629.28
|
| Rate for Payer: Frontpath All Commercial |
$1,628.40
|
| Rate for Payer: Humana ChoiceCare |
$1,528.75
|
| Rate for Payer: Humana Medicare |
$902.70
|
| Rate for Payer: Lucent All Commercial |
$902.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,593.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,327.50
|
| Rate for Payer: PHP All Commercial |
$1,342.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$690.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,366.44
|
| Rate for Payer: Signature Care EPO |
$1,469.10
|
| Rate for Payer: Signature Care PPO |
$1,557.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,504.50
|
| Rate for Payer: United Healthcare Commercial |
$1,394.76
|
| Rate for Payer: United Healthcare Medicare |
$584.10
|
|
|
HC W SUT ANCHOR 2.7
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,327.50 |
| Max. Negotiated Rate |
$1,646.10 |
| Rate for Payer: Aetna Commercial |
$1,529.28
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Cigna All Commercial |
$1,527.51
|
| Rate for Payer: CORVEL All Commercial |
$1,646.10
|
| Rate for Payer: Coventry All Commercial |
$1,557.60
|
| Rate for Payer: Encore All Commercial |
$1,629.28
|
| Rate for Payer: Frontpath All Commercial |
$1,628.40
|
| Rate for Payer: Humana ChoiceCare |
$1,528.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,593.00
|
| Rate for Payer: PHCS All Commercial |
$1,327.50
|
| Rate for Payer: PHP All Commercial |
$1,342.37
|
| Rate for Payer: Sagamore Health Network All Products |
$1,366.44
|
| Rate for Payer: Signature Care EPO |
$1,469.10
|
| Rate for Payer: Signature Care PPO |
$1,557.60
|
| Rate for Payer: United Healthcare Commercial |
$1,394.76
|
|
|
HC W SUT ANCHOR 2.7 INST KIT
|
Facility
|
OP
|
$945.00
|
|
| Hospital Charge Code |
41606167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$797.58
|
| Rate for Payer: Aetna Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$542.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$590.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$358.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$343.04
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Centivo All Commercial |
$481.95
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Humana Medicare |
$481.95
|
| Rate for Payer: Lucent All Commercial |
$481.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$368.55
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$803.25
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
| Rate for Payer: United Healthcare Medicare |
$311.85
|
|
|
HC W SUT ANCHOR 2.7 INST KIT
|
Facility
|
IP
|
$945.00
|
|
| Hospital Charge Code |
41606167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.75 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$816.48
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
|
|
HC W SUT ANCHOR 3.5 #0
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,327.50 |
| Max. Negotiated Rate |
$1,646.10 |
| Rate for Payer: Aetna Commercial |
$1,529.28
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Cigna All Commercial |
$1,527.51
|
| Rate for Payer: CORVEL All Commercial |
$1,646.10
|
| Rate for Payer: Coventry All Commercial |
$1,557.60
|
| Rate for Payer: Encore All Commercial |
$1,629.28
|
| Rate for Payer: Frontpath All Commercial |
$1,628.40
|
| Rate for Payer: Humana ChoiceCare |
$1,528.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,593.00
|
| Rate for Payer: PHCS All Commercial |
$1,327.50
|
| Rate for Payer: PHP All Commercial |
$1,342.37
|
| Rate for Payer: Sagamore Health Network All Products |
$1,366.44
|
| Rate for Payer: Signature Care EPO |
$1,469.10
|
| Rate for Payer: Signature Care PPO |
$1,557.60
|
| Rate for Payer: United Healthcare Commercial |
$1,394.76
|
|
|
HC W SUT ANCHOR 3.5 #0
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,646.10 |
| Rate for Payer: Aetna Commercial |
$1,493.88
|
| Rate for Payer: Aetna Medicare |
$584.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$584.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,016.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,106.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$671.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$642.51
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Centivo All Commercial |
$902.70
|
| Rate for Payer: Cigna All Commercial |
$1,527.51
|
| Rate for Payer: CORVEL All Commercial |
$1,646.10
|
| Rate for Payer: Coventry All Commercial |
$1,557.60
|
| Rate for Payer: Encore All Commercial |
$1,629.28
|
