|
HC Z 2.7 PLATE 6H 72MM
|
Facility
|
IP
|
$1,348.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.19 |
| Max. Negotiated Rate |
$1,253.87 |
| Rate for Payer: Aetna Commercial |
$1,164.89
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cigna All Commercial |
$1,163.54
|
| Rate for Payer: CORVEL All Commercial |
$1,253.87
|
| Rate for Payer: Coventry All Commercial |
$1,186.46
|
| Rate for Payer: Encore All Commercial |
$1,241.06
|
| Rate for Payer: Frontpath All Commercial |
$1,240.39
|
| Rate for Payer: Humana ChoiceCare |
$1,164.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,213.42
|
| Rate for Payer: PHCS All Commercial |
$1,011.19
|
| Rate for Payer: PHP All Commercial |
$1,022.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,040.85
|
| Rate for Payer: Signature Care EPO |
$1,119.05
|
| Rate for Payer: Signature Care PPO |
$1,186.46
|
| Rate for Payer: United Healthcare Commercial |
$1,062.42
|
|
|
HC Z 2.7 PLATE 6H 72MM
|
Facility
|
OP
|
$1,348.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,253.87 |
| Rate for Payer: Aetna Commercial |
$1,137.92
|
| Rate for Payer: Aetna Medicare |
$431.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$417.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$774.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$842.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$496.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$474.58
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Centivo All Commercial |
$733.45
|
| Rate for Payer: Cigna All Commercial |
$1,163.54
|
| Rate for Payer: CORVEL All Commercial |
$1,253.87
|
| Rate for Payer: Coventry All Commercial |
$1,186.46
|
| Rate for Payer: Encore All Commercial |
$1,241.06
|
| Rate for Payer: Frontpath All Commercial |
$1,240.39
|
| Rate for Payer: Humana ChoiceCare |
$1,164.48
|
| Rate for Payer: Humana Medicare |
$431.44
|
| Rate for Payer: Lucent All Commercial |
$733.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,213.42
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,011.19
|
| Rate for Payer: PHP All Commercial |
$1,022.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$525.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1,040.85
|
| Rate for Payer: Signature Care EPO |
$1,119.05
|
| Rate for Payer: Signature Care PPO |
$1,186.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,146.01
|
| Rate for Payer: United Healthcare Commercial |
$1,062.42
|
| Rate for Payer: United Healthcare Medicare |
$431.44
|
|
|
HC Z 2MM SCREW DRIVER
|
Facility
|
IP
|
$518.70
|
|
| Hospital Charge Code |
41608537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$389.02 |
| Max. Negotiated Rate |
$482.39 |
| Rate for Payer: Aetna Commercial |
$448.16
|
| Rate for Payer: Cash Price |
$311.22
|
| Rate for Payer: Cigna All Commercial |
$447.64
|
| Rate for Payer: CORVEL All Commercial |
$482.39
|
| Rate for Payer: Coventry All Commercial |
$456.46
|
| Rate for Payer: Encore All Commercial |
$477.46
|
| Rate for Payer: Frontpath All Commercial |
$477.20
|
| Rate for Payer: Humana ChoiceCare |
$448.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.83
|
| Rate for Payer: PHCS All Commercial |
$389.02
|
| Rate for Payer: PHP All Commercial |
$393.38
|
| Rate for Payer: Sagamore Health Network All Products |
$400.44
|
| Rate for Payer: Signature Care EPO |
$430.52
|
| Rate for Payer: Signature Care PPO |
$456.46
|
| Rate for Payer: United Healthcare Commercial |
$408.74
|
|
|
HC Z 2MM SCREW DRIVER
|
Facility
|
OP
|
$518.70
|
|
| Hospital Charge Code |
41608537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$482.39 |
| Rate for Payer: Aetna Commercial |
$437.78
|
| Rate for Payer: Aetna Medicare |
$165.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$160.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$297.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$324.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$190.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.58
|
| Rate for Payer: Cash Price |
$311.22
|
| Rate for Payer: Cash Price |
$311.22
|
| Rate for Payer: Centivo All Commercial |
$282.17
|
| Rate for Payer: Cigna All Commercial |
$447.64
|
| Rate for Payer: CORVEL All Commercial |
$482.39
|
| Rate for Payer: Coventry All Commercial |
$456.46
|
| Rate for Payer: Encore All Commercial |
$477.46
|
| Rate for Payer: Frontpath All Commercial |
$477.20
|
| Rate for Payer: Humana ChoiceCare |
$448.00
|
| Rate for Payer: Humana Medicare |
$165.98
|
| Rate for Payer: Lucent All Commercial |
$282.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.83
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$389.02
|
| Rate for Payer: PHP All Commercial |
$393.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.29
|
| Rate for Payer: Sagamore Health Network All Products |
$400.44
|
| Rate for Payer: Signature Care EPO |
$430.52
|
| Rate for Payer: Signature Care PPO |
$456.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$440.89
|
| Rate for Payer: United Healthcare Commercial |
$408.74
|
| Rate for Payer: United Healthcare Medicare |
$165.98
|
|
|
HC Z ACETAB CUP 28X46MM
|
Facility
|
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,696.19 |
| Rate for Payer: Aetna Commercial |
$3,354.39
|
| Rate for Payer: Aetna Medicare |
$1,271.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,232.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,282.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,462.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,398.99
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Centivo All Commercial |
$2,162.07
|
| Rate for Payer: Cigna All Commercial |
$3,429.91
|
| Rate for Payer: CORVEL All Commercial |
$3,696.19
|
| Rate for Payer: Coventry All Commercial |
$3,497.47
|
| Rate for Payer: Encore All Commercial |
$3,658.44
|
| Rate for Payer: Frontpath All Commercial |