| Rate for Payer: Frontpath All Commercial |
$1,628.40
|
| Rate for Payer: Humana ChoiceCare |
$1,528.75
|
| Rate for Payer: Humana Medicare |
$902.70
|
| Rate for Payer: Lucent All Commercial |
$902.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,593.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,327.50
|
| Rate for Payer: PHP All Commercial |
$1,342.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$690.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,366.44
|
| Rate for Payer: Signature Care EPO |
$1,469.10
|
| Rate for Payer: Signature Care PPO |
$1,557.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,504.50
|
| Rate for Payer: United Healthcare Commercial |
$1,394.76
|
| Rate for Payer: United Healthcare Medicare |
$584.10
|
|
|
HC W SUT ANCHOR 3.5MM
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,327.50 |
| Max. Negotiated Rate |
$1,646.10 |
| Rate for Payer: Aetna Commercial |
$1,529.28
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Cigna All Commercial |
$1,527.51
|
| Rate for Payer: CORVEL All Commercial |
$1,646.10
|
| Rate for Payer: Coventry All Commercial |
$1,557.60
|
| Rate for Payer: Encore All Commercial |
$1,629.28
|
| Rate for Payer: Frontpath All Commercial |
$1,628.40
|
| Rate for Payer: Humana ChoiceCare |
$1,528.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,593.00
|
| Rate for Payer: PHCS All Commercial |
$1,327.50
|
| Rate for Payer: PHP All Commercial |
$1,342.37
|
| Rate for Payer: Sagamore Health Network All Products |
$1,366.44
|
| Rate for Payer: Signature Care EPO |
$1,469.10
|
| Rate for Payer: Signature Care PPO |
$1,557.60
|
| Rate for Payer: United Healthcare Commercial |
$1,394.76
|
|
|
HC W SUT ANCHOR 3.5MM
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,646.10 |
| Rate for Payer: Aetna Commercial |
$1,493.88
|
| Rate for Payer: Aetna Medicare |
$584.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$584.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,016.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,106.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$671.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$642.51
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Centivo All Commercial |
$902.70
|
| Rate for Payer: Cigna All Commercial |
$1,527.51
|
| Rate for Payer: CORVEL All Commercial |
$1,646.10
|
| Rate for Payer: Coventry All Commercial |
$1,557.60
|
| Rate for Payer: Encore All Commercial |
$1,629.28
|
| Rate for Payer: Frontpath All Commercial |
$1,628.40
|
| Rate for Payer: Humana ChoiceCare |
$1,528.75
|
| Rate for Payer: Humana Medicare |
$902.70
|
| Rate for Payer: Lucent All Commercial |
$902.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,593.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,327.50
|
| Rate for Payer: PHP All Commercial |
$1,342.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$690.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,366.44
|
| Rate for Payer: Signature Care EPO |
$1,469.10
|
| Rate for Payer: Signature Care PPO |
$1,557.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,504.50
|
| Rate for Payer: United Healthcare Commercial |
$1,394.76
|
| Rate for Payer: United Healthcare Medicare |
$584.10
|
|
|
HC W SUT ANCHOR 4.5
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,976.25 |
| Rate for Payer: Aetna Commercial |
$1,793.50
|
| Rate for Payer: Aetna Medicare |
$701.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$701.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,220.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,328.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$806.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$771.38
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Centivo All Commercial |
$1,083.75
|
| Rate for Payer: Cigna All Commercial |
$1,833.88
|
| Rate for Payer: CORVEL All Commercial |
$1,976.25
|
| Rate for Payer: Coventry All Commercial |
$1,870.00
|
| Rate for Payer: Encore All Commercial |
$1,956.06
|
| Rate for Payer: Frontpath All Commercial |
$1,955.00
|
| Rate for Payer: Humana ChoiceCare |
$1,835.36
|
| Rate for Payer: Humana Medicare |
$1,083.75
|
| Rate for Payer: Lucent All Commercial |
$1,083.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,912.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,593.75
|
| Rate for Payer: PHP All Commercial |
$1,611.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$828.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,640.50
|
| Rate for Payer: Signature Care EPO |
$1,763.75
|
| Rate for Payer: Signature Care PPO |
$1,870.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,806.25
|
| Rate for Payer: United Healthcare Commercial |
$1,674.50
|
| Rate for Payer: United Healthcare Medicare |
$701.25
|
|
|
HC W SUT ANCHOR 4.5
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,593.75 |
| Max. Negotiated Rate |
$1,976.25 |
| Rate for Payer: Aetna Commercial |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cigna All Commercial |
$1,833.88
|
| Rate for Payer: CORVEL All Commercial |
$1,976.25
|
| Rate for Payer: Coventry All Commercial |
$1,870.00
|
| Rate for Payer: Encore All Commercial |
$1,956.06
|
| Rate for Payer: Frontpath All Commercial |
$1,955.00
|
| Rate for Payer: Humana ChoiceCare |
$1,835.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,912.50
|
| Rate for Payer: PHCS All Commercial |
$1,593.75
|
| Rate for Payer: PHP All Commercial |
$1,611.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,640.50
|
| Rate for Payer: Signature Care EPO |
$1,763.75
|
| Rate for Payer: Signature Care PPO |
$1,870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,674.50
|
|
|
HC W SUT ANCHOR 5.5
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,688.00
|
| Rate for Payer: Aetna Medicare |
$660.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$660.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,250.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$759.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$726.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Centivo All Commercial |
$1,020.00
|
| Rate for Payer: Cigna All Commercial |
$1,726.00
|
| Rate for Payer: CORVEL All Commercial |
$1,860.00
|
| Rate for Payer: Coventry All Commercial |
$1,760.00
|
| Rate for Payer: Encore All Commercial |
$1,841.00
|
| Rate for Payer: Frontpath All Commercial |
$1,840.00
|
| Rate for Payer: Humana ChoiceCare |
$1,727.40
|
| Rate for Payer: Humana Medicare |
$1,020.00
|
| Rate for Payer: Lucent All Commercial |
$1,020.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,800.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,500.00
|
| Rate for Payer: PHP All Commercial |
$1,516.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$780.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,544.00
|
| Rate for Payer: Signature Care EPO |
$1,660.00
|
| Rate for Payer: Signature Care PPO |
$1,760.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,576.00
|
| Rate for Payer: United Healthcare Medicare |
$660.00
|
|
|
HC W SUT ANCHOR 5.5
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cigna All Commercial |
$1,726.00
|
| Rate for Payer: CORVEL All Commercial |
$1,860.00
|
| Rate for Payer: Coventry All Commercial |
$1,760.00
|
| Rate for Payer: Encore All Commercial |
$1,841.00
|
| Rate for Payer: Frontpath All Commercial |
$1,840.00
|
| Rate for Payer: Humana ChoiceCare |
$1,727.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,800.00
|
| Rate for Payer: PHCS All Commercial |
$1,500.00
|
| Rate for Payer: PHP All Commercial |
$1,516.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,544.00
|
| Rate for Payer: Signature Care EPO |
$1,660.00
|
| Rate for Payer: Signature Care PPO |
$1,760.00
|
| Rate for Payer: United Healthcare Commercial |
$1,576.00
|
|
|
HC W TEMP FIX PIN 1.1 4212
|
Facility
|
OP
|
$784.00
|
|
| Hospital Charge Code |
41606640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$729.12 |
| Rate for Payer: Aetna Commercial |
$661.70
|
| Rate for Payer: Aetna Medicare |
$258.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$258.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$450.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$297.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$284.59
|
| Rate for Payer: Cash Price |
$486.08
|
| Rate for Payer: Cash Price |
$486.08
|
| Rate for Payer: Centivo All Commercial |
$399.84
|
| Rate for Payer: Cigna All Commercial |
$676.59
|
| Rate for Payer: CORVEL All Commercial |
$729.12
|
| Rate for Payer: Coventry All Commercial |
$689.92
|
| Rate for Payer: Encore All Commercial |
$721.67
|
| Rate for Payer: Frontpath All Commercial |
$721.28
|
| Rate for Payer: Humana ChoiceCare |
$677.14
|
| Rate for Payer: Humana Medicare |
$399.84
|
| Rate for Payer: Lucent All Commercial |
$399.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$705.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$588.00
|
| Rate for Payer: PHP All Commercial |
$594.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$305.76
|
| Rate for Payer: Sagamore Health Network All Products |