$3,656.45
|
| Rate for Payer: Humana ChoiceCare |
$3,432.69
|
| Rate for Payer: Humana Medicare |
$1,271.81
|
| Rate for Payer: Lucent All Commercial |
$2,162.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,980.80
|
| Rate for Payer: PHP All Commercial |
$3,014.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
| Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
| Rate for Payer: Signature Care EPO |
$3,298.75
|
| Rate for Payer: Signature Care PPO |
$3,497.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
| Rate for Payer: United Healthcare Commercial |
$3,131.83
|
| Rate for Payer: United Healthcare Medicare |
$1,271.81
|
|
|
HC Z ACETAB CUP 28X46MM
|
Facility
|
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.80 |
| Max. Negotiated Rate |
$3,696.19 |
| Rate for Payer: Aetna Commercial |
$3,433.88
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Cigna All Commercial |
$3,429.91
|
| Rate for Payer: CORVEL All Commercial |
$3,696.19
|
| Rate for Payer: Coventry All Commercial |
$3,497.47
|
| Rate for Payer: Encore All Commercial |
$3,658.44
|
| Rate for Payer: Frontpath All Commercial |
$3,656.45
|
| Rate for Payer: Humana ChoiceCare |
$3,432.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
| Rate for Payer: PHCS All Commercial |
$2,980.80
|
| Rate for Payer: PHP All Commercial |
$3,014.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
| Rate for Payer: Signature Care EPO |
$3,298.75
|
| Rate for Payer: Signature Care PPO |
$3,497.47
|
| Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
|
HC Z ACETAB CUP 43X28
|
Facility
|
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.80 |
| Max. Negotiated Rate |
$3,696.19 |
| Rate for Payer: Aetna Commercial |
$3,433.88
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Cigna All Commercial |
$3,429.91
|
| Rate for Payer: CORVEL All Commercial |
$3,696.19
|
| Rate for Payer: Coventry All Commercial |
$3,497.47
|
| Rate for Payer: Encore All Commercial |
$3,658.44
|
| Rate for Payer: Frontpath All Commercial |
$3,656.45
|
| Rate for Payer: Humana ChoiceCare |
$3,432.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
| Rate for Payer: PHCS All Commercial |
$2,980.80
|
| Rate for Payer: PHP All Commercial |
$3,014.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
| Rate for Payer: Signature Care EPO |
$3,298.75
|
| Rate for Payer: Signature Care PPO |
$3,497.47
|
| Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
|
HC Z ACETAB CUP 43X28
|
Facility
|
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,696.19 |
| Rate for Payer: Aetna Commercial |
$3,354.39
|
| Rate for Payer: Aetna Medicare |
$1,271.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,232.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,282.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,462.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,398.99
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Centivo All Commercial |
$2,162.07
|
| Rate for Payer: Cigna All Commercial |
$3,429.91
|
| Rate for Payer: CORVEL All Commercial |
$3,696.19
|
| Rate for Payer: Coventry All Commercial |
$3,497.47
|
| Rate for Payer: Encore All Commercial |
$3,658.44
|
| Rate for Payer: Frontpath All Commercial |
$3,656.45
|
| Rate for Payer: Humana ChoiceCare |
$3,432.69
|
| Rate for Payer: Humana Medicare |
$1,271.81
|
| Rate for Payer: Lucent All Commercial |
$2,162.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,980.80
|
| Rate for Payer: PHP All Commercial |
$3,014.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
| Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
| Rate for Payer: Signature Care EPO |
$3,298.75
|
| Rate for Payer: Signature Care PPO |
$3,497.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
| Rate for Payer: United Healthcare Commercial |
$3,131.83
|
| Rate for Payer: United Healthcare Medicare |
$1,271.81
|
|
|
HC Z ACETAB CUP 45X28
|
Facility
|
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.80 |
| Max. Negotiated Rate |
$3,696.19 |
| Rate for Payer: Aetna Commercial |
$3,433.88
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Cigna All Commercial |
$3,429.91
|
| Rate for Payer: CORVEL All Commercial |
$3,696.19
|
| Rate for Payer: Coventry All Commercial |
$3,497.47
|
| Rate for Payer: Encore All Commercial |
$3,658.44
|
| Rate for Payer: Frontpath All Commercial |
$3,656.45
|
| Rate for Payer: Humana ChoiceCare |
$3,432.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
| Rate for Payer: PHCS All Commercial |
$2,980.80
|
| Rate for Payer: PHP All Commercial |
$3,014.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
| Rate for Payer: Signature Care EPO |
$3,298.75
|
| Rate for Payer: Signature Care PPO |
$3,497.47
|
| Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
|
HC Z ACETAB CUP 45X28
|
Facility
|
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,696.19 |
| Rate for Payer: Aetna Commercial |
$3,354.39
|
| Rate for Payer: Aetna Medicare |
$1,271.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,232.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,282.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,462.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,398.99
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Centivo All Commercial |
$2,162.07
|
| Rate for Payer: Cigna All Commercial |
$3,429.91
|
| Rate for Payer: CORVEL All Commercial |
$3,696.19
|
| Rate for Payer: Coventry All Commercial |
$3,497.47
|
| Rate for Payer: Encore All Commercial |
$3,658.44
|
| Rate for Payer: Frontpath All Commercial |
$3,656.45
|
| Rate for Payer: Humana ChoiceCare |
$3,432.69
|
| Rate for Payer: Humana Medicare |
$1,271.81
|
| Rate for Payer: Lucent All Commercial |
$2,162.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,980.80
|
| Rate for Payer: PHP All Commercial |
$3,014.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
| Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
| Rate for Payer: Signature Care EPO |
$3,298.75
|
| Rate for Payer: Signature Care PPO |
$3,497.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
| Rate for Payer: United Healthcare Commercial |
$3,131.83
|
| Rate for Payer: United Healthcare Medicare |
$1,271.81
|
|
|
HC Z ALL GLEN GUIDE/BONE R
|
Facility
|
OP
|
$4,809.02
|
|
| Hospital Charge Code |
41607781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,058.81
|
| Rate for Payer: Aetna Medicare |
$1,538.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,490.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,761.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,006.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,769.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,692.78
|
| Rate for Payer: Cash Price |
$2,885.41
|
| Rate for Payer: Cash Price |
$2,885.41
|
| Rate for Payer: Centivo All Commercial |
$2,616.11
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Humana Medicare |
$1,538.89
|
| Rate for Payer: Lucent All Commercial |
$2,616.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,875.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,087.67
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
| Rate for Payer: United Healthcare Medicare |
$1,538.89
|
|
|
HC Z ALL GLEN GUIDE/BONE R
|
Facility
|
IP
|
$4,809.02
|
|
| Hospital Charge Code |
41607781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,606.76 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,154.99
|
| Rate for Payer: Cash Price |
$2,885.41
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
|
|
HC Z ALL POLY PAT 29MM
|
Facility
|
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$847.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$821.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$975.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$932.66
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Centivo All Commercial |
$1,441.38
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$847.87
|
| Rate for Payer: Lucent All Commercial |
$1,441.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$847.87
|
|
|
HC Z ALL POLY PAT 29MM
|
Facility
|
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z ALL POLY PAT 29MM DIA
|
Facility
|
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z ALL POLY PAT 29MM DIA
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,059.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,026.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,218.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,165.82
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Centivo All Commercial |
$1,801.73
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,059.84
|
| Rate for Payer: Lucent All Commercial |
$1,801.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,059.84
|
|
|
HC Z ALL POLY PAT 32MM
|
Facility
|
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z ALL POLY PAT 32MM
|
Facility
|
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$847.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$821.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$975.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$932.66
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Centivo All Commercial |
$1,441.38
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$847.87
|
| Rate for Payer: Lucent All Commercial |
$1,441.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$847.87
|
|
|
HC Z ALL POLY PAT 32MM DIA
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,059.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,026.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,218.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,165.82
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Centivo All Commercial |
$1,801.73
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,059.84
|
| Rate for Payer: Lucent All Commercial |
$1,801.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,059.84
|
|
|
HC Z ALL POLY PAT 32MM DIA
|
Facility
|
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z ALL POLY PAT 35MM
|
Facility
|
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z ALL POLY PAT 35MM
|
Facility
|
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$847.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$821.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$975.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$932.66
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Centivo All Commercial |
$1,441.38
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$847.87
|
| Rate for Payer: Lucent All Commercial |
$1,441.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$847.87
|
|
|
HC Z ALL POLY PAT 35MM DIA
|
Facility
|
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z ALL POLY PAT 35MM DIA
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,059.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,026.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,218.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,165.82
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Centivo All Commercial |
$1,801.73
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,059.84
|
| Rate for Payer: Lucent All Commercial |
$1,801.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,059.84
|
|
|
HC Z ALL POLY PAT 38MM
|
Facility
|
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$847.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$821.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$975.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$932.66
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Centivo All Commercial |
$1,441.38
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$847.87
|
| Rate for Payer: Lucent All Commercial |
$1,441.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$847.87
|
|