$605.25
|
| Rate for Payer: Signature Care EPO |
$650.72
|
| Rate for Payer: Signature Care PPO |
$689.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$666.40
|
| Rate for Payer: United Healthcare Commercial |
$617.79
|
| Rate for Payer: United Healthcare Medicare |
$258.72
|
|
|
HC W TEMP FIX PIN 1.1 4212
|
Facility
|
IP
|
$784.00
|
|
| Hospital Charge Code |
41606640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$729.12 |
| Rate for Payer: Aetna Commercial |
$677.38
|
| Rate for Payer: Cash Price |
$486.08
|
| Rate for Payer: Cigna All Commercial |
$676.59
|
| Rate for Payer: CORVEL All Commercial |
$729.12
|
| Rate for Payer: Coventry All Commercial |
$689.92
|
| Rate for Payer: Encore All Commercial |
$721.67
|
| Rate for Payer: Frontpath All Commercial |
$721.28
|
| Rate for Payer: Humana ChoiceCare |
$677.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$705.60
|
| Rate for Payer: PHCS All Commercial |
$588.00
|
| Rate for Payer: PHP All Commercial |
$594.59
|
| Rate for Payer: Sagamore Health Network All Products |
$605.25
|
| Rate for Payer: Signature Care EPO |
$650.72
|
| Rate for Payer: Signature Care PPO |
$689.92
|
| Rate for Payer: United Healthcare Commercial |
$617.79
|
|
|
HC W TISSUE PLCT VIAFLOW 1
|
Facility
|
OP
|
$7,851.60
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41605105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,301.99 |
| Rate for Payer: Aetna Commercial |
$6,626.75
|
| Rate for Payer: Aetna Medicare |
$2,591.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,591.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,509.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,908.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,979.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,850.13
|
| Rate for Payer: Cash Price |
$4,867.99
|
| Rate for Payer: Cash Price |
$4,867.99
|
| Rate for Payer: Centivo All Commercial |
$4,004.32
|
| Rate for Payer: Cigna All Commercial |
$6,775.93
|
| Rate for Payer: CORVEL All Commercial |
$7,301.99
|
| Rate for Payer: Coventry All Commercial |
$6,909.41
|
| Rate for Payer: Encore All Commercial |
$7,227.40
|
| Rate for Payer: Frontpath All Commercial |
$7,223.47
|
| Rate for Payer: Humana ChoiceCare |
$6,781.43
|
| Rate for Payer: Humana Medicare |
$4,004.32
|
| Rate for Payer: Lucent All Commercial |
$4,004.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,066.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,888.70
|
| Rate for Payer: PHP All Commercial |
$5,954.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,062.12
|
| Rate for Payer: Sagamore Health Network All Products |
$6,061.44
|
| Rate for Payer: Signature Care EPO |
$6,516.83
|
| Rate for Payer: Signature Care PPO |
$6,909.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,673.86
|
| Rate for Payer: United Healthcare Commercial |
$6,187.06
|
| Rate for Payer: United Healthcare Medicare |
$2,591.03
|
|
|
HC W TISSUE PLCT VIAFLOW 1
|
Facility
|
IP
|
$7,851.60
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41605105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,888.70 |
| Max. Negotiated Rate |
$7,301.99 |
| Rate for Payer: Aetna Commercial |
$6,783.78
|
| Rate for Payer: Cash Price |
$4,867.99
|
| Rate for Payer: Cigna All Commercial |
$6,775.93
|
| Rate for Payer: CORVEL All Commercial |
$7,301.99
|
| Rate for Payer: Coventry All Commercial |
$6,909.41
|
| Rate for Payer: Encore All Commercial |
$7,227.40
|
| Rate for Payer: Frontpath All Commercial |
$7,223.47
|
| Rate for Payer: Humana ChoiceCare |
$6,781.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,066.44
|
| Rate for Payer: PHCS All Commercial |
$5,888.70
|
| Rate for Payer: PHP All Commercial |
$5,954.65
|
| Rate for Payer: Sagamore Health Network All Products |
$6,061.44
|
| Rate for Payer: Signature Care EPO |
$6,516.83
|
| Rate for Payer: Signature Care PPO |
$6,909.41
|
| Rate for Payer: United Healthcare Commercial |
$6,187.06
|
|
|
HC W T-PLATE 6-H
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,975.32 |
| Rate for Payer: Aetna Commercial |
$1,792.66
|
| Rate for Payer: Aetna Medicare |
$700.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$700.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,219.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,327.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$806.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$771.01
|
| Rate for Payer: Cash Price |
$1,316.88
|
| Rate for Payer: Cash Price |
$1,316.88
|
| Rate for Payer: Centivo All Commercial |
$1,083.24
|
| Rate for Payer: Cigna All Commercial |
$1,833.01
|
| Rate for Payer: CORVEL All Commercial |
$1,975.32
|
| Rate for Payer: Coventry All Commercial |
$1,869.12
|
| Rate for Payer: Encore All Commercial |
$1,955.14
|
| Rate for Payer: Frontpath All Commercial |
$1,954.08
|
| Rate for Payer: Humana ChoiceCare |
$1,834.50
|
| Rate for Payer: Humana Medicare |
$1,083.24
|
| Rate for Payer: Lucent All Commercial |
$1,083.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,911.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,593.00
|
| Rate for Payer: PHP All Commercial |
$1,610.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$828.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,639.73
|
| Rate for Payer: Signature Care EPO |
$1,762.92
|
| Rate for Payer: Signature Care PPO |
$1,869.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,805.40
|
| Rate for Payer: United Healthcare Commercial |
$1,673.71
|
| Rate for Payer: United Healthcare Medicare |
$700.92
|
|
|
HC W T-PLATE 6-H
|
Facility
|
IP
|
$2,124.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,593.00 |
| Max. Negotiated Rate |
$1,975.32 |
| Rate for Payer: Aetna Commercial |
$1,835.14
|
| Rate for Payer: Cash Price |
$1,316.88
|
| Rate for Payer: Cigna All Commercial |
$1,833.01
|
| Rate for Payer: CORVEL All Commercial |
$1,975.32
|
| Rate for Payer: Coventry All Commercial |
$1,869.12
|
| Rate for Payer: Encore All Commercial |
$1,955.14
|
| Rate for Payer: Frontpath All Commercial |
$1,954.08
|
| Rate for Payer: Humana ChoiceCare |
$1,834.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,911.60
|
| Rate for Payer: PHCS All Commercial |
$1,593.00
|
| Rate for Payer: PHP All Commercial |
$1,610.84
|
| Rate for Payer: Sagamore Health Network All Products |
$1,639.73
|
| Rate for Payer: Signature Care EPO |
$1,762.92
|
| Rate for Payer: Signature Care PPO |
$1,869.12
|
| Rate for Payer: United Healthcare Commercial |
$1,673.71
|
|
|
HC W T-PLATE 7-H
|
Facility
|
IP
|
$2,361.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,771.20 |
| Max. Negotiated Rate |
$2,196.29 |
| Rate for Payer: Aetna Commercial |
$2,040.42
|
| Rate for Payer: Cash Price |
$1,464.19
|
| Rate for Payer: Cigna All Commercial |
$2,038.06
|
| Rate for Payer: CORVEL All Commercial |
$2,196.29
|
| Rate for Payer: Coventry All Commercial |
$2,078.21
|
| Rate for Payer: Encore All Commercial |
$2,173.85
|
| Rate for Payer: Frontpath All Commercial |
$2,172.67
|
| Rate for Payer: Humana ChoiceCare |
$2,039.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,125.44
|
| Rate for Payer: PHCS All Commercial |
$1,771.20
|
| Rate for Payer: PHP All Commercial |
$1,791.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,823.16
|
| Rate for Payer: Signature Care EPO |
$1,960.13
|
| Rate for Payer: Signature Care PPO |
$2,078.21
|
| Rate for Payer: United Healthcare Commercial |
$1,860.94
|
|
|
HC W T-PLATE 7-H
|
Facility
|
OP
|
$2,361.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,196.29 |
| Rate for Payer: Aetna Commercial |
$1,993.19
|
| Rate for Payer: Aetna Medicare |
$779.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$779.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,356.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,476.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$896.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$857.26
|
| Rate for Payer: Cash Price |
$1,464.19
|
| Rate for Payer: Cash Price |
$1,464.19
|
| Rate for Payer: Centivo All Commercial |
$1,204.42
|
| Rate for Payer: Cigna All Commercial |
$2,038.06
|
| Rate for Payer: CORVEL All Commercial |
$2,196.29
|
| Rate for Payer: Coventry All Commercial |
$2,078.21
|
| Rate for Payer: Encore All Commercial |
$2,173.85
|
| Rate for Payer: Frontpath All Commercial |
$2,172.67
|
| Rate for Payer: Humana ChoiceCare |
$2,039.71
|
| Rate for Payer: Humana Medicare |
$1,204.42
|
| Rate for Payer: Lucent All Commercial |
$1,204.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,125.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,771.20
|
| Rate for Payer: PHP All Commercial |
$1,791.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$921.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,823.16
|
| Rate for Payer: Signature Care EPO |
$1,960.13
|
| Rate for Payer: Signature Care PPO |
$2,078.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,007.36
|
| Rate for Payer: United Healthcare Commercial |
$1,860.94
|
| Rate for Payer: United Healthcare Medicare |
$779.33
|
|
|
HC W Y-PLATE 5TH MET L
|
Facility
|
OP
|
$7,084.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,588.86 |
| Rate for Payer: Aetna Commercial |
$5,979.57
|
| Rate for Payer: Aetna Medicare |
$2,337.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,337.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,068.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,428.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,688.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,571.78
|
| Rate for Payer: Cash Price |
$4,392.58
|
| Rate for Payer: Cash Price |
$4,392.58
|
| Rate for Payer: Centivo All Commercial |
$3,613.25
|
| Rate for Payer: Cigna All Commercial |
$6,114.18
|
| Rate for Payer: CORVEL All Commercial |
$6,588.86
|
| Rate for Payer: Coventry All Commercial |
$6,234.62
|
| Rate for Payer: Encore All Commercial |
$6,521.56
|
| Rate for Payer: Frontpath All Commercial |
$6,518.02
|
| Rate for Payer: Humana ChoiceCare |
$6,119.14
|
| Rate for Payer: Humana Medicare |
$3,613.25
|
| Rate for Payer: Lucent All Commercial |
$3,613.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,376.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,313.60
|
| Rate for Payer: PHP All Commercial |
$5,373.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,763.07
|
| Rate for Payer: Sagamore Health Network All Products |
$5,469.47
|
| Rate for Payer: Signature Care EPO |
$5,880.38
|
| Rate for Payer: Signature Care PPO |
$6,234.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,022.08
|
| Rate for Payer: United Healthcare Commercial |
$5,582.82
|
| Rate for Payer: United Healthcare Medicare |
$2,337.98
|
|
|
HC W Y-PLATE 5TH MET L
|
Facility
|
IP
|
$7,084.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,313.60 |
| Max. Negotiated Rate |
$6,588.86 |
| Rate for Payer: Aetna Commercial |
$6,121.27
|
| Rate for Payer: Cash Price |
$4,392.58
|
| Rate for Payer: Cigna All Commercial |
$6,114.18
|
| Rate for Payer: CORVEL All Commercial |
$6,588.86
|
| Rate for Payer: Coventry All Commercial |
$6,234.62
|
| Rate for Payer: Encore All Commercial |
$6,521.56
|
| Rate for Payer: Frontpath All Commercial |
$6,518.02
|
| Rate for Payer: Humana ChoiceCare |
$6,119.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,376.32
|
| Rate for Payer: PHCS All Commercial |
$5,313.60
|
| Rate for Payer: PHP All Commercial |
$5,373.11
|
| Rate for Payer: Sagamore Health Network All Products |
$5,469.47
|
| Rate for Payer: Signature Care EPO |
$5,880.38
|
| Rate for Payer: Signature Care PPO |
$6,234.62
|
| Rate for Payer: United Healthcare Commercial |
$5,582.82
|
|
|
HC XEROFORM 4X4
|
Facility
|
IP
|
$5.38
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
41605575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$4.65
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna All Commercial |
$4.64
|
| Rate for Payer: CORVEL All Commercial |
$5.00
|
| Rate for Payer: Coventry All Commercial |
$4.73
|
| Rate for Payer: Encore All Commercial |
$4.95
|
| Rate for Payer: Frontpath All Commercial |
$4.95
|
| Rate for Payer: Humana ChoiceCare |
$4.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.84
|
| Rate for Payer: PHCS All Commercial |
$4.04
|
| Rate for Payer: PHP All Commercial |
$4.08
|
| Rate for Payer: Sagamore Health Network All Products |
$4.15
|
| Rate for Payer: Signature Care EPO |
$4.47
|
| Rate for Payer: Signature Care PPO |
$4.73
|
| Rate for Payer: United Healthcare Commercial |
$4.24
|
|
|
HC XEROFORM 4X4
|
Facility
|
OP
|
$5.38
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
41605575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$4.54
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.95
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Centivo All Commercial |
$2.74
|
| Rate for Payer: Cigna All Commercial |
$4.64
|
| Rate for Payer: CORVEL All Commercial |
$5.00
|
| Rate for Payer: Coventry All Commercial |
$4.73
|
| Rate for Payer: Encore All Commercial |
$4.95
|
| Rate for Payer: Frontpath All Commercial |
$4.95
|
| Rate for Payer: Humana ChoiceCare |
$4.65
|
| Rate for Payer: Humana Medicare |
$2.74
|
| Rate for Payer: Lucent All Commercial |
$2.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$4.04
|
| Rate for Payer: PHP All Commercial |
$4.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4.15
|
| Rate for Payer: Signature Care EPO |
$4.47
|
| Rate for Payer: Signature Care PPO |
$4.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.57
|
| Rate for Payer: United Healthcare Commercial |
$4.24
|
| Rate for Payer: United Healthcare Medicare |
$1.78
|
|
